Avin Patel

Osgood Schlatter Disease

A common knee complaint among adolescents is Osgood Schlatter Disease (OSD). It is more prevalent among active people, and although the pain always resolves, there is usually a palpable bony lump on the knee for life. This lump is often an incidental finding in adult patients who present with another issue- they may not know they ever had the condition.

Osgood Schlatter Disease

What Happens in Osgood Schlatter Disease?

The muscles of the quadriceps (front of the thigh) converge into the quadricep tendon at the front of the knee. The knee cap sits within this tendon, and the tendon joins onto the front of the shin bone, right at the top. Exactly where the tendon meets the bone is a growth plate. This is like a cross between cartilage and bone, which eventually hardens when the area has finished growing (in the late teens). Girls tend to develop OSD at a slightly younger age than boys, as their growth plates mature a year or two earlier. Typically we expect their resolution to be earlier than boys’ too. Onset anywhere between about 9 and 14 years of age is within the expected range.

If the quadriceps are under a lot of strain, they can pull on this soft area. This causes pain, inflammation, swelling, and sometimes bone avulsion. Avulsion is where a small part of the bone is pulled away in a micro-fracture. The precise area is likely to be tender. A few bursae are often irritated by the process of OSD, in which case the pain may be more widespread.

Quadriceps strain could be due to increased activity, especially sports that involve lots of running, jumping, or kicking. Growth spurts may also be significant if the thigh bone grows rapidly, causing relative tension on the muscles.

Other areas in the body can undergo a similar process. The process that happens in OSD is traction apophysitis. This literally means inflammation and pulling on the growth plate. When it occurs in the heel, it is known as Sever’s disease.

Managing OSD

OSD is aggravated by activity that demands strong and sudden contraction of the quadriceps. Running and jumping sports are particularly significant. Proper stretching and exercises pre and post sport are important. Cool compresses may also help. Massage techniques for the quadriceps are recognised as part of a conservative treatment plan. Completely stopping sport is often not realistic, and it certainly is not a guaranteed cure. However an exercise plan with enough rest days to reduce irritation may be sensible. Your osteopath can help devise this.

Ultimately, symptoms will largely pass as the growth plate matures. However, it is noted that people who had OSD may be more likely to present with other issues later in life. This may or may not be statistically significant, but any strategies that minimise the bony change to the area could be useful. If you are an adult with a history of knee problems including OSD, your osteopath will assess the body as a whole to work out how these conditions are liked together. You may find it beneficial to seek osteopathic treatment to manage your symptoms and then to help keep them at bay.

Make an appointment in Leicestershire or Rutland here.

Tongue Tie

Getting started with breastfeeding can be difficult for any mum and baby, but a range of challenges arise when the baby has a tongue tie or lip tie.

Tongue Tie

What is Tongue Tie?

Under your tongue, there is a stringy piece of tissue (frenulum) that connects the centre of the tongue to the base of the mouth. It should be far back enough that it does not limit the movement of the front of the tongue. A tongue tie can be diagnosed when the tongue movement is limited by a frenulum that is too short or connects too far forward. They can be notoriously hard to diagnose, particularly for the less severe cases. 

What is a Lip Tie?

If you turn your top lip out in front of a mirror, you’ll see a similar frenulum in the centre of the lip, joined high up on the gum. Again, if this tissue is short or attaches over too broad an area, there may be feeding issues. Effective feeding requires the top lip to turn right out, otherwise latch might be shallow or have a poor seal.

Lip tie is much less well known than tongue tie, and as such it may be more easily missed.

Signs and Symptoms 

As the condition is a spectrum, not all cases will present in the same way. Some common signs we expect are:

  • painful latch when breastfeeding 
  • baby taking on a lot of air while feeding (breast or bottle)
  • noisy feeding 
  • a “heart shaped” tongue when crying (illustrated)
  • inability to stick tongue out (young babies may mirror you, but not all will)
  • milk residue on the tongue after feeding- not to be mistaken with thrush. This happens if the tongue does not rub against the roof of the mouth. 

It is worth noting that there are other causes for most of these signs, and that a false diagnosis of tongue tie is just as problematic as a missed diagnosis. If these signs are not picked up soon after birth, you can ask your paediatric osteopath, midwife, health visitor, GP, or lactation consultant for another opinion.

