New Parents' Pains

The long-awaited but sudden transition into parenthood puts all sorts of demands on the body for both parents. Osteopathy can help with the muscle and joint pains, and we can offer some advice for changing your discomfort-inducing habits too.

Carrying Baby

Babies often seem happiest when being held, so it’s not surprising to realise that you’re holding your baby much more than you might have anticipated. If your baby likes to be as close to you as possible, have a look at baby-wearing carriers or wraps. A comfortable one will spread baby’s weight through your upper and lower back, allowing you to soothe them while getting on with your day.

As baby gets heavier and more mobile, their mattress will need moving deeper into the cot. This can make it much more difficult to pick baby up and set them down, so make sure you’re using your legs wherever possible, and listening to your body if you do feel any twinges. Exercises to keep the whole back moving might be a suitable plan of action, and your osteopath can help you with this.

Infant Feeding

If you’re feeding with a bottle, try and keep track of which side you held baby on last. You might find that you favour one side due to the positions that your furniture supports best, but mixing it up is good for you and baby. Management for torticollis and plagiocephaly put a lot of emphasis on giving baby opportunities to strengthen both sides of the neck.

For feeding in bed or on a sofa, try and set yourself up with pillows or cushions before you get started- it’s easier to throw out an extra pillow than squeeze another one in once baby’s latched on. Make sure your arms are supported enough that the shoulders can relax, and the upper back and neck aren’t straining.

Breastfeeding

Finding a comfortable position in which to breastfeed can be a struggle. But you might find you have access to positions that wouldn’t work so easily for bottle feeding too. The same ideas apply as above: keep your arms supported to take the strain off the neck and shoulders. If you’re feeding in bed, you might like to lay back and have baby belly to belly with you, or lay on your side and have baby laying on the mattress with you. Be aware of the safe sleep 7 if you are prone to falling asleep during feeding.

The Upper Back

The upper back is particularly susceptible to overworking when you have a new baby, and often this can be completely asymptomatic. Problems arise when the restriction in the upper back begins to have a knock-on effect for another area, typically the lower back or neck. This might manifest slowly as recurrent headaches or neck tension, or it might be more dramatic and lead to a sudden disc bulge or muscle strain.

Your osteopath will be able to spot these developing patterns, even if you’re not feeling any discomfort.

Make here to make an appointment in Naas for your aches and pains

The Pelvic Floor and Osteopathy

The pelvic floor is, as the name suggests, a sling of muscles that sit at the base of the pelvis. Their role is to support the organs within the pelvis, and assist with urinary and faecal continence. Its function is relevant to osteopathy, as dysfunction in these muscles can impact nearby muscles and joints.

Relevance to Everyone

We hear a lot about pelvic floor exercises for new mothers and older women. But everyone has a pelvic floor (men too!), and it makes sense to keep the muscles strong before they present a problem. Beyond local fatigue and pain to the muscles, when demand is higher than the muscles can tolerate, they can put a strain on neighbouring structures, resulting in lower back or leg pain. The image above shows how some of the muscles connect to the tailbone and sacrum. The tailbone in particular can be relatively prone to discomfort from problems like this- its only joint is to the bone above it, so tension pulling it one way can be hard to correct. The tailbone can be irritated by a fall other trauma, including birth, which can in turn cause tension in the pelvic muscles and glutes. A strong pelvic floor is more resilient to these demands.

Prenatal Preparation

If you were planning on running a marathon, you’d train for months beforehand. Pregnancy is not unlike a marathon- for nine months there is a constantly growing weight on the sling of muscles, and they need to be able to cope with this demand, regardless of the nature of the birth. Beginning a routine of pelvic floor exercises before even trying to conceive is not a bad idea: it’s never too early to begin training the pelvic floor.

The Pelvic Floor and Osteopathy

We talk a lot about the diaphragm and its relationship with problems above and below it. The pelvic floor works similarly to the diaphragm: resisting pressure in the abdomen and often inadvertently holding stress and tension. Tension may be more likely to manifest if the muscles are weaker, as they already have to work harder. This also means that weaker muscles are less able to relax. Strengthening exercises may therefore be appropriate even for tight muscles, but it is imperative that relaxing the muscles between contractions becomes a main focus.

Combining a roots-up approach of addressing the muscles’ strength alongside any other related musculoskeletal aches and pains may therefore be the most appropriate course of action for you. Direct or indirect techniques for the pelvic muscles as well as the lower back or leg muscles and joints is one approach to addressing aches and pains within the pelvis or elsewhere. We understand that this is a sensitive area, and as with anywhere else, nothing will be done without your ongoing consent. For comfort, we recommend wearing close fitting shorts to your appointment for maximum modesty while also allowing us to examine any relevant muscles and joints thoroughly.

Click here to make an appointment for your pelvic floor in Naas

Piriformis Syndrome

Sciatica is a partial diagnosis: it tells us that the sciatic nerve is irritated, but on its own it doesn’t tell us where the problem is. Piriformis syndrome is a form of sciatica, in which the nerve is irritated by the piriformis: a deep gluteal muscle.

Anatomy & Risk Factors

We’re all constructed slightly differently, and some people have a sciatic nerve that runs straight through their piriformis muscle. For others, the two might just run close to each other. If the muscle tenses up and causes symptoms in the sciatic nerve, it can become a vicious cycle: the symptoms cause the muscle to tense further to protect the area, and symptoms become worse.

Onset might follow new demands on the piriformis, such as starting a new exercise or increasing the frequency, intensity, or duration of an existing routine. Symptoms may not develop instantly, so be aware of any changes made in the week or so before their onset that could be relevant.

Sometimes these things start for no apparent reason, but we will still endeavour to work out the factors at play. Maybe there’s another area working in an unusual way that has had an impact on the way the hip moves. This in turn could cause the muscle to overwork and irritate the nerve.

Symptoms of Piriformis Syndrome

The symptoms are largely the same as sciatica caused by anything else:

• pain (often shooting) from the buttock, down the back of the thigh and into the calf or shin.

• pins and needles or tingling in the same area

• weakness on some movements of the affected leg

In addition to these points, there may also be:

• an increase in symptoms when taking the leg backwards, or turning it out

• tenderness and reproduction of symptoms when applying pressure or stretch to the muscle

Take note of the things you can do that make your pains better or worse. Some people prefer a warm bath or a cool compress, and some cases get better with exercise and worse with rest, or vice versa. Keeping a pain diary can be useful if you struggle to draw these connections off the top off your head.

