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

 

 

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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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Best Treatment for Tail Bone Pain

Tail Bone Pain and How Osteopathy Can Help

Tail bone pain, also known as coccydynia, can be a real nuisance for those who suffer from it. The tailbone, or coccyx, is a small triangular bone located at the base of the spine. When this bone becomes inflamed or injured, it can cause severe discomfort and make it difficult to sit or perform everyday activities.

Fortunately, osteopathy offers a natural way to alleviate tailbone pain and promote healing. In this post, we will explore the causes of tailbone pain, how osteopathy can help, and what to expect during a session with an osteopath.

Causes of Tail Bone Pain

There are several potential causes of tail bone pain, including:

  • Direct injury: Falls or trauma to the tailbone can lead to inflammation and pain.
  • Prolonged sitting: Sitting for long periods of time, especially on hard surfaces, can put pressure on the tailbone and cause discomfort.
  • Childbirth: Women may experience tailbone pain after giving birth due to the pressure and strain placed on the coccyx during labor.
  • Repetitive strain: Activities that involve repetitive movements or poor posture can contribute to tailbone pain over time.

Osteopathy for Tail Bone Pain

Osteopathy is a holistic approach to healthcare that focuses on the musculoskeletal system and how it influences the body’s overall wellbeing. Osteopaths use manual techniques to diagnose and treat a wide range of conditions, including tail bone pain.

During an osteopathic session for tail bone pain, the osteopath will:

  • Conduct a thorough assessment: The osteopath will examine your posture, range of motion, and any areas of tenderness or discomfort around the tailbone.
  • Develop a personalized treatment plan: Based on their assessment, the osteopath will create a treatment plan tailored to your specific needs and goals for pain relief and healing.
  • Use gentle manual techniques: Osteopaths may use techniques such as soft tissue massage, joint mobilization, and stretching to alleviate pain and improve the function of the musculoskeletal system.
  • Provide lifestyle recommendations: Osteopaths may also offer advice on posture, ergonomics, and exercises to support your recovery and prevent future episodes of tailbone pain.

What to Expect During an Osteopathic Session

If you decide to seek treatment for tail bone pain from an osteopath, here is what you can expect during a typical session:

  • Discussion of your symptoms: The osteopath will ask about your medical history, current symptoms, and any activities or factors that may be contributing to your tailbone pain.
  • Physical assessment: The osteopath will perform a hands-on assessment of your posture, range of motion, and areas of tenderness to determine the underlying cause of your pain.
  • Treatment: Using gentle and precise manual techniques, the osteopath will work to relieve tension, improve alignment, and promote healing in the affected area.
  • Home exercises and self-care recommendations: The osteopath may provide you with exercises, stretches, and lifestyle modifications to support your recovery and prevent future episodes of tailbone pain.

The Benefits of Osteopathy for Tail Bone Pain

Osteopathy offers several key benefits for individuals suffering from tailbone pain:

  • Natural pain relief: Osteopathic techniques are gentle, non-invasive, and drug-free, making them a good alternative to traditional pain management approaches.
  • Improved mobility: By addressing the underlying causes of tailbone pain and promoting proper alignment and mobility, osteopathy can help you move more freely and comfortably.
  • Enhanced overall wellbeing: Osteopathy takes a holistic approach to healthcare, considering the interconnectedness of the body’s systems and focusing on promoting overall health and vitality.

Over the years our Osteopaths have seen many patients with tailbone pain. Often the muscles of the pelvic floor may be involved. This can be addressed and patients have reported great results from osteopathic treatment.

If you are struggling with tail bone pain, consider seeking relief through osteopathy. A qualified osteopath can help you address the root cause of your pain, alleviate discomfort, and support your body’s natural healing process. Don’t let tailbone pain hold you back – schedule an appointment with an osteopath today and take the first step toward a pain-free and active lifestyle.

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