Avin Patel

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.

Make an appointment here to assess your joint pain

Labrum Tears

“Labrum” is latin for “lip” and refers to the ring of cartilage that supports some ball and socket joints. Both the hip and shoulder joints have labra.

Labrum Injuries

Ball and socket joints are particularly mobile, and the labrum helps to keep movement within a healthy range. But it is possible for the labrum itself to be injured, often by a forceful injury.

Cartilage is slow to heal, so symptoms can persist for a while if not addressed. Your osteopath will aim to improve local joint health to aid healing. They can also advise you on how to best look after the joint as it heals.

Shoulder Labrum Injuries

The shoulder is a very mobile joint. This is due to the small and shallow socket. Unfortunately, this means that it is not the most stable joint. We rely on the soft tissues (ligaments, muscles, and cartilage) around the joint to protect the it.

SLAP Lesions

SLAP stands for Superior Labrum Anterior + Posterior. This kind of injury is particularly prevalent among throwing athletes, but can also be caused by a fall or other trauma. It occurs near the point where the biceps tendon attaches to the labrum- an area under a lot of stress during throwing movements.

This problem may present with pain, stiffness, and clicking or locking of the shoulder on certain movements. It may be particularly difficult to use the arm in overhead movements, or performing movements like putting on a coat sleeve.

Hip Labrum Problems

Hip labrum injuries may be caused by road traffic accidents, falls, or shearing forces as with twisting. Although the hip socket is deeper and therefore more stable than the shoulder, the cartilage can still be injured. Symptoms are often quite generic to a number of hip problems, and may include:

  • Pain in the groin or front of thigh
  • Clicking of locking of the joint
  • Pain on activity

FAI: Femoral Acetabular Impingement

FAI is slightly different. Rather than being a form of labral tear, its presence can predispose the development of a tear. In this condition, part of the ball and socket is misshapen. This can affect the “ball” after childhood issues: Perthes Disease, repetitive movements, or some fractures can predispose this. The socket can cause the same problem if it extends further than it should.

The problem with FAI is the ball makes excessive contact with the socket, causing pain and stiffness. These symptoms are particularly evident after periods of prolonged or repeated hip flexion, such as sitting or performing squatting exercises. This unusual force can play a role in the development of FAI later in life. FAI is also associated with the development of osteoarthritis in the hip, so it’s well worth doing something about it.

Management

Cartilage is slow to heal, but benefits from full, gentle movement. This can be difficult to achieve on your own, as the necessary movement may be painful. Your osteopath can do this movement for you, and give you exercises to achieve the movement yourself. When a joint is painful, the muscles around it often tighten it up to protect it. Unfortunately, this prevents the required movement from happening organically. We can help relax these muscles too, to give your body the best conditions in which to heal itself.

If your hip or shoulder injury sounds like this, get in touch with us today.

Carpal Tunnel Syndrome

The carpal tunnel is a narrow space in the wrist. Nerves and tendons pass through here on their way to or from the hand.

The carpal tunnel

The median nerve runs through the tunnel, and it can be irritated in this small space. This nerve supplies some of the palm with sensation and movement.

When the nerve is irritated, it can cause pain, weakness, numbness, and pins and needles in the area it supplies. These are symptoms of Carpal Tunnel Syndrome (CTS). These symptoms are often worse at night, potentially due to compression of the wrist while sleeping. Bending the wrist is an aggravating factor in itself.

How Carpal Tunnel Syndrome Occurs

The nerve can be irritated in two ways: from pressure from within the tunnel, or from outside.

Internal Pressure

Overuse of the muscles whose tendons run through the tunnel can cause CTS. This is generally agreed to be the most common cause of CTS. Previously known as “repetitive strain injury” or RSI, this can be associated with excessive computer work. The effect on the carpal tunnel is more apparent with poor ergonomics- resting the wrists on a hard desk while typing adds more pressure to the nerve.

