Avin Patel

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

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

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.

Click here to make an appointment in Leicestershire or Rutland

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.

The Thorax

Everything between the base of the neck and the top of the lumbar spine is within the thorax. This includes the upper back, ribs, and lungs.

The thorax

The Upper Back (Thoracic Spine)

A lot of people have quite a “rounded” posture. When sitting they are somewhat slumped, and their shoulders come forwards. Alongside this, the thoracic spine is often rounded (or kyphotic) too. These are side effects of the demands of modern life. We have a lot of reasons to sit still and work on things directly in front of us, and not enough time to move. Over time, this can encourage the rounded posture, which becomes compounded by the local muscles. The pectoral muscles are a good example. These muscles bring the shoulders forward when they contract. Likewise, they become shortened when this position is the default. This makes it harder to get back to an upright posture.

Despite all of this, we often don’t notice these changes in ourselves immediately. They do take time to develop, but they frequently do not come with local symptoms. Instead, other areas compensate for the lost movement. This too can be asymptomatic until something goes wrong- often in the neck or lower back.

The Ribs and Breathing Mechanics

There are twelve pairs of ribs in the thorax, and they all work slightly differently. The upper ribs move in a “pump handle” fashion, lifting forwards and up. The lower ribs flare out like a bucket handle. The way the ribs attach to the spine is quite uniform, but their attachment at the front is variable. Ribs 1 to 7 attach directly onto the sternum, and 8-10 attach indirectly via cartilage. The last two (11 and 12) are short, and they do not attach to the front at all, which is why they are called “floating ribs”. Costochondritis is a musculoskeletal cause of chest pain. Here, the rib joints at the front of the chest become inflamed and painful.

Tension in the thorax

Some people have an extra rib or two at the lowest bone in the neck. These are called cervical ribs, and can be associated with problems like thoracic outlet syndrome. Most people will never know they have them, as they typically require imaging to find them. We expect that the majority of people with cervical ribs will not develop any symptoms either, but if you have a family history of problems like TOS, there could be a connection.

When breathing efficiently, the shoulders should stay still and the tummy should move smoothly along with the chest. Inefficient breathing almost always involves the diaphragm. You can read more about that in our post about tension. Similarly, if you find that your shoulders click or clunk, there may be a problem of the shoulder blades running awkwardly over the ribs. This is often a postural problem or a muscular imbalance, and we can help.

The Thorax and Osteopathy

So despite often being asymptomatic, the thorax is an area frequently involved with problems. If you have neck pain or headaches, shoulder or lower back pain, you might benefit from an assessment. If you struggle to manage your stress, or find yourself grinding your teeth, there may be changes to make to your breathing, and your osteopath can help.

We will assess your body as a whole, observing how the different areas influence each other in your case. This allows us to get to the bottom of the problem, and gives us a better chance of helping you become pain free in the long term.

Book online here for appointments in Leicestershire

Red Flags for Lower Back Pain

Red flags are indicators that something needs urgent intervention. We keep an eye out for them in every treatment, but they are also good for you to be aware of as the patient.

Red flags for lower back pain

Lower Back Pain and Osteopathy

Your Lower Back Pain is considered within our remit if it fits the criteria for Non-Specific Lower Back Pain (NSLBP). This rules out infections, tumours, and fractures among other serious causes of lower back pain.

Note that although sciatica does not count as NSLBP, it is still within our remit. We can also help manage the symptoms of rheumatic conditions such as Ankylosing Spondylitis.

Conditions and Their Red Flags

These flags indicate serious pathology and require immediate intervention. At their worst, if they are present in a patient who is attending treatment, they may require an ambulance to hospital.

Cauda Equina Syndrome

Some of the most serious red flags that we see among LBP patients are those that indicate Cauda Equina Syndrome. This condition is caused by the compression of nerves at the bottom of the spinal cord. Compression here can quickly cause irreversible damage, which can cause permanent incontinence and paralysis. Any one of these flags is enough for you to consider urgent medical attention- call 111 if you are unsure.

