Avin Patel

Plantar Fasciitis

The plantar fascia is a layer of connective tissue on the sole of the foot. When it becomes inflamed, you have plantar fasciitis (PF).

Plantar Fasciitis

Symptoms of Plantar Fasciitis

The bone of the heel is called the calcaneus. PF usually starts with a sharp pain at the front-most tip of the calcaneus. It may be located more towards the inner arch than the centre of the foot, and pain may radiate towards the toes. It may be worse when stretched- so walking can be painful. However, as you continue to walk, it may ease up. Symptoms return after rest.

There are a number of conditions that behave similarly, such as problems with a nerve. Your osteopath can give you a diagnosis at your appointment.

What Happens in Plantar Fasciitis

Fasciitis is inflamation of the layer of tissue between skin and muscle. There is a thick layer of fascia on the sole of the foot (the plantar aspect) which behaves like a tendon to some degree. Plantar fasciitis may begin with micro-tears to the tissue, similar to what happens in a ligament with a minor sprain. This may be an injury associated with sports, or it could be the result of normal ageing and degeneration. The symptoms become more significant if they don’t self resolve. Some consider it a degenerative condition leading to inflammation, rather than an inflammatory condition in itself. This is not to say that there is no way out of it- improving local tissue health will enable better healing.

Sometimes it is called “policeman’s heel” in reference to the repetitive trauma of persistent walking. You may also hear people talk about “heel spurs” in reference to plantar fasciitis, but this is misleading as heel spurs are protrusions made of bone, and not present or relevant in all cases.

Plantar fasciitis is a common injury in runners, but it also affects 10% of the non-athletic population. Onset does not have to be traumatic as such, but wearing unsupportive or restrictive footwear can play a role. Flip flops and high heels are noted as common factors in the development of PF.

Treatment and Advice

Dry needling and acupuncture have been investigated as potential treatment methods, and results suggest that they may provide some benefit. In the same paper, manual therapy was found to be more effective than corticosteroid injections for plantar fasciitis.

PF can take a while to clear up, so it’s worth doing everything you can to help it on its way. Your osteopath can help you with the details, but the NHS recommends avoiding shoes that are tight or lack support, and to limit the time you spend standing.

If you’re suffering with foot pain, book an appointment now.

Shoulder or Elbow Pain

The shoulder is more than just a ball and socket joint. It is a very mobile joint supported by a number of ligaments and strong muscles. There are other smaller joints that make up the shoulder complex along with the ball and socket, and all have their own functions and susceptibilities.

The elbow is mainly a hinge joint, but there are additional joints to incorporate the two forearm muscles. The elbow is much less mobile than the shoulder, which may be why we see a lot fewer elbow injuries in clinic. But there are still things that can go wrong, and ways in which your osteopath can help.

Shoulder Pain

Sports injuries can cause a number of shoulder problems. These can be immediate or further down the line after insufficient rehabilitation. Read about sports injuries such as labrum tears here.

Frozen Shoulder anatomy and movement

This is a non-exhaustive collection of conditions your osteopath is qualified to help you with:

Shoulder Arthritis

Osteoarthritis can affect the ball and socket joint. As this joint is similar to the hip in its structure, arthritis affects it in a similar way.

As with anywhere else, there is always something that can be done to make an arthritic shoulder more comfortable. Working to release the muscles that are guarding the joint is one step in the direction of improving movement. If the movement can be improved, the cartilage can begin to heal, or at least slow the progress of the arthritis.

Your osteopath will also look at any adaptations your body has made to compensate for lost movement. This improves joint and muscle health globally- not just at the affected joint.

Biceps Tendinopathy

Tendinopathy is a term that encompasses tendinitis/tendonitis and tendinosis. It refers to inflammation of the tendon- in this case the tendon of biceps brachii.

Usually the long head of biceps is affected, but not the short head. The long head attaches onto the shoulder blade before running very closely to the ball and socket joint. It may be because of this close proximity that it is susceptible to irritation, especially by repeated overuse such as overhead throwing.

Other conditions also predispose the development of biceps tendinopathy. Otherwise asymptomatic changes, such as those to ligaments around the scapula, can make this injury more likely. Or more obvious things, like rotator cuff injuries, can put added strain onto the biceps. There is also a link with shoulder instability, such as after a dislocation. It is important to get injuries like this checked out, even if they seem minor.

Rotator Cuff Injury

Following on from biceps, another commonly treated shoulder injury is of the rotator cuff. This is a collection of muscles around the shoulder blade that work together to rotate the arm.

A fall or other trauma, including sports injuries, can strain the rotator cuff. Conservative management is the recommended first line of treatment. When the injury is mild enough, you can avoid surgery and the shoulder can be rehabilitated by your osteopath.

Preventing your shoulder injury is better than curing it!

You may notice that a lot of shoulder injuries are associated with overhead throwing. If you do a sport that requires this movement, or work in a role that leads to a lot of overhead work, preventative treatment may be a good strategy for you to avoid an injury. Book in here.

