Sometimes pain is felt somewhere different to the area that’s caused it. We see this a lot with upper back stiffness causing the lower back to overwork and become painful. But referred pain is different: here the brain misinterprets the pain signal that it receives.

Understanding the Pain Signal

The body is full of nerves that can send a pain signal to the brain to alert it to potential danger. Everyone is slightly different, but we all follow a similar pattern of nerves. Each nerve supplies a stripe of the body with sensation.

Pain at any point in the stripe will trigger the nerve to send a signal to the brain. The brain knows which nerve is providing the message, but sometimes it misinterprets the detail. The misinterpretation is just like how some people have a heart attack without chest pain, just jaw or arm pain. If a joint within a stripe is irritated, such as the neck joint labelled above, the brain could assume the pain is anywhere within the stripe. As a result, you may feel no neck pain at all, just pain in the arm. But the arm wouldn’t be tender, and movement might not alter symptoms either.

Another commonly affected area is the pelvic joint: the SIJ. This can cause pain in the back of the thigh that can be easily mistaken for sciatica. But unlike sciatica, the pain is unlikely to be sharp or shooting, and tests that identify sciatica will come up negative.

With the heart attack example in mind, we do need to be aware that sometimes referred pain comes from organs. Again, there are patterns that we expect the body to follow, but there is overlap between referred pain that could be coming from a joint, and the same symptoms coming from an organ. We use our detailed case history to help catch these cases, but we will also monitor your progress and refer you for further investigation if appropriate.

Diagnosing Referred Pain

Although everyone’s stripes vary slightly, they are all pretty similar. Your osteopath will be able to tell which nerve is responsible by the area in which you feel the pain. From here, they can work back to other structures within that nerve’s remit to identify the irritated area. Looking at the way you move, as well as testing the joints and muscles passively, we can work out the joint or other area that’s causing the problem.

Managing Referred Pain

Identifying the cause is the first step towards getting on top of the pain. Often, once the problem area is identified, the referred pain should respond quickly to treatment. Whereas sciatica-type issues can take days or weeks to respond to changes further up the nerve, referred pain is often much more immediate. If the cause of the pain is a simple irritated joint, sometimes a quick click will take the edge off the symptoms. A combination of the usual strategies to relax off tight muscles and improve movement in joints can make a big difference, especially when supported with advice and exercises.

In any case, your osteopath can give you an idea of a prognosis at the end of your first session. Your osteopath will also give you a tailored plan and diagnosis to structure your recovery.

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

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

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

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

Heat vs Ice for Self Management

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

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

Contrast Bathing

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

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

Exercises for Self Management

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

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

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

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

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

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

What can an Osteopath Treat?

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

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

Osteo, Physio, and Chiro

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

What to Expect at your Appointment

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

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

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

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

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

Symptoms of Long Covid

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

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

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

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

Management Strategies

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

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

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

Changes in Breathing and Osteopathy

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

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Pain is complicated, and what we feel is dependent on countless factors, including hormones. We’ve spoken before about how lifestyle factors, as well as psychology and medication can affect chronic pain.

Thyroid Hormones and Pain

Hyperthyroidism, where the body produces too much thyroid hormone, and hypothyroidism, where it doesn’t produce enough, are quite common conditions. Symptoms of either can be quite vague, so may be mistaken for something else. Although there are a lot of causes for these conditions, levels can be easily checked with a blood test.

Beyond the sometimes painful symptoms of hyperthyroidism, thyroid hormones appear to have an effect on pain processing. The exact relationship is unknown, but it seems that higher levels of the hormone are linked to pain from hot or cold stimuli.

The NHS website notes that hypothyroidism is associated with a sensitivity to cold. It also mentions pins and needles and carpal tunnel syndrome. Hyperthyroidism can cause a sensitivity to heat.

There may also be a link between thyroid problems and incidence of fibromyalgia. Fibromyalgia still remains largely unexplained, so to find associations with factors like hormone levels could be promising.

Oestrogen and Testosterone

One study noted links between fibromyalgia and oestrogen changes in the menstrual cycle. The same study reported generally higher rates of pain with higher levels of oestrogen. This included artificial oestrogen, such as the combined contraceptive pill. HRT is another form of artificial hormone, and may be associated with an increase in jaw joint pain.

