What is Bursitis?

What are bursa?

Bursa are synovial fluid filled sacs that are approximately 4cm in diameter and 2mm thick.

Busa are located in many joints of the body such as the subacromial/subdeltoid bursa in the shoulders, olecranon bursa in the elbows, trochanteric bursa in the hip, prepatellar and infrapatellar bursa of the knee and the retrocalcaneal bursa in the ankle.

They aim to help the bones, tendons, ligaments and muscles in the joints to glide and move smoothly and decrease friction.

What is bursitis

Bursitis is inflammation and irritation of the bursa.

Symptoms include pain, tenderness, decreased joint range of motion. This can be particularly prominent on any compression of the bursa such as when laying on that side to sleep, overhead movements and more.

Bursitis can commonly occur with tendonitis of other muscles that attach to the site such the rotator cuff or gluteal muscles.

Bursitis can be diagnosed using ultrasound or MRI.

An acute bursitis can take anywhere from 4-6 weeks to heal if there is no re-injury or aggravation

Why does bursitis occur

Bursitis can occur as a result of a traumatic injury to an area or as a repetitive movement in activities such as carpentry, painting, gardening, shovelling and sports such as tennis, golf and baseball.

You are more likely to develop bursitis if you have conditions such as arthritis, gout, immune deficiencies such as HIV and diabetes, autoimmune conditions such as rheumatoid arthritis, scleroderma and lupus. Trauma and infection also predispose you to greater risk of bursitis.

How can you prevent bursitis?

As an athlete make sure you are warming up properly for 5 to 10 minutes prior to exercise and warming down properly after exercise and maintaining proper recovery strategies.

Use good equipment such as braces, shoes and pads to protect your joints.

Maintain a healthy lifestyle through exercise and diet by eating foods rich in vitamins, antioxidants, fibre, omega-3 and other anti-inflammatory foods. Avoid foods containing excess sugar and saturated fats.

What are the medical treatments for Bursitis

Medication that can be used for treatment includes nonsteroidal anti-inflammatory drugs (NSAIDS) to decrease acute pain, corticosteroid injections into the affected area and if the bursa is infected antibiotics.

Surgical treatment such as an arthroscopy in which the bursa will be drained and scar tissue removed.

What are some conservative treatments for Bursitis

Activity modification to avoid aggravating movements may be suggested. This can include overhead motions with the arms, running or laying on the side of bursitis of a hip, kneeling, bending and squatting for bursitis of the knee.

Exercise to strengthen the surrounding musculature as well as mobility to ensure that the joint and other compensatory mechanisms are working to the best of their ability may also be prescribed.

Some practitioners may choose to use ultrasound therapy or TENS machine for treatment however results are varied.

Seeing an Osteopath can also help with the symptoms of bursitis.

What will happen when you come to an osteopathic appointment?

When you come to an osteopathic appointment there are three stages of consultation. We will ask you about your injury, the mechanism of how you did it, what movements hurt, what makes it better. From there we will assess the area and test for impingement that may be caused by bursitis as well as other tests for the muscles and joints.

Through treatment we aim to decrease pain, increase range of motion and achieve specific patient set goals. Treatment can involve muscle energy techniques that focus on the muscle, joint mobilisation, fascial release, ligament release and more. After treatment we may prescribe exercises and refer you back to your doctor for scans if we think further investigation is required.

References:

What You Need to Know About Knee Bursitis – Well Heeled Podiatry. (n.d.). Retrieved June 27, 2024, from https://www.wellheeledpodiatry.com.au/what-you-need-to-know-about-knee-bursitis#:~:text=Activities%20like%20frequent%20kneeling%2C%20squatting%2C%20or%20bending%20the

Bennett, S., Macfarlane, C., & Vaughan, B. (2017). The Use of Osteopathic Manual Therapy and Rehabilitation for Subacromial Impingement Syndrome: A Case Report. EXPLORE, 13(5), 339–343. https://doi.org/10.1016/j.explore.2017.01.002

Bursa. (n.d.). Kenhub. https://www.kenhub.com/en/library/anatomy/bursa

‌bursa | Description, Types, & Function. (n.d.). Encyclopedia Britannica. https://www.britannica.com/science/bursa-anatomy

Chmielewski, R., Pena, N., Capalbo, G. (2013). Osteopathic manipulative treatment of pes anserine bursitis using the triple technique: a case report. AAOJ 23. Pp 34-38. https://www.researchgate.net/profile/Nicole-Pena-6/publication/287632071_Osteopathic_manipulative_treatment_of_pes_anserine_bursitis_using_the_triple_technique_A_case_report/links/5ff26ee5a6fdccdcb82a73d4/Osteopathic-manipulative-treatment-of-pes-anserine-bursitis-using-the-triple-technique-A-case-report.pdf?_sg%5B0%5D=started_experiment_milestone&origin=journalDetail&_rtd=e30%3D

Cleveland Clinic. (2020, May 29). Bursitis; Causes, Treatment & Prevention. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10918-bursitis

McCormack, J. (2023, October 10). Hip Bursitis Exercises To AVOID by a Physical Therapist. Flawless. https://flawlessphysio.co.uk/hip-bursitis-exercises-to-avoid/#:~:text=Walking%2C%20running%2C%20cycling%2C%20and%20many%20cardio%20exercise%20machines%2C

MSN. (n.d.). Www.msn.com. Retrieved June 27, 2024, from https://www.msn.com/en-us/health/condition/Bursitis/hp-Bursitis?source=conditioncdx

Sears, B. (2022, March 3). Bursae Are Small Structures That Protect Your Joints. Verywell Health. https://www.verywellhealth.com/bursae-anatomy-function-and-treatment-4686312

click to book

Lymphatic Drainage Sequence

Lymphatic system

Lymphatic Drainage 

Lymphatic fluid has a variety of functions. It is part of the immune system as it produces and releases lymphocytes – a type of white blood cells to protect against bacteria, virus’ and fungi. It absorbs nutrients from the intestines and moves them into the blood stream. It also gathers excess fluid and swelling and removes them.  