Managing Piriformis Syndrome

When nerves are irritated, it usually takes a while for them to settle down after the stimulus is removed. Therefore, giving a general prognosis can be difficult- but it may be easier to manage the root cause of piriformis syndrome than other causes of sciatica.

Treatment will likely involve massage and exercises to relax the gluteal muscles. It may also be appropriate to work on desensitising the nerve itself, especially if symptoms have been present for a while.

Exercises may initially focus on relaxing the muscle and getting the body used to moving properly again. Over time, and depending on the details of your case, they may be more focused on strengthening the glutes so that they no longer have to work so hard and become tense. If your onset was sport related, there may be additional advice we can give for adapting your form or other details of your training.

Make an appointment for your sciatica/piriformis syndrome here

The SIJ (Sacroiliac Joint)

The sacroiliac joint is a large joint on either side of the base of the spine. It does not allow a lot of movement, and its role is more about shock absorption than mobility. Due to its proximity to the spine, when it causes pain it can be mistaken for a spinal issue.

SIJ Anatomy

The SIJ is the joint between the base of the spine (sacrum) and part of the pelvis (ilium). Unlike joints within the spine, it is not well suited to a lot of movement. The SIJs are not smooth like spinal joints, rather the surfaces tesselate with each other and are supported by lots of ligaments. As a result, they are good shock absorbers, soaking up the forces that travel up from the legs during walking and exercise, reducing the need for cushioning in the lower back.

Referred Pain

Sometimes pain is felt far from its cause- this happens quite frequently with SIJ problems. The diagram above shows some of the patterns that can appear. Pain radiating down the back of the legs is often quickly labelled as sciatica, but with referred pain from the SIJ, the sciatic nerve is completely uninvolved.

Rather than the trapping of a nerve, the cause of these symptoms are misinterpretation of information by the brain. A signal is received to say that there is a problem in a large area, and rather than correctly identifying it as an SIJ issue, the brain assumes that the pain should be felt somewhere else. This is not a problem in itself, and your osteopath will look at your whole history and the way you move to work out the root cause.

The SIJs in Pregnancy

During pregnancy, the SIJs undergo the biggest changes they ever will. From the first trimester, hormones are released to prepare the pelvis to move in labour. The multitude of ligaments that support the joint become more relaxed, which can inadvertently cause lower back pain as the SIJ moves more than is comfortable and the rest of the back compensates.

This mobility allows the pelvis during labour to work with the baby en route down the birth canal. So while we wouldn’t want to restrict the new movement of the SIJs, we do still want you to be comfortable. Excessive movement during pregnancy can lead to pain across the front of the pelvis as well as the back, which is best managed with a strengthening routine. The sooner this can be addressed the better, as severe pain can limit your positioning options during birth.

Management

Once the SIJ is identified as the cause of your symptoms, we will also check which other areas are involved. Without trauma, the SIJs are unlikely to be symptomatic in isolation. Depending on the rest of your case, your treatment plan may be focused on exercises and strengthening, or improving mobility elsewhere in the body. Often a combination of mobilising and strengthening is appropriate.

Your osteopath will also be mindful of other conditions that can affect this area, including some rheumatological conditions like Ankylosing Spondylitis. Do let us know if your pain comes with prolonged morning stiffness, and can vary from severe pain and stiffness to nearly asymptomatic for seemingly no reason.

Click here to make an appointment for your SIJ or lower back pain in Naas

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a cause of pain and other symptoms in the palm of the hand. It can be associated with lifestyle, including the angle at which you hold your wrist at your desk if you are office based.

Why It Happens

The carpal tunnel is a small space in the palmar side of the wrist. One side is bordered by the wrist bones, and the other is contained by ligament-like soft tissue. This tissue is what is often cut during surgery for CTS. Structures running through the tunnel include blood vessels, muscle tendons, and nerves. If the area becomes compressed, the nerve can be irritated, and lead to the symptoms of CTS.

Compression can be caused by pressure from outside the tunnel, such as positioning. If your armrests at your desk are too high or low, they can put the tunnel on stretch, or compress the area and encourage the forearm muscles to tighten up. Similarly, sleeping with your wrists flexed can cause compression overnight, and may lead to an increase of symptoms first thing in the morning. A sudden increase in sport or activity could also play a role.

Symptoms of Carpal Tunnel Syndrome

Symptoms are typically isolated to the area supplied by the affected nerve, below the point at which it is irritated. For most people, that encompasses the palm of the hand, from the thumb to halfway along the width of the ring finger.

As this is a nerve problem, symptoms might include tingling or pins and needles, numbness, weakness, and pain. The pain might be described as sharp and shooting or dull, deep, and persistent. Some people compare it to a toothache in nature.

Fluid Retention and Carpal Tunnel Syndrome

People who have more fluid in their tissues than is typical are at higher risk of developing carpal tunnel syndrome. This is because there is more pressure within the tunnel, and the nerve is more likely to be irritated. This includes people who:

• have lymphoedema in the arm

• are pregnant, especially in the third trimester

• have heart failure or kidney problems that cause fluid retention

Diagnosis and Treatment

The first thing your osteopath wants to know is “is it really carpal tunnel syndrome?”. There are other causes of hand pain that can present very similarly- occasionally we see patients who have had surgery for CTS only to find that the problem starts higher up the arm, and the symptoms have not changed. Diagnostic tests to determine if the irritation truly is in the wrist are a good place to start, but we will also use your case history to work out what the most likely causes are.

Depending on the factors that have led to your pain, treatment might be focused on:

• reducing tension in the forearm muscles

• encouraging drainage in the wrist area

• stretching and exercising the wrist into a more neutral position

Sometimes it is also a good idea to work on the hand itself, or the elbow. Your osteopath will explain this to you in your appointment, and they may provide you with exercises or other changes to make at home or work.

Make an appointment in Naas for your hand pain here

Diastasis Recti

During pregnancy, the abdominal muscles need to adapt to make room for the growing uterus. Diastasis recti (DRA) is when the muscles on the front of the abdomen separate (as they should), but do not come back together as well as expected after pregnancy. Please note that recovery after giving birth is a slow process, and although guidelines for DRA are limited, we do not recommend assessing, diagnosing, or attempting to treat DRA before 6 weeks postpartum.

