Avin Patel

IBS: Irritable Bowel Syndrome

IBS is a common condition, but it can be hard to pin down as it is considered functional. This is in contrast to structural conditions, in which a sign would be there to find through imaging, biopsies, or other tests. However, this is not to say that IBS is not real.

IBS Basics

The condition is characterised by:

  • Abdominal cramps
  • Bloating
  • Diarrhoea
  • Constipation

Sometimes it can be difficult to spot a pattern, or you may find that stress or certain foods trigger them. It can become a vicious cycle when the stress and anxiety of potential symptoms actually aggravates them further.

Some people find that they develop back pain alongside IBS flare ups, which can be a direct referral from the digestive system rather than a back problem as such. Therefore, osteopaths need to be aware of the symptoms of IBS and how we may be able to help a patient manage them.

Diagnosis

As the condition is functional, any diagnostic tests are performed to rule out other conditions. There are similarities with conditions that require treatment and monitoring such as ulcerative colitis and Crohn’s disease. Not to be confused, they are under the umbrella of IBD. This stands for Inflammatory Bowel Disease, and can be life threatening if not managed properly.

Your GP may also use blood tests to check for deficiencies. These are more likely when the body is not absorbing nutrients properly, such as IBD or IBS where diarrhoea is significant. Be sure to mention if your diet does not contain a specific food group, such as vegetarianism or veganism. B12 deficiency is more common in people who do not consume animal products, so special effort may need to be made to ensure adequate intake of certain nutrients.

Osteopathy and IBS

The ASA recognises that osteopathy can help with some issues of digestion. A research study has also shown that there may be benefit to patients with IBS to have manipulative treatment to the spinal joints (“clicking”). Clicking joints has a local effect on the joint, muscles, and nerves, so a possible explanation for this is that the click calms down the nerves that supply the bowel. This may just provide temporary relief, but sometimes taking the edge off helps to wind down the cycle of anxiety and IBS. Thinking mechanically like this, your osteopath may also want to treat further up the back in case there is a relationship between a lower back that is overworking and the nerves mentioned above.

Stress is often an aggravating factor for IBS. We can help with the effects of tension, which you may find helps to break the stress cycle somewhat. There is also a relationship between the diaphragm, which typically tightens up with chronic stress, and the digestive system. We know that the diaphragm has a direct effect on reflux as its normal function supports the sphincter at the top of the stomach. For people whose IBS symptoms involve stomach symptoms (such as increased burping), this could be a useful avenue to explore in clinic.

Make an appointment in Leicestershire or Rutland here for digestive issues.

Self Management Basics

The points made below are non-prescriptive, and intend to give an idea of the advice your osteopath may give you after fully analysing your case and giving you a diagnosis.

Studies repeatedly show that the best results come from treatment alongside self management. This might include:

  • using a warm or cool compress
  • stretches
  • strengthening exercises
  • general aerobic exercise

Your osteopath will give you advice tailored to your case at the end of your initial appointment. As your symptoms change, your self-management advice will be changed accordingly.

self management: exercises

Heat vs Ice for Self Management

During the case history, we ask patients if they’ve found anything that makes their symptoms better or worse. It’s not uncommon for someone to say that they wanted to try heat or ice, but were unsure which was the right one.

As a general rule, ice is good for reducing inflammation, and heat is good for tight muscles. As heat can aggravate inflammation, and even sore muscles are typically a bit inflamed, ice is generally the safer bet. That said, you don’t want to keep it in place for more than 10 minutes per hour, as the aim is to take the edge off rather than limit the blood supply. There are also times when a bit of inflammation is a good thing. It comes up for a reason, and it brings nutrients to the area that needs it. The problems arise when the inflammation stays stagnant for too long, in which case contrast bathing might be the most appropriate.

Contrast Bathing

The term refers to the use of both a warm and cool compress. Some people prefer to do this in the shower, letting the water run warmer and cooler on the affected area. For others a cool pack and a wheat bag are more suitable. Your osteopath can advice what might be appropriate for you. Heat or ice alone should be used for no more than 10 minutes in an hour. Contrast bathing needs shorter and more frequent usage, as the idea is the heat opens up blood vessels and the cool closes them. This essentially creates a pump in the area, encouraging blood and fluid to come and go- great for moving on old inflammation.