Longer Term Effects

As a baby grows, a tie may rectify itself. However sometimes an adult can be diagnosed with a tie too. Restricted tongue movement may affect speech development, but this is not always the case. If a tie is significant enough to impact feeding for a long time, this might cause slow weight gain. Speak to your health visitor if you are worried and need to get your baby weighed as not all GP surgeries have the facilities.

Management 

Conservative management is recommended where possible, but there is also a limited window when surgery is optimal. Young babies do not have the nerve development in the frenulum that older babies do. Corrective surgery after this point is more complicated as anaesthetic needs to be used.

Your paediatric osteopath can offer conservative management. The frenulum is a soft tissue, which can be stretched and exercised like any other. Techniques in the treatment room to encourage its mobility can be a solution in some cases.

It may also be worth working with a lactation consultant if you are breastfeeding. Some babies quickly get to grips with it once their tie is resolved, but others still struggle. A lactation consultant can offer techniques to make feeding more comfortable and efficient.

Make an appointment for your baby across Leicestershire and Rutland here.

Pelvic Joint Pain in Pregnancy: SPD & PGP

SPD stands for Symphysis Pubis Dysfunction. The pubic symphysis is the big joint in the centre of the front of the pelvis. During pregnancy, it can become unstable and painful due to a combination of factors.

SPD and PGP: pregnancy joint pain

Factors in SPD

From early on in pregnancy, the body begins to produce the hormone relaxin. Its role is to relax the ligaments around the sacrum (base of the spine). This bone needs to move a lot to allow the baby to make its way down the birth canal during labour. This additional mobility combined with postural changes to accommodate a growing bump can put a high demand on the joints of the lower back and pelvis. Symptoms may be more prevalent when other areas of the body are not moving as well as they should. In these cases, the compensation is not spread evenly over the body, and instead becomes focused over a smaller area.

PGP: Pelvic Girdle Pain

A broader term associated with SPD is PGP. This refers to pain at the back of the pelvis too. It often goes hand in hand with SPD as the pelvis is like a ring, and changes in one part tend to affect the others.

The SIJs are the joints at the back of the pelvis. They are the point at which the spine meets the pelvis, and some people have a dimple over the joint. For some people, they take a lot of the pressure from the changing body in pregnancy. This might manifest as lower back or buttock pain when walking, sitting to standing or vice versa, and turning over in bed. Sometimes symptoms can also be similar to sciatica, when the pain is referred down the thigh and lower leg. Unlike sciatica, this pain is less of a shooting pain and may be more of a deep ache.

SPD and PGP Management

If any of the joints in the pelvis are overloaded in pregnancy, your osteopath will look at the pelvis as a whole, and its relationship with the rest of the body. Sometimes the lower back becomes stiff, maybe due to the deeper curve caused by the bump. Whatever the reason, we will work to ensure that the whole body is moving well, with the intention of taking pressure off the pelvis. Beyond treatment in clinic, you will also be given advice and exercises where appropriate.

Beyond the discomfort of SPD, allowing the condition to progress may hinder your options at birth. Severe cases can be further aggravated by positions where the legs are open wide. We want to start treatment before your case becomes severe, so if you feel any discomfort in the pubic symphysis at all, book an appointment via the link below.

As hormone levels return to normal after birth, most cases of SPD and PGP begin to calm down naturally. However some people are left with symptoms long after birth, and are often inclined to “just get on with it”. As with cases during pregnancy, we can assess the whole body mechanics and look for the factors involved in these longer term cases too.

Make an appointment for pregnancy related joint pain here.

Plagiocephaly

Young babies’ heads are relatively soft and can become misshapen. Plagiocephaly is the term for a flat spot on the head.

Plagiocephaly and brachycephaly

To be more precise, a flat spot on the back of the head is called brachycephaly.

Causes of Plagiocephaly

At birth, babies heads are often misshapen, and this often corrects itself. The soft joints in the skull mean that a baby’s head can manoeuvre through the narrow birth canal without injury. Head shape may be more dramatically affected by an instrumental delivery (forceps or ventouse). It is also possible that the head shape was affected by the positioning in the uterus.

