Avin Patel

The Stomatognathic System

This complicated name simply refers to the mouth (stoma-) and the jaws (-gnath). Osteopaths look at the stomatognathic system with particular interest in its relationship with the rest of the body. It might come as a surprise that the two have much bearing on one another, but it can be a relevant consideration when getting to the bottom of your problem. It can be especially significant with neck and shoulder pain, or some headaches.

The Stomatognathic System

How Posture Affects The Jaw

The image above shows the demands placed on the jaw muscles by slouching.

  1. The front of the neck is stretched to keep the head up
  2. This would pull the mouth open, but…
  3. A reflex tightens the muscles around the jaw to keep the mouth closed

These muscles that tighten up are the same that might be tight if you clench or grind your teeth. While the muscles on the front of the neck are stretched, those on the back are working hard. The muscles right at the top of the neck, at the base of the skull, contract to raise the head. They are only small, so can be overworked quickly. It is often these that are involved with cervicogenic headaches. Treating these muscles might provide symptomatic relief, but will not solve the problem if the slouching remains.

Causes of Slouching

Often, when we examine someone who struggles to sit up straight, we find two things. Firstly, the muscles on the front of the shoulders and chest are tight and shortened. Secondly, the muscles of the upper back that work against those tight ones are weakened. In the simplest terms, the plan here is to relax and stretch the muscles of the front, and then strengthen the upper back muscles. When we look at an individual, we might find that there are additional areas to work on in terms of mobility. If you’ve been stuck in a hunched over position, the base of the neck will have had to overwork to compensate for lost movement. There might also be stiffness in the joints around the shoulder, such as those at either end of the collar bone.

We look at these findings as part of the larger picture, aiming to identify and manage each one to allow the whole body to move more efficiently. In managing these symptoms, you may find that other minor problems resolve themselves too, such as tension that was affecting your breathing.

Osteopathy and the Stomatognathic Complex

Your osteopath will evaluate the problem as a piece of the whole body puzzle. A detailed case history at the start of your first appointment will help us to get a better understanding of the factors at play. Sometimes correcting a slouched posture is as simple as improving the balance of muscles as mentioned above. If the problems originate from the stomatognathic system, and especially the alignment of teeth, we may want to work alongside your dentist to solve the problem in its entirety.

Make an appointment in Leicestershire or Rutland here

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

Tongue Tie

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

Tongue Tie

What is Tongue Tie?

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

What is a Lip Tie?

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

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

Signs and Symptoms 

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

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

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

Longer Term Effects

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

Management 

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

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

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

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

Plagiocephaly

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

Plagiocephaly and brachycephaly

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

Causes of Plagiocephaly

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

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

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

Red Flags

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

Management of Plagiocephaly

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

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

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

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

Make an appointment in Rutland or Leicestershire here.

Infant Torticollis

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

Infant torticollis

Signs of Torticollis in Infants

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

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

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

Causes of Torticollis

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

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

Secondary Effects

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

Managing Torticollis

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

Make an appointment in Leicestershire or Rutland here.

Cranial Osteopathy and Celebrity Parents

Cranial osteopathy for babies is no stranger to celebrities. Kate Lawler of Virgin Radio is one of the latest to seek treatment for her newborn.

What is cranial osteopathy?

Cranial osteopathy involves gentle treatment of the head and neck. Adults can be treated cranially too, but as babies’ skull bones are not solidly fused, they may be more receptive to treatment. Techniques are gentle, and focus on minute movements of the skull and neck joints.

Your osteopath may also want to work more locally on problem areas. Like with adults, sometimes a baby might have a tight muscle that’s causing discomfort. Direct, gentle stretching might be the quickest way to make progress.

Cranial osteopathy for babies

Why do people do it?

Birth is inherently traumatic to babies, and can leave them with areas of tension. Even babies who had relatively easy births can have problems like torticollis, where the neck is tight on one side. This might be subtle, but can still make feeding difficult, or lead to a flat spot on the head due to continued pressure on one side. Young babies can only communicate by crying, so sometimes an unsettled baby might actually be a baby with tension. Subtle aches and pains might interfere with sleep without leaving many other clues.

Other celebrity parents to recently seek cranial treatment for their babies include Pippa Middleton and Cara De La Hoyde. Their babies’ colic and general fussiness were the reasons for pursuing treatment.

What should I expect from cranial treatment?

During the first session, your osteopath will take a full case history, asking you about baby’s current health and anything relevant from pregnancy or birth. They may then ask you to undress baby so they can examine them. This might involve moving joints and feeling how baby moves on their own. Other times the osteopath may be more focused on the head and neck alone. Treatment itself is not much of a spectator support. Subtle movements in the head and neck are performed while baby is in a relatively comfortable position. Periodically, your osteopath may reassess the problem areas to monitor how treatment is going.

Your osteopath may also treat other areas of the body directly. Sometimes babies hold tension in the diaphragm, which can be associated with digestive issues like reflux. It can also limit how deeply they can breathe, and encourage further tightness in the neck and shoulders. Treating the diaphragm directly is sometimes the quicker way to get results, or treating in conjunction with work on the neck can help. The nerves that supply the diaphragm leave the spinal cord in the neck, so the two areas together can be useful.

