Frozen Shoulder

Frozen shoulder is the common name for adhesive capsulitis. This technical name gives a better idea of what's really causing the problem:

• Adhesive: sticky, restricted

• Capsul-: the capsule made of fibrous tissue that surrounds the ball and socket joint

• -itis: inflammation

So frozen shoulder is a condition in which the capsule of the shoulder becomes sticky and inflamed. Three movements are classically lost while the condition is active: taking your arm out to the side, reaching back (like putting on a coat sleeve), and rotating out (like washing your hair). They are often associated with muscle tightness around the shoulder joint and shoulder blade.

The Phases of Frozen Shoulder

Frozen shoulder goes through three phases, each lasting for a few months. The entire process from onset to resolution is often over a year, and can be as long as three years. Osteopathic treatment may be able to speed up the process, but unfortunately the condition will still have to work through all three phases. These are:

• Freezing phase: pain and restriction begin to develop

• Frozen phase: pain reduces, but restriction remains

• Thawing phase: everything begins to return to normal

Risk Factors and Causes

Unfortunately, in many cases this happens for unknown reasons. Symptoms can develop slowly, without trauma or other changes. There are some risk factors, including immobilisation of the shoulder, such as a sling after surgery or a fracture. There are also higher incidences in people with heart disease, diabetes, and Parkinsons'. Medications may also play a role. However not everyone who develops frozen shoulder will fit into any of these categories.

Some people will go on to develop the same problem on the other side within a decade of the original problem's resolution. If you're noticing familiar signs and think this might be the case for you, try to start treatment as soon as you can for the best results.

Treatment Plans

Conservative treatments like osteopathy should be tried before surgery or steroid injections are considered. Early treatment might include techniques to encourage movement from the shoulder joint, and massage techniques to the surrounding muscles. Working on the muscles around the shoulder blade can provide extra shoulder movement surprisingly quickly. This is often because the muscles were tight to try and protect the painful shoulder joint. In being so, they also restrict the movement of the shoulder blade, which plays a big role in overall shoulder movement. By improving movement in this joint, some of the demand is removed from the affected ball and socket joint. You get the dual benefit of increased movement and a chance to heal.

Your osteopath will look at the effect of your shoulder problem on the rest of your body. Often, as the body tries to protect the shoulder, muscles tighten further around the neck and upper back. These changes can cause other aches and pains around the area, or sometimes headaches. While working to improve shoulder movement, we will also keep compensatory changes at bay.

Make an appointment in Naas for your frozen shoulder here

Chronic Pain

When pain persists for over three months, it is considered chronic. When it is present for a long period like this, it can affect the patient biologically, psychologically, and socially.

Chronic pain is complex, and influenced by a number of factors. The image above shows a few. Physical health plays a role, affected by sleep, smoking, and diet. Psychology is important too- if someone is told that their bones are “crumbling” it will affect the way they move and trust their body. Some medications can increase sensitivity to pain, and ongoing insurance claims can genuinely affect symptoms.

How Chronic Pain Works

You can think of pain as a protector- it is there for a reason. It can be overprotective though, becoming hypersensitive. This can manifest as more intense pain than normal, or pain in response to things that shouldn’t cause pain.

The hypersensitivity can be blamed on the nervous system. The area in pain is not to blame. But the nervous system is influenced by so many different things, it can be hard to make changes on your own. A doctor may prescribe painkillers to help you get on top of things, but patients often don’t want to take them for too long. Side effects can be unpleasant, or they may be concerned that the cause has not been addressed. Pharmacology can work really well alongside therapies like osteopathy to start to unpick the problem.

Ongoing Stimulus

Chronic pain can be caused by a condition, such as osteoarthritis, that continues to produce pain. This is known as “secondary chronic pain”. Although this can be associated with the hypersensitivity mentioned above, it is not always. This kind of pain is easier to manage, as fixing or improving the cause will reduce the pain.

Primary Chronic Pain

If your pain cannot be attributed to another condition, it is considered primary chronic pain. Fibromyalgia is one of a handful of conditions that count as a primary cause.

There is a grey area over chronic lower back pain. It can be difficult to pinpoint the exact cause of a case of lower back pain. Even MRIs are imperfect, as many people have structural changes (like bulging discs) without any symptoms. We know that chronic lower back pain does exist once the original problem has resolved, and in this case it would be considered primary. But it is not always clear if someone’s original stimulus has resolved or not.

Your osteopath has tests they can perform to help decipher the cause of your pain. If you have already had investigations like imaging and blood tests, bring your results to your appointment as they may be useful.

Osteopathy and Chronic Pain

Whether your pain is primary or secondary, we may be able to help. We mentioned above that pain is influenced by many factors, but fortunately osteopathy addresses a number too. Beyond the mechanical parts of the picture, we can help with lifestyle advice, reassurance, and education to name a few. Outcomes are better among empowered patients who understand what is happening and why. We cannot cure all chronic pain, but if we may be able to help you manage it.

