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

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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

 

 

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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)

 

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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

 

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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)

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Occipital Neuralgia

What is Occipital Neuralgia?

Occipital neuralgia is an irritation and/or damage to the greater or lesser occipital nerve. In 90% of cases the greater occipital is the primary nerve irritated, and only 10% of cases had the lesser occipital nerve as the cause.

When these structures are damaged it can result in a bilateral (on both sides) ache, throbbing or burning pain that begins at the base of the skull and comes over the scalp. This can sometimes occur in a ram’s horn pattern going from the base of the neck in a circle to in front of the ear and near the eye. It is likely to occur after there is a trauma to the area such as a bend and twist of the neck.

In addition to the symptoms above there can be pain in the upper neck that can be associated with nausea and sensitivity to light. There can be a positive tunnel’s sign – reproduction of neurological tingling and numbness, after there is palpation o f these nerves. Other symptoms can include tinnitus (ringing of the ears), dizziness and blurred vision, scalp tenderness and headaches.

Assessment:

When you see an osteopath physical examination will include examination of the neck to identify tight muscles at the mase of the skull, range of motion, neurological testing and identification of referral pain. Tests that identify any possible ligament damage, facet irritation and nerve irritation will also be performed. These tests may aggravate your symptoms however that is necessary in order to pinpoint what is going on.

To rule out any damage to the nerves of the skull and those that innervate the arms neurological strength and sensation testing will be performed. Outcome measures such as the neck disability index may be performed and a referral to the patient’s general practitioner for an MRI/CT and possible nerve block may also be required.

Treatment:

Conservative treatment includes manual therapy such as osteopathy, massage and physiotherapy that focuses on decreasing tight muscle, neuropathic pain and referral.

Our osteopathic practitioners can use a variety of techniques including inhibition, soft tissue, mobilisation, manipulation as well as techniques from osteopathy in the cranial field – something which we specialise in and is performed by no other modality. It is common after treatment to experience some aggravated symptoms however this should subsite within one to two days.

The application of heat and steroids can be used to temporarily manage pain levels and medication is typically prescribed by your doctor. Over the counter anti-inflammatory medications can also have an effect. It is advised that these methods are used regularly and over a shorter period of time.

Other conservative interventions include nerve blocks which last a period of three to four months can also be affective as they contain anaesthetic and anti-inflammatory medications.

Pulsed radiofrequency uses a radiology machine as a treatment mechanism. The theory is that by exposing the nerve to many high voltage short duration pulses can decrease the nerve sensation and pain. Stimulation of the nerve using a neurostimulator can also block nerve sensation and decrease pain.

If none of these methods are effective, then occipital release surgery is recommended. This surgery takes 2-3 hours while the patient is under general anaesthesia with a recovery period of two to three weeks. However, risks of this surgery include permanent numbness of the scalp.

If you are experiencing any of these symptoms and wish to see an osteopath for conservative treatment you’re welcome to book an appointment at eclipse health and osteopathy today. Call 5613 3505 or book through our website.

References

Dougherty, C. (2014, April 16). Occipital Neuralgia. Current Pain and Headache Reports 18, 411. https://doi.org/10.1007/s11916-014-0411-x

Hammond, S.R. and Danta, G. (1978). Occipital Neuralgia. Clinical and Experimental Neurology, 15. Pp 258-270. Occipital neuralgia – PubMed (nih.gov)

John Hopkins Medicine, (2022). Occipital Neuralgia. John Hopkins Medicine. Occipital Neuralgia | Johns Hopkins Medicine

London Pain Clinic, (2022). Nerve Pain – Occipital Neuralgia. London Pain Clinic. Nerve Pain – Occipital Neuralgia – London Pain Clinic

London Pain Clinic, (2022). Occipital Neuralgia. London Pain Clinic Occipital Neuralgia – London Pain Clinic

Marks, H., (2020, July 23). Occipital Neuralgia. WebMD. Occipital Neuralgia: Symptoms, Causes, Diagnosis, Treatments, and More (webmd.com)

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Back Pain

Back Pain

What is Back Pain?

According to the Australian Government 16% of the Australian population experience back pain. Back pain can contribute to psychological distress, chronic pain other comorbidities such as arthritis (AIHW, 2023). Back pain is reported at an increased rate as you age and can interfere with activities of daily living (AIHW, 2023).