Plagiocephaly is closely related to torticollis, which is a neck muscle spasm causing reduced neck movement. Before babies can sit by themselves, they spend a lot of time laying down or reclined. If the neck is uncomfortable when turned one way, they will favour the other side. Combined with gentle but prolonged pressure on the head, this can lead to a flat spot.

Weakness in the neck, which is more common in premature babies, can cause plagiocephaly by a similar means. With premature babies, the effects may be especially pronounced, as their skulls are softer at birth than full term babies.

Red Flags

Osteopaths with paediatric training will screen for red flags in babies with plagiocephaly. Craniosynostosis is an example of a red flag. This is a condition in which the joints in the skull fuse early, which requires medical intervention. The condition is rare, but you should speak to your GP if you suspect that this may be the cause of your baby’s unusual head shape.

Management of Plagiocephaly

There are a number of interventions for plagiocephaly that may or may not be effective. The NHS does not routinely advise for the use of helmets, as they are expensive, may be uncomfortable, and are not well supported by research.

It is important that you do not adopt unsafe sleep habits in an attempt to address your baby’s plagiocephaly. Current guidance is to lay your baby down on a firm mattress, flat on their back. If they are able to roll by themselves, you do not need to roll them back.

Tummy time and supported sitting (before your baby is able to sit unassisted) is recommended to encourage strengthening. Your health visitor can give you guidance on what is appropriate for your baby, and tips that might make these exercises more enjoyable for both of you. Alongside the benefits of strengthening, these exercises require no pressure on the head, so may help with the correction of a flat spot.

Cranial osteopathy uses gentle techniques. Some parents say that this helps to provide comfort for their babies. This kind of treatment does not involve the stronger manipulation (or “clicking”) that you might expect from an adult osteopathy appointment. Among other structures, osteopaths work on tight muscles, so if a baby has plagiocephaly due to tightness in the neck, gentle osteopathic techniques may form part of an appropriate treatment plan.

Make an appointment in Rutland or Leicestershire here.

Infant Torticollis

Torticollis, in adults and babies, is a condition involving neck tightness and reduced movement. This article will focus on torticollis among infants, but some of the information provided will also apply to adults.

Infant torticollis

Signs of Torticollis in Infants

Typically, torticollis is caused by spasm of the SCM muscle. This is the muscle that sticks out on the front of the neck when you rotate your head. In addition to rotation in one direction, it is responsible for bending the neck in the other. Therefore, when in spams, it causes rotation one way and side-bending in the other.

While a baby is very young and lacks neck control, signs can be hard to spot. Sometimes it helps to look at pictures you’ve taken of your child to see if they favour rotation in one direction. It may also be more obvious if:

  • baby prefers to feed laying on one side vs the other, if the feeding position is not in a neutral position for the neck
  • they interact more with toys on one side of their baby gym or seat
  • their cot is next to a plain wall, and they get irritable when placed in such a way that they have to face it

Causes of Torticollis

True congenital torticollis is present from birth (or before). There are controversies about whether the details of the birth have an effect on this. Muscles respond to the demands put on them, so if a baby has their neck in an asymmetric position in the womb, some muscles will tighten up.

Your paediatric osteopath will screen for sternomastoid “tumour” of infancy. Despite the worrying name, it is not a cancer. “Tumour” literally just means mass, and in this case it is a fibrous mass within the SCM muscle. It appears in the first few weeks of life, and in about 50% of cases, it will resolve on its own. Some children who have this condition will have torticollis at the same time, or after it resolves. Your osteopath can help to manage the tight muscle.

Secondary Effects

Young babies have especially soft skulls. While they lack the mobility to spend much time sitting or crawling, they will likely sit in positions where there is pressure on the back or side of their head. If their neck mobility is reduced, they will have more pressure on one spot, as turning the head is uncomfortable. As a result, they may develop a flat spot on the head. This is called plagiocephaly.

Managing Torticollis

Where tight muscles are involved, your paediatric osteopath may be able to help. You can expect gentle techniques to massage and stretch the muscle during your appointments. Where necessary, they will also work gently through the affected joints. Exercises or advice may also be appropriate. Where safe to do so, your osteopath may advise that you help your baby to spend some time every day in a supported sitting position. Plenty of tummy time is usually advisable too, as both positions allow the neck muscles to begin to strengthen.

Make an appointment in Leicestershire or Rutland here.