The path of lymphatic drainage is as follows: Blood capillaries -> Interstitial Fluid -> Lymph Capillaries -> Lymph Veins -> Lymph Ducts -> Large circulatory Veins

The fluid is moved through muscle activation of all muscles. You can assist this process by practicing breathing with your diaphragm (breathing into your belly) and also through muscle contraction.

It is not advised to perform lymphatic drainage if you have congestive heart failure, cardiac oedema, acute infections, acute DVT, malignancy, severe unstable hypertension or up to 6 weeks after surgery/trauma.

Patients with swelling not caused by these above conditions or with the condition lymphoedema can perform self lymphatic drainage in combination with other activities such as swimming for a minimum of one hour per day.

The following can all be done laying on your back.

Diaphragm Release

  1. Place hands on the lower ribs.
  2. Breathe in for four counts, hold breath for four counts, breathe out for four counts.
  3. Repeat 3 times.

Thoracic duct release

  1. Hand over the centre of the chest under the collarbones – keep this hand relaxed.
  2. Place your other hand over the top with firm pressure.
  3. With the top hand move the bottom hand in and down in the shape of a C
  4. Repeat this 5 times alongside slow breaths.

Axillary Release/Pec Release

  1. Pinch your pec muscles between your thumb and other fingers.
  2. Move your arm in a straight line diagonally towards the wall behind you. Only do this about 20 degrees and stop if there is pain.
  3. Bring the arm in front of the body diagonally trying to touch the opposite hip.
  4. Repeat until you feel the muscle relax. Try to not have your shoulder activated during this process.

Galbreath and Cervical Lymph node release

  1. Firstly, grab the ear and move it in a circle.
  2. With two knuckles either side of the jaw tracing until you reach your chin. From there trace back along the jaw and down the neck.
  3. Repeat 3 times.

Sinus release/facial drainage

Maxillary:

  1. Place your little fingers or thumbs either side of your nose just above the nostrils.
  2. Hold until you feel a softening and release then drag back towards the ear.
  3. Repeat 5 times.

Frontal:

  1. With your little fingers or thumbs hook under the brow bone.
  2. Wait till you feel a softening and then drag out following the brow bone back towards the ear.
  3. Repeat 5 times.

Inguinal release

  1. Find your hip bone and pubic bone. Following the diagonal line come to the mid point and press gently with your fingers.
  2. Bring your leg towards your head with your knee bent.
  3. Gently move your hip in a controlled circle until you feel the muscle under your hand start to relax.

Popliteal Release

  1. Begin seated. Bend and straighten your knee to assist in fluid movement.
  2. Contact the back of your knee with your fingers and the sides of your knee with the heel of your hand. Use both hands to encourage fluid movement by pushing to one side and then the other.

Massage:

You can help manually move fluid with your hands after doing all of these steps as the channels will be open.

Begin with your legs and work up, dragging the fluid past the immediate joints e.g. foot past ankle, ankle past knee, knee to hip. Take your hands off when you pass the individual joints and start again until you feel a decrease of fluid in the area – this will stop a backwash of fluid.

As Osteopaths we regularly see people with lymphatic congestion and do a lot of work to help with lymphatic drainage and restoring the body to a state where it can clear excess fluid. If you would like to know more or book an appointment call our clinic on 07 5613 3505

References:

BRMI | Therapeutics – Lymphatic Drainage & Massage. (n.d.). Bioregulatory Medicine | BRMI Bioregulatory Medicine Institute. Retrieved June 28, 2024, from https://www.brmi.online/lymph

Cleveland Clinic. (2023, July 31). What Does the Lymphatic System Do? Learn Its Function & How It Works. Cleveland Clinic; Cleveland Clinic. https://my.clevelandclinic.org/health/body/21199-lymphatic-system

Physiopedia. (n.d.). Manual Lymphatic Drainage. Physiopedia. https://www.physio-pedia.com/Manual_Lymphatic_Drainage

The Editors of Encyclopedia Britannica. (2019). lymphatic system | Structure, Function, & Facts. In Encyclopædia Britannica. https://www.britannica.com/science/lymphatic-system

 

 

Book with an Osteo

What can you take to help your nerves regenerate?

Lymphatic system

What can you take to help your nerves regenerate?

Benfotiamine

Alpha Lipoic Acid (ALA)

Acetyl-L-Carnitine

Methylcobalamin (Vitamin B12)

  • Supports Nerve Health: Methylcobalamin is a form of vitamin B12 that is important in maintaining healthy nerve cells and red blood cells.
  • Improves Cognitive Function: It has been linked to improved cognitive function and may help reduce the risk of neurodegenerative diseases.
  • Boosts Energy Levels: Vitamin B12 is essential for energy production and can help combat fatigue.

Coenzyme Q10 (CoQ10)

Gamma-Linolenic Acid (GLA)

N-Acetyl Cysteine (NAC)

  • Benefits: Acts as an antioxidant and supports the production of glutathione, which helps protect nerve cells from oxidative stress.

Magnesium

  • Benefits: Helps regulate nerve function and reduce symptoms of neuropathy.

Vitamin D

  • Benefits: Supports overall nerve health and may help reduce pain and inflammation associated with nerve damage.

