Avin Patel

SIJ Pain and Pregnancy

The SIJ is a strong joint that connects the pelvis to the base of the spine. It is considered a “shock absorber” rather than a joint of mobility.

The SIJ and its referral patterns

The role of the SIJ changes in childbirth. As the baby enters the birth canal, it has to turn in a specific way to navigate through the pelvis. This is made easier by laxity of the SIJ ligaments, and increased mobility throughout the pelvis. Movement is still small, but significant compared to what is considered normal at any other time.

The SIJ in Early Pregnancy

SIJ laxity is enabled by the hormone “relaxin”. It is produced in preparation for birth from the first trimester, at which point associated aches can arise. These might be focused around the lower back, or follow the pattern illustrated above: spreading to the buttocks and legs.

Later Pregnancy

As the bump grows, the centre of gravity shifts forwards. Typically, we compensate for this by leaning back. This can lead to tightness in the muscles of the lower back as they adapt to a deeper curve in the back. However, these muscles act around the SIJ, and increased tension through them can increase pressure on the joint. These changes can cause further irritation.

At this point, the factors irritating the SIJ will not ease until birth. It is recommended that symptoms are addressed sooner rather than later. Although some discomfort in pregnancy is unavoidable, excessive pain and limited function does not have to be tolerated.

Birth and beyond

Standard pregnancy-related SIJ pain often resolves at birth or shortly after. It may take longer if the joint became inflamed, or if the joint at the front of the pelvis was irritated in response. These complications occur in SPD, which is best addressed as early as possible, and definitely before birth. This causes acute pain in the front of the pelvis, and can limit options available in childbirth. Birthing positions with the legs wide apart are not recommended for women with SPD.

If you have lower back pain associated with pregnancy, make an appointment online to get it assessed.

Arthritic Pain

Osteoarthritis and associated arthritic pain can affect any joint in the body where there is a cartilage covered bone. Commonly it affects joints of the hands or feet, spine, shoulders, hips, and knees.

Arthritic Pain

Why is arthritis painful?

Some of the pain actually comes from the body’s attempts to protect itself from discomfort. When arthritis affects part of a joint surface, it becomes uncomfortable to move through that range. Rather than purely stopping a movement at that painful range, the body tries to find a way around it. This might mean changes to posture or the way you walk, which in turn asks more of other muscles and joints.

So alongside the arthritic pain itself, you feel the strain of muscles and otherwise healthy joints having to behave differently. If the muscles that act on the joint itself get tight to try and protect the joint, they can actually cause it to become more stiff. In later stage arthritis, the space within the joint reduces. Muscles around it holding it even tighter doesn’t help the cartilage to recover.

In more advanced arthritis, pieces of cartilage can break off within the joint and “catch” on movement. The catching is usually quite unpredictable as the cartilage floats loose within the joint, so it’s hard to anticipate and prevent the pain. This in turn can lead to more compensation as the body tries to prevent any painful movement.

What can we do for arthritic pain?

To ease the symptoms of arthritis, you need to manage both the effects of the changes within the joints, and the body’s reaction to them.

Cartilage is happiest when it’s being compressed and decompressed fully. This allows waste products to be squeezed out to make room for nutrients to enter it. However, when a joint has a painful range, the body will avoid moving through that full range and pumping the cartilage as it should. It can take some work to encourage the body to move normally again.

During treatments with your osteopath, we can use gentle movements to convince the body that it is safe to move how it used to. This starts the process of compressing and decompressing the cartilage again, meaning the environment around the cartilage is already more healthy after the first treatment. Over time, and with exercise, the cartilage is given the best chance it can have to heal, or at least slow the progress of arthritis.

Your osteopath will also work to ease off the over-protective muscles that might be holding the joint stiff. If other areas are adapting as mentioned above, this can also be addressed.

Arthritis is not something you just have to live with until you can get a joint replacement! Book now to start getting your movement back.

Neck Pain

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

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

Muscle pain

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

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

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

Joint pain

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

Neck pain from arthritis

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

Intervertebral discs

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

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

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

Ligament sprains

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

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

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

Managing neck pain

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

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

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