Anything that reduces space within the tunnel can predispose CTS. One common factor is fluid retention, as may occur with:

  • pregnancy
  • kidney disease
  • heart failure
  • some medications

As cells become more full of fluid, they take up more space and can lead to compression.

External Pressure

Positional problems can cause unnecessary pressure on the nerve from outside the tunnel. One reason that symptoms may be worse overnight is that we commonly sleep with a flexed wrist. This causes compression through the tunnel, and can encourage symptoms to develop overnight.

As discussed previously, direct pressure to the wrist at work will also apply external pressure.

Persistent Symptoms of Carpal Tunnel Syndrome

Occasionally we see patients who still have symptoms after CT release surgery. This is a procedure to make space in the tunnel by cutting the band of tissue near the surface. Persistent symptoms tell us that either there is something in the wrist that continues to cause irritation, or it’s not the wrist at all.

The median nerve can also be irritated further up the arm, causing similar symptoms but having nothing to do with the wrist. One of the muscles that turns the hand over is another point at which the nerve can be compressed. Alternatively, other nerves could be irritated as far up as the neck, causing discomfort, weakness, or numbness into the hand. However, this latter alternative is unlikely to mimic CTS so closely.

Persistent symptoms without surgery do not necessarily mean that surgery is the answer. As overuse of the wrist muscles is considered the most likely cause on average, it makes sense that symptoms may remain as long as the wrist is overused. Your osteopath may be able to help here.

Treatment

Osteopathy is built on the principle that the body can heal itself. As mentioned above, this may be as simple as changing a movement to remove an aggravating factor. Whether this means strengthening one muscle group to take the load off another, or advising the use of a splint overnight,

In the case of wearing a splint, it may be possible to work on other factors at play in order to avoid reliance. Advice such as using ice, or self massage to reduce the impact of overstrained muscles can help here. Techniques from the treatment room that may be adapted for exercise at home could include gentle “flushing” techniques. These aim to reduce any inflammation or fluid build up in the wrist.

For help managing symptoms of carpal tunnel syndrome, book now.

Thoracic Outlet Syndrome

The thoracic outlet is the area between the arm and ribs where nerves and blood vessels leave the thorax (rib cage). There is not a lot of space here, so sometimes those nerves and vessels can be compressed. This causes symptoms into the arm, and is known as Thoracic Outlet Syndrome (TOS).

Thoracic Outlet Syndrome

The Thoracic Outlet

There are a few small spaces in the outlet where nerves and vessels pass through. They become even smaller in certain movements, such as taking your arm out to the side or rotating out. As a result, people who do these movements in daily life may be more prone to developing TOS. They may also notice that their symptoms are worse when moving through these positions.

However, the two most common causes of TOS are traumatic or anatomical. It may be the case that you were already predisposed to TOS because of your anatomy, but it took an injury on top of that to initiate it.

Symptoms of TOS

With both kinds of TOS, symptoms affect the arm. Symptoms may be mild a lot of the time with an increase during activity. There may also be a pattern associated with things like desk work. Tight pectoral muscles can play a role in TOS, and modern life encourages this tightness.

Neurological TOS

The symptoms of TOS caused by nerve compression are similar to those of compressed nerves elsewhere. They can include:

  • Weakness
  • Wasting of hand muscles
  • Numbness
  • Pins and needles

When a nerve is repeatedly irritated, it can become hyper sensitive. This means that longer-standing problems typically take longer to resolve.

Vascular TOS

If a blood vessel is compressed, this is more urgent. This form of TOS is usually related to a cervical rib: where the lowest vertebra in the neck has ribs. This in itself is not too rare or significant, but when it compresses a blood vessel it can have major complications. Treatment may be surgical to remove or reduce the side of the rib.

There are tests we can use to determine whether your TOS is caused by a trapped nerve or vessel. It may also be evident which type you have from the case history. Vascular TOS can cause:

  • Arm swelling
  • Pain in the arm or hand in a less defined area
  • Changes to skin colour in the arm (looking more red or blue)
  • Pain when using the affected arm

Managing Thoracic Outlet Syndrome

In cases where conservative treatment is appropriate, your osteopath will devise a plan for you. Treatment might involve relaxing of the muscles around the thoracic outlet. As mentioned above, modern life can easily lead to tight pectoral muscles. This is further exacerbated by weakness in the upper back, allowing shoulders to round further and compress the outlet more.