Common conditions that may cause back pain include sprains and strains, herniated discs, spinal stenosis, scoliosis, joint degeneration, inflammatory back pain and osteoporosis (Casiano et. al., 2023).

Causes of low back pain can include heavy physical work, frequent twisting, bending or lifting, weak musculature and more. It is important to see your doctor if there are any changed to bowl and bladder movements or incontinence, no improvement or worsening in pain levels as well as numbness, tingling or weakness in the lower limb or groin (Casiano et. al., 2023).

Osteopathy is targeted towards the improvement of physiological function and support of homeostasis when altered by impaired somatic dysfunction of the musculoskeletal system (TFLBPCG, 2016). The American Osteopathic Association analysed studies on both acute and chronic non-specific low back pain and found that osteopathic manipulative treatment was effective at reducing pain and increasing functional status.

A study by Rehman et. al. (2020) found significant evidence that OMT was effective in reducing pain and disability. It focused not only on muscular treatment but also visceral osteopathy – a more indirect modality. It showed that 8 weeks of osteopathic treatment when compared to standard care was shown to have significant improvement in return to work.

Another study by Licciardone et. al. (2014) investigated osteopathic manual therapy in regard to pain reduction and biomechanical dysfunction. The study looked at 230 patients receiving treatment for 15 minutes every week. In the study a low back pain response was considered a decrease of pain of 30% or greater between the initial appointment and the 12 week follow up. The study focused on various anatomical landmarks and their position to determine biomechanical dysfunction and used 3 different outcome measures to assess results.

A range of techniques were found to be effective in decreasing pain including HVLA manipulation (High Velocity Low Amplitude), soft tissue, myofascial release, positional release, muscle energy technique. In addition, the study highlighted the importance of the psoas muscle due and its contribution to low back pain in the increased likelihood of low back pain returning if the psoas was not focused on.

Economically, Verhaeghe et. al. (2018) found OMT (Osteopathic Manipulative Treatment) to be a cost-effective treatment option for low back pain with improved health outcomes (measured as quality adjusted life years) when compared with usual care.

While osteopathy is a manual therapy there are also aspects that patients can do at home to improve their health. Owen et. al. (2019) used a variety of exercise types and criteria to identify the most effective form of exercise. Pain is best modified through exercise such a pilates, aerobic exercise and stabilisation/control exercise.

Physical  function an capability is best improved using stabilisation/control exercise and resistance training. These were followed by water exercise, pilates and yoga. Mental health greatly contributes to physical health and healing and as such is an important fact to consider in both hands on and exercise therapy. Resistance and aerobic training were most beneficial for mental health and muscle strength.

 

In addition to strengthening you can also stretch to relieve muscle tension. Some stretches that you may find helpful include the “Cat Cow”, “Thread the Needle” and “Lumbar rotation”.

Instructions for Cat Cow:

Start on your hands and knees with your back in a neutral position. Make sure your hands are under your shoulders and knees under your hips. Arch your back while lifting your head up and tailbone out. This will make a dish like shape with your spine. Hold this position for 5 seconds. Bend your back, tuck your head and tail bone making a sad face shape with your spine. HINT: pull your bellybutton to the ceiling. Hold this position for 5 seconds and then repeat.

Instructions for Lumbar Rotation:

Start lying on your back with arms outstretched palms facing the floor. Keeping one leg flat on the floor bring the other to 90 degrees. Roll the bent leg over the straight as far as is comfortable. You will feel a stretch in your back and opposite armpit. Repeat on both sides. This can be done as a static stretch or as a fluid side to side movement.

Instructions for Thread the Needle:

Start facing the floor with hands and knees equal distance apart, hands under shoulders and knees under hips. Bring one hand off the floor and reach between your other hand and leg. Follow with your shoulder and head moving towards the floor taking the hand towards the opposite wall and allowing your back to twist and stabilising elbow to bend. A stretch should be felt down the side, shoulder blade and neck. Hold and then return to the starting position. Repeat.