Curcumin

  • Benefits: The active compound in turmeric, curcumin has anti-inflammatory and antioxidant properties that can support nerve health.

Omega-3 Fatty Acids

  • Benefits: Found in fish oil, these fatty acids support nerve cell membrane health and reduce inflammation.

These ingredients work together to support nerve health, reduce oxidative stress, and improve overall metabolic and cognitive function.

References

Balakumar, P., et al. (2016). Benfotiamine attenuates hyperglycemia-mediated vascular endothelial dysfunction: Role of oxidative stress. Pharmacological Research, 105, 198-204. https://doi.org/10.1016/j.phrs.2016.01.021

Biewenga, G. P., et al. (2017). The role of lipoic acid in the treatment of diabetic polyneuropathy. Current Diabetes Reports, 17(9), 79. https://doi.org/10.1007/s11892-017-0904-8

Gibson, G. E., et al. (2016). Abnormal thiamine-dependent processes in Alzheimer’s Disease. Lessons from diabetes. Molecular and Cellular Neuroscience, 77, 47-54. https://doi.org/10.1016/j.mcn.2016.01.005

Gorąca, A., et al. (2011). Lipoic acid – biological activity and therapeutic potential. Pharmacological Reports, 63(4), 849-858. https://doi.org/10.1016/S1734-1140(11)70698-1

Malaguarnera, M. (2012). Carnitine derivatives: clinical usefulness. Current Opinion in Gastroenterology, 28(2), 166-176. https://doi.org/10.1097/MOG.0b013e32834e7b4b

Obeid, R. (2013). Vitamin B12 in health and disease: Deficiency and its prevention. Nutrition Reviews, 71(2), 110-122. https://doi.org/10.1111/nure.12001

Sima, A. A., et al. (2014). Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy. Diabetes Care, 37(1), 89-94. https://doi.org/10.2337/dc13-1380

Smith, A. D., et al. (2018). Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial. PLoS One, 13(9), e12244. https://doi.org/10.1371/journal.pone.012244

Stabler, S. P. (2013). Vitamin B12 deficiency. New England Journal of Medicine, 368(2), 149-160. https://doi.org/10.1056/NEJMcp1113996

Thornalley, P. J., et al. (2014). Benfotiamine prevents the development of experimental diabetic nephropathy. Diabetologia, 57(5), 1030-1040. https://doi.org/10.1007/s00125-014-3183-8

Veronese, N., et al. (2018). Acetyl-L-carnitine supplementation and the treatment of depressive symptoms: A systematic review and meta-analysis. Psychosomatic Medicine, 80(2), 154-159. https://doi.org/10.1097/PSY.0000000000000546

Volvert, M. L., et al. (2013). Benfotiamine prevents peripheral neuropathy in diabetic mice. Diabetes & Metabolism, 39(6), 554-561. https://doi.org/10.1016/j.diabet.2013.09.002

Ziegler, D., et al. (2016). Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabetes Care, 39(3), 336-343. https://doi.org/10.2337/dc15-092

Understanding Tissue Healing Times:

Understanding Tissue Healing Times

When we sustain an injury, one of the first questions that come to mind is, “How long will it take to heal?” The answer depends on various factors, including the type of tissue injured, the extent of the damage, and individual health conditions. Understanding the healing process can help manage expectations and optimize recovery.

Phases of Tissue Healing

Tissue healing generally occurs in three phases:

  1. Inflammatory Phase: This phase is the bodies immediate response to injury and typically is characterised by redness, swelling, heat, and pain. The primary goal is to prevent further damage and initiate the healing process.
  2. Proliferative Phase: This phase starts within 24-48 hours post-injury and can last several weeks. During this time there is production of new, healthy tissue and the wound begins to close.
  3. Remodelling Phase: This final phase can last from several months to over a year. The new tissue slowly gains strength and flexibility as the body continues to remodel and refine the new tissue.

Healing Times for Different Tissues

Different tissues in the body heal at varying rates. Here’s a breakdown of typical healing times for various tissues:

  • Muscle Tissue: Muscle injuries, such as strains, can take anywhere from a few weeks to several months to heal, depending on the severity. Grade one strains are where the muscle fibres have been over stretched however not torn and take between one and three weeks to heal. Grade two strains are where most fibres are torn, and they take anywhere from three weeks to three months to heal. Finally grade three strains are where all of the fibres are torn – this usually required surgery to fix and can take anywhere from four to six weeks to heal.
  • Tendons: Tendon injuries often require 4-6 weeks for initial healing, but full recovery – that is return to activity, can take several months due to the limited blood supply to tendons.
  • Ligaments: Similar to muscle gradings, ligament healing times vary based on the injury grade. A mild, grade1 sprain can take 4-10 days, grade 2 sprain in 3 weeks to six months and a grade three sprain – also called a rupture can heal in five weeks to eight months and may need surgical intervention.
  • Bones: Bone fractures typically heal within six to eight weeks however can take up to three months depending on their severity. Factors such as age, nutrition and type of fracture can affect healing time.
  • Cartilage: Cartilage injuries are particularly challenging due to the tissue’s poor blood supply. Healing can take anywhere from two months to two years.
  • Nerves: Nerve injuries may or may not heal. If they do they heal very slowly, at a rate of about 1-3 millimetres per day. Healing can take months to years.

Factors Influencing Healing Times

Several factors can affect how quickly tissues heal:

  • Age: Younger individuals generally heal faster than older adults.
  • Overall Health: Good nutrition, hydration, and overall health can significantly impact healing times.
  • Blood Supply: Tissues with a rich blood supply, like muscles, tend to heal faster than those with limited blood supply, like tendons and cartilage.
  • Extent of Injury: More severe injuries naturally take longer to heal.
  • Post Injury Care: proper care, rest recovery and rehabilitation are important to improve positive outcomes after injury.

