Avin Patel

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.

Scoliosis

A scoliosis is a lateral curve of the spine: a curve visible from behind. No one is perfectly straight, but sometimes this curve can present problems. If it is only present in certain positions such as sitting, it is called a functional scoliosis. When the curve is there all the time it is called a structural scoliosis.

Signs and Symptoms

Initially, this may present with or without pain. In children, parents may be the first to notice things like:

  • One raised shoulder
  • Lateral curves
  • Clothing sitting unevenly
  • Ribs raised on one side when bending forwards

Functional Scoliosis

Functional scolioses are generally not problematic and can be managed with lifestyle changes. For example if someone only has a scoliosis when sitting with their wallet in the back pocket they can be advised that this is the cause.

Functional Scoliosis

There may also be habitual factors at play. If you tend to stand with one leg bent, the body will aim to correct this imbalance before it reaches your head. If you wear a heavy shoulder bag, you may develop a temporary concavity on that side.

These are not problems in themselves unless they cause discomfort, or stop resolving when the position is corrected.

Structural Scoliosis

Structural scolioses tend to form during childhood or adolescence. Often the cause is unknown, so it is referred to as an idiopathic scoliosis. If this is picked up before a person finishes growing they may be referred for treatment.

Structural Scoliosis

Ageing spines also develop these curves- most elderly people have some sort of curve.

If not Idiopathic

In contrast to functional curves, this type of scoliosis can come down to the structure of the bones. In other cases, neurology plays a role. Scoliosis can follow trauma or be caused by conditions such as cerebral palsy. Neuromuscular scoliosis requires medical intervention.

Treatment and Management

In mild cases osteopathic management may help. However for more severe cases the patient may be referred for a brace or surgery. Severity of the angle can be measured using an X-ray of the spine.

Although osteopaths cannot change the curve in adults with a structural scoliosis, we can work to relieve symptoms. The muscles on the concave side of the curve will be shortened and tighter and the opposite will be true on the convex side. The body is generally good at adapting to these changes but if they are uncomfortable we can work to balance.

In reality, the curve is unlikely to be purely lateral. Rotation through the mid and upper back is common, and can cause compression through the ribs on one side. Osteopathy can help work on the muscles between the ribs, as well as general breathing mechanics. We can also suggest exercises to continue at home.

If you suffer the effects of scoliosis, book in today and see what we can do.

Piriformis Syndrome

Piriformis Syndrome is a form of sciatica. By definition, sciatica is irritation of the sciatic nerve. The piriformis is a deep muscle in the buttocks, and when it’s tight it can irritate the sciatic nerve.

It’s not always possible to tell exactly where sciatica originates from. It could be from the back, in the form of a disc bulge, or it could be further down the leg. Sometimes it’s irritated in two places: a double crush. If we can be sure what’s causing the pain, we can work in a more targeted way.

One place that can be easier to identify as a cause is the buttock. There may be some movements that clearly exacerbate symptoms, or something in the way it started that tells your osteopath what’s involved.

Sciatic Nerve Irritation

When a nerve is irritated, it can become inflamed. This might lead to symptoms such as:

  • pins and needles
  • numbness
  • pain in a defined line following the nerve

Just like we all look unique on the outside, we have difference inside too. Some people have a sciatic nerve that just runs close to piriformis, but others will have a nerve that pierces the muscle. Neither is a problem in itself, but there are theories that the latter group might be more susceptible to developing the condition.

What Can Cause Piriformis Syndrome?

Straight forward piriformis syndrome is due to a tight piriformis muscle. This might be due to:

  • change in centre of gravity, such as pregnancy
  • sudden increased demand on the buttock, like starting an intensive new exercise
  • compensation after an injury

Management

Effective management involves breaking the pain-protection cycle, in which the muscle gets tighter because of the pain. Of course, this cycle only gets worse.

Once the reason for the initial tightening has been discovered, that can be addressed to break the cycle and prevent future episodes of the same pain. Then the muscle itself can be treated in clinic and with exercises at home.

Piriformis syndrome responds well to acupuncture or dry needling. Your osteopath may also use massage and stretching techniques on the muscles around the buttock and into the lower back or leg.

The longer the pain has been present, the harder it can be to calm the nerve down. Techniques to target the nerve and reduce the “danger signal” have their place in clinic and in your home exercises. By addressing both parts of the cycle, we plan to get you back to normal as soon as possible.

If you have the symptoms of piriformis syndrome, don’t suffer another day. Book an appointment online.

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.

Sciatica

The sciatic nerve runs from the lower back down the back of the thigh and outside of the calf. Sciatica is a symptom of irritation of this nerve.

Scatica and its causes

Symptoms

When the nerve is irritated, symptoms can develop anywhere along the length of it. For some people this means pain from the back to the foot, and for others it can be a lot more focal. A sharp, shooting pain in a defined line is a typical symptom of sciatica. This is rarely constant but might be somewhat unpredictable. Pins and needles in the same area, or numbness or weakness are also common.