In response to this, your osteopath might give you exercises to do between sessions. A stretch for the chest and strengthening for the upper back complement each other well.

As with any presentation, your osteopath will also look further afield to identify other predisposing factors. Treatment to the neck, upper back, or around the shoulder blade could be appropriate depending on your case.

If these sound like your symptoms, you can make an appointment online.

Rheumatic Pain

The word “rheumatic” has quite a broad meaning, primarily encompassing problems with joints.

What’s the difference between osteoarthritis and rheumatoid arthritis? Whereas we think of osteoarthritis as a more mechanical process of wear, tear, and repair, rheumatoid arthritis is led by inflammation. One hallmark of inflammatory arthritis is that it is worse after rest- waking up with pain that takes more than half an hour to ease can be an indicator of this.

Some other conditions in the same family include:

  • Rheumatoid arthritis (RA)
  • Psoriatic arthritis
  • Ankylosing spondylitis or AxSpA

Early stage rheumatic diseases are easily missed because they act like a number of other conditions. However there are often subtle differences in the early stages that your osteopath will be aware of. If something doesn’t seem quite right, we may refer you to your GP for blood tests and other investigations.

Effects of Rheumatic Diseases

Examples of Rheumatic Diseases

Osteopathy will not cure rheumatic diseases, but it can help to manage the symptoms.

Rheumatoid Arthritis (RA)

One of the better known conditions is RA. Like most of them, it is an autoimmune condition where the body attacks its own joints. There are a few varieties of RA, with some coming with periods of remission.

RA can affect the hands, causing increased bony growth over finger joints and leading the hand to point away from the thumb (ulnar deviation). These are the effects of damage caused by RA and the body’s attempt to correct it.

The joints of the spine can also be affected, and this may be one of the first symptoms to show. Your osteopath will be looking out for indicators of RA.

Psoriatic Arthritis

Roughly a third of people with psoriasis will also have psoriatic arthritis. This behaves similarly to RA in that it also attacks the joints and can come and go. Psoriatic arthritis often affects the small joints of the hands and feet, and can come with changes to the fingernails.

PA can also attack the spine. As PA symptoms can start before psoriasis itself does, it can easily be mistaken for another kind of back pain. Your osteopath will look for inflammatory signs and symptoms to find the true cause.

Ankylosing Spondylitis (AS) /AxSpA

AS is poorly recognised but there is progress being made. Its name refers to how it causes fusion of the spine and pelvis (ankylosis). Early symptoms can be quite diffuse, so it can be missed before the late stage when it causes ankylosis. The term to encompass it at all stages is Axial Spondyloarthropathy (AxSpA)

Your osteopath is in a great position to help you get a diagnosis. This can only be made by a rheumatologist but there are tools your osteopath can use to support a hypothesis and help get you referred.

Treatment for AxSpA should be gentle and little but often. You can turn around a painful day with five minutes of treatment, but overtreating can make it worse.

A diagnosis of AxSpA opens the door to strong medications that can slow the disease process.

How can osteopathy help with rheumatic pain?

We can’t cure inflammatory diseases but we may be able to help with symptom relief and getting a diagnosis.

Osteopathy can help provide symptomatic relief to the affected joints and help keep the rest of the body working well to accommodate this.

If you need help for your rheumatic pain, book an appointment today.

Shoulder or Elbow Pain

The shoulder is more than just a ball and socket joint. It is a very mobile joint supported by a number of ligaments and strong muscles. There are other smaller joints that make up the shoulder complex along with the ball and socket, and all have their own functions and susceptibilities.

The elbow is mainly a hinge joint, but there are additional joints to incorporate the two forearm muscles. The elbow is much less mobile than the shoulder, which may be why we see a lot fewer elbow injuries in clinic. But there are still things that can go wrong, and ways in which your osteopath can help.

