Avin Patel

Osteoporosis and Osteopenia

Often mistaken for osteoarthritis, osteoporosis is a condition of reduced bone density. Its less severe sibling is osteopenia. Both are diagnosed by special processing of an X-ray image.

What is Osteoporosis?

Measuring bone density gives us a good idea about the strength of bones, and indicates whether there is an increased risk of fracture. Bone density can be measured using an X-ray, which allows a figure to be calculated based on appearance. This is then compared to an average score to determine whether density is adequate or low. Before developing into osteoporosis, bone will become osteopenic. This means that density is reduced, but does not yet cross the threshold.

Osteoporosis and osteopenia vs normal bone density

An X-ray is performed on the lower back (lumbar spine) and hip. This data is used to calculate the bone density.

Risk Factors

Post-menopausal women are in the category most likely to lose bone density. Due to the hormonal changes that lie behind this risk factor, women who have had their ovaries removed are also at higher risk. If a woman goes through the menopause early, whether spontaneously or due to surgery, she may be offered hormone replacement therapy (HRT). This negates the hormonal shift and reduces the risk of a drop in bone density.

Some medications also affect bone density. Longer courses of steroids and anti-oestrogen medications can play a role here. Being underweight or having a history of an undereating disorder are also linked.

Relevance to Osteopathy

Osteoporosis is a systemic condition, and not something that we can directly help with. However, we still need to know if you are affected by it, as its presence means there are some areas that need a more gentle treatment. Sometimes there are no signs of osteoporosis until a bone is fractured, so preventative management and testing are important.

As osteoporotic bones are also more likely to fracture, we need to know if we should be considering this kind of injury. Fractures are out of our remit, and appropriate attention is somewhat urgent.

Sometimes people come to clinic for help in correcting their posture. Although sometimes the cause of a hunched posture is something we can help with, like hip arthritis, it can also be an effect of osteoporosis. When bone density is low, the spine can be affected. At this point, a minor fall or even a cough or sneeze can sometimes be enough to cause a crush fracture. This is where the large parts of the vertebrae (which weight bear) collapse in on themselves. They tend to settle into a wedge shape, which changes the shape of the spine. As we cannot change the shape of the bones, we cannot resolve this. We may, however, be able to provide some relief if there are compensatory muscle and joint pains associated with it.

Management and Prevention of Osteoporosis

The most effective treatment for osteoporosis or osteopenia is to gradually and gently increase weight bearing exercise.

Your doctor may also recommend that you take medication to strengthen the bones. Strong bones need minerals such as calcium, so there may also be dietary changes you can make to help yourself. Not only is it necessary to consume the minerals required, but vitamin D will help you absorb them.

If you need help to get back into exercise for your bones, make an appointment in Leicestershire here.

Bursitis

Bursitis means “inflamed bursa”. Bursae are little fatty sacs called found all over the body. Each bursa sits between tissues, often a tendon and a bone, that would otherwise rub together. Their role is to prevent injury by friction, but sometimes they become irritated themselves.

How it Happens

Bursae tend to become inflamed from excess pressure or friction, which can be internal or external.

Internal friction usually comes from a tight muscle repeatedly rubbing against the bursa. Pain in this case could be in both the muscle and bursa. External pressure is often behavioural, for example sitting in such a way that a bursa is under continual pressure.

More Common Examples

There are too many bursae to count, but some come up more than others. 

Bursitis: hip and knee bursae

Trochanteric Bursitis

At the top of the thigh bone there is a bony lump called the greater trochanter. Some people call this their hip, although it is below the hip joint. The IT band and the muscle that it blends with (TFL) run over this prominence. The ITB is usually relatively tight, as it plays a role in stabilising the knee. But if it becomes too tight and puts too much pressure on the bursa, you can develop trochanteric bursitis.

Due to the relationship with the knee, treatment might involve more work to the knee or even ankle than to the painful area itself.