Do not go straight from one extreme of temperature to the other. With contrast bathing, a couple of flannels that have been run under warm or cool water may be extreme enough. Your osteopath can also advise about how long you should let the skin acclimatise before switching to the other temperature.

Exercises for Self Management

The exercise plan your osteopath devises will be completely personalised to you. General exercise is almost always a good thing to promote healing and reduce pain. If you are recovering from an acute injury, this may not be appropriate, as you will be advised.

Stretching can be good to manage a tight muscle. Often we don’t realise that muscles are tight, because they cause a problem elsewhere. Patients often come in and mention their “bad posture” of rounded shoulders, but the shoulders themselves are often relatively comfortable. In this case, tightness comes from the chest muscles, and a combination of stretching the chest and strengthening the upper back can bring the shoulders back to where they should be. If this strain was causing problems elsewhere, such as in the neck or lower back, this might be the first step.

Strengthening is sometimes used in a seemingly counterintuitive way. For example, if a muscle is tight because it is working too hard, what we really need to do is make it work harder still in order to strengthen. If the demands placed on it are then less than it’s capable of, it will function better.

Make an appointment for your aches and pains in Leicestershire or Rutland here.

What is an Osteopath?

An osteopath is a professional whose title is legally protected. This means that anyone who calls themselves an osteopath is a member of the General Osteopathic Council, has completed a recognised qualification, and annually maintains their professional insurance and knowledge.

What do osteopaths do?

A simple explanation of osteopathy is that it’s a therapy focused on the musculoskeletal system, and its diagnosis and treatment without medicines. Osteopaths use your case history and observation of movement to understand the problem and its causes. Treatment itself is usually hands on, using massage techniques and joint movements to improve the body’s function.

What can an Osteopath Treat?

You’re welcome to book in with any aches and pains that you think could be related to muscles, joints, or nerves. We can also help with chronic pain, where the cause can be harder to identify. The ASA allows us to claim to treat the following conditions (click on one to read more):

We may also be able to help with problems that are not listed, you’re welcome to get in contact if you are unsure whether we can help.

Osteo, Physio, and Chiro

We are often asked about the difference between what we do, and what a physiotherapist or chiropractor would do. Our training is all quite similar in terms of knowledge and techniques, although it could be argued that chiropractors have the most emphasis on joint manipulation (clicking). Physiotherapists are typically not taught this at undergraduate level, but may learn it in postgraduate training. Most osteopaths are likely somewhere between the other two professions in terms of treatment style and manipulation- but it is important to understand that we all fall on a spectrum. The question should maybe focus less on which profession you need to see, and rather which individual suits you.

What to Expect at your Appointment

Your osteopath may send you some forms to fill in ahead of time, so check your email after booking. When you arrive, you can expect to be treated sensitively and professionally: your treatment and its contents is confidential. Your osteopath will take an extensive case history to help identify any possible factors in your presenting complaint. After this, they will have a few ideas of what might be going on, and they may ask you to remove some clothing. You might prefer to wear a vest and shorts for comfort, but you will not be required to dress down further than you are happy to. We can work through clothing where necessary.

You will be examined, with the osteopath asking you to perform movements and maybe repeating them for you when you are sitting or laying down. Other tests may be appropriate too to get to the root cause of your symptoms. When they are happy with a diagnosis, they can begin treatment. As mentioned above, this is usually a combination of work to muscles and joints, and your consent will be required throughout.

At the end of your session, you can expect to have a diagnosis and explanation for your symptoms, an idea of how long it will take to manage, and often a few exercises to do at home. Some conditions can be resolved quickly, and others are expected to take longer or to come and go. You don’t need a referral from your GP to see an osteopath, so if you’ve been on the fence about making your appointment, you can click the link below.