 

References:

Australian Institute of Health and Welfare. (December 14, 2023). Back Problems. Chronic musculoskeletal conditions : Back problems – Australian Institute of Health and Welfare (aihw.gov.au)

Casiano, V.E., Sarwan, G., Dydyk, A.M., Varacallo, M. (2023). Baack Pain. StatPearls. Back Pain – StatPearls – NCBI Bookshelf (nih.gov)

Licciardone, J.C., Kearns, C.M., Crow, W.T. (2014). Changes in biomechanical dysfunction and low back pain reduction with osteopathic manual treatment: Results from the osteopathic trial. Manual Therapy 19 (4), 324-330. https://doi.org/10.1016/j.math.2014.03.004

Owen, P.J., Miller, C.T., Mundell, N.L., Verswijveren, S.J.J.M., Tagliaferri, S.D., Brisby, H., Bowe, S.J., Belavy, D.L. (2019). Which specific modes of exercise training are most effective for treating low back pain? Netwrk meta-analysis. British Medical Journal, 1-12. https://doi.org/10.1136/bjsports-2019-100886

Rehman, Y., Ferguson, H., Bozek, A., Blair, J., Allison, A., Johnston, R. (2020). Osteopathic manual treatment for pain severity, functional improvement, and return to work in patients with chronic pain. Journal of Osteopathic Medicine 120 (12). https://doi.org/10.7556/jaoa.2020.128

Task Force on the Low Back Pain Clinical Practice Guidelines. (2016). American Osteopathic Association Guidelines for Osteopathic Manipulative Treatment (OMT) for Patients With Low Back Pain. Journal of Osteopathic Medicine 116 (8), 536-549. https://doi.org/10.7556/jaoa.2016.107

Vergaeghe, N., Schepers, J., Van Dun, P., Annemans, L. (2018). Osteopathic care for low back pain and neck pain: A cost-utility analysis. Complementary Therapies in Medicine 40 207-213. https://doi.org/10.1016/j.ctim.2018.06.001

 

 

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Things to Avoid with Degenerative Disc Disease

Things to Avoid with Degenerative Disc Disease

What to Avoid with Degenerative Disc Disease

Degenerative disc disease is a common condition that affects the spinal discs as we age. It can cause pain, stiffness, and reduced mobility in the spine, making everyday activities difficult. If you have been diagnosed with degenerative disc disease, there are certain things you should avoid to prevent worsening of your symptoms. Here are some key things to steer clear of:

Avoiding High-Impact Activities

High-impact activities such as running, jumping, or heavy lifting can put excessive strain on the spinal discs, worsening the degeneration process. It is important to avoid these activities as much as possible to prevent further damage to your spine.

Avoiding Prolonged Sitting or Standing

Prolonged sitting or standing can also exacerbate symptoms of degenerative disc disease. It is important to take regular breaks to stretch and move around to relieve pressure on the spinal discs. Using ergonomic chairs and desks can also help reduce strain on your spine.

Avoiding Poor Posture

Poor posture can put additional stress on the spinal discs, leading to increased pain and stiffness. It is important to maintain good posture at all times, whether sitting, standing, or walking. Avoid slouching or hunching over, and use proper body mechanics when lifting objects to protect your spine.

What Is Helpful for Degenerative Disc Disease

While there are certain things to avoid with degenerative disc disease, there are also several helpful strategies to manage your symptoms and improve your quality of life. Here are some key things that can be beneficial:

Regular Exercise

Regular exercise can help strengthen the muscles supporting the spine, improve flexibility, and reduce pain associated with degenerative disc disease. Low-impact exercises such as swimming, yoga, or Pilates can be particularly beneficial for maintaining spinal health.

Healthy Eating Habits

Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help reduce inflammation in the body and support overall spine health. Avoiding processed foods, sugary drinks, and excessive alcohol can also benefit your spinal health.

Properly Managing Stress

Chronic stress can exacerbate symptoms of degenerative disc disease and increase inflammation and pain levels. It is important to find healthy ways to manage stress, such as practicing mindfulness, meditation, or relaxation techniques. Seeking support from a therapist or counsellor can also be helpful in coping with stress.

How Osteopathy Can Help

Osteopathy is a holistic healthcare approach that focuses on the diagnosis, treatment, and prevention of musculoskeletal disorders, including degenerative disc disease. Osteopaths use hands-on techniques such as manual manipulation, stretching, and massage to relieve pain, improve mobility, and promote healing in the body.