Shoulder Pain

Sports injuries can cause a number of shoulder problems. These can be immediate or further down the line after insufficient rehabilitation. Read about sports injuries such as labrum tears here.

Frozen Shoulder anatomy and movement

This is a non-exhaustive collection of conditions your osteopath is qualified to help you with:

Shoulder Arthritis

Osteoarthritis can affect the ball and socket joint. As this joint is similar to the hip in its structure, arthritis affects it in a similar way.

As with anywhere else, there is always something that can be done to make an arthritic shoulder more comfortable. Working to release the muscles that are guarding the joint is one step in the direction of improving movement. If the movement can be improved, the cartilage can begin to heal, or at least slow the progress of the arthritis.

Your osteopath will also look at any adaptations your body has made to compensate for lost movement. This improves joint and muscle health globally- not just at the affected joint.

Biceps Tendinopathy

Tendinopathy is a term that encompasses tendinitis/tendonitis and tendinosis. It refers to inflammation of the tendon- in this case the tendon of biceps brachii.

Usually the long head of biceps is affected, but not the short head. The long head attaches onto the shoulder blade before running very closely to the ball and socket joint. It may be because of this close proximity that it is susceptible to irritation, especially by repeated overuse such as overhead throwing.

Other conditions also predispose the development of biceps tendinopathy. Otherwise asymptomatic changes, such as those to ligaments around the scapula, can make this injury more likely. Or more obvious things, like rotator cuff injuries, can put added strain onto the biceps. There is also a link with shoulder instability, such as after a dislocation. It is important to get injuries like this checked out, even if they seem minor.

Rotator Cuff Injury

Following on from biceps, another commonly treated shoulder injury is of the rotator cuff. This is a collection of muscles around the shoulder blade that work together to rotate the arm.

A fall or other trauma, including sports injuries, can strain the rotator cuff. Conservative management is the recommended first line of treatment. When the injury is mild enough, you can avoid surgery and the shoulder can be rehabilitated by your osteopath.

Preventing your shoulder injury is better than curing it!

You may notice that a lot of shoulder injuries are associated with overhead throwing. If you do a sport that requires this movement, or work in a role that leads to a lot of overhead work, preventative treatment may be a good strategy for you to avoid an injury. Book in here.

Elbow Pain

We see much fewer elbow problems than shoulder problems in clinic, but that’s not to say we can’t still help. One of the most common elbow complains is epicondylitis: tennis elbow and golfers elbow. This condition is easy to identify and there is plenty that can be done in the treatment room and at home to speed up its recovery. To read more about epicondylitis, see our full post on the topic.

Sprained Elbow

The elbow is a hinge joint, and it is supported by a lot of ligaments. Injuries that force the elbow to straighten too far, or bend slightly sideways, can cause a sprain. This usually affects the big ligament on the inside of the elbow.

Shoulder and elbow anatomy

One common mechanism of injury is a fall onto an outstretched hand which can cause the elbow to buckle back. This movement is limited by ligaments as well as bone. In high power injuries it is important to check that there is no fracture.

If your injury is confirmed to be a purely soft tissue injury (or if the fracture is healing well), your osteopath can step in. Ligaments have a poor blood supply, so need to be surrounded by healthy fluid to heal quickly. This means that some swelling is actually helpful- but it is important not to let that fluid stagnate. Your osteopath can help with flushing the old fluid back towards the heart. They can also give you exercises to encourage the same movement at home.

Ligament injuries can be slow to heal, but it is important not to over-protect the injury. Immobilising an elbow sprain unnecessarily can make you more likely to develop frozen shoulder. As the ligament heals, your osteopath will encourage you to start moving it as much as is appropriate. This helps the fibres knit back together in the correct direction, making a stronger ligament than a poorly rehabilitated one.