Elbow Pain

We see much fewer elbow problems than shoulder problems in clinic, but that’s not to say we can’t still help. One of the most common elbow complains is epicondylitis: tennis elbow and golfers elbow. This condition is easy to identify and there is plenty that can be done in the treatment room and at home to speed up its recovery. To read more about epicondylitis, see our full post on the topic.

Sprained Elbow

The elbow is a hinge joint, and it is supported by a lot of ligaments. Injuries that force the elbow to straighten too far, or bend slightly sideways, can cause a sprain. This usually affects the big ligament on the inside of the elbow.

Shoulder and elbow anatomy

One common mechanism of injury is a fall onto an outstretched hand which can cause the elbow to buckle back. This movement is limited by ligaments as well as bone. In high power injuries it is important to check that there is no fracture.

If your injury is confirmed to be a purely soft tissue injury (or if the fracture is healing well), your osteopath can step in. Ligaments have a poor blood supply, so need to be surrounded by healthy fluid to heal quickly. This means that some swelling is actually helpful- but it is important not to let that fluid stagnate. Your osteopath can help with flushing the old fluid back towards the heart. They can also give you exercises to encourage the same movement at home.

Ligament injuries can be slow to heal, but it is important not to over-protect the injury. Immobilising an elbow sprain unnecessarily can make you more likely to develop frozen shoulder. As the ligament heals, your osteopath will encourage you to start moving it as much as is appropriate. This helps the fibres knit back together in the correct direction, making a stronger ligament than a poorly rehabilitated one.

Elbow Bursitis

Bursae are fat pads found all over the body, sitting between bones and soft tissue as a cushion. Their role is to prevent friction. The one sitting on the tip of the elbow is the olecranon bursitis, and it can form an egg-sized lump when irritated by prolonged repeated pressure. One cause of this could be sitting at a desk with a bent elbow resting heavily on the table. This is why we also call it “student elbow”.

Beyond advising you to stop applying pressure to the elbow like this, your osteopath can help by looking further afield. There may be a relationship with the triceps muscle or other local structures that can be addressed. There may even be a tightness in the back that encourages leaning to that side. Your osteopath will look at the body as a whole to get to the root cause.

If you have a problem with your shoulder or elbow, make your appointment to get it sorted here.

Frozen Shoulder

The technical name for frozen shoulder is “adhesive capsulitis”, which gives a good idea of what’s happening in the joint. Surrounding the ball and socket joint of the shoulder, there is a capsule of soft tissue. It’s a flexible material that allows the shoulder to move properly and keeps the joint fluid inside.

But in frozen shoulder it becomes sticky (or “adhesive”). This causes restricted movement and pain, particularly in the movements illustrated below.

Frozen shoulder: affected movements and anatomy

Factors involved in developing Frozen Shoulder

Often it is unclear why this develops. Sometimes it may follow trauma, including surgery, but other times it has no identifiable trigger. We do know that some other conditions are associated with a higher risk of adhesive capsulitis, such as:

  • Diabetes
  • Parkinson’s disease
  • Heart disease

There’s also a link to immobilised shoulders. This is one reason you don’t want to wear a sling unnecessarily for mild shoulder or elbow injuries. It is unclear how this predisposes a shoulder to freeze, all we know is that it happens.

Finally, as one shoulder “thaws”, there is a relatively high incidence of the other one freezing. Again, the reason why is unclear.

Prognosis for Frozen Shoulder

Unfortunately, this is not a quickly resolving condition. The good news is that it appears to be self-limiting, and responsive to conservative treatment. It can be broken down into three stages, each with their own timeframe.

Freezing

The first stage is called the freezing stage. This covers from the first changes to the point of most restricted movement.

The freezing stage can last up to nine months. This early stage appears to be most responsive to acupuncture.

Frozen

This period is the most restricted in terms of movement, but not necessarily the most painful. Pain from the freezing stage begins to resolve, or at least doesn’t get any worse.

The frozen stage has a very variable timeframe, lasting somewhere between 4 and 20 months. This period may be reduced by manual therapy.

Thawing

The tail end of the resolving stage can be long and drawn out. But as both pain and movement are improving, it might not feel so long.

Similar to the frozen stage, thawing can last from 5 to 26 months.

Management

Encouraging movement from the joint and surrounding muscles in the treatment room can benefit the shoulder. Limiting maximum lost movement and speeding up the three stages is the aim in treatment.

Medication is the second line of treatment. Anti inflammatories, including both NSAIDs and steroids can be prescribed for frozen shoulder. Sometimes a steroid injection will also be offered, although there are long term side effects of steroid injections, and no real long term benefits for this condition. Surgery is another option, but it is not routinely offered.

In summary, adhesive capsulitis is a frustrating condition to have, but there are ways your osteopath can help at all stages. As early stages seem most responsive to acupuncture, it’s worth getting checked out as soon as you can.

If you suspect you have frozen shoulder, get on top of it sooner rather than later. Book in today.