Patella Bursitis 

There are two bursae around the knee cap that are quite prone to irritation. The infrapatellar bursa sits just below the knee cap, and the prepatella bursa is in front of it. When these are inflamed, the quadriceps are often part of the problem. The knee cap actually sits within the quadriceps tendon, so tightness in the quads can make the kneecap move inefficiently.

When the cause of this is tightness through the quads, additional problems may arise. The additional pressure on the knee cap can cause friction within the joint too. If this persists, the cartilage on the back of the knee cap may become irritated. Given long enough, it may also develop arthritis.

Olecranon Bursitis

The olecranon is the name for the point of your elbow. Bursitis here is less associated with a tight muscle, and more commonly caused by external pressure. The other name for this bursitis is “student’s elbow”, as leaning the elbow on a desk is associated with developing it. As the bursa is so close to the skin, it can look quite dramatic when inflamed. A large lump may develop, which is not painful in every case.

Osteopathy and Bursitis 

Osteopaths can help with your tight muscles. When assessing your bursitis, we will look for patterns in neighbouring areas. It may be the case that the long term solution to your pain is to address a muscle or joint elsewhere that isn’t working properly. 

Book an osteopathic appointment in Leicestershire here.

Hypermobility

Hypermobility refers to joints that are more flexible than average. Some people are generally quite “bendy”, whereas for others it can be a sign of another condition. The NHS says that about 1/30 people are hypermobile.

Hypermobility signs and symptoms

Managing Hypermobility

Your osteopath needs to be aware of your hypermobile joints, as they can play a role in both your initial problem, and your treatment plan. If your hypermobility is caused by a condition, it may be the case that your ligaments undergo more damage than the average person, and they do not heal as well. This will need to be taken into account by your osteopath.

The image above shows 9 points on the body. These are the points used to measure a person’s hypermobility on the Beighton Scale. Your osteopath can test these quickly, observing you standing with your knees and elbows locked, bending forwards to touch the floor, and bending your thumb and fingers back on both hands. We then have a number to give an idea of roughly how hypermobile you are.

Of course this does not test all joints, and if you have particularly mobile hips, you could still score 0. Your osteopath will take your whole case history into account and assess your body thoroughly at your appointment.

Related Conditions

Some connective tissue disorders cause hypermobile joints. Having one of these conditions may mean that you are more likely to develop joint pain or dislocations.

Ehlers-Danlos Syndrome (EDS)

There are a number of different forms of EDS, but a number of them present with hypermobile joints. Hypermobile EDS is the most common type. Other signs of EDS may be unusually stretchy skin, scoliosis, or a more pronounced kyphosis. Some forms of EDS are genetic, but not all.

Marfan Syndrome

Marfan is less common than EDS, but there are a lot of similarities between the two. The symptoms of Marfan Syndrome begin to develop in late adolescence. As with EDS, hypermobile joints and a scoliosis are common features. In adulthood, there may be early onset osteoarthritis, especially in the hips. Recurrent soft tissue injuries are also common alongside joint pain.

Down’s Syndrome

Joint laxity is considered “almost universal” in children with Down’s Syndrome. This commonly causes flat feet, which is associated with later development of walking. Hips and ankles are often affected, and the bones in the neck may be unstable.

Local Hypermobility

After an injury such as a joint dislocation, the ligaments and capsule of that joint may become lax. Their role is to prevent the joint moving too far, so when they are not in their best condition, the joint is more likely to dislocate again. Repeated dislocations may predispose the joint to developing arthritis. Unfortunately, ligaments take a long time to heal, and often do not return to their original condition. You may have noticed this yourself after a bad sprain.

One way to support a joint with lax ligaments is to help the surrounding muscles support the joint. Your osteopath can give you exercises to strengthen the relevant muscles as part of your treatment plan. We will work with you to find a way that suits you, whether that means using machines at the gym, or a small weight at home.

If you have joint pain alongside hypermobility, you can book an appointment here.