Anatomy of Diastasis Recti

The muscles on the anterior abdominal wall are joined in the middle by the linea alba. This is a long piece of tissue, not dissimilar to a tendon, that runs from the bottom of the sternum (breastbone) to the pelvis. It is able to stretch to accommodate a growing baby (or other mass, including fat), but it is not contractile tissue like muscle. This means that it does not shrink back quickly once the need for expansion is removed.

Diagnosing Diastasis Recti

Frustratingly, there is little in the way of guidance for diagnosing or managing DRA. Good resources urge practitioners to take the depth of separation into account, as well as the width and length. As mentioned above, this should not be assessed before 6 weeks post partum, as diagnosing muscle separation before the body has had a chance to heal is not useful.

When you are past the 6 week mark, your osteopath can help you to test for a diastasis, or you can do it yourself. In clinic this will be done with you laying on your back on the plinth, or you can do it at home on your bed or the floor:

1. Laying on your back with your knees bent, place your fingers gently on the centre of your abdomen. A diastasis often occurs around the belly button, but it can be anywhere from the bottom of the sternum to the pelvis. You may need to reassess with your hands in a different place to be sure where your diastasis is.

2. Raise your head up as if looking down at your tummy, so that the abdominal muscles engage.

3. If you feel a gap under your fingers with the muscles engaged either side, you may have a diastasis.

General guidance suggests that a gap smaller than two finger widths does not warrant a diagnosis. You may still benefit from some rehabilitative exercises, especially if the gap is deep.

Effects Elsewhere

We often think of core “weakness” as a factor in lower back pain. Research is actually quite inconclusive, and a diastasis is not always a sign of muscle weakness anyway.

There is a stronger link between diastasis and hernia, which makes sense as there is less tissue for the intestines to push against before they can form a hernia here. This is more reason to avoid high intra-abdominal pressure, as you would get from exercises like crunches. If you feel a lump that you suspect is a hernia, you should get it checked to be sure. Note that the strangulation of a hernia, or a hernia that is significant enough to cause a bowel blockage are red flags. Severe abdominal pain or a reduction in bowel movement should be investigated urgently if you have a hernia.

Management Strategies

The best approach is focused on strengthening exercises. This is a slow process, as the stretched tissue itself is not a muscle, but it may be influenced by the muscles that it attaches to. Core exercises are good, but you need to address lateral and rotational movements as well as the usual flexion- and crunch type exercises are best avoided. Your osteopath can work with you to devise an exercise plan that suits you best, using exercises such as planks, side planks, and other variations. Don’t underestimate the demand of day to day activity on your core either; for example walking incorporates the movements mentioned above with minimal strain.

Click here to make an appointment for your diastasis in Naas

Neuralgia

“Neuralgia” just means “nerve pain”, but it is a term used more specifically than that. It has been defined as:

“intense, typically intermittent pain along the course of a nerve, especially in the head or face.”

Trigeminal Neuralgia

The trigeminal nerve is a nerve that supplies the face with feeling and movement. “Tri-” in its name refers to the three branches it splits into on either side, illustrated above. Typically with trigeminal neuralgia, only one side of the face is affected, and it is rare that all three branches would be symptomatic at once.

Symptoms are episodic but intense. Sharp, extreme pain in the affected area of the face can be caused by facial movement or even light touch to the skin. The pain can last a few seconds to a couple of minutes. There are other conditions that can cause episodic facial pain, such as migraine or dental problems, so these need to be considered when making a diagnosis. Your GP may want to send you for an MRI to be certain.

Unfortunately, often the exact cause of trigeminal neuralgia is unknown. Generally it is considered an issue of nerve compression somewhere near the top of the spinal cord or where the nerve exits the skull. You may find that gentle osteopathic treatment to the head and neck can help to manage your symptoms over time.

Post-Herpetic Neuralgia

Chicken pox is caused by a virus in the herpes family, which can lay dormant in the nervous system for years after the initial infection before attacking again as shingles. It often causes blisters along the course of a nerve, which can be particularly clear around the ribs where a nerve travels between each rib. For most people it will be unpleasant, but will resolve without too much complication. But for about 20% of people, it can lead to post-herpetic neuralgia.

Symptoms include a sharp pain between the ribs that may be intermittent or constant. The skin in that area may also be hyper sensitive to stimuli that are not normally painful. Usually symptoms will resolve within a year, but sometimes they persist for much longer. Your GP may be able to support you with prescribed painkillers that are more effective for nerve pain. Your osteopath may also be able to help with desensitising techniques.

Pain that lasts more than three months is considered chronic and may be treated differently by the nervous system. The sooner you can seek treatment for your pain the better, but there are still be things we can do to help the 10-20% of the population affected by it.

Sciatica

Technically sciatica is a neur (nerve) algia (pain), although it is not usually considered to be under the same umbrella as the conditions above. Pain is not always so intense, and other symptoms such as pins and needles or numbness can be more significant. Irritation can be caused by mechanical issues along the nerve, and your osteopath can work to identify those causes and relieve you of them.

Click here to make an appointment in Naas for your nerve pain

Digestion

Osteopaths are qualified to help with a diverse range of problems. It may come as a surprise to learn that some digestive issues are within our remit.

The Diaphragm and Acid Reflux

We work a lot with muscles, so working with the diaphragm to help manage some digestive issues is comfortable territory. The diaphragm is a sheet of muscle that separates the thorax from the abdomen, sitting between the lungs and stomach. Its main role is to inflate and deflate the lungs, but it also helps to support the sphincter at the top of the stomach. This sphincter serves a purpose of preventing the flow of stomach contents back up the oesophagus (food pipe). When this does happen, you get heartburn or symptoms of reflux.

Stress can cause tightness in the diaphragm, which can affect the muscle’s function and lessen its ability to support the sphincter.

Reflux can also affect babies. Click here to read our post on infant reflux and silent reflux.

Irritable Bowel Syndrome (IBS)

IBS is a common problem, and can cause bloating, constipation, cramps, and diarrhoea. There is no one test for IBS, but it can present similarly to other conditions that may be ruled out through medical testing.

A key part of managing IBS is to work out what triggers your symptoms: a food diary can help here. But some people also find that hands on treatment such as osteopathy can help. Research looking at a potential relationship between manipulation of the spine (clicking the joints in the back) and IBS symptoms showed some hopeful results. A possible explanation for this is that the clicking might have a calming effect on the nerves that run near the joint, such as those that supply the bowel. “Resetting” these nerves might give relief to some people.