Optimising Healing

To optimise healing, it’s essential to follow medical advice, maintain a healthy lifestyle, and be patient. Understanding the typical healing times for different tissues can help set realistic expectations and encourage a proactive approach to recovery.

References:

Overview of Sprains and Other Soft-Tissue Injuries – Injuries and Poisoning. (n.d.). MSD Manual Consumer Version. https://www.msdmanuals.com/home/injuries-and-poisoning/sprains-and-other-soft-tissue-injuries/overview-of-sprains-and-other-soft-tissue-injuries

PT, J. T., & MPT. (2020, February 1). How Long Do Injuries Take to Heal? Thrive Physical Therapy. https://thriveptpilates.com/2020/02/how-long-do-injuries-take-to-heal/

Tissue Healing Times and Wound Healing Phases. (n.d.). Physical Therapy Web. Retrieved July 30, 2024, from https://physicaltherapyweb.com/tissue-healing-timelines/

What You Need To Know About Tissue Healing | The Prehab Guys. (2020, July 22). [𝗣]𝗥𝗲𝗵𝗮𝗯. https://theprehabguys.com/tissue-healing-timelines/

The Benefits of Pregnancy Massage

The Benefits of Pregnancy Massage:

Pregnancy is a beautiful journey, but it often comes with its share of physical and emotional challenges. One way to help alleviate some of these discomforts is through pregnancy massage, also known as prenatal massage. This specialised form of massage therapy is tailored to the unique needs of expectant mothers and offers a range of benefits supported by evidence.

  1. Reduction in Pain and Discomfort

Pregnancy can bring about various aches and pains as the body adapts to the baby’s growth – particularly in the back, hips and legs as the mother’s centre of gravity changes and the body begins to compensate. Prenatal massage can help alleviate these discomforts by targeting specific muscle groups and using techniques such as Swedish massage, which involves gentle, long strokes and kneading.

  1. Improved Circulation

As the body undergoes changes during pregnancy, circulation can become less efficient. This is as the amount of blood your body has is increased by 45% and the uterus can sometimes press on blood vessels decreasing the blood flow to the legs. Prenatal massage helps improve blood flow, which can reduce swelling in the hands and feet, a common issue for many pregnant women. Increasing the circulation can also help deliver nutrients and oxygen better to the mother and baby.

  1. Reduction in Stress and Anxiety

Pregnancy can be a stressful time, and managing stress is crucial for the health of both the mother and the baby. Pregnancy massage can decrease the level of cortisone (the stress hormone) and increase happy hormones such as serotonin and dopamine.  This can better overall mental health and contribute to a more positive pregnancy experience.

  1. Better Sleep

Many pregnant women struggle with sleep disturbances due to physical discomfort and hormonal changes. Prenatal massage can promote better sleep by relaxing the muscles and calming the nervous system. 

  1. Preparation for Labor

Regular prenatal massage can help prepare the body for labour by improving muscle tone and flexibility. Some specific techniques like perineal massage can reduce the risk of tearing during delivery.

  1. Emotional Support and Connection

The physical touch and care provided during a prenatal massage can offer emotional support and a sense of connection. This can be particularly beneficial for first-time mothers who may feel anxious about the changes they are experiencing. The nurturing environment of a massage session can provide a safe space for relaxation and emotional release.

  1. Safety Considerations
  1. Timing: Most experts recommend avoiding massage during the first trimester due to the higher risk of miscarriage during this period, although there is no evidence that physical therapy of any kind causes miscarriage
  2. Qualified Therapist: It’s crucial to have the massage performed by a therapist trained in prenatal massage. They will know the appropriate techniques and positions to ensure safety and comfort.
  3. Pressure Points: Certain pressure points, particularly around the ankles and wrists, are believed to potentially trigger contractions. A trained therapist will avoid these areas.
  1. Potential Risks
  1. Blood Clots: Deep tissue massage is generally avoided during pregnancy as it can potentially dislodge blood clots, which are more common during pregnancy.
  2. Preeclampsia and Other Complications: Women with certain conditions such as preeclampsia, high blood pressure, or a history of preterm labour should consult their healthcare provider before getting a massage2.

References;

American Massage Therapy Association (AMTA). (n.d.). Pregnancy and massage. Retrieved from https://www.amtamassage.org/resources/massage-and-health/medical-treatments/pregnancy-and-massage/

Cleveland Clinic. (n.d.). Prenatal massage. Retrieved from https://health.clevelandclinic.org/prenatal-massage

FamilyEducation. (n.d.). Circulation problems during pregnancy. FamilyEducation. Retrieved August 8, 2024, from https://www.familyeducation.com/pregnancy/complications/circulation-problems

Healthline. (n.d.). Where not to massage a pregnant woman. Retrieved from https://www.healthline.com/health/pregnancy/where-not-to-massage-a-pregnant-woman

PregnancyResource.org. (n.d.). Prenatal massage. Retrieved from https://www.pregnancyresource.org/prenatal-massage/

Verywell Health. (n.d.). Pregnancy massage: Benefits, contraindications, and safety. Retrieved from https://www.verywellhealth.com/pregnancy-massage-benefits-contraindications-and-safety-5190485

WebMD. (n.d.). Pregnancy and massage. Retrieved from https://www.webmd.com/baby/pregnancy-and-massage

What to Expect. (n.d.). Prenatal massage. Retrieved from https://www.whattoexpect.com/pregnancy/pregnancy-health/prenatal-massage/

Book now

Radiculopathy

Radiculopathy

What is radiculopathy?