Trigger Points

Everyone has experienced a “knotted” muscle at some point- but what happens if it doesn’t untangle itself? Longer lasting knots can become trigger points (TrPs), and left untreated they can behave in unexpected ways.

Symptoms of Trigger Points

The more common muscle knots can typically be massaged or stretched out, and are gone within a few days. But when they persist, we expect them to develop additional symptoms, such as:

  • Tenderness within a muscle
  • Pain characterised as a deep, dull ache
  • Location easily pinpointed
  • Some relief from heat and massage, but only temporarily
  • Benefit from activity, but aggravated by extreme exercise, or holding a position for too long

Some of these symptoms overlap with more serious pathologies like rheumatoid conditions, so see a professional if they apply to you.

The symptoms change if the TrP is left untreated for too long. We consider anything lasting 3 months or fewer to be “acute”, whereas anything longer becomes “chronic”. Chronic myofascial pain, and chronic TrPs are more likely to be complex.

Chronic Trigger Points

Whereas acute trigger points behave like straight forward “knots”, chronic TrPs are different. The image above illustrates some referral patterns from muscles in the neck and face.

Referred pain is a relatively common occurrence. One of the most recognised patterns is when a heart attack comes with jaw or arm pain instead of chest pain. What happens here is the brain misinterprets the location of a painful stimulus, and causes symptoms in the wrong area. Although that sounds chaotic, it typically follows quite predictable patterns. Your osteopath will be on the lookout for these patterns, as they can often be disguised as something else. Muscles in the buttock, for example, can cause pain down the back of the thigh and be mistaken for sciatica.

Trigger Points within Other Problems

With referred pain in mind, it’s not surprising that TrPs are associated with chronic headaches and migraines, jaw pain, and lower back pain. One study found that the majority of patients sent to an orofacial pain clinic had trigger points at the root of their problem.

The image above shows some patterns associated with three muscles: the masseter, trapezius, and sternocleidomastoid. All three refer pain into the head and face, so all three could be mistaken as headaches or migraines. The masseter muscle (overlying the jaw) could cause pain that is misinterpreted as a problem with the jaw joint, or even toothache.

Causes and Predisposing Factors

TrPs can develop in response to an injury or traumatic event, or more gradually. Poor posture or other causes of persistently overloading a muscle could cause them if given enough time. Similarly, other conditions can allow them to develop, specifically other chronic pain conditions like fibromyalgia.

There are overlapping points between myofascial pain and fibromyalgia. One of these points is subclinical nutrient deficiencies. Myofascial pain syndrome has been associated with slightly low levels of B vitamins, vitamin C, folic acid, calcium, iron, and potassium. As the numbers are only slightly low, they may be disregarded after blood tests despite being significant.

Managing TrPs

TrPs often come with referred pain, which your osteopath is able to identify. This pain will resolve as the trigger point itself is managed. This might mean that your jaw pain is actually nothing to do with the jaw joint itself, but is all down to local trigger points. They might be local to the muscles involved in chewing, or they might be as far away as the top of the shoulder. Your osteopath will work to identify and minimise them.

Traditional acupuncture can be effective in managing TrPs. Dry needling, where the needle is inserted directly into the trigger point, has also shown to be beneficial. Some may also be responsive to direct massage work.

If you suffer from muscle knots or trigger points, book in today to see how we can help.

Chronic Pain

Chronic Pain is defined as pain lasting over three months. This may be due to a constant stimulus, such as an arthritic joint, or it might be Primary Chronic Pain

Chronic pain is multifactorial

Primary Chronic Pain (PCP) is a pain condition that cannot be attributed to another cause. This encompasses conditions such as:

Risk Factors

Some of these conditions affect certain demographics, some of which cannot be changed. Migraine and fibromyalgia are more commonly diagnosed in women, for example. However, chronic pain is also associated with a number of modifiable factors.

We know that smokers are more likely to suffer from chronic pain conditions. Similarly, poor diet is considered a risk factor for chronic pain. Poor or insufficient sleep also predisposes a person to develop it. Mental health conditions often come hand in hand with pain too. To summarise, the more you can improve any facet of your health, the less likely you are to develop a pain condition.