Digestive Issues and the Rest of the Body

Beyond treating digestive issues themselves, your osteopath will consider your body as a whole. When you have abdominal symptoms, you might find yourself taking on a more hunched posture subconsciously. This is a common response to abdominal pain, but over time it can cause other areas in the body to react and compensate.

We frequently see problems associated with upper back stiffness in clinic. The upper back can become restricted without causing too many local symptoms, so often the first symptom is down to the lower back or neck working harder. Prolonged hunching over a desk can be the cause of this, but similarly, postural changes due to abdominal discomfort can have the same effect. Work to improve movement through the upper back might not have a direct impact on your abdominal symptoms, but better movement in one area means that other areas are not overworking to accommodate it. Treatment might include work to the joints, whether clicking or gently mobilising them. Massage work to local muscles and the diaphragm can also be beneficial.

To complement the progress made in clinic, you may be given exercises or advice for things to do at home. Alongside a food diary, you might find that breathing exercises help, as they work through the diaphragm and can reduce your stress response.

Click here to make an appointment in Naas

Sciatica

Sciatica is a term that’s often thrown about in the wrong context. Technically, sciatica is irritation of the sciatic nerve, which is a large nerve that runs down the back and side of the leg. It’s an example of radiculopathy- where a nerve is compressed or otherwise irritated, causing shooting pains, pins and needles, weakness, or numbness in the affected area. You can’t have sciatica in your arm, but you can have a radiculopathy of another nerve, and your osteopath may be able to help with both.

Anatomy of the Sciatic Nerve

The sciatic nerve is formed from a number of nerves as they leave the lower spine (fig A). They combine to form the sciatic nerve within the pelvis, then run down the back of the thigh. The nerve splits around the knee, with one portion running down the back of the calf and into the sole of the foot. The other branch wraps around the outside of the lower leg.

Potential Causes of Sciatica

Sciatica can be caused by a problem right at the start of its journey. Figures C and D show how spinal structures can impinge on the sciatic nerve. When discs bulge, they tend to push straight back, or backwards and off to one side. It’s the latter that is likely to catch a nerve, as this is where the nerves run. Fig D shows a (severe) spondylolisthesis, where a fracture or unusual anatomy cause the bulk of a vertebra to slip forwards, pulling on the nerve as it goes. Note that this is a rare condition, and unusual in that very few conditions actually cause something in the spine to be misplaced. Even when the bone is displaced, see that the disc remains firmly attached to both bones- even when a disc “slips” it remains connected to the bones above and below.

The nerve can also be irritated further down the body. One common example is piriformis syndrome. Through its course, the sciatic nerve runs close to (or sometimes even through) the piriformis muscle.

Therefore, if the piriformis muscle becomes tight or irritated, it can easily irritate the sciatic nerve, causing the symptoms of sciatica to spread down the nerve.

Managing Sciatica

Your osteopath is qualified to diagnose and treat your sciatica. Treatment depends on the cause of your pain, but will typically involve a combination of hands on treatment and exercises to continue at home.

When a bulging disc is involved, patients are often focused on “putting the disc back in”. The discs are very deep in the back, and they are under pressure from the rest of the body above, so they can’t be encouraged “back in” with much lasting effect. However, you may find that some exercises that make temporary room for the disc to recede do take the edge off your symptoms. The long term approach is to reduce the strain on the affected level by ensuring the rest of the back is moving well. We will also work to treat the rest of the course of the nerve.

Other causes may be best treated more focally. Soft tissue work, including massage and stretching for the piriformis muscle can have quick results, especially when combined with relevant lifestyle changes. Your osteopath will discuss these if they are relevant to your case.

Click here to make an appointment in Naas for your sciatica

Joint Aches and Pains

General aches and pains are a daily feature in clinic, and can be indicative of a number of conditions.

Patients are often keen to know what’s causing their pain, and the good news is that osteopaths are qualified to give a diagnosis in most cases. We take a detailed case history to get an idea of what might be going on, and sometimes this alone gives us enough information to tell what the problem is.

Diagnosing and Managing Joint Pain

Joint pain is often quite isolated to the joint in question, but it can refer elsewhere. Typically, this referral follows a pattern, but it can be mistaken for something else if not fully investigated. For example, sometimes a problem with a joint in the lower back can cause pain to radiate down the leg, similarly to sciatica. We will ask questions during your case history to differentiate between referred joint pain and nerve pain to get a correct diagnosis and devise an appropriate treatment plan.

Osteoarthritis is a common example of a joint pain condition. Pain often starts gradually, but symptoms can come on suddenly in some cases. Signs of OA include:

• achey pain within the joint, or into the groin if the hip is affected

• a crunchy or grinding feeling on some movements

• muscle tension around the joint

• restricted movement locally

Your osteopath can diagnose osteoarthritis, and we are qualified to help manage it. It’s a condition of cartilage, which is a living tissue and responds well to improved movement. Working into the joint and easing surrounding musculature makes it easier for your daily movements to positively impact the health of the joint.

Signs of Inflammation

Inflammation can affect joints and soft tissues. An inflamed joint is often stiff after rest, but also aggravated by doing too much movement. It responds well to cool compresses, but warmth might make it worse. This is more likely with soft tissue inflammation that sits closer to the surface. A warm compress can encourage further inflammation and discomfort, whereas a cool one encourages the inflammation to clear a bit.

Sometimes inflammation of a joint is an indicator of a rheumatological condition. These often require medical intervention, but your osteopath may still be able to help you manage the symptoms alongside your GP or rheumatologist. Not only can we help with local inflammation and muscle tightness, but we can work with you to make sure that the body is not overcompensating and causing secondary aches and pains elsewhere.

If you’re unsure whether you would benefit from heat or ice, speak to your osteopath.

Heightened Pain Sensitivity

Some conditions manifest with a general increased sensitivity to pain. One example of such a condition is fibromyalgia. Alongside fatigue and difficulty concentrating, this condition is characterised by widespread muscle and joint pain or stiffness. Patients may also notice that their muscles are especially reactive to touch, feeling more achey or sore than would be expected.

Diagnosis of fibromyalgia can be slow, as there is no specific test for it and other conditions need to be ruled out first. Fortunately, it is becoming more well known, and research is slowly being produced.