Radiculopathy is described as irritation of a single nerve root that can be caused by a variety of musculoskeletal and immune factors. This is different from Myelopathy which is narrowing of the vertebra causing compression of the spinal cord.

Radiculopathy can be caused at any level of the spine however it is most common in the cervical spine (neck) and lumbar spine (low back). Radiculopathy of the neck is most common over 40 years of age however radiculopathy into your legs is generally more common irrespective of age. It can result in muscular atrophy and weakness.

What is it caused by?

Radiculopathy can be caused at the level of the spine or along the nerve pathway.

Compression of the nerve root can be caused by disc herniation (disc bulge), trauma resulting in narrowing or displacement of the spine, bone or tumour growth, diabetes, and immune disease.

A peripheral cause may be Deep Gluteal Pain Syndrome. It presents with pain on sitting, burning/cramping in the buttock and posterior thigh, radiculopathy in the lower limb and can be caused by a history of trauma.

What are the conservative treatments:

Conservative treatment includes manual therapy, such as Osteopathy, pharmaceutical pain therapy and the use of corticosteroid injections. This treatment aims to decrease inflammation around the nerve and as a result reduce pain. Results vary and some patients may have a decrease in pain and increase in function however it is only a short-term solution (Chou et. al., 2015).

What is involved in surgery:

Surgery in the case of a disc bulge includes a discectomy – that is the removal of excess disc tissue that is compressing the nerve and causing radicular symptoms. This procedure is performed as a minimally invasive surgery and typically the patient will be discharged the same or next day. Risks include recurrent disc herniation – a bulging disc at a different level of the spine, infection and bleeding. The success rate for this surgery is between 70% – 90% (Cluett, 2023)

What can we do as osteopaths?

Osteopathic treatment commonly consists of de-loading and decompressing the area. This can be done using traction, mobilisation, soft tissue and nerve flossing (Kuligowski et. al., 2021). Mobilisation was found to be effective at improving functional ability and range of motion when applied in both a rhythmic or static position (Hassan et. al., 2020).

Practitioners may decide to use manipulation in the thoracic in the treatment of cervical radiculopathy. A study by young et. al. (2019) revealed that thoracic manipulation improved pain, disability, cervical rom and deep neck flexor endurance.

A study by Langevin et. al. revealed that when combined with exercise manual therapy is effective in reducing neck radiculopathy pain and increasing functionality. This included mobilisation and facet gliding as well as strengthening of the deep stabilising muscles, muscles of the spine and muscles that would help increase range of motion that were specific to the patient (Langevin et. al., 2015).  Strengthening exercise can include press ups, flexion rotation stretches, lumbar glides and pelvic tilts (Sears, 2023)

Addition of neurodynamic exercises such as sciatic nerve flossing can result in reduced nerve symptoms and mechanical sensitivity however do not appear to assist in decreasing pain (Plaza-Manzano et. al., 2020).

 

Sciatic Nerve Flossing Instructions:

  • Begin in a seated position and straighten your knee on the effected leg.
  • Pull your toes towards your head.
  • Look to the floor.
  • Reverse those steps until you are again in a normal seated position.
  • Repeat ten times.

 

References:

Chou, R., Hashimoto, R., Friedly, J., Fu, R., Bougatsos, C., Dana, T., Sullivan, S.D., Jarvik, J. (2015). Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis. Annals of Interna; Medicine 162, 373-381. https://doi.org/10.7326/M15-0934

Cluett, J. (20 September, 2023). Lumbar Discectomy for a Herniated Disc. Very Well Health. Lumbar Discectomy – Spine Surgery to a Herniated Disc (verywellhealth.com)

Healthline. (23 April, 2018). Nerve Flossing Exercises to Try. Nerve Flossing: How it Works for Sciatica and Other Conditions (healthline.com)

Kuligowski, T., Skrzek, A., Cieslik, B. (2021). Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature. International Journal of Environmental Research and Public Health 18. https://doi.org/10.3390/ijerph18116176

Langevin, P., Desmeules, F., Lamothe, M., Robitaille, S., Roy, J.S. (2015). Comparison of 2 Manual Therapy and Exercise Protocols for Cervical Radiculopathy: A Randomised Clinical Trial Evaluating Short-Term Effects. Journal of Orthopaedic and Sports Physical Therapy 45, 1-17. https://doi.org/10.2519/jospt.2015.5211

Plaza-Manzano, G., Cancela-Cilleruelo, I., Fernández-de-Las-Peñas, C., Cleland, J.A., Arias-Buria, J.L., Thoomes-de-Graaf, M., Ortega-Santiago, R. (2020). Effects of Adding a Neurodynamic Mobilization to Motor Control Training in Patients With Lumbar Radiculopathy Due to Disc Herniation: A Randomized Clinical Trial. American Journal of Physical Medicine and Rehabilitation 99 (2), 124-132. https://doi.org/10.1097/PHM.0000000000001295.

Sears, B. (27 May, 2023). Epidural Corticosteroid Injections for Sciatica: Epidural for nerve pain in the lower back, buttocks, and thigh. Very Well Health. Epidural Corticosteroid Injections for Sciatica (verywellhealth.com)

Young, I.A., Pozzi, F., Dunning, J., Linkonis, R., Michener, L.A. (2019). Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial. Journal of Orthopaedic and Sports Physical Therapy 49 (5), 299-309. https://www.jospt.org/doi/10.2519/jospt.2019.8150

 

 

Book with an Osteopath

Shin Splints

What are Shin Splints?

Shin Splints are the common name for a condition in which the muscles on top of the shin bones – the tibia and the fibula, become tight and as a result cause pain.