The Psychology of Pain

A prominent pain scientist, Lorimer Moseley, explains how the brain plays a role in how we perceive pain. If you are walking through tall grass and feel a small scratch, you probably won’t feel much pain. But what if that scratch later turns out to have been a snake bite, and you end up hospitalised and in agony? Next time you go walking in tall grass, a small scratch from a twig could genuinely feel like a snake bite. The brain wants to protect you, and it can learn to amplify the danger signal if it deems it necessary.

This is why understanding your condition is so important for a good prognosis. To take the snake analogy further- you’re much less likely to get that massive pain response if you see the twig brush your leg. The brain now has two pieces of information to use when deciding what would be a proportional reaction.

Lorimer Moseley has done another video specifically for chronic pain. You can watch it here.

Chronic Lower Back Pain

Back pain can become a PCP condition if the original cause resolves, but the pain does not.

Secondary Chronic Pain (SCP) contrasts to PCP in that the pain is attributed to a structural condition. In that sense, long term Lower Back Pain caused by osteoarthritis, osteoporotic fracture, or chronic disc bulge could be SCP. As this pain is due to a constant stimulus, it may not follow as many of the risk factors listed above as PCP. But it can still be debilitating, and treatment needs to be multifaceted. We want to treat the cause, but also the compensations, and the associated sensitivity that may have developed.

Frustratingly, diagnosis for chronic lower back pain is not as easy as going and getting a scan. Not all structural things show up with imaging, and most of us have asymptomatic things that may look like a problem on a scan. These false positives are the reason the NHS does not recommend routine scanning for lower back pain. Your osteopath can be your first port of call for most cases of lower back pain.

If your pain has crossed the three month threshold, book an appointment now to see how we can help.

Ergonomics

We often talk about the patterns of dysfunction we see in our patients who are stuck at a desk all day. Hunched shoulders with tight pectoral muscles, and stiff upper backs are a couple of the most common ones. But we know that for a lot of people, working at a computer is unavoidable, and even moving to a standing desk does not resolve all problems. Looking at your ergonomics is a good place to start.

Typical Desk

Chances are, if you have to work at a computer you have a traditional desk and office chair. If you work from home, hopefully you have a table and chair to work with, but maybe you’re perched at the breakfast bar or even working from the sofa. There are improvements we can make in the way you sit, and possibly in your hardware too.

“Ergonomics” is a word thrown around a lot, and although it might sound like a definitive answer, really it just refers to a set of guidelines. A desk that is perfectly set up for one person will not suit another. Even a desk perfectly set up to ergonomic guidelines might not be the best for you- be prepared to make changes to get it just right.

Basic desk ergonomics

Desk Ergonomics Guide:

If you sit in an office chair to work at your computer, you can get started with these points:

  • Make sure your feet are supported. If you can’t reach the floor, find something to put under your feet. A small box or pack of printer paper might do. When your feet are unsupported, there is more pressure on the back of your thighs from your chair, which can cause leg or knee pain.
  • Ideally, you want your hips to be at just over 90°. This won’t be possible in some chairs, but could be something to aim for if you’re out to buy a new one. You may be able to adapt flat-seated chairs with a small pillow.
  • If your chair has arm rests, try to put them to the same height as the desk. You might have them slightly lower so you can tuck the chair under, but this encourages pressure on your wrists from the desk. This in turn could lead to carpal tunnel syndrome.
  • Ensure that the arm rests support your forearms at natural elbow height. To meet both this and the previous guideline, you may have to elevate the whole seat.
  • The top of your screen should be at eye level or just above. This discourages you from dropping your head to look down at the screen, putting strain on the neck.

The Ideal Chair

The best possible office chair will almost certainly have a lot of moving parts. To follow the above guidelines, you need a chair that can have its arms adjusted to the height of your desk. Rather than directly changing the arm height, this may be best achieved by changing the height of the whole chair. Raising the arms may cause you to hitch your shoulders up, which can lead to shoulder and neck tension.

