Avin Patel

Reflux

Acid reflux or heartburn can affect all ages. In this post we will cover both adult and infant cases of reflux.

Reflux

Newborn Reflux

Young babies are renowned for “spitting up” after feeds. This is normal, and often the amount they produce looks like a lot more than it is. Spill a teaspoon of milk on a hard surface or muslin and you’ll be better able to estimate how much of their meal they’re really losing.

Reflux is different, and may or may not involve being sick at all. If your baby is routinely being sick and you have concerns about their ability to gain weight, speak to your health visitor or GP in the first instance.

Signs and Symptoms

One important sign for young babies is arching of the back. Other suggestions of discomfort after feeding can be vague, including:

  • persistent crying, even when held
  • resisting being laid down on their front, back, or side

They may also show signs that something is amiss during feeding. Noisy feeding, taking on air, and hiccupping can be associated with infant reflux. They may be signs of something else though, such as tongue tie.

Silent reflux can, unsurprisingly, be a lot harder to diagnose. The arching back might be the only clear sign, as the stomach contents does not make it back up to the mouth. This may be misdiagnosed as colic, which is a symptom rather than a diagnosis in itself.

Adult Reflux

The anatomy is slightly different for adults, so we generally think about different causes for symptoms. Some specific foods and drinks might aggravate your symptoms, or simply consuming too much at once and laying down soon afterwards could do it.

Persistent irritation of the base of the oesophagus can cause more significant damage, so if your symptoms don’t improve as expected, we may want to refer you back to your GP.

The Role of the Diaphragm

At any age, the diaphragm can play a significant part in reflux. The diaphragm is a sheet of muscle that attaches to the lower ribs, like a parachute. As it forms a membrane between the abdomen and thorax, anything that runs between the two areas will have to pass through the diaphragm itself. This actually helps to protect against reflux and is termed “the anti-reflux barrier“. Tension from the diaphragm around the base of the food pipe (oesophagus) helps to keep stomach contents from returning. However, dysfunction of the diaphragm could reduce the efficacy of the barrier.

Stress can often cause diaphragm problems, alongside changes in breathing and gastric function. This is covered in more detail in our blog post here.

Osteopathic Management

Treatment will vary from case to case. Work to release the diaphragm will often feature, which might entail direct massage to the area, or stretches to the ribs to encourage movement. If stress is the root cause here, it may also be beneficial to work on the upper back and shoulders. We may also to offer advice for aggravating factors in diet.

For babies, it may be more helpful to think outside the box, and begin to develop the ability to adopt more upright positions. This will depend on your baby’s age, ability, and other factors in their case.

Make an appointment here to assess your baby’s or your own reflux

Rheumatoid Arthritis

Sometimes patients will mention that they have a family history of arthritis, but they’re not sure if it’s rheumatoid arthritis (RA) or osteoarthritis. Full diagnosis of RA usually requires a blood test or imaging from your GP or rheumatologist. But there are a few points that set RA and OA apart that we can identify in clinic.

Rheumatoid arthritis and its effects on the hand

Signs and Symptoms of Rheumatoid Arthritis

RA often starts earlier in life than OA, but there is some overlap. Symptoms can start anywhere between the late 20s and 50s. OA could start in this window too, but often there is an underlying injury that causes increased demand on the joint that becomes arthritic.

Small joints are typically affected first by rheumatoid arthritis: joints of the hands, feet, and neck might show the first signs. Localised achiness is common, but as the condition is autoimmune, there might also be more generalised symptoms. Feeling generally under the weather or fatigued can be the result of a rheumatoid arthritis flare. Due to the inflammatory nature of the condition, pain is often worse after rest or intensive exercise. Morning stiffness that lasts more than 30 minutes should be investigated by your osteopath or GP. Ice is often quite soothing for inflammatory pain, but avoid direct contact with the skin, or application for more than 10 minutes per hour.

Osteoarthritic pains frequently affect larger joints, such as the hip and knee. These too may be worse after too much movement or first thing in the morning. However these symptoms often clear quickly with movement, and should not cause more than half an hour of discomfort in the early stages. We can also help you to manage osteoarthritis.

Joint Deformities

After many flare ups, the affected joints can be structurally altered. The hands often show this clearest. Again, both RA and OA can cause hard swellings on the knuckles and finger joints, but RA can also cause a “swan neck” deformity or ulnar deviation (both illustrated above). These signs point quite clearly to rheumatoid arthritis.

Managing Rheumatoid Arthritis

Osteopaths are qualified to help manage arthritic and rheumatic pains. However, we cannot prevent the flares that cause damage over time. This is why it is important for us to work alongside your GP and rheumatologist. Medication is often the most effective part of your treatment plan, working to prevent or minimise the flares and the damage they can inflict. Diagnosis might follow a blood test to identify inflammatory or autoimmune markers. Sometimes imaging is also appropriate for certainty. Note that not all “full” blood tests that you might have had for other reasons would show the markers that are tested in an RA blood test.