Click here to make an appointment in Naas to address your aches and pains

Cramps and Muscle Spasms

Most of us experience a cramp every now and then, but if you suffer from them frequently, you might be after some intervention. Osteopathy may be able to help.

What is a Cramp?

A cramp is defined as “a painful involuntary spasmodic contraction of a muscle”. Usually this is quite quick to resolve on its own, but for some people it can be painful, with the ache lingering long after the muscle has relaxed. Cramps most often occur overnight, especially in the calf muscles. Athletes may experience cramps in other areas depending on their sport, and this is more likely to occur during or immediately after exercise.

Although there are similarities, a cramp is not the same as a muscle “knot”. A knot is a tight area of muscle that is likely tender to touch. Typically it would last longer than a cramp, and might respond well to heat or massage.

People Most Affected by Cramps

Research suggests that a range of people are at higher risk of developing cramps:

• Over 60 year olds

• Pregnant women (especially later on in pregnancy)

• Athletes, particularly if training in hot environments

• People with COPD

Frustratingly, there is a lot we don’t know about why these people are affected.

Potential Causes and Management

Despite the prevalence of cramps, we still don’t fully understand them. Although athletes are more affected than the general population, and there appears to be a link with high temperatures, cramp is not actually associated with dehydration or electrolyte imbalance. General stretching may help, but it has been noted that stretching just before exercise has little effect. By this token, osteopathic muscle work on a preventative basis my be beneficial.

In pregnancy, there are a number of theories for what might cause cramps. Aches and pains are common in the back of the legs anyway, as the centre of gravity moves forwards with the growing bump and puts more demand on these muscles. Fatigue could therefore be a factor. Pregnancy is also a period in which nerve irritation can increase, such as carpal tunnel syndrome. One reason for this is that fluid retention adds compression to the nerve in the wrist- something similar could happen in the calves to predispose cramp.

We can’t change your centre of gravity in pregnancy, but we may be able to help the muscles to manage the demands better. Ensuring that other areas are working well, and providing exercises to strengthen the affected muscles may help. Treatment itself can also involve massage to the overworked muscles for symptomatic relief.

Simple nocturnal calf cramps are one part of the picture that does seem to respond well to intervention. Medications have little effect, but massage and stretching can help to manage the symptoms. We can provide you with a treatment and exercise plan which can be adjusted over time as things improve.

Make an appointment for your muscle pains in Naas here.

Circulation and Osteopathy

When we think of circulation, it might bring to mind cold hands and feet. This might be caused by issues with blood circulation, but it’s not the only system we need to think about. Whereas the vascular system has a pump to keep it moving, the lymphatic system does not. This is the kind of circulation your osteopath may be able to help with best.

What is the Lymphatic System?

When oxygenated blood enters a cell, some leaves as deoxygenated blood. But other products are separated and do not make their way back to the venous system. Instead they travel between cells to reach the lymphatic system. This system plays a big role in immunity: it links to the spleen and is punctuated by lymph glands. These are the same glands that become raised when you are unwell, such as those around your jaw that can become hard and tender when you have a bad cold.

Lymphoedema

As mentioned above, the lymphatic system is not driven by the heart. Instead it moves slowly, and it can back up. Lymphoedema is the effect of insufficient lymph drainage, often when lymph nodes are removed. We commonly see the effects of this in the arm of people who have had the lymph nodes removed from their armpit, which may be due to breast cancer. As the lymph’s route is disrupted, it struggles to find its way back to the system- but the lymph keeps forming and it builds up in the affected area.

If you have lymph nodes removed, you should be advised about how to manage potential lymphoedema. This might involve compression garments, physiotherapy, or exercises to do at home. Sometimes you need a bit more help than what is provided by default. Osteopaths can help with drainage techniques, working both locally to clear the lymph, but further afield too to create negative pressure that encourages the lymph to flow again.

Local Circulatory Issues

Lymph can also build up when there is an injury, even if the lymphatic system has not been altered as above. If you sprain an ankle, for example, swelling can build up rapidly. This is the body’s attempt at protecting and repairing the injury. Among the fluid there will be white blood cells, working to target anything that might pose a threat to health. There will also be nutrients for the cells that have been injured. This is why we don’t advise that you ice an issue for more than 10 minutes at a time- the inflammation is there for a reason. A cool compress is fine to take the edge off and make the area more comfortable. But removing the swelling completely is not as helpful as you might think.

The BMJ has suggested a new strategy to replace the “RICE” advice that we are familiar with. Whereas RICE stands for rest, ice, compression, and elevation, the new advice is PEACE & LOVE.

P: protect (rather than rest)
E: elevate (no change)
A: avoid anti-inflammatories
C: compression (no change)
E: education (avoiding excessive intervention and listening to your body to allow it to heal)

After the early phase passes, the LOVE acronym guides your longer term recovery.

L: load
O: optimism
V: vascularisation
E: exercise

All of these points make reference to taking an active role in your recovery through graded exercise. Your osteopath can help guide you here, monitoring your progress to ensure that you are loading and vascularising to an appropriate degree. Ligaments are particularly slow to heal, so rehabilitation is extra important for local health and to prevent compensation elsewhere. Your osteopath can look at the whole area to ensure that everything is behaving well throughout your recovery.

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Rheumatic Pain

Rheumatology is a broad collection of conditions, and many of them cause pain. Often the pain is focused to joints or muscles, and osteopaths are recognised as able to help manage these symptoms.

Osteoarthritis is an example of a rheumatological condition, but it behaves unlike many others, as it is generally non inflammatory. It is not an autoimmune condition either, meaning it is not caused by the body attacking its own cells. Your osteopath is capable of providing you with a diagnosis for your condition, so we are in a good position to spot when something is not quite right, and refer for investigation and medication accordingly. Inflammatory conditions typically do not like long periods of rest, nor do they respond well to higher levels of activity. Your osteopath can help manage your symptoms by treating within the comfortable area, and advising you on how much exercise is appropriate at any given time.

There are a number of rheumatological conditions that might cause someone to seek osteopathic treatment, and two are explained in more detail below.

Rheumatoid Arthritis (RA)

Rheumatoid arthritis is one of the better recognised rheumatological conditions, and about 1% of the general population is diagnosed with it. The condition tends to affect the small joints of the hands, feet, and neck first, but can also affect larger joints. Symptoms include joint pain, and both stiffness and instability. This is an inflammatory autoimmune condition, in which the body attacks the joint surface in an inflammatory episode. When the episode subsides, the body tries to heal itself, but the joint is typically left with increased mobility which can lead to instability. Joints of the hands often heal incorrectly, leading to the deformities illustrated above.