Elbow Bursitis

Bursae are fat pads found all over the body, sitting between bones and soft tissue as a cushion. Their role is to prevent friction. The one sitting on the tip of the elbow is the olecranon bursitis, and it can form an egg-sized lump when irritated by prolonged repeated pressure. One cause of this could be sitting at a desk with a bent elbow resting heavily on the table. This is why we also call it “student elbow”.

Beyond advising you to stop applying pressure to the elbow like this, your osteopath can help by looking further afield. There may be a relationship with the triceps muscle or other local structures that can be addressed. There may even be a tightness in the back that encourages leaning to that side. Your osteopath will look at the body as a whole to get to the root cause.

If you have a problem with your shoulder or elbow, make your appointment to get it sorted here.

Frozen Shoulder

The technical name for frozen shoulder is “adhesive capsulitis”, which gives a good idea of what’s happening in the joint. Surrounding the ball and socket joint of the shoulder, there is a capsule of soft tissue. It’s a flexible material that allows the shoulder to move properly and keeps the joint fluid inside.

But in frozen shoulder it becomes sticky (or “adhesive”). This causes restricted movement and pain, particularly in the movements illustrated below.

Frozen shoulder: affected movements and anatomy

Factors involved in developing Frozen Shoulder

Often it is unclear why this develops. Sometimes it may follow trauma, including surgery, but other times it has no identifiable trigger. We do know that some other conditions are associated with a higher risk of adhesive capsulitis, such as:

  • Diabetes
  • Parkinson’s disease
  • Heart disease

There’s also a link to immobilised shoulders. This is one reason you don’t want to wear a sling unnecessarily for mild shoulder or elbow injuries. It is unclear how this predisposes a shoulder to freeze, all we know is that it happens.

Finally, as one shoulder “thaws”, there is a relatively high incidence of the other one freezing. Again, the reason why is unclear.

Prognosis for Frozen Shoulder

Unfortunately, this is not a quickly resolving condition. The good news is that it appears to be self-limiting, and responsive to conservative treatment. It can be broken down into three stages, each with their own timeframe.

Freezing

The first stage is called the freezing stage. This covers from the first changes to the point of most restricted movement.

The freezing stage can last up to nine months. This early stage appears to be most responsive to acupuncture.

Frozen

This period is the most restricted in terms of movement, but not necessarily the most painful. Pain from the freezing stage begins to resolve, or at least doesn’t get any worse.

The frozen stage has a very variable timeframe, lasting somewhere between 4 and 20 months. This period may be reduced by manual therapy.

Thawing

The tail end of the resolving stage can be long and drawn out. But as both pain and movement are improving, it might not feel so long.

Similar to the frozen stage, thawing can last from 5 to 26 months.

Management

Encouraging movement from the joint and surrounding muscles in the treatment room can benefit the shoulder. Limiting maximum lost movement and speeding up the three stages is the aim in treatment.

Medication is the second line of treatment. Anti inflammatories, including both NSAIDs and steroids can be prescribed for frozen shoulder. Sometimes a steroid injection will also be offered, although there are long term side effects of steroid injections, and no real long term benefits for this condition. Surgery is another option, but it is not routinely offered.

In summary, adhesive capsulitis is a frustrating condition to have, but there are ways your osteopath can help at all stages. As early stages seem most responsive to acupuncture, it’s worth getting checked out as soon as you can.

If you suspect you have frozen shoulder, get on top of it sooner rather than later. Book in today.

Circulation

Poor circulation can cause pins and needles, numbness, and pain in the affected tissues. Localised issues with circulation can be due to mild problems with muscles causing compression. If the causes are more serious, your osteopath can refer you on to somewhere more appropriate.

More widespread symptoms can be a sign of something more systemic going on.

Problems with circulation due to injury or lymphoedema

Post injury swelling

After a sprain or similar injury, we tend to try and minimise inflammation and swelling, but it is there for a reason. In the early stages, inflammation brings in nutrients to help heal the area. However, this swelling is not helpful when it’s static for long periods. As nutrients enter the injured tissue, waste products leave- but if they stay nearby and aren’t flushed out, they prevent the flow of new nutrients in.