Hypermobility

The changes to affected joints can cause instability and hypermobility. This can be a cause of neck pain between flare ups, as the muscles of the neck have to work harder to keep the area stable. We can help manage this discomfort, providing exercises to strengthen the muscles so that they can manage the increased demand. Your osteopath will also look elsewhere in the body to check that other areas are working well, and not putting yet more demand on the neck.

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Infant Milestones

Healthcare professionals use milestones to help monitor your baby’s development. It is important to note that every child develops at their own pace, and that “normal” is a broad range. Monitoring can help to identify significant problems, but may also indicate more subtle things that can be influenced with treatment.

Milestones: tummy time helps to strengthen baby's muscles

Head Control

Babies are born with very little head control until their neck muscles begin to develop. “Tummy time” is encouraged from very early on to support your baby in developing the back of the neck, and in getting used to laying on their front.

It’s not uncommon for babies to resist tummy time, especially if there are minor underlying problems. Reflux can make a baby more likely to sick up when put on their tummy, but waiting half an hour or so after a meal might be enough to prevent this. Sometimes reflux is associated with tightness in the diaphragm. The diaphragm helps to support the sphincter that keeps the stomach contents down, so if this is the case with your baby, you might find benefit in some osteopathic treatment to the diaphragm.

We can work with you to find more comfortable ways to get your baby on their front. Distracting toys can be very useful here, or tricks like laying baby on your front. This keeps them slightly more upright, and they find comfort in being close to you.

Sitting

Supported sitting before baby is ready to do so themselves can help to strengthen the necessary muscles and encourage confidence. Before baby has adequate head control, this should be done carefully if at all- your paediatric osteopath or health visitor can advise. At this stage, encouraging rolling can be a more appropriate first step.

You might notice that your baby prefers to roll one way and struggles with the other. Sometimes this is associated with torticollis: when the neck is restricted in turning one way. This is commonly just a muscular problem, so management is relatively simple. We do screen for more serious conditions that present similarly and will refer on where appropriate.

Gross Motor Milestones

Crawling and walking can occur in either order, with some babies being happy to sit still until they learn to cruise and walk. Core strength, building on that gained for sitting, is crucial.

Some joints are very soft until later childhood, so avoid pulling your baby up by the hands. Instead allow them to use their own strength, with you just providing support and guidance. Once they are able to pull themselves up, you can try setting up a course along low tables and sofas to encourage cruising.

Osteopathy and Infant Milestones

Specific examples are given above for how your paediatric osteopath may be able to help your baby to reach their milestones. It is important to reiterate that babies all develop on their own timeline, and that our role is to support where there may be a hurdle. We can help to identify ailments that might be hindering your baby’s movement, and address them appropriately. If you are concerned about your baby’s development, your health visitor or GP may be the most appropriate first port of call.

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The Pelvic Floor

Everyone has a pelvic floor, which is a sling of muscles at the base of the abdomen. Similarly to the diaphragm, which can be associated with various aches and pains, the pelvic floor muscles are often forgotten.

Pelvic floor anatomy

Pregnancy and Childbirth

Some people think that a caesarean birth will prevent strain on the pelvic floor. In fact, a lot of the strain comes from pregnancy itself. The uterus is supported by ligaments, but the majority of its weight rests on the sling of muscles. Pregnancy (and the fourth trimester) causes new demands on muscles across the body as joints become more mobile and the centre of gravity moves. Unsurprisingly, the pelvis and its soft tissues are among the most affected.

Regardless of the birth, all new mothers are given advice for strengthening the pelvic muscles. Ideally, these exercises should be carried out before birth, or even pregnancy. Stronger muscles are more able to relax, so strengthening exercises are not contradictory to an unassisted birth. If you have suffered a birth injury, your osteopath may be able to help.

Pelvic Bones and The Pelvic Floor

Coccyx pain (coccydynia) will almost always have a connection to the pelvic floor. We often work on the gluteal muscles, as they attach all along the length of the coccyx. But exercises and techniques for the pelvic floor can be helpful too. Coccyx pain can develop after trauma, such as a fracture after a fall. If the coccyx itself is moved to a new angle, this can be the cause of the pain. External techniques to local joints and muscles can be sufficient, but some cases may require internal techniques. This will never be performed without your explicit consent, nor at the first appointment. Your osteopath can discuss the possibility of this technique with you if appropriate.

There may also be a relationship with SIJ pain or pain at the front of the pelvis. The connection is less direct, but still significant. We think of the pelvis as a ring: a problem in one of the three joints will have an effect on the other two. It stands to reason that the muscles that connect the bones will also be under different tensions.

Tension and Incontinence

Beyond the points mentioned above, general tension can be a problem with these muscles. Some people hold tension here without realising. It might manifest as pelvic or upper leg pain during stressful situations, such as while at work. Surprisingly, tension itself can be a cause of incontinence. A cycle can develop where the anxiety of potential incontinence causes more tension, which leads to leakage.

Pelvic tension can also develop in response to a traumatic event, such as birth trauma, medical investigations, or assault. These cases may be best addressed with a combination of talking therapy and osteopathy. Treatment does not need to be hands on if you are uncomfortable with it. We can use a range of indirect techniques and exercises to create change.

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