It mostly occurs after an increase in activity – either frequency, length or intensity, and can last for an undetermined amount of time depending on various factors such as exercise, rest and strength.

Medial Tibial Stress Syndrome:

Medically, shin splints are referred to as Medial Tibial Stress Syndrome (MTSS). It is caused by overuse and is commonly seen in athletes and military personnel. The cause of MTSS is not known however many factors can cause it including overtraining, poor unsupportive footwear, ankle muscle imbalance, tight triceps surae muscles (calf/soleus) and your back being out of balance.

Typically MTSS presents with a diffuse (wide spread) palpable pain worse after exercise – it is more common in females than males. The pain is usually described as a dull ache that gets better with rest. One reason MTSS is so painful is due to periostitis – the inflammation of the periosteum (covering of the bone) where the muscle attaches.

Specific movements that may cause pain is knee extension – that is the straightening of the leg, as this activated the muscles affected. Inflammation of the Achilles tendon (Achilles tendonitis), the bursa on the back of the heel (retrocalcaneal bursitis), plantar fasciitis (irritation of the plantar fascia), medial arch discomfort, calf pain and cramping, iliotibial band syndrome and Osgood Schlatter’s can also occur at the same time as MTSS.

One of the risks of having MTSS repeatedly or long term is a stress fracture. Signs this has occurred is when pain occurs after activity has finished into cooldown and daily activities. Another sign is when the pain becomes less wide spread and more specific to the inside of the tibia (shin bone) and the from halfway up the shin down after exercise. Imaging such as x-ray and magnetic resonance imaging (MRI) can be used to detect other sources of pain as well as stress fractures.

Treatment:

Treatment of MTSS varies depending on therapist and sport. In the acute, short-term treatment use of compression stockings, anti-inflammatories, rest and either ice or heat depending on the varied evidence. Kinesiology taping uses tape that aims to relieve pain, facilitate proprioception, change muscle activation and correct abnormal movement patterns.

Long term orthotics (inserts) and supportive shoes can be used to try and correct the posture of the foot. Increasing the supination (weight on the outside of the foot), strength of the inverter/evertor muscles and releasing the muscles on the bottom of the foot can also be helpful. Supplements such as vitamin D, calcium for bone health/density and magnesium for muscle fatigue should be taken long term as preventatives.

Manual therapy, such as osteopathy can be beneficial in both the short and long term phases of shin splints/MTSS. Through various techniques such as soft tissue, myofascial release, mobilisation and manipulation treatment is aimed at decreasing muscle tension, improving joint mobility and releasing the fascia of the foot and lower leg.

References

Bhusari, N. and Deshmukh, M. Shin splint: a review. Cereus, 15 (1), e33905. https://doi.org/10.7759/cureus.33905

Guo, S., Lui, P. (2022). Efficacy of Kinesiology taping on the management of shin splints: a systematic review. The physician and sports medicine 50 (5), 369-377. https://doi.org/10.1080/00913847.2021.1949253

Schulze, C. Finze, S., Bader, R., Lison, A. (2014). Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study. The Scientific World Journal, 790626. https://doi.org/10.1155/2014/790626


Yüksel, O., Ozgürbüz, C., Ergün, M., Işlegen, C., Taskiran, E., Denerel, N., Ertat, A. (2011). Inversion/eversion strength dysbalance in patients with medial tibial stress syndrome. Journal of sports science & medicine 10 (4), 737-742. Inversion/Eversion strength dysbalance in patients with medial tibial stress syndrome – PubMed (nih.gov)

Ozgürbüz, C., Yüksel, O., Ergün, M., Işlegen, C., Taskiran, E., Denerel, N., Karamizrak, O. (2011). Tibial bone density in athletes with medial tibial stress syndrome: a controlled study. Journal of sports science & medicine 10 (4), 743-747. Tibial bone density in athletes with medial tibial stress syndrome: a controlled study – PubMed (nih.gov)

 

Click Book with one of our Osteopaths

Ankylosing Spondylitis

Ankylosing Spondylitis

What is Ankylosing spondylitis?

Ankylosing spondylitis is an autoimmune condition where inflammation occurs first in the sacroiliac, intervertebral and intercostal joints. From there inflammation also occurs in joint cartilage causing degeneration, ossification (making bone) and then joint fusion.

Patients are more likely to develop ankylosing spondylitis if a family member has the disease due to the hereditary nature of the condition.

It is more likely to occur in the Caucasian population, males more than females and between the ages of 20-40 years. It typically presents as a sudden onset of low back pain that lasts for three months or more. The stiffness is worse after periods of inactivity, improved through the day, and is helped with heat. Pain and grinding can occur in the spine alongside muscle weakness and balancing issues.  

You may also develop associated issues such as tendonitis, fasciitis and dactylitis. Sometimes patients may also present with eye issues such as uveitis and iridocyclitis – inflammation of the eye. This can present with sudden eye pain, redness, light sensitivity and decreased vision.

Assessment:

When you come in for your appointment your osteopath will assess different regions of your body and spine including your neck, back, pelvis and hips.

We may send you for a blood test looking for HLAB27 and an increased level of inflammatory factors interleukin 12, 17 and tumour necrosis factor which can be an indication of a genetic disposition for ankylosing spondylitis. X-ray’s may also be ordered to confirm the presence of the disease.

To be diagnosed with ankylosing spondylitis you may need to have a combination of the below;

  • Inflammatory pain and morning stiffness in the low back for a minimum of three months. This should improve with exercise and is not relieved by rest.
  • Limitation of range of motion in the lumbar spine in rotation, flexion/extension and side bending
  • Decreased chest examination.
  • Sacroiliitis identified on X-ray that is between grades two and four.
  • Decreased joint space, calcification of ligaments, squaring of the vertebrae and joint fusion.