Circulation

Poor circulation can cause pins and needles, numbness, and pain in the affected tissues. Localised issues with circulation can be due to mild problems with muscles causing compression. If the causes are more serious, your osteopath can refer you on to somewhere more appropriate.

More widespread symptoms can be a sign of something more systemic going on.

Problems with circulation due to injury or lymphoedema

Post injury swelling

After a sprain or similar injury, we tend to try and minimise inflammation and swelling, but it is there for a reason. In the early stages, inflammation brings in nutrients to help heal the area. However, this swelling is not helpful when it’s static for long periods. As nutrients enter the injured tissue, waste products leave- but if they stay nearby and aren’t flushed out, they prevent the flow of new nutrients in.

Some areas of the body are easier to encourage circulation than others. The calf works as a pump when we walk to push blood back up towards the heart, so walking or calf exercises can be useful to clear swelling in the ankle and knee. Other areas respond best to hands on techniques.

Heat and ice can be advised by your osteopath where appropriate. Cold compresses encourage blood vessels to constrict, whereas warmth encourages them to dilate. Repeating one after the other simulates a pumping mechanism.

Poor circulation due to Lymphoedema

When blood enters a cell, it leaves in two parts. Some makes its way back to the veins, and some ends up as lymph. Lymph is fluid that bathes cells, allowing for nutrient and waste exchange. It flows through the lymphatic system, through lymph nodes (what we know colloquially as “glands”) before re-entering the venous system at the top of the chest.

Lymphoedema literally means “lymph swelling”. A common cause of this is after cancer, when lymph nodes have been removed through surgery or damaged by radiotherapy. For patients who have had lymph nodes around the armpit removed due to breast cancer, lymphoedema can affect the arm.

Managing lymphoedema is an important task. If the cause is surgical, you should be managed with Decongestive Lymphatic Therapy in the early stages. Once this is under control, you can be left to manage the symptoms yourself. Self massage is a big part of this, and your osteopath can help.

Vascular Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome can affect vascular circulation

The thoracic outlet is the space around the front of the shoulder where nerves and blood vessels pass between the ribcage and arm. A number of muscles and other structures in this area can compress the nerves or blood vessels and cause pain, numbness, or pins and needles into the arm.

The most common form of TOS is neurological, but in 3-10% of cases it can be blood vessels that are compromised. Although most vascular TOS cases require referral back to the GP, your osteopath will be able to differentiate between the two types and support you in getting the right care.

You should seek urgent care from your GP or hospital if your arm symptoms include:

  • white or blue skin
  • swelling
  • cold skin

For more mild cases of vascular TOS, and for neurological TOS, your osteopath can work to reduce the compression around the area. This may mean working to strengthen the upper back muscles, relaxing off the chest muscles, or identifying other causes of your symptoms.

If you have problems with your circulation, book an appointment to see how we can help.

Tennis Elbow

Tennis elbow is the common name for lateral epicondylitis. Although it can start as a simple muscle injury, the word “epicondylitis” tells us it’s become a bit more complicated. This means there’s inflammation where the end of the muscle meets the bone at the elbow.

Typical symptoms include pain and tenderness in the forearm and side of the elbow, especially during activity. This pain can also lead to a feeling of reduced strength. The inflammation can cause some swelling around the side of the elbow which is tender to touch. The body may also start compensating subconsciously. This might mean causing strains elsewhere in the arm or wrist as you move differently to avoid discomfort.

Tennis Elbow and Golfers Elbow

As the name suggests, tennis elbow can be a form of sports injury, but it doesn’t come on suddenly. Repetitive aggravation of the wrist extensor muscles irritates the junction between bone and muscle and causes localised pain and tenderness.

However, you don’t have to play tennis to develop this injury. Other sports can cause it in the same way, or even more innocuous things like carrying heavy shopping bags can bring it on. If left unmanaged it can develop beyond the usual muscle strain.

How your osteopath can help

Diagnosing tennis elbow is easily done, and although it can be a slow condition to rehabilitate, your osteopath can work with you to resolve it.

Relaxing off the muscles will reduce the pull on the bone and begin to let the whole area calm down. Your osteopath might also want to work more generally around the elbow, wrist, and shoulder to keep everything working well together. Advice for reducing or managing inflammation may also be appropriate.

Understanding the cause of the episode is important, especially if this is something that keeps coming back.

Tennis elbow vs golfer’s elbow

You may have heard of golfer’s elbow, another form of epicondylitis. Golfers elbow affects the medial epicondyle in the same way as tennis elbow affects the lateral epicondyle. Tight muscles or injury lead to inflammation around the muscular-bony junction. As before, you don’t have to play golf to develop it.

Repetitive overuse of the wrist flexor muscles predispose a person to developing golfer’s elbow. Playing a sport with a thin handle that requires you to grasp tighter can sometimes be enough to irritate the area, and prevention might be as simple as wrapping it with a thicker grip. Your osteopath can advise you on this.

The sooner you can address your tennis elbow, the better the prognosis. Book an appointment today.