Osteopathic symptomatic relief may include gentle joint mobilisation to help flush through the inflammation. Massage techniques for the nearby muscles can help to prevent excessive stiffness, and a strengthening routine can help to support the increasingly hypermobile joints.

You can read more about Rheumatoid Arthritis here.

Ankylosing Spondylitis (AS)

In contrast to the relatively well recognised RA, Ankylosing Spondylitis is often mistaken for standard lower back pain. As a result, there is a roughly 8 year delay in diagnosis. The best outcomes come from appropriate and timely medication, so it is important that the condition is picked up as early as possible. Signs and symptoms that might point towards a diagnosis of AS are:

• lower back pain that begins before the age of 40

• pain and stiffness that is worse first thing in the morning or after rest

• good response to ice or anti inflammatory medications

• a family or personal history of other rheumatological conditions (especially RA or psoriatic arthritis)

• a family or personal history of IBD: ulcerative colitis or Crohn’s disease

Diagnosis is made with a combination of blood tests and imaging. Not all cases cause changes that are visible on x-ray or MRI. This may be where the belief that men are more affected originates- women may be less likely to have the expected bony changes. Although medication is the most important aspect of treating AS, osteopathy may be able to help manage the discomfort alongside it.

Make an appointment for your rheumatic pain in Naas here

Minor Sports Injuries

Sport is great for the body as a whole, but it can sometimes be the cause of injuries. A handful of common soft tissue injuries are covered below: visit your osteopath to manage problems before they arise by identifying areas that are underworking or compensating. We can also help to rehabilitate your current injury- as long as it is minor and not a fracture or other emergency.

Meniscus Tears

The illustration above shows two C-shapes within the knee. These are two pieces of cartilage called the menisci. Their roles are to help stabilise the knee and absorb forces that travel through it. They can be damaged by forceful rotation, as often seen in footballers who plant a foot then twist through that leg.

Symptoms can come and go, especially if the tear goes along the cartilage rather than through it (a bucket handle” tear). This kind of tear can allow the loosened piece to easily displace and return to position. As a result, aggravating movements may not always bother the knee, and pain and swelling may be dependent on the current positioning of the cartilage flap.

Some meniscus tears need to be repaired with surgery, but more minor injuries can benefit from osteopathy to improve local joint health and mobility. Both of these benefits are key to providing the cartilage with the nutrients it needs to heal.

Labrum Injuries

Another piece of cartilage that supports the joint is the labrum. This is a lip of cartilage that sits at the edge of the socket in some ball and socket joints, such as the hip and shoulder. It helps to reduce excessive joint movement, thus stabilising the area. However traumatic injuries can cause a tear. Falls are a common cause, but repetitive throwing can also cause a shoulder labrum tear.

As these too are cartilage injuries, they are best managed by improving the general health within the joint. Movement encourages new joint fluid in, and helps to pump that fluid into the cartilage itself. Improving movement on your own can be difficult as the pain is limiting, but your osteopath can gently improve your range during treatment and provide you with exercises to continue the progress.

Sprains

Sprains are ligament injuries not to be confused with strains, which involve muscle. Ankle sprains are common sports injuries, but other areas can be affected too. Shoulder and elbow sprains are more common among athletes in throwing sports.

Major sprains can make a joint unstable and prone to further injury. Early rehabilitation can help, but ligaments are generally slow to heal and may not reach their original tension. Sometimes a more effective management strategy is to strengthen the surrounding area. Strong muscles supporting the affected ligaments can help to prevent excessive movement and ease the relative demand on the muscles themselves. We can help to develop this plan and adapt it as your joint stability improves.

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Fibromyalgia

Fibromyalgia is a poorly understood condition characterised by widespread chronic pain, cognitive difficulties, and gastric disturbance.

Diagnosing Fibromyalgia

Fibromyalgia cannot be diagnosed with any single test as it is a functional condition. This means that imaging and blood tests cannot pick it up. However, they can still be useful to rule out other conditions. Chronic joint and muscle pain can be a sign of autoimmune or rheumatological conditions. Osteopaths are qualified to make some musculoskeletal diagnoses, but we will usually refer you back to your GP to make sure these other possible diagnoses can be disregarded. This process can usually be ongoing while you continue with your osteopathic treatment plan.

We currently work from the 2010 diagnostic criteria for diagnosing fibromyalgia. This requires three criteria to be met:

1. pain affecting at least 3 areas at a >9/10 pain level, or 7 areas at >5/10

2. consistent symptoms lasting 3 months or more

3. no other explanation for the symptoms

Beyond the pain, there may also be an increase in headaches and IBS-type symptoms. Sleep may become less refreshing, and energy and concentration may be reduced.

Who is Affected?

The condition tends to affect women more than men, at an estimated rate of 7 to 1. Onset most commonly begins between the ages of 30 and 50, but it is not too unusual for it to occur outside this bracket. Similarly to some rheumatological conditions, the onset often follows some sort of trauma. This may be an emotional trauma or a physical one. Bereavement and break ups can initiate it, as can injuries, surgeries, or giving birth.

Current Theories

Research on fibromyalgia is frustratingly inconclusive in general. There are a number of theories but none are well supported. Ideas of toxin build up have led to an offering of a range of therapies that may or may not have any benefit. PainScience.org has collated a lot of the current thinking, including the similarities with trigger points and myofascial pain syndrome. Unfortunately, this is another poorly understood condition, meaning treatment options can become a trial and error situation while an individual discovers what best suits them.

Managing Fibromyalgia

Osteopathy is recognised as a therapy that may be able to help an individual with their fibromyalgia. The approach that research highlights as most effective is a gradual increase in exercise. Of course, when you’re in pain and exhausted, it feels like useless advice, but we can help devise an achievable plan. As your capacity for exercise grows, we can adjust accordingly.

Some people find that gentle work to the muscles provides some relief. If the discomfort causes you to hold yourself in an awkward position, working on these secondary effects may be useful too.

The NHS recognises that many treatments can ease symptoms, but expects that some pain will still remain. It is important to have realistic expectations, and you may find that a combination of therapies is the best solution for you. Medication and talking therapies are also recommended- speak to your GP about these avenues.