The same paper looked at the effects of testosterone. It showed that male mice recovered from sciatica quicker and more completely than the females. In human studies, the authors noted that women appear to suffer less neck and shoulder pain associated with desk work if their testosterone levels are higher. Both men and women also seemed less likely to have rheumatoid arthritis if their testosterone levels are high.

We need to bear in mind that it won’t be hormones alone that are responsible for these differences. The paper recognised that they are “thought to be one of the main mechanisms explaining sex differences in pain perception”, but other factors such including psychosocial ones will be at play.

Menopause

With the knowledge that oestrogen has an effect on pain, it is not surprising that the menopause is associated with changes in pain sensitivity. Some women find that their headaches dissipate once they go through the menopause, whereas others might develop a migraine for the first time.

Another paper looked specifically at lower back pain and the menopause. Again, it recognised that pain is multifactorial, and that we need to consider biology, psychology, and social factors.

Stress perceptions, tension, anxiety, depression, and difficulty concentrating—increase throughout the transition, and have been found to be associated with an increase in back pain.

We need to recognise that the menopause is associated with increased pain for a number of reasons.

In a slightly different vein, pain may be higher post-menopause because injury is more likely. As oestrogen levels drop, so does collagen. Collagen’s role is to create strong, somewhat elastic tissue, such as cartilage. Less collagen is linked to higher levels of joint pain and cartilage degeneration. This is the process that also underpins osteoarthritis. Lower oestrogen is also a factor in the development of osteoporosis, which increases the likelihood of fractures.

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The fourth trimester is a baby’s first three months of life. During this period, both the baby and parents undergo huge changes, developmentally, emotionally, and physically. The demands are high and the learning curve is steep. We talk about sports injuries happening when you suddenly increase your exercise, or start a new one suddenly. The first few months with a newborn require just that: new activities and lots of them.

Post-Partum Recovery

After the relatively quick changes of pregnancy come the even quicker adjustments to post-partum. In some cases, this means sudden resolution of pain. In other cases it means the opposite. Either way, the centre of gravity changes with birth, so the posture of pregnancy needs to change immediately. Aches and pains may come and go, but your osteopath can help if they don’t resolve on their own.

After a caesarean, you should be advised on management of your scar, including hygiene and mobilisation techniques. Follow the advice for the rest period and reduced lifting- this is major abdominal surgery. Research now leans away from the notion that a “weak” core leads to lower back pain, even after surgery.

Feeding Baby in the Fourth Trimester

Bottle and breastfeeding require awkward positions, sometimes for long periods. This can be especially true overnight, when the struggle to stay awake while feeding compounds the issue. If your body is working well, you can maintain almost any position for a short while without discomfort: movement is the key. This is easier said than done if you’ve finally got the perfect latch and don’t want to move baby (or if they’ve fallen asleep mid-feed), but there are changes you can make to your own posture without affecting theirs.

Try and set yourself up in a relatively symmetrical position before feeding. This won’t be perfect, as feeding is not a symmetrical activity. If you need one elbow bent- particularly if it is supporting baby’s weight, make sure you have something to support it. Try not to spend the whole feed looking down at baby and make sure you’re not putting too much strain through your wrists. The image below shows a position that is likely to become uncomfortable quickly, but it could be perfectly effective for a short while.

If you’re breastfeeding, you may prefer to try other positions. Side lying in bed can give your neck and arms a rest, and you might even be able to roll away if baby falls asleep mid-feed.

Carrying Baby and their Apparatus

During the fourth trimester, babies rarely want to be away from their parents. Even putting them down for naps can be impossible, so to get anything done you might try a carrier. There are both soft and structured carriers available, and it may be a case of trying a few to determine which suits you and your baby.

Not forgetting that it’s not always the baby themselves who is the problem! Car seats can be heavy and ungainly, and manoeuvring a pushchair into a car is not always as easy as you’d expect. Safe lifting typically involves lifting “within your base”, meaning you want to keep the item you’re lifting as close to your body as possible. Leaning forwards to lift something puts more strain on the muscles than lifting something up from between your feet.

Car seats for the youngest babies are often too bulky to hold within your base while allowing your legs space to move. Baby car seats often have a little handle on the side for this reason. Loop your arm through the main handle, and hold onto the smaller one on the side. Keep your arm close to your side to distribute the weight more centrally, and to leave space for you to walk.

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