During an osteopathic treatment session, the osteopath will assess your spinal alignment, mobility, and muscle strength to identify any areas of dysfunction or imbalance. They will then use multiple techniques to release tension, improve joint mobility, and restore normal function to the spine.

Osteopathy may help alleviate symptoms of degenerative disc disease by:

  • Relieving pain and stiffness in the spine
  • Improving spinal alignment and mobility
  • Reducing muscle tension and inflammation
  • Preventing further degeneration of the spinal discs

Many people with degenerative disc disease find relief from their symptoms and improved quality of life through osteopathic treatment. Osteopathy is a  complementary therapy that can be used in conjunction with other medical treatments to manage your condition.

Degenerative disc disease can be a challenging condition to live with, but with the right strategies and support, you can effectively manage your symptoms and improve your quality of life. By avoiding high-impact activities, maintaining good posture, and practicing healthy habits, you can help prevent further damage to your spine.

In addition to these lifestyle changes, osteopathy can be a valuable treatment option for relieving pain, improving mobility, and promoting healing in the body. If you are struggling to manage your symptoms of degenerative disc disease, consider seeking the help of an osteopath to guide you on your journey to better spinal health.

Our Osteopaths are also here to support you to continue doing what you love. If this is something that may be impacting your degenerative changes, we will educate you and help to improve what you are doing to decrease the damage occurring. We are here to support you through your health journey and one of our aims is to help you continue doing activities that bring you joy.

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Shoulder Tendinopathy

Shoulder tendinopathy

Shoulder Tendinopathy and Osteopathy: Understanding and Treatment

What is Shoulder Tendinopathy?

Shoulder tendinopathy is a common condition that affects the tendons in the shoulder. Tendons are tough bands of tissue that connect muscles to bones. When tendons in the shoulder become irritated or damaged, it can result in pain, stiffness, and limited range of motion in the shoulder. Shoulder tendinopathy can occur in any of the tendons in the shoulder, but it most commonly affects the rotator cuff tendons.

Symptoms of Shoulder Tendinopathy

The symptoms of shoulder tendinopathy can vary depending on the severity of the condition, but common symptoms include:

  • Pain: Pain in the shoulder that worsens with movement or at night
  • Stiffness: Stiffness in the shoulder that limits range of motion
  • Weakened muscles: Weakness in the shoulder muscles
  • Swelling: Swelling and tenderness in the shoulder area

If you are experiencing any of these symptoms, it is important to seek treatment from a healthcare professional to prevent further damage to the shoulder.

Treatment Options for Shoulder Tendinopathy

There are several treatment options available for shoulder tendinopathy, including:

  • Rest and Ice: Resting the shoulder and applying ice to reduce inflammation
  • Physical Therapy: Physical therapy exercises to strengthen the shoulder muscles and improve range of motion
  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
  • Steroid Injections: Corticosteroid injections to reduce inflammation and pain in the shoulder

How Osteopathy Can Help

Osteopathy is a form of manual therapy that focuses on the musculoskeletal system, including the bones, muscles, and joints. Osteopaths are trained to diagnose and treat a wide range of conditions, including shoulder tendinopathy. Osteopathic treatment for shoulder tendinopathy may include:

  • Manual Therapy: Osteopaths use hands-on techniques such as massage, stretching, and manipulation to improve the mobility of the shoulder joint and reduce pain
  • Exercise Prescription: Osteopaths may prescribe specific exercises to strengthen the shoulder muscles and improve range of motion
  • Postural Correction: Osteopaths can assess and correct any postural imbalances that may be contributing to the shoulder pain

Many patients with shoulder tendinopathy have found relief from their symptoms through osteopathic treatment. Osteopathy can help address the underlying causes of shoulder tendinopathy and improve overall shoulder function.

Preventing Shoulder Tendinopathy

While shoulder tendinopathy can be a challenging condition to treat, there are steps you can take to prevent it from occurring in the first place. Some tips for preventing shoulder tendinopathy include:

  • Proper Technique: When participating in sports or activities that involve repetitive shoulder movements, make sure to use proper technique to avoid putting excessive strain on the shoulder tendons
  • Gradual Progression: Gradually increase the intensity and duration of your exercise routine to prevent overuse injuries
  • Warm-Up: Always warm up before exercising to prepare your muscles and tendons for activity
  • Strength Training: Incorporate strength training exercises into your routine to help support the shoulder muscles and tendons

Shoulder tendinopathy can be a painful and debilitating condition, but with the right treatment and preventative measures, you can manage your symptoms and improve your shoulder function. Osteopathy is a popular treatment option for shoulder tendinopathy, providing relief from pain and improving overall shoulder mobility. If you are struggling with shoulder pain, consider seeking help from an osteopath who can develop a personalised treatment plan to address your specific needs.