Some areas of the body are easier to encourage circulation than others. The calf works as a pump when we walk to push blood back up towards the heart, so walking or calf exercises can be useful to clear swelling in the ankle and knee. Other areas respond best to hands on techniques.

Heat and ice can be advised by your osteopath where appropriate. Cold compresses encourage blood vessels to constrict, whereas warmth encourages them to dilate. Repeating one after the other simulates a pumping mechanism.

Poor circulation due to Lymphoedema

When blood enters a cell, it leaves in two parts. Some makes its way back to the veins, and some ends up as lymph. Lymph is fluid that bathes cells, allowing for nutrient and waste exchange. It flows through the lymphatic system, through lymph nodes (what we know colloquially as “glands”) before re-entering the venous system at the top of the chest.

Lymphoedema literally means “lymph swelling”. A common cause of this is after cancer, when lymph nodes have been removed through surgery or damaged by radiotherapy. For patients who have had lymph nodes around the armpit removed due to breast cancer, lymphoedema can affect the arm.

Managing lymphoedema is an important task. If the cause is surgical, you should be managed with Decongestive Lymphatic Therapy in the early stages. Once this is under control, you can be left to manage the symptoms yourself. Self massage is a big part of this, and your osteopath can help.

Vascular Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome can affect vascular circulation

The thoracic outlet is the space around the front of the shoulder where nerves and blood vessels pass between the ribcage and arm. A number of muscles and other structures in this area can compress the nerves or blood vessels and cause pain, numbness, or pins and needles into the arm.

The most common form of TOS is neurological, but in 3-10% of cases it can be blood vessels that are compromised. Although most vascular TOS cases require referral back to the GP, your osteopath will be able to differentiate between the two types and support you in getting the right care.

You should seek urgent care from your GP or hospital if your arm symptoms include:

  • white or blue skin
  • swelling
  • cold skin

For more mild cases of vascular TOS, and for neurological TOS, your osteopath can work to reduce the compression around the area. This may mean working to strengthen the upper back muscles, relaxing off the chest muscles, or identifying other causes of your symptoms.

If you have problems with your circulation, book an appointment to see how we can help.

Tennis Elbow

Tennis elbow is the common name for lateral epicondylitis. Although it can start as a simple muscle injury, the word “epicondylitis” tells us it’s become a bit more complicated. This means there’s inflammation where the end of the muscle meets the bone at the elbow.

Typical symptoms include pain and tenderness in the forearm and side of the elbow, especially during activity. This pain can also lead to a feeling of reduced strength. The inflammation can cause some swelling around the side of the elbow which is tender to touch. The body may also start compensating subconsciously. This might mean causing strains elsewhere in the arm or wrist as you move differently to avoid discomfort.

Tennis Elbow and Golfers Elbow

As the name suggests, tennis elbow can be a form of sports injury, but it doesn’t come on suddenly. Repetitive aggravation of the wrist extensor muscles irritates the junction between bone and muscle and causes localised pain and tenderness.

However, you don’t have to play tennis to develop this injury. Other sports can cause it in the same way, or even more innocuous things like carrying heavy shopping bags can bring it on. If left unmanaged it can develop beyond the usual muscle strain.

How your osteopath can help

Diagnosing tennis elbow is easily done, and although it can be a slow condition to rehabilitate, your osteopath can work with you to resolve it.

Relaxing off the muscles will reduce the pull on the bone and begin to let the whole area calm down. Your osteopath might also want to work more generally around the elbow, wrist, and shoulder to keep everything working well together. Advice for reducing or managing inflammation may also be appropriate.

Understanding the cause of the episode is important, especially if this is something that keeps coming back.

Tennis elbow vs golfer’s elbow

You may have heard of golfer’s elbow, another form of epicondylitis. Golfers elbow affects the medial epicondyle in the same way as tennis elbow affects the lateral epicondyle. Tight muscles or injury lead to inflammation around the muscular-bony junction. As before, you don’t have to play golf to develop it.