What qualifications should my osteopath have?

All osteopaths must be registered with the GOsC. This means that they have completed a recognised qualification, which might be a DO, BSc, or M.Ost.

Cranial osteopathy can be learnt in a post-graduate course. Some courses are specifically focused on treating babies and children, whereas others are more general. Depending on the course, your osteopath may have additional letters after their name, or they might just have their osteopathy qualification.

You can book your baby in for cranial osteopathy here.

Clicky Jaw: The TMJ

When you find yourself with a clicky jaw, it can be hard to know how to address it. Is it a job for your dentist? Will the GP be interested? Or could you start with your osteopath?

The role of posture in a clicky jaw

Often patients mention their clicky jaw during treatment for something else. Sometimes this is because they didn’t think it warranted its own appointment, other times it’s just that they didn’t know where to start.

What Causes a Clicky Jaw?

The jaw joint is basically a hinge joint with a disc of cartilage in the middle. Some muscles in the cheek attach to this disc, and if they get tight, they can pull the disc in a way that allows it to fold.

Clicky jaw anatomy

This folding is not permanent, and will likely only happen at a certain point in the movement. This might mean restriction in opening your mouth all the way, or a click when it’s open very wide.

When a clicky jaw is caused by this muscle pull, it can be really easy to manage. Sometimes just a few minutes of work will temporarily resolve it completely, although typically it will return if just treated once.

Management

As mentioned above, jaw symptoms might resolve quickly but temporarily after the first treatment. For this reason, your osteopath will devise a plan for a longer term benefit. This might include daily exercises to keep the muscles relaxed. There may be secondary effects into the neck and shoulders, or as far away as the diaphragm, so breathing exercises might be helpful too.

If the muscles are getting tight because of teeth grinding, we might need help from a third party. Your dentist may be able to provide you with a “splint” to limit night-time teeth grinding. If you grind your teeth because of anxiety, you might like a referral to a counsellor. We will not refer you onto anyone without your consent.

As always, osteopathy is holistic, and the jaw is no exception. The first diagram shows how holding your head forwards can cause tightening in the muscles that pull on the disc. In order to get to the root of the problem, your osteopath needs to help you fix this. Treatment around the neck and shoulders could be enough, or there might be room for improvement into your lower back too.

If you’re irritated by a clicky jaw, make an appointment today.

Preventing Migraines

Migraines are not just headaches: they can come with a number of additional symptoms.

Symptoms of migraines

Symptoms of Migraine

Not every migraine will include every symptom, and not every symptom will be present at the same time. Most symptoms last under an hour but the headache can last longer.

  • A throbbing headache on one side of the head or focused over an eye
  • Nausea or vomiting
  • Altered sensation in the arm or jaw area
  • Visual aura preceding the headache

Migraines are still not fully understood. The two main theories accepted today are that they are caused by nerves or blood vessels. However, there seem to be a number of associated factors that vary from person to person.

Factors that may lead to Migraines

Keeping a food diary can be a great way of spotting triggers. A huge array of ingredients have been associated with migraines, so pinning down any that specifically affect you is important. Another common factor is sleep: both too much and not enough.

Stress is often cited as a factor in migraines, with some people finding their symptoms come on as soon as they are put in a stressful situation. The link between stress and migraines could lie in tension. If your body responds to stress by tensing your shoulders and neck, this might have a direct effect on the nerves and vessels considered responsible for migraine. Osteopaths are qualified to help with the management of tension in muscles.

Management

You may find that if you feel the first symptoms of a migraine coming on, you can halt its progression yourself. Often this means lying in a dark room or taking some medication, but this doesn’t work for everyone.

Some patients find that manual therapy is more effective in reducing their migraines than medication. Alongside the aforementioned management of tense muscles, osteopaths can work on joints to improve the function of the musculoskeletal system as a whole. This may help to reduce frequency or intensity of migraines.

If you suffer from migraines, book an appointment so we can find what works for you.

Neuralgia

Neuralgia literally just means “nerve pain”, but it is used to mean something more specific.

Examples of neuralgia

The basics

Technically any pain, like a mild trapped nerve, could be called neuralgia. But the term is actually used to describe significant sensitivity, not just irritation.

It is often associated with other conditions, such as diabetes or multiple sclerosis. It can also be post-viral, as with postherpetic neuralgia. In all of these cases, a nerve is irritated or damaged, which leads to its sensitisation.

Symptoms

Sensitisation makes painful sensations more painful, and some non-painful sensations surprisingly uncomfortable. This could mean that the feeling of bedsheets on skin is unbearable, for example.

Pain in neuralgia can be described as burning, electric, sharp, or stabbing. In contrast, it can also feel like more of an ache. Typically this pain will follow quite a defined line, which is a clear sign to your osteopath that the pain is following a specific nerve.