Medical Treatment:

Corticosteroids can be beneficial in a short course and long term non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs can assist in preserving quality of life.  

Osteopathic Treatment:

Osteopathic treatment is unable to cure ankylosing spondylitis, however it aims to improve quality of life and activities of daily living. This is through a holistic approach that focuses on the local biomechanical changes as well as the greater impact on muscles and posture.

Treatment focuses on mobilisation of joints, ligament and soft tissue techniques and decreasing swelling. There has been evidence that suggests significant improvement in pain and quality of life when combined with physical strengthening focusing on weightlifting, resistance training and core stability.

Typically, due to the progression of ankylosing spondylitis no manipulation is used as it poses significant risk of damage to soft tissue and joint structures.

Needling:

Use of needling through the modalities of acupuncture or dry needling has been shown to be effective.

Needling can have a pain-relieving affect and assist in immune function. In addition, the meridian theory followed in acupuncture believes that needling points related to the kidney can have a benefit in alleviating spinal pain, improving spinal function and reduce the levels of tumour necrosis factor and inflammatory factors.

Specific needling/acupuncture points that can be used to decrease pain include KD3/6, LV8, ST36, GB34, BL11/23/29/52/40

Referencing:

Ebrahimiadib, N., Berijani, S., Ghahari, M., & Golsoorat Pahlaviani, F. (2021). Ankylosing Spondylitis. Journal of Ophthalmic and Vision Research, 16(3). https://doi.org/10.18502/jovr.v16i3.9440

Seiler, M., Vermeylen, B., Poortmans, B., Feipel, V., & Dugailly, P.-M. (2020). Effects of non-manipulative osteopathic management in addition to physical therapy and rehabilitation on clinical outcomes of ankylosing spondylitis patients: A preliminary randomized clinical trial. Journal of Bodywork and Movement Therapies, 24(4), 51–56. https://doi.org/10.1016/j.jbmt.2020.06.028

Xuan, Y., Huang, H., Huang, Y., Liu, D., Hu, X., & Geng, L. (2020). The Efficacy and Safety of Simple-Needling Therapy for Treating Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine, 2020, 1–10. https://doi.org/10.1155/2020/4276380

Zhang, Y., & Song, A. (2022). Clinical research progress of acupuncture therapy in the treatment of ankylosing spondylitis. Medical Theory and Hypothesis, 5(2), 4. https://doi.org/10.53388/tmrth202206004

 

 

Consult an Osteopath

Baker’s Cyst

What are Baker’s Cysts:

Also called popliteal cysts, baker’s cysts occur behind the knee in the popliteal fossa and are fluid filled sacs. They are predominantly asymptomatic and usually discovered during imaging for another unrelated condition.

Symptoms associated with these cysts include knee pain, tightness, and discomfort. Pain worsens with increased activity and decreases range of motion. Inflammation is most visible when the knee is at full extension and least visible at 45 degree flexion.

Lower limb swelling can occur due to the cyst’s impingement of blood vessels and in some cases may present the same as deep vein thrombosis. If the cyst bursts it can cause inflammation/swelling, sharp knee/calf pain and a sensation of water running down the calf. When the cyst busts it can cause nerve entrapment, blood vessel blockage and compartment syndrome.

It is typically diagnosed through physical examination and imaging such as plain radiography, ultrasound and MRI.

Causes:

The knee is a synovial joint where a capsule of synovial fluid cushions between the two bones. Bakers’ cysts can occur when this synovial fluid accumulates and moves between muscle attachments to the knee. This is due to the pressure gradient between the knee joint capsule and fossa moving fluid flow into the fossa.

While more common in adults they can also occur in children. However rather than being caused by a co-morbidity they typically occur when the knee joint capsule herniates.

Commonly occurring in patients aged 35 to 70 years of age or in children 4 to 7 years of age.

Inflammation of the semimembranosus (hamstring) bursa can also cause fluid build up in addition to arthritis, meniscus damage and other degenerative conditions.

Risk factors:

Patients that have a history of trauma to the knee cartilage and meniscus are at greater risk of developing a baker’s cyst. In addition, they commonly occur when patients have degenerative conditions such as arthritis.

 

Treatment:

If the cyst is asymptomatic and is discovered by accident during imaging or another condition no treatment is typically performed.

Conservative treatment involves behaviour modification such as decreasing aggravating activity and taking anti-inflammatories/pain relief.

In children conservative treatment of the cyst is preferred if the site is not painful and the size of the cyst is less than 3 cm. If the cyst is larger than this and presents with pain surgical excision is considered.

Aspiration (drainage) of the cyst can be performed in which a needle is placed through the posterior leg at the popliteal fossa and into the baker’s cyst. From there a syringe is used – this procedure is performed under ultrasound guidance. Corticosteroid injections into the baker’s cyst aiming to decrease the size of the cyst and relieve pain can also be performed. Risks with these interventions include pain, bleeding, infection, tissue damage and cyst recurrence.

Surgical intervention includes arthroscopy where the degenerative tissue is removed. Complete excision of the cyst can also be performed however this is not recommended in patients that have developed the cyst secondary to degenerative conditions.

Our Osteopaths have found that patients report increased range of motion and improved function after treatment.