Make an osteopathy appointment in Leicestershire or Rutland here

Mythbusting in Osteopathy

We hear a lot of misinformation in clinic, whether our patients pick it up from other medical professionals or less trustworthy sources. It might seem pedantic, but correcting the way we think can hugely improve our pain. If you believe that your back is fragile, you are likely to worry more about it and become over protective. In reality, movement is exactly what most problems need. Here are some of the most common myths we hear from our patients, and the associated truths:

“Arthritis means suffering until a joint replacement”

Osteoarthritis (the “wear and tear” form of arthritis), is a condition affecting cartilage. Sometimes we forget that cartilage (and bone, in fact) are living tissues. If you broke a bone, you would expect it to heal. If your cartilage is damaged, it will take a while, but it does have the capacity to improve. Identifying arthritis in its early stages has a good outlook. The condition produces a vicious cycle, where reduced movement negatively impacts joint health overall, allowing the cartilage to become more damaged. Your osteopath can work with you to improve local movement, which allows nutrients back into the area and gives the cartilage the best chance to heal.

“A slipped disc will cause me sciatica forever”

Firstly, we need to address the “slipped disc” idea. Some people use the term without thinking too much into it, but others report feeling that something popped out, or even feeling the bulge itself. Discs are made of a couple of layers: inside they are soft, whereas the outside is a flexible but strong fibrous layer. They are so firmly stuck to the vertebrae above and below, that in a severe accident, the bone is more likely to break than for the disc to detach. So don’t worry about a disc moving freely away from the spine.

What can happen is that the soft inner layer can push against a weakened spot in the fibrous layer. This can cause a bulge in the disc, or sometimes the soft layer can partially leak out. Sometimes either of these scenarios will cause pain locally in the back, or they might irritate a nerve, causing pain down the leg.

It is important to note that disc bulges often happen without any symptoms. A study showed that after the age of 40, most people had at least one bulging disc. However, less than half the population suffer from lower back pain or sciatica. This is one reason why the NHS does not routinely offer imaging for lower back pain or sciatica. This changes if there are any red flags present.

Sciatica, disc bulges, and spondylolistheses

“My spine needs clicking back into place”

This one is similar to the idea of discs being somewhere they shouldn’t. Clicking a spinal joint is quite a lot like clicking your knuckles. If you’ve done so, you might notice that when you get the click, your finger moves a bit further with the noise. That’s not to say that the joint was out of place, it was just stiff.

When we click a spinal joint, we choose a restricted one. The short but powerful movement demands a little bit extra from that joint, and aims to get the movement back that has been lost. It’s never about repositioning. Rarely, a vertebra is out of place, but clicking would not be a solution. This is called a listhesis (fig. D), and is also known as a spondylolisthesis (spinal listhesis) or retrolisthesis (a backwards slippage instead of forwards). Sometimes this is purely anatomical, causing you no problems and only identified on a scan that’s looking for something else. Alternatively, it can be traumatic, in which a fracture to part of the spinal bone allows a shift in positioning. If the slip is significant enough, your osteopath may be able to feel a “step” in your spine, however this will require referral back to your GP, as we don’t click joints back into place.

Make an appointment here for a full osteopathic assessment and treatment in Leicestershire or Rutland

Perthes’ Disease

Perthes’ Disease is a rare childhood disease affecting the shape of the hip joint. It eventually burns itself out, but can be a cause of arthritis later in life. It also goes by the name “Legg-Calve-Perthes Disease”.

Perthes' Disease

What Is Perthes’ Disease?

This is a condition in which the blood supply to part of the thigh bone is disrupted. Specifically, it is the head of the femur (the ball of the ball and socket) that is affected. Bone is living tissue, and in children affected by Perthes’, it is still growing. Reduction of the blood supply causes part of the bone to die (necrosis), and become misshapen. Long term effects depend on the details of the repair stage described below.

Frustratingly, we don’t know exactly what causes the disease to develop. Some cases are associated with rapid growth spurts that somehow disrupts the blood supply. Other cases are associated with trauma or infection, or even congenital hip dislocation. In about 1/10 cases the other hip develops the same condition after the first.