If possible, the arms of the chair will only be half length too. This allows you to get close to the desk and use the keyboard without having to sit on the edge of your seat.

Make sure there’s no padding in strange places. Some office chairs have extra support for the upper back, which pushes forward on the part of your back that sticks out most. Similarly, a high-backed chair with cushioning at the back of your head will also push you too far forward. Padding in the small of your back or neck is more likely to complement the natural position your body wants to take.

Standing Desk Ergonomics

Many of the above guidelines ring true for a standing desk. You still want to have your screen at the right height to keep your head in a neutral position. Your shoulders still need to be relaxed, and you want to avoid pressure on your wrists.

If you are transitioning to a standing desk, it might be easiest to spend a bit of time standing and the rest sitting to begin with. Changing your whole day’s activity from sitting to standing is a significant shift for your body to manage. You may also want to look at “anti-fatigue mats” for standing desks. These may prevent foot pain and any compensations you make further up to make that more comfortable.

A standing desk doesn’t necessarily need to be ruled out if you work from home. Rather than buying a whole new piece of furniture, you can pick up a standing desk converter. This simply raises the screen and keyboard so you can keep using your original desk or table.

Movement Above All

Ergonomics is a good start, but the real solution is to keep moving as much as possible. Anything from moving your printer to the other side of the room or making sure you get up for a drink every half an hour or so will make a difference. Importantly, you need to keep moving at your desk itself too. If you sat in a perfectly ergonomic position for 8 hours straight, you definitely wouldn’t be comfortable. It’s alright to lean into one side for a bit, then cross one leg over the other, then hunch forward. In fact, this cycling through “bad” postures is probably less likely to cause you aches and pains.

More movement gives the body less of a chance to build these patterns. For the residual issues, we can treat you as they appear or we can get into a regular treatment routine.

Book now for treatment of work-related aches and pains

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

Joint Pains

We all get aches and pains from time to time, sometimes coming out of nowhere. When should you get yours assessed or treated?

Aches and pains

Addressing minor aches and pains with check-ups

Just like you see your optician or dentist for regular check ups without symptoms, you can do the same with your osteopath. This means you can mention little twinges and aches that you might not otherwise make an appointment for.

Some problems develop from the way the body has adapted to other aches and pains. We can spot these changes at a check up and nip them in the bud.

An example of how mild aches and pains can affect the body

Adaptability

Our bodies change throughout our lives, and the demand we put on our tissues does too.

Childhood growth spurts to old age

Children can benefit from check ups too. Growth spurts can be associated with aches and pains, such as those at the top of the shin. This can develop into Osgood Schlatter disease if not prevented. Working to improve flexibility can minimise symptoms and allow your child to carry on as normal.

The incidence of “wear and tear” conditions like osteoarthritis increase with age. Often this can be managed well when caught early- even before it becomes symptomatic. Not only does this keep the affected joint healthy, but it prevents need for other joints to compensate.

Pregnancy, menopause, and other hormonal changes

We associate pregnancy with lower back pain, both due to hormones and changes to balance. The menopause is another time when hormones go through a major shift. This too can be accompanied by a number of aches and pains. For some women, menopause coincides with the onset of migraines, which might respond better to manual therapy than medication.

“Non-specific” aches and pains

Both neck and lower back pain can be defined as “non-specific”. This just means that the cause is not serious, and that it is suitable for treatment.

Mild twinges in muscles might be intermittent or recurrent and hard to pin down. Nevertheless, we can still assess the area even between symptomatic periods. These things don’t tend to happen in isolation, so your osteopath is likely to be able to find a cause of your symptoms.

We can also offer advice with the aim of preventing future episodes. This might be in the form of exercises to stretch or strengthen an area, or it might be more focused to first aid.

If you’re ready to address your aches and pains, book 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.