  • Urinary and or faecal incontinence
  • Urinary retention
  • Saddle-area numbness
  • Severe weakness in both legs

Vertebral Infection

It is possible to develop an infection in the spine or nearby. Osteomyelitis is a bacterial infection of bone, which can occur in the vertebrae. General symptoms of an infection in this area include:

  • fever
  • local redness
  • heat

We take a thorough case history at your first appointment, which is key to spotting flags like these. Red flags for infection are not just about the symptoms, but also underlying conditions and recent medical interventions. Bacteria reaches the spine via the blood, so infections elsewhere are relevant. You are more likely to develop an infection in the spine if you have:

  • Diabetes
  • A history of tuberculosis
  • A recent history of a urinary tract infection (UTI)
  • A tooth infection
  • A history of IV drug use
  • An HIV+ status, or if you are otherwise immunocompromised (including taking medication that supresses your immune system)

Spinal Tumour

Cancer is a very rare cause of lower back pain, and although some flags are relatively common (upper back pain, local tenderness, or pain aggravated by straining) other flags can be quite clear.

  • Slow development of symptoms
  • Pain that is severe and unremitting
  • Night pain (especially that which disturbs sleep)
  • Unexplained weight loss
  • Pain that persists after 4-6 weeks of manual therapy such as osteopathy
  • A history of cancer
  • Being over 50 years old

Spinal Fracture

Spinal fractures can be surprisingly subtle, and should be considered after any trauma. For those with low bone density, such as people with osteoporosis or osteopenia, even minor trauma can lead to a fracture. This may present as seemingly typical lower back pain, and may not be discovered until it shows on a routine MRI or X-Ray years later. However, if you bring a fracture to clinic, we want to identify it before starting treatment and making it worse. We will look for:

  • Traumatic onset of pain, or recent history of trauma
  • Severe spinal pain that started suddenly
  • Severe tenderness over one point of the spine
  • Relief from the pain when lying down
  • Possible “step” between vertebrae

In The Absence of Red Flags

If you are concerned about any of these symptoms for yourself, please call 111, your GP, or go to hospital. If you are confident that your back pain is mechanical, you are welcome to contact us via the link below to make your appointment.

For non-specific lower back pain, you can book an appointment online.

Costochondritis

Costochondritis is inflammation of the cartilage in the chest where the ribs meet the sternum (breastbone).

Costochondritis

With chest pain, we need to rule out problems with the heart or lungs. Other conditions can also cause chest or rib pain, such as fibromyalgiaanxiety, and shingles.

Symptoms and Causes of Costochondritis

Symptoms themselves can be hard to pin down, as they often come on gradually for no apparent reason, but they can also come and go without explanation. You may find it helpful to keep a pain diary for a few days to see if you can spot any patterns. Coughing, sneezing, and taking deep breaths are likely to aggravate symptoms.

Pain itself is focused around the front of the chest, and could be anything from a dull ache to a sharp pain. Sometimes it is also described as more of a pressure. In some cases, the pain is only felt when the area is touched. More than one rib is often involved, but rib 5 is the most likely to be symptomatic. This is quite high up within the chest, roughly level with the armpit.

The cause of costochondritis can be hard to pin down. Some cases develop after new or repetitive movements like painting a room or moving furniture. There may also be a link with low vitamin D levels.

Slipping Rib Syndrome

A closely related condition is slipping rib syndrome (SRS). The rib doesn’t actually slip, but the connection between the lower ribs becomes lax and irritated. In contrast to costochondritis, SRS affects the lower ribs.

When the tissues become lax, the tip of the rib can move more than it usually would. If it catches a nerve that runs between ribs, it can cause significant pain and may be mistaken for shingles. Alternatively, the hypermobility might cause a strain to the intercostal muscles that run between the ribs. It is also possible for SRS to cause general inflammation in the front of the ribs, which is how it may be mistaken for costochondritis.

Some research suggests that when costochondritis develops alongside Slipping Rib Syndrome, osteopathic manipulation can be beneficial. As hypermobility in one end of the rib will have an effect on the other end (where the rib meets the spine), osteopathic treatment may help the symptoms of SRS.

Mobilisation of the joints at the back of the ribs may also help with the symptoms of costochondritis.