Trigeminal Neuralgia

One of the nerves that supplies the face is the trigeminal nerve. It branches into three smaller nerves:

  • Occipital (upper) branch: supplying the top of the face
  • Maxillary (middle) branch: supplying the middle of the face
  • Mandibular (lower) branch: supplying the bottom jaw

Usually it is the middle or lower branch that is affected, and very rarely does it affect both sides. Pain can come out of nowhere, or follow exposure to cold air, touch, or eating. Pain is severe but usually quick to pass. However it might come and go throughout the day.

In addition to the possible causes mentioned above, trigeminal neuralgia can be caused by pressure from a blood vessel. Your GP may want to send you for a scan or further to make sure nothing serious is causing the irritation.

Evidence suggests that osteopathy can be beneficial for pain relief in trigeminal neuralgia. Although it is unlikely that we would be able to affect the root cause of the pain, we may be able to help to calm the nerve down. Your GP may offer painkillers and suggest you keep a pain diary to better understand your triggers.

Postherpetic Neuralgia

Shingles is caused by the same virus as chicken pox: herpes zoster. It can become symptomatic years after recovering from chicken pox because it stays dormant in the nervous system. The rash from shingles tends to follow the course of a nerve, so it’s not too surprising that there might be neurological symptoms.

After the rash fades, you may find symptoms of neuralgia in its place. These can include the sharp pains and increased sensitivity mentioned above. Symptoms typically self resolve within a year, but the process may be sped up with treatment. Osteopaths work with nerve pain frequently, and can use techniques to try and desensitise the nerve.

Shingles is highly contagious, and you should not see your osteopath before the rash has cleared. You can get in contact to discuss your symptoms if you’re not sure whether you’re safe to come in yet.

If you suffer from neuralgia, make an appointment and see what we can do for you.

Neck Pain

As with lower back pain, there are a number of causes for neck pain that your osteopath can help with.

Neck pain: muscles, joints, discs, and ligaments commonly involved

Muscle pain

One major cause of neck pain is tight or strained muscles. Any prolonged position will be uncomfortable for muscles in the short term. If this position becomes a usual position over days and weeks, the muscles will adapt for efficiency. This means shortening, or tightening the muscles that are rarely stretched.

There is an increased demand on muscles when the head is not held in a neutral position. Looking down at a phone or low computer screen puts as much of a requirement through the neck as if your head was twice as heavy- or more.

Muscles will also react to other causes of pain as the body tries to protect itself. Most people with neck pain will also have some tightness in the neck, regardless of the original cause. This can lead to headaches.

Joint pain

Off to the side of each vertebra is a joint that connects it to the one above, and another that connects it below. These joints are small but they can be quite painful if irritated. Sometimes they might lock up in response to a problem with another structure in the neck, which can cause muscle tightness that perpetuates the cycle. The tight muscle keeps the joint stiff, so the discomfort causes the muscle to stay tight. We have a range of techniques from gentle cranial techniques and acupuncture to quick manipulations.

Neck pain from arthritis

Osteoarthritis and rheumatoid arthritis can both affect the small joints of the neck. Even when it’s uncomfortable, one of the best things you can do to manage this is keep it moving. It can be really helpful to see your osteopath for guidance with this. When we are in pain, we might worry about causing damage if we push through the pain. Osteopaths can help you find a good balance of movement and discomfort to manage the symptoms of your arthritis.

Intervertebral discs

Like back pain can be caused by a problem with a disc, the same is true in the neck. If the fibrous outer layer of a disc is weakened (which is not unusual), the soft layer inside can push against it and cause a small bulge. Discs themselves are not as sensitive as things like muscles. It is possible to have a disc bulge without any symptoms at all.

If the bulge pushes on a nerve, it can cause pins and needles, numbness, weakness, or pain. The lower nerves leaving the neck actually supply the arms, so a “trapped nerve” in the neck could be the cause of symptoms in the hand. Only the first few nerves in the neck supply the head, and when they’re irritated they can cause headaches.

Disc problems sound worse than they are. We work to find the original cause of a bulge, which may be something further afield like stiffness in the upper back. By addressing issues that have caused the disc to overwork in the first place, we give the disc space to heal and reduce the chance of it happening again.

Ligament sprains

This can be as simple as a cricked neck, or the cause may have been more traumatic. Mild ligament sprains are classified as an injury where under 10% of the ligament’s fibres have been damaged. They tend to resolve within a month, but you’re welcome to make an appointment to try and speed up recovery or work out why it happened in the first place.

More significant ligament sprains can take a few months to heal. Blood supply to ligaments is poor, which limits their capacity to recover quickly. However your osteopath can work around the whole area to help keep fluids moving and give the injury the best environment possible to heal.

It is important to keep moving your neck even after an injury. Neck braces and collars are not recommended for the vast majority of neck sprains. Loading the tissue within a safe limit will encourage the fibres to knit back together stronger.

Managing neck pain

All four of these structures are within your osteopath’s remit. We have a range of techniques to suit any patient with any problem: we don’t just “click necks”! If you prefer a more gentle approach, we can provide that too.

An important part of your treatment plan will include self management. Alongside your diagnosis and prognosis, we can advise you on how to manage between appointments with an exercise plan and other advice.

See how we can help with your neck pain, book in now.