Repetitive overuse of the wrist flexor muscles predispose a person to developing golfer’s elbow. Playing a sport with a thin handle that requires you to grasp tighter can sometimes be enough to irritate the area, and prevention might be as simple as wrapping it with a thicker grip. Your osteopath can advise you on this.

The sooner you can address your tennis elbow, the better the prognosis. Book an appointment today.

Sports Injuries

Minor sports injuries are frustrating, especially when they limit your return to exercise. Osteopaths can help you from the early stages of injury to rehabilitation to help you come back more resilient.

Ligament sprains

Sprains are a very common injury from all kinds of sports. A sprain is an injury to a ligament, whereas a strain is a muscle injury. The former is graded from 1 to 3, with 1 being very minor and 3 being a total rupture of a ligament.

All grades can be accompanied by swelling, tenderness, heat, and redness. Second and third grade sprains show excess movement on examination, ranging from laxity to instability.

Ankle sprains are some of the most common sprains. The three main types types are inversion, eversion, and high ankle sprains. These are all caused by different movements as illustrated below:

The first aid advice for sprains and strains has changed: no longer do you “RICE” a soft tissue injury, you now give it “PEACE and LOVE“! Although the “PEACE” part of the plan is similar to the rest, ice, compress, and elevate of “RICE”, there’s now focus on rehabilitation too.

“LOVE” stands for: Load, Optimism, Vascularisation, Exercise. After an injury like this, it can be hard to work out the best way to return to normal on your own. These new guidelines show the importance of getting the rehab right, and this is somewhere your osteopath can help. Combining work done in the treatment room with exercises to safely re-strengthen the whole area helps with all four elements of “LOVE”.

Sports injuries to cartilage

Cartilage in the shoulder and knee can be susceptible to injury in throwing and twisting sports.

Shoulder cartilage: the labrum

The shoulder is a very mobile ball and socket joint because the socket is so shallow. There is a larger part of cartilage that sits within the socket and extends around the ball of the shoulder slightly called the labrum. In sports that involve a lot of high power, large range shoulder movement, the labrum can be injured. Read more about labrum injuries on our dedicated post here.

Knee cartilage: the menisci

By a similar mechanism, the menisci of the knee can be injured by twisting through the knee while weight-bearing. This is one sports injury you’ve probably seen in footballers. Each knee has two menisci that both sit on the top of the shin bone: the medial meniscus and the lateral meniscus. These are both roughly C-shaped pieces of cartilage which cushion the joint and distribute weight across the surface of the knee bones.

With both the labrum and the meniscus, injuries can cause immediate pain and delayed swelling. Cartilage has a poor blood supply, so the swelling is initially the body’s way of getting nutrients to the area; but we want to keep this fluid moving to remove the waste products from the joint and bring in more nutrition. Osteopathy can help here.

By keeping the area around the injury at its best condition, your osteopath can help keep that fluid moving. This gives the injury the best environment possible to heal itself. As the injury improves, you may be given more exercises and advice to restrengthen the area and get you back to normal.

Your osteopath will also be monitoring your injury to check the progress is in line with where it should be, and can refer you on for imaging or further intervention as necessary.

Overuse sports injuries

Sports injuries: tennis and golfers elbow

Repetitive movements such as those needed for racket sports can sometimes cause inflammation around the muscles in question. One obvious example is epicondylitis:

  • Lateral epicondylitis is tennis elbow and affects the extensor muscles.
  • Medial epicondylitis is golfer’s elbow: the wrist flexor muscles are involved

In both cases, the end of the muscles around the elbow become inflamed.

Your osteopath can easily diagnose epicondylitis and work to ease off the irritated muscles and reduce surrounding inflammation. As with most things, the sooner your injury is addressed, the quicker it can be resolved.

Alongside exercise advice, your osteopath may suggest changes to make with regards to your sporting equipment. For example, a thicker grip on a handle is easier on the forearm muscles than a thinner one.

Avin has a background in sports as an ex-professional rugby player. Book an appointment for your sports injury today.