Tietze Syndrome

The same cartilage is affected in Tietze Syndrome as costochondritis. Here there is local swelling over the joint, whereas swelling is more generalised in costochondritis. Tietze Syndrome is poorly understood and considered a rare disease with no clear cause. Occasionally Tietze Syndrome develops after a chest infection. This seems to be due to coughing rather than the infection itself. Your osteopath will work to rule this in or out.

If you have chest pain similar to that described above, you can make an appointment here.

Kyphosis and Lordosis

Unlike having a scoliosis, it is not a problem, nor a diagnosis to “have a lordosis”. Everyone more than a few days old will have them, and you will have had your kyphosis since before birth.

Kyphosis and Lordosis

Kyphosis

A Kyphosis is an area of the spine that sticks out. The main one is the upper back, or thoracic spine. There is a secondary one in the sacrum and coccyx (tailbone).

Some conditions lead to a more prominent kyphosis, such as osteoporosis and Scheuermann’s disease (formally known simply as “kyphosis”). In these cases, the shape of the bones in the upper back is changed. Osteoporotic vertebral crush fractures typically cause the vertebrae to become wedge shaped. Scheuermann’s leads to wedge shaped vertebrae too, although this is due to the speed at which the front and back of the vertebral body is growing. If increased thoracic kyphosis is accompanied by discomfort or reduced movement, your osteopath may be able to help.

Lordosis

A lordosis is where the spine dips in. There is a lordosis in the neck, and another in the lower back. These are known as the cervical lordosis and lumbar lordosis respectively.

One period in which the lumbar lordosis may become exaggerated is in pregnancy. As the bump grows, the body may arch the back in reaction. This can cause intermittent pain by compressing the structures at the back of the spine. Although this will only be a temporary problem, we may be able to help in the meantime.

Kyphosis, Lordosis, Posture, and Pain

You may have seen images online labelling different postures alongside the “good” posture. In reality, we are all built as differently on the inside as we are on the outside. Therefore, one person’s “perfect posture” would be different to another’s.

The real problem is being too still for too long. If you stood still in the most perfect position for a couple of hours, you would have some sort of discomfort. We are designed to move, and moving through “bad” postures will always be necessary sometimes.

As a general rule, if the way you stand and move does not cause any problems, it does not need changing.

Osteoarthritis and Spinal Curves

The thoracic kyphosis and cervical lordosis become more apparent in people with advanced hip osteoarthritis. The body compensates for the lost movement in the hip by bending forwards, then brings the head back up with more extension in the neck.

The ideal solution is to catch it before reaching this stage, but there may be something that can be done further down the line. If your hip arthritis has led to a joint replacement and you are left with this posture, we can help to train your body back to where it should be.

If you’re worried about your posture, or just want a check up, you can make an appointment online now.

Pregnancy and Osteopathy

Pregnancy may be the time in which the body goes through the most changes in the shortest period. Like any other significant physical change, this can lead to discomfort. Although we expect some discomfort in pregnancy and post-partum, not all of it is unavoidable.

Lower back effects of pregnancy

Back and Pelvic Girdle Pain

One of the biggest causes of pain in pregnancy is the lower back and pelvis. From very early on in the first trimester, the body produces a hormone to relax ligaments. Its aim is to loosen the pelvis in preparation for birth, but its affects are more wide reaching.

Pelvic girdle pain (PGP) is pain that can affect both the front of the pelvis and the two sacroiliac joints at the back. It can be worse going from sitting to standing, or turning in bed at night. Some people find it feels better with exercise, but that it will feel a lot worse the next day. PGP is a result of the changes your body is going through, so it might be quite unpredictable in nature. Your osteopath can work with you to identify the factors that make your PGP better or worse. We can also give you exercises to complement the work we do in clinic.

If you have PGP in the run up to birth, you may need to alter your birth plan to accommodate it. It is advised to avoid wide-leg positions in this case. For maximum freedom in the delivery room, seek treatment sooner rather than later.

Sciatica and Piriformis Syndrome

Postural changes in response to a changing centre of gravity can mean more demand on the muscles of the back, buttocks, and hamstrings. These muscles just so happen to be in the same area as the sciatic nerve.

Piriformis syndrome in pregnancy

Sometimes a mix of strengthening and stretching is enough to ease off symptoms. In Piriformis Syndrome, the sciatic nerve is irritated by a tight muscle deep in the buttock. If pregnancy posture is to blame, we can work to alter the way you stand, or advise lifestyle changes to minimise chance for irritation.