 

 

References:

Al Khateeb, A. (2024). Bakers Cyst. Baker cyst | Radiology Case | Radiopaedia.org

Fredericksen, K., & Kiel, J. (2021). Bedside ultrasound-guided aspiration and corticosteroid injection of a baker’s cyst in a patient with osteoarthritis and recurrent knee pain. Journal of the American College of Emergency Physicians Open, 2(2), e12424. https://doi.org/10.1002/emp2.12424

Leib, A. D., Roshan, A., Foris, L. A., & Varacallo, M. (2020). Baker’s Cyst. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430774/

Mansour, M. A., Shehata, M. A., Shalaby, M. M., Arafa, M. A., & Almetaher, H. A. (2021). Baker’s cyst in children: conservative management versus surgical excision according to clinical and imaging criteria. Annals of Pediatric Surgery, 17(1). https://doi.org/10.1186/s43159-021-00071-1

‌Nanduri, A., Stead, T. S., Kupsaw, G. E., DeLeon, J., & Ganti, L. (2021). Baker’s Cyst. Cureus, 13(12). https://doi.org/10.7759/cureus.20403

Patel, C. (29 August 2012). Baker’s Cyst. Baker’s cyst – wikidoc

Van Nest, D. S., Tjoumakaris, F. P., Smith, B. J., Beatty, T. M., & Freedman, K. B. (2020). Popliteal Cysts: A Systematic Review of Nonoperative and Operative Treatment. JBJS Reviews, 8(3), e0139. https://doi.org/10.2106/JBJS.RVW.19.00139

 

Book Online

Nerve Impingement

Lymphatic system

What is Nerve Impingement?

Nerve impingement or entrapment occurs when nearby bone – whether it be vertebrae or otherwise, impinge on the pathway of the nerve or the nerve itself resulting in neurological symptoms.

Nerve impingement typically only occurs on a single side unless it presents in the spine when caused by a disc or narrowing of the spinal foramen (gaps where the nerves exit the spinal cord). In the extremities it can occur at the elbow, knee, fibular, hips, wrists and shoulders.

It is more common if the patient has experiences trauma in the past. There can be feelings of the joint “Giving out”, decreased sensation of hot/cold, fine touch, sharp and dull as well as tingling, numbness or weakness. 

In the legs the most common nerve impingement is of the peroneal/fibular nerve which runs on the outside of your shin. When this nerve is impinged it can cause a foot drop where the food cannot lift the ball of their feet or toes. They may have pain in the knee or below, weakness in the movement of pulling the toes to the ceiling and a burning/tingling pain on the top of the foot.

The most common form of nerve impingement in the upper limb is of the median nerve. This is commonly known as carpal tunnel and affects 3% of the adult population, mostly female and between the age of 40 and 60 years old. Like nerve entrapment of the lower limb patients will experience neurological symptoms and weakness. Repetitive movements found in occupations such as admin (office work) and trades can increase the risk of carpal tunnel syndrome.

 

Assessment:

Firstly, your osteopath will look at the area of symptoms and the associated chain. For example, if it is the foot they will look at the foot, knee, hip and low back. They will assess range of motion, the nerve pathway and possibly perform a Tinel tap (taping the nerve to reproduce neural symptoms). They may refer you to a radiographer for imaging such as an x-ray if this was after an acute trauma, ultrasound to identify soft tissue lesions or scar tissue build up. In addition, general practitioners (GP’s) can perform motor conduction studies where they test musculature innervated by nerves in the same chain to identify what nerve may be impinged.

Lower limb neurological assessments will also be performed that identify reflexes, strength of muscles/nerves, light touch sensation of nerves, sharp and cold sensation of nerves. These tests will be performed on both sides to make sure it is an issue with the peripheral nervous system and not the central nervous system (spinal cord). 

 

Treatment:

Osteopathically your practitioner will work on decreasing tissue tension in the area – this includes muscles and ligaments. They will work on the joint itself as well to increase space and range of motion.

As the nerves begin in the spinal cord you may find your practitioner works on the entire chain (Neck, shoulder, elbow wrist or low back, pelvis/hip, knee and ankle). This can be done using a variety of techniques such as soft tissue, mobilisation, manipulation (if deemed appropriate) as well as more indirect techniques such as balance ligamentous tension, osteopathy in the cranial field and functional techniques. In addition, we may prescribe stretching, strengthening and nerve gliding exercises.

As we are a holistic therapy, we will also ask about your lifestyle factors such as sleeping position, work, exercise and more. We may suggest changes to the positions or activities you are doing to see if it makes an improvement of the symptoms.

Surgically, nerve blocks using a lidocaine solution may be used or a local corticosteroid injection. If there is a build-up of scar tissue in the area the practitioner may work on that or refer you to a specialist for a procedure called neurolysis for nerve decompression – this has been seen to be effective in patients with nerve injured less than or equal to 8 cm in length. There is a healing time of 3-4 months however healing can take up to 12 months depending on a range of factors.

 

References

Carpal tunnel syndrome: MedlinePlus Genetics. (n.d.). Medlineplus.gov. https://medlineplus.gov/genetics/condition/carpal-tunnel-syndrome/

Fortier, L.M., Markel, M., Thomas, B.G., Sherman, W.F., Thomas, B.H., Kaye, A.D. (2021). An update on

peroneal nerve entrapment and neuropathy. Orthopaedic reviews, 13(2). Pp 24937. https://doi.org/10.52965/001c.24937

Klifto, K.M., Azoury, S.C., Gurno, C.F., Card, E.B., Levin, L.S., Kovach, S.J. (2022). Treatment approach

to isolated common peroneal nerve palsy by mechanism of injury: systemic review and meta-analysis of individual participatnts’ data. Journal of plastic, reconstructive and aesthetic surgery, 75(2). Pp 683-702. https://doi.org/10.1016/j.bjps.2021.09.040

LaPrade, R. (2022). Peroneal Nerve Entrapment.

Peroneal Nerve Entrapment (drrobertlaprademd.com)

Book with an Osteopath