Make an appointment for your fibromyalgia in Naas here

Tension

Stress and tension can manifest physically in the body, causing aches and pains in potentially unexpected ways. There are a few areas that are commonly affected, often associated with the effects of stress on breathing and digestion.

Breathing

When we are relaxed and breathing efficiently, most of the work is done by the diaphragm. Illustrated above, the diaphragm doesn’t look like what you might expect a muscle to look like. It is more of a sheet that connects to the ribs and spine at its edges. In the centre it has a space for things like the food pipe (oesophagus) to pass through.

During stressful periods, the movement of the diaphragm can become limited. However, the demand for oxygen does not diminish, so the body has to find a way around it. There are secondary muscles of breathing in the tops of the shoulders. Rather than efficiently moving the lower ribs, they work hard to move the upper ribs to create the pressure in the chest to inflate and deflate the lungs. The body can manage like this briefly, but the muscles soon tire. This might be felt as soreness and tension in the tops of the shoulders. If left unmanaged, this can develop into neck pain and headaches, or limit shoulder movement.

The Sympathetic Nervous System (SNS)

You might have heard of “fight or flight”. This is a term for the part of the nervous system that kicks in to respond to stressful events. As the name suggests, it’s a primal thing that is only meant to get you through a brief threat. One role of the system is to divert blood away from the digestive system. It sends the blood to muscles to provide them with energy and allow you to fight or flee.

The immediate effects on the digestive system could be abdominal pains or lack of appetite. As the sympathetic nervous system calms back down, order is restored and these symptoms subside. But modern life subjects us to prolonged stress that can keep the SNS engaged. Digestion can become inefficient and uncomfortable, causing both local discomfort as well as compensatory patterns. If you have abdominal pain, you might subconsciously hunch over into a protective position. This isn’t ideal for the diaphragm, and can change the demand on the rest of the body too.

How can Osteopathy Help?

Your osteopath will look at you as a whole to spot these potential patterns and work out the root causes. Of course, reducing stress would be a useful strategy, but we understand that life often isn’t that simple! However, some people respond well to mindfulness and breathing exercises. Even if you find that breathing exercises have little bearing on your stress, you might find that they help to improve diaphragm function and reduce strain on the shoulder muscles.

In the treatment room, we will look to ease the tight muscles that play a primary role, as well as those that have tightened in response to other problems. Addressing the root at the same time as the other symptoms can help to break the cycle of tension and discomfort. If your stress is related to work, and you’re spending longer hours stuck at a desk, we may focus a lot on the upper back, as this often gets stiff with a sedentary lifestyle and places more demand elsewhere. We can also help with your desk ergonomics- even more important if you work from home and struggle to get the support from work.

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Migraine Prevention

Osteopathy has been recognised as a therapy that may help with prevention of migraines. In 2015, migraine was ranked the 3rd highest cause of disability worldwide.

What is a Migraine?

Migraines can be hard to identify as there are a number of varieties. Some people will experience the headache without the aura. For some patients, the migraine is abdominal, with no headaches at all. For simplicity, the main features of migraines without aura are as follows:

• A headache that periodically returns, with each attack lasting between 4 hours and 3 days

• The headache is confined to one side of the head and may be described as throbbing

• The intensity of the headache is moderate to severe

• There may also be nausea, or sensitivity to light or sound

• Physical activity typically makes symptoms worse

Auras are:

• A collection of symptoms that develop slowly and last no more than an hour each

• Symptoms may include visual or other sensory disturbances

• Speech and language may also be affected, but this will not come with any weakness

• At the end of this period, symptoms will have disappeared completely with no residual features

Potential Risk Factors

There is a lot that is not understood about migraines, but there are some factors that have been frequently found to have some sort of connection with migraine attacks. Certain foods and drinks may trigger symptoms, sugar and caffeine are often identified with the help of a food diary. There may also be hormonal links- some women find that their symptoms start with puberty, come and go through their menstrual cycle, and improve or progress during pregnancy or the menopause.

Stress is also a common factor, which may also be associated with muscle tension in the neck and shoulders.

How can Osteopathy Help?

Osteopaths look at the body as a whole, so we can spot problems in one area of the body that may be overloading another. Every case is unique, but if your migraine is associated with an excessive demand on the neck, we will assess the upper back and shoulders to see why the need is so high. Often, especially for people who have a sedentary job, the upper back becomes stiff without causing many direct symptoms. As movement is lost here, the body tries to pick it up elsewhere- typically the neck and lower back. Sometimes rectifying this stiffness is as easy as working through the muscles and joints and making changes to the way your desk is set up. Other times it may be most beneficial to provide you with mobility or strengthening exercises.

The classic “desk posture” is associated with rounded shoulders too, which can further affect neck movement. A holistic approach like this might involve working on a number of different areas to ease the original problem.

As osteopaths have relatively long appointments, we may also be able to help you to identify your triggers. Discussion during treatment might highlight a pattern that you hadn’t spotted alone, which can subsequently be addressed. We can also work alongside your GP’s medication routine- you don’t have to choose one or the other. However, people who seek osteopathic treatment often want to avoid medication where possible, and that can still yield good results. One study found that osteopathic treatment can be more effective than medication alone.

Make an appointment in Naas for your migraines here

Shoulder, Elbow, and Arm Pain

Osteopaths don’t just treat backs! There are a range of conditions that we can help with that affect the arm and its joints.

Shoulder Problems

The shoulder is more than just a ball and socket joint. The collar bone attaches at the front, and the shoulder blade is associated with the ribs that it slides over. As all of these structures work closely together, a problem with one can cause symptoms in another. Likewise, a problem in the shoulder can cause pain in the neck, or even headaches. This is why we look at the body as a whole when making a diagnosis and devising a treatment plan

A common complaint we see in clinic is frozen shoulder. This is not just a term for stiffness and pain in the shoulder, but a specific problem. The layer of tissue that surrounds the main shoulder joint becomes tight and sticky, reducing some specific movements. The rest of the shoulder and upper back then have to work harder to compensate for those lost movements. You can read more about frozen shoulder here.

Sports injuries can often affect part of the shoulder. The biceps muscle runs into the joint itself, so injuries to it can cause deeper discomfort than simple muscle strains. Throwing sports are demanding on the shoulder, and can be associated with cartilage injuries as well as ligament sprains. Your osteopath will use your case history, as well as the way you move, to determine the problem and work out a treatment plan.