Typically, the longer a nerve spends in an irritated state, the longer it takes to calm back down. Don’t wait for your symptoms to get unbearable before you seek help.

Carpal Tunnel Syndrome in Pregnancy

The same hormone that relaxes ligaments also has an effect on the circulatory system and kidneys. Water retention and cramps may be related to this, as more fluid is present in body tissues. This generalised low-level swelling is responsible for an increase in risk for carpal tunnel syndrome during pregnancy.

Carpal tunnel syndrome in pregnancy

The carpal tunnel is the space beneath a ligamentous tissue in the wrist. Nerves pass through this narrow tunnel, and can be compressed when there’s excess pressure in the area. This can be due to aforementioned water retention, or repetitive strain to the muscles that pass through.

Your hormonal causes of this water retention will resolve after birth, but your osteopath can help in the meantime. Treatment and exercises to clear the fluid from the wrist can give some relief. We can also look elsewhere in the arm to see if anything else is contributing to the pressure. If appropriate, we can also advise on the use of a wrist support or cool compress.

Osteopathic Treatment in Pregnancy

Osteopathy is a gentle, conservative therapy. Some patients prefer to avoid any kind of manual therapy during the first trimester, which would still give plenty of time to address any aches and pains before they progress.

If you’re suffering from muscular or joint pain during pregnancy, book now to get on top of them before birth.

Ankylosing Spondylitis and AxSpA

Ankylosing Spondylitis is a rheumatological condition related to rheumatoid arthritis and inflammatory bowel disease. Like these conditions, it is autoimmune: meaning the body is attacking its own cells.

Ankylosing Spondylitis

Symptoms and Disease Process

Initially, AS may seem like basic lower back pain. You may be inclined to ignore it and wait for it to go away. Symptoms may come and go in the early stages, but they will slowly progress. This is because after periods of inflammation, the body heals incorrectly, growing new bone over the joints in the lower back and pelvis. This is what the “ankylosing” refers to: it means fused or anchored. Along with the lower back pain and stiffness, symptoms can be quite wide reaching:

  • Uveitis: inflammation within the eye causing redness
  • Ethesitis: inflammation at the point where tendon meets bone, for example at the base of the achilles tendon
  • Inflammatory pattern of pain: morning stiffness, improvement with NSAIDs such as ibuprofen
  • Arthritis of any kind in hands, feet, or limbs

We might suspect AS or another rheumatoid condition if you have inflammatory back pain and:

  • Psoriasis
  • IBD (Crohn’s Disease or Ulcerative Colitis)

Misconceptions about AxSpA and Ankylosing Spondylitis

Recently a lot of information about AS has arisen. Previously we thought that AS affected men more than women, but we know now that it just affects them differently. It seems to affect both sexes equally. We also thought that the “question mark posture” with the flattened lower back was a good diagnostic point. Now we know that it is a sign of extensive fusion. These important points make spotting AS earlier possible.

We also have new ideas for treating patients with AS. Whereas with other patients we may see stiffness or over-compensation in the upper back and manipulate it, this is inappropriate in AS patients. The upper back is not unaffected by the process of AS, and these bones are more prone to injury from strong techniques than in the general population.

Medical Referral and Treatment

Early stage AS is technically called AxSpA (Axial Spondyloarthritis). This is when we want a diagnosis because intervention here is most effective. Diagnosis needs to be made by a rheumatologist, although we can refer back to the GP if we suspect AxSpA/AS. Investigation may include blood tests and MRI. For best results in managing the condition, medication may be appropriate. Some stronger medications also have to be prescribed by the rheumatologist, so early referral to the specialist is ideal.

Osteopaths cannot cure AS, but we may be able to help you manage symptoms. Inflammatory conditions like this are aggravated by rest or excessive activity, so treatment and advice are about striking a balance. On a bad day with AxSpA, you may find relief in a few minutes of gentle treatment. With later stage AS, you may benefit from work to the muscles around affected joints, and mobilisation of joints that are compensating for the fusions.

Book now if you suspect your back pain might be Ankylosing Spondylitis/AxSpA