Symptoms of Perthes’ Disease

Perthes’ begins between the ages of 4 and 10, and many more boys are affected than girls. Early signs often include a limp, which is likely to be worse after exercise. This may be completely painless or persistently painful. Where there is pain, it may spread to the groin or as far as the knee (illustrated above).

The Repair Stage

Once blood flow returns, the body begins to heal the damaged tissue. Some cases heal perfectly, and even an X-ray would not clearly show that there was ever a problem. Other cases can lead to a deformed femoral head, which may have a flat portion or a rough texture compared to a healthy one. This is likely to impact range of movement and may cause a limp. Sometimes a brace will be recommended by the orthopaedics team, in order to hold the femoral head in the roundest part of the socket. This aims to encourage the bone to grow into the correct shape.

Your Osteopath’s Role

We cannot resolve the blood supply, but we may be able to help with the compensatory patterns that develop in response to the pain. A child with suspected Perthes’ Disease requires referral to their GP and on to the orthopaedics team. We can support with symptom management and ensuring the hip maintains as much normal movement as possible.

Longer term complications of the condition can include a limp or early onset arthritis. We may be able to help manage the arthritis, especially if addressed at the earliest symptoms. A limp caused by asymmetry of the thigh bones is not an inherent problem- a well managed limp can be pain free. This depends on the body’s ability to adapt to the demands of the limp. As long as the legs and back can compensate for these changes indefinitely, it should be comfortable. This might require intermittent treatment over years, or it may be perfectly manageable with prescribed exercises.

Make an appointment in Leicestershire or Rutland here

Long Covid

Long Covid is a poorly understood condition, and new information is still emerging. This post was last updated in February 2022

Long covid

Early reports (before the vaccine roll-out) suggested that around 4.5% of people who contracted covid would still suffer the effects 8 weeks later. 2.3% still had symptoms 12 weeks after onset. However, we expect to see fewer new cases of long covid now that the majority of the adult population has been vaccinated. ONS reports that people are 13% less likely to report LC symptoms after the first jab, and 9% less likely again after the second.

Symptoms of Long Covid

The most common symptoms, as identified by a survey of over 1500 LC patients, were:

  1. fatigue (affecting the vast majority of those surveyed)
  2. muscle aches
  3. shortness of breath
  4. difficulty concentrating
  5. inability to exercise
  6. headache

There are a number of cross overs in these symptoms with conditions like ME/CFS and fibromyalgia. Osteopaths are qualified to help manage the symptoms of fibromyalgia.

As muscle aches and headaches are symptoms that we often help with, it’s important that we are informed about Long Covid. Patients may come to clinic looking for pain relief without realising that their symptoms are the long term effects of a covid infection.

Management Strategies

As LC is a new condition, management protocols are few and far between. There have been articles published in medical journals suggesting potential strategies, such as one in the BMJ. This post recognises the difficulty in managing LC, but also the importance of a multidisciplinary approach.

Initial assessment should be done by your GP or hospital team. Pre-existing conditions can be affected by LC, for example blood sugar management in diabetes can be more difficult. Your medical team can also watch out for red flags and other complications.

When your team is happy with your progress, you may benefit from a wider multidisciplinary team. The BMJ article mentioned above puts emphasis on mental health support, return to exercise where appropriate, and improving general health. If you do not receive sufficient support to rebuild your capacity for exercise, your osteopath can take on this role. We can prescribe and monitor exercises, while addressing the mechanical changes that may contribute to your reduced ability.

Changes in Breathing and Osteopathy

We have written before about the role of stress on breathing. When the diaphragm is dysfunctional, breathing is less efficient, and smaller muscles are recruited to help around the shoulders. This can be associated with headaches– another feature of long covid. Work to the diaphragm and associated muscles aims to improve breathing efficiency. With this we hope that you will be able to breathe deeper and easier, improving fatigue and exercise capacity. With these muscles under less demand, muscular pains in the shoulders and neck should begin to settle.

Make an appointment in Leicestershire or Rutland here