Elbow Problems

Elbow problems seem to be much less common than those affecting the shoulder. One that we see relatively often is Tennis Elbow. This often starts as a mild muscular issue, but develops into something more persistent and inflammatory if continually aggravated. We have a post on tennis and golfer’s elbow here.

Bursitis is a condition that can affect almost anywhere in the body, including the elbow. Bursae are little fatty sacs that sit between bone and tendons to prevent friction. Sometimes they can become irritated themselves, causing pain and swelling. “Student’s elbow” is a term for a rather dramatic-looking form of bursitis that affects the point of the elbow. Repeated pressure, as caused by leaning on an elbow on the desk, can cause the irritation that leads to bursitis. In the case of student’s elbow, this can cause an egg-sized swelling, which may or may not be painful at all.

It is also possible to sprain an elbow. This typically results from trauma such as a fall onto the arm, but something more subtle like a dog pulling a lead could be a cause too. Ligaments are slow to heal, so your osteopath will work to ease the load on the area and improve general tissue health. We don’t routinely recommend supports for sprains, as using the area (gently) helps it to heal stronger.

Remember that you don’t need an existing diagnosis or a referral from your GP to make an appointment with your osteopath. Click the link below to instantly book an appointment online.

Make an appointment for your arm pain in Naas here.

Cervicogenic Headaches (From the Neck)

Headaches can be notoriously difficult to find a root cause for. Some headaches come from structures in the neck, which can be relatively easy to test for. In many cases, treatment can be quite straight forward too.

Identifying Cervicogenic Headaches

Cervicogenic just means “from the neck”. Symptoms can be quite similar to tension-type headaches (TTHs), for which treatment is different. The main difference between the two is that TTHs are considered “primary headaches”. This means that they are not caused by another condition. Cervicogenic headaches can be diagnosed whenever a headache can be attributed to a known issue in the neck, either by clinical diagnosis or imaging. Alternatively, they can be diagnosed if two of the following points are true:

1. A headache develops alongside the development of a neck problem

2. The headache improves or resolves when the neck problem does the same

3. Neck movement is limited, and some movements aggravate the headache

4. Diagnostic blocks (such as nerve blocks) effectively remove headache symptoms

Symptoms can be anywhere in the red area illustrated. Despite covering the eye, they will not cause visual disturbances. Dizziness and nausea are not typical symptoms either. Headaches with these additional symptoms may indicate migraine, for which we may still be able to help. Pain may feel like it radiates up from the neck and over the top or side of the head. If the cause is a tight muscle in the neck, you might find that a warm compress on the neck, or resting the head help. For other causes, a cool compress may be more beneficial. Your osteopath can advise the more appropriate for you.

Tension Type Headaches

TTHs have the following symptoms:

1. They cause pain on both sides of the head

2. The pain can be described as pressing, or tightening, but not pulsating

3. Intensity of the pain is mild to moderate

4. Typical physical activity, like walking or going up stairs, does not aggravate symptoms

There can be a lot of variation between TTHs, and a single headache can last anywhere from 30 minutes to over a week. In contrast, cervicogenic headaches usually last less than a day, but may be frequent.

Managing Cervicogenic Headaches

Osteopaths are qualified to help with these kinds of headache. We will assess the neck, and usually the upper back too, to determine what structures may be having an effect. Often the muscles and joints of the neck are overworked by restricted areas further down the spine. This can be particularly evident with underlying conditions like osteoarthritis. When arthritis affects the hips, it can encourage you into a forward posture, for which the neck has to compensate. In cases like these, we might find that improving hip and lower back function takes the stress off the neck, and improves the headaches.

Whatever the underlying cause, or causes of your headaches, your osteopath will work to identify as many as possible. Treatment is gentle and drug free, using massage, stretching, and joint manipulation techniques to improve function throughout the body. We aim to take the burden off the overworked areas and get your whole body moving more comfortably and efficiently.

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Tennis Elbow

Tennis elbow is the common name for lateral epicondylitis. The epicodyle is part of the humerus (upper arm bone) that sits close to the elbow. It is where the muscles attach that control wrist movement. The "-itis" in the name refers to the inflammation that occurs in the condition, which is focused around the connection between the muscle and the bone.

"Tennis" Elbow

Despite the name, the condition can develop without the patient ever having touched a tennis racket. The muscles that become problematic are the same that are used in a backhand swing, but of course this is not all they are used for. Moving a heavy kettle or pan of water can put demand on the same muscles, known as the wrist extensors.

Golfer's Elbow

The opposite side of the arm can be affected in the same way. This is medial epicondylitis, colloquially known as "golfer's elbow". As before, you can develop this condition without playing the sport it is named after. Wrist flexion could be overused when carrying large shopping bags that would drag on the floor unless you engage your wrist. Even carrying a child for a long time could require extra work from these muscles.

The Process

Rather than tennis elbow being an example of a tight muscle, it's a process beyond that. If the muscle is tight or strained enough for long enough, it can begin to irritate the join between muscle and bone. This causes inflammation, at which point symptoms can change. Whereas before there might have just been some local aching or tenderness in the muscle, the pain may become more deep and persistent. Inflammation often responds well to a cool compress whereas simple muscle tightness often prefers heat. Your osteopath will ask if you've found anything that makes the symptoms better or worse, so these factors can be quite telling.

Osteopathy and Tennis Elbow

Your osteopath will take a holistic approach at managing your pain. We want to get to the bottom of why the condition developed in the first place, as well as providing relief. Treatment itself might involve massage techniques to the affected muscles, as well as mobilising techniques for the elbow and wrist joints. Self management can be really important here, especially if the cause is identified as a factor that could be modified.

When epicondylitis is actually related to racket sports, sometimes it can respond to a simple change in the grip. If you racket's grip is skinny, it asks the affected muscles to work harder just to hold on, predisposing the problem before the game has even started. Wrapping the handle with an additional roll of grip tape might ease the load enough for you to continue playing while getting better.

If your symptoms are worse in the morning, it might be related to your sleeping position. We don't often recommend braces to immobilise joints, but in this case it might be appropriate. An off-the-peg wrist brace can sometimes be a good way to prevent tension in the affected muscles overnight, especially if you find that you sleep in a curled up position. You won't be wearing the brace while awake, as general movement is key to maintaining strength and mobility. It also helps to move the inflammation along.

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