If the cause is a disc bulge, movements that stress the disc can aggravate symptoms. Examples of this are heavy lifting, twisting, and straining on the toilet. It is important to note that symptoms are not indicators of damage. Nor does intensity of symptoms predict how long an episode will last. Sometimes people with the most debilitating pain are the quickest to recover.

Causes of sciatica

The basic cause of sciatica is irritation of the nerve in the back or upper leg. There are a number of ways this can happen, and sometimes there are multiple causes. Two of the most common are:

  • Nerve compression in the back due to a bulging disc (diagram C)
  • Nerve compression in the buttock due to a tight gluteal muscle (piriformis syndrome)

When is Sciatica not Sciatica?

Not all pains in the back of the leg are down to the sciatic nerve.

Hamstrings

The sciatic nerve runs through the same area as the hamstrings, so pain can be mistaken for sciatica when it’s not a nerve at all. A simple pulled muscle can imitate the symptoms without any sciatic involvement.

Referred pain

Sometimes the brain misinterprets pain signals and detects pain where it shouldn’t be. You may have heard of people having heart attacks but experiencing jaw pain: this is the same mechanism. Nerves cover a broad area, so when a nerve brings a pain signal to the brain, the brain has to work out where exactly the pain is coming from. Heart pain isn’t a usual sensation, so the brain thinks the pain must be coming from somewhere else in that nerve’s area. One nerve that supplies the heart also supplies the jaw, so the brain makes an educated guess.

The same can happen in the back and leg. Irritated joints in the lower back and pelvis can cause pain in the back of the thigh. This doesn’t necessarily mean that anything is wrong with your leg! Your osteopath can work out what’s happening and what needs to be done.

Plantar fasciitis

Pain and pins and needles in the foot can be symptoms of sciatica, but when they’re isolated to the sole of the foot alone they could be something else. Plantar fasciitis is inflammation of the soft tissues on the sole, unrelated to the sciatic nerve.

Book an appointment today to get on top of your sciatica

Lower Back Pain

Roughly 80% of us experience low back pain at least once in our lives, but the vast majority of cases are not serious. Even cases that lead to time off work are not necessarily indicative that something is damaged.

Osteopaths can help with lower back pain formally categorised as “non-specific”. This is an umbrella term that includes pain caused by:

  • Tight or strained muscles
  • “Slipped” discs
  • Irritated joints in the spine or pelvis
  • Ligament sprains in the back

“Non-specific” does not mean that we don’t know what is causing your pain or that we can’t do anything about it. It just means that more serious causes such as fractures or disease can be ruled out.

Do I need a scan?

These non-serious causes rarely correspond to findings on MRI or X-Ray. Making an appointment with your osteopath before getting a scan could mean being symptom free before your hospital appointment date.

In fact, evidence shows that MRIs show problems with discs in people without symptoms, so scans are far from the gold standard for diagnosing back pain. This is one reason that imaging is no longer recommended as a GP’s first strategy for straight-forward back pain. You also don’t need a doctor’s referral to see an osteopath, you can make an appointment yourself.

Due to comprehensive training, osteopaths are able to distinguish between non-specific lower back pain and more serious causes. If your back pain does require medical attention, we can support you in getting to the right practitioner.

How can I prevent lower back pain?

Some lifestyle factors have been shown to predispose an individual to developing lower back pain. These include:

  • Being overweight
  • Lack of activity
  • Overexerting during physical activity, including at work

So staying active without pushing too hard, and staying at a healthy weight will help to prevent future episodes.

Problems with the lower back are often linked to dysfunction elsewhere, such as stiffness in the upper back. Upper back restriction is something we commonly see in clinic, often exacerbated by long periods of sitting still such as when stuck at a desk. When the upper back is restricted, the body compensates by putting more movement through the other areas of the back. This can cause the muscle tension and strains mentioned above.

During an appointment, your osteopath will look at the whole body. This means we can identify these areas of restriction before they cause symptoms. Exercises and advice to keep these stiff areas at bay are also great ways to prevent episodes of pain.

What can an Osteopath do for back pain?

Osteopaths use a range of techniques for pain relief and rehabilitation. Hands-on techniques such as massaging and stretching muscles, or moving and clicking joints can be useful. Avin is also qualified in Medical Acupuncture, which has been proven to improve low back pain.

Because osteopaths look at the whole individual, we are in a position to find any factors that might have fed into the symptoms you have today.

Back pain can be debilitating and scary, so an important part of your treatment plan is rehabilitation. Exercises help keep your back happy between treatments, but they also serve the purpose of letting your body know that it is safe to move. The sooner we can get you comfortable again, the sooner you can get back to normal.

If you suffer from these symptoms, you can make an appointment at any of our 6 clinics.