Our Osteopaths regularly help patients with shoulder tendinopathy, this condition is one of the more common presentations in our clinic in Runaway Bay Marina. If you would like to know more about how we can help feel free to call our clinic on 07 5613 3505.

Remember, early intervention is key to preventing long-term complications from shoulder tendinopathy. Don’t let shoulder pain hold you back from doing the things you love – seek help from a healthcare professional today.

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How Can Arthritis In The Lumbar Spine Be Treated?

How Can Arthritis In The Lumbar Spine Be Treated?

Treating Lumbar Spine Arthritis with Osteopathy

Arthritis is a common condition that affects millions of people worldwide. Lumbar spine arthritis, specifically, can be particularly debilitating as it causes pain and stiffness in the lower back. Luckily, there are treatment options available, including osteopathy.

What is Lumbar Spine Arthritis?

Lumbar spine arthritis, also known as osteoarthritis of the spine, is a degenerative condition that affects the joints and discs in the lower back. It is characterized by the breakdown of cartilage in the joints, leading to inflammation, pain, and stiffness. Common symptoms include pain in the lower back, stiffness, decreased range of motion, and difficulty standing or walking for long periods of time.

Osteopathic Treatment for Lumbar Spine Arthritis

Osteopathy is a holistic approach to healthcare that focuses on the body’s musculoskeletal system. Osteopathic treatment for lumbar spine arthritis aims to reduce pain, improve mobility, and enhance overall function.

The Osteopaths at Eclipse Health and Osteopathy see many patients with arthritis in the lower back, these patients often report feeling they have more mobility and less pain after treatment. As an osteopath we don’t just look at the area affected. Often an Osteopath will look at surrounding areas and their tissues. This may include the hips and lower limbs including feet and ankles, upper back and any other area that may be causing tension and reducing function.

Here are some common techniques used by osteopaths to treat lumbar spine arthritis:

Spinal Manipulation

One of the techniques used in osteopathy is spinal manipulation. This involves the gentle manipulation of the spine to mobilise vertebrae, reduce pain, and improve mobility. Spinal manipulation may help relieve pressure on the affected joints and discs in the lower back, reducing inflammation and promoting healing. Spinal manipulation may or may not be used in patients with arthritis depending on the degree of joint damage,

Soft Tissue Massage

Soft tissue massage is another commonly used technique in osteopathy for treating lumbar spine arthritis. This involves the manipulation of soft tissues, such as muscles and tendons, to reduce tension, improve circulation, and promote healing. Soft tissue massage can help alleviate pain and stiffness in the lower back, while also improving range of motion.

Exercise Prescription

Exercise is an important component of osteopathic treatment for lumbar spine arthritis. Osteopaths often prescribe specific exercises to improve strength, flexibility, and overall function in the lower back. These exercises can help stabilize the spine, reduce pain, and prevent further degeneration of the affected joints.

Postural Correction

Correcting posture is essential for managing lumbar spine arthritis. Poor posture can put additional strain on the lower back, exacerbating pain and stiffness. Osteopaths work with patients to improve posture, teaching proper body mechanics and ergonomics to reduce stress on the spine and prevent further damage.

Diet and Nutrition

Good nutrition is integral to managing lumbar spine arthritis. Osteopaths may recommend dietary changes and supplements to reduce inflammation, promote healing, and support overall joint health. A balanced diet rich in antioxidants, omega-3 fatty acids, and vitamins and minerals can help reduce pain and improve mobility in the lower back.

Lumbar spine arthritis can be a challenging condition to manage, but with the right treatment approach, it is possible to reduce pain, improve mobility, and enhance overall function. Osteopathy offers a holistic treatment option for lumbar spine arthritis, focusing on reducing inflammation, improving joint function, and promoting healing. If you are suffering from lumbar spine arthritis, consider consulting with an osteopath to develop a personalized treatment plan that addresses your specific needs and goals.

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