Book an appointment to address your chronic pain here.

Hip and Knee Osteoarthritis

Osteoarthritis (OA) can affect any joint with cartilage inside. Two commonly affected joints are the hip and knee. You can read more about the process of osteoarthritis here.

Knee Arthritis

There are actually three joints in the knee, and any one of them can develop OA. The main joint is the big hinge joint between the thigh and shin bone. OA is an issue of cartilage, and there is plenty of it in this joint. Beyond the usual cartilage coating the bones within the joint, there are two additional pieces in each joint. These are the menisci, and their role is to support the joint by providing a better connection between the bones.

The second joint in the knee is the patellofemoral joint: where the knee cap meets the rest of the knee. This can also be subject to arthritis. The joint is quite often overworked, as it sits within the tendon for the quadriceps. If these muscles are tight, they put extra pressure on the joint and cause friction. Overuse like this is a factor in developing arthritis. Symptoms of patellofemoral arthritis can include:

• Pain at the front of the knee

• Pain on going up and down stairs or ramps

• Relief when fully straightening your knee

• Aching in the front of the thigh

The third knee joint is on the outside, where the fibula joins the rest of the knee. This joint is small and is less likely to present a problem than the others, but your osteopath will consider it if appropriate.

Hip Arthritis

The hip can develop arthritis with very few symptoms until the late stages. Often the first sign is a loss of extension (moving your leg backwards). The body is good at adapting to this loss, and rather than challenging itself, it finds the path of least resistance. It tilts the pelvis so you can still move your leg back, but without using the hip to do so.

Hip arthritis is associated with compensation through the back and neck, which can ultimately cause the development of more arthritis in these areas.

One of the most common joints to be replaced is the hip. Contrary to popular belief, this is not the only outcome for people who develop arthritis in the joint. In the early stages, it may even be possible to reverse some of the damage if you can achieve better movement through the hip. The more progressed the condition, the more likely you are to be considered for surgery, so early action is key.

Osteopathy for Osteoarthritis

Your osteopath is qualified to help with your arthritis. We can help to improve the movement in the joint, which will allow the body to get as much nutrition as it can to the area. We will also look at any compensatory patterns that have developed elsewhere in response to the arthritis. Preventing and managing new symptoms may be realistic treatment goals for you.

Click here to make an appointment in Naas for your arthritis.

Neck Pain

A problem in the neck can be the result of dysfunction elsewhere. Often restriction in the upper back causes the neck to overwork, for example. On the other hand, sometimes neck problems are the cause of symptoms somewhere else, like some headaches.

Osteopaths can help with neck pain that involves the muscles, nerves, or joints. Traumatic injuries should be triaged by a doctor, but we may be able to help with rehabilitation after it has been investigated.

Causes of Neck Pain

Just like the lower back, there are a number of potential causes for neck pain. Often it comes out of nowhere, developing gradually over time, or appearing when you wake up one morning. Even minor problems can seem quite dramatic, as most problems will trigger the brain to try and protect the area. It does this by tightening up the muscles, which can cause restriction and pain in itself.

Your osteopath will use information from your case history and movements to determine the cause. Often there are a combination of causes, so treatment will aim to address all of these and the connections between them. Whether your neck pain comes from an arthritic joint or an irritated nerve, we can help.

Complications of Neck Pain

Cervicogenic headaches are headaches caused by something in the neck. Sometimes these headaches are very brief, but other times they are recurrent and can last for days at a time.

These headaches usually affect one side at a time, but future episodes may be on the other side. Pain is not typically accompanied by visual disturbances or nausea. At the start, pain may be intermittent and focused towards the top of the neck or base of the skull. As it moves over the top or side of the head, the pain may become more continuous.

If the brain receives a pain signal from somewhere in the neck, sometimes it misinterprets where it’s come from. It’s the same process as when people get jaw or arm pain instead of chest pain during a heart attack. This is called referred pain, and it can happen in the neck too. The message the brain gets about pain includes the nerve that detected it. At the top of the neck, the first few nerves also supply the skin of the head and face. As a result, a problem at the top of the neck could be misinterpreted as a headache by the brain, without a direct mechanical link. That is not to say that you are imagining the pain. We can help with this cause of headaches too.

Neck pain with associated symptoms in the arm can indicate a problem with a disc. Discs don't really slip, but they can bulge, and sometimes they will irritate a nerve. The nerves in the neck mostly supply the arm, so if one is impinged you may get pins and needles, numbness, weakness, or pain in the arm. Your osteopath will be able to tell which level is affected by the location of your symptoms.

As with most things, if you can nip your neck pain in the bud, you have a better chance of avoiding the development of secondary problems. It’s never too soon to come and see your osteopath- if you have recurrent neck pain but are symptom free at the moment, we can still work to prevent its recurrence.

You can book online here for an appointment in Naas.

Osteoarthritis

Osteoarthritis (OA) is a condition that affects most of us eventually. We used to think of it as "wear and tear" of joints, but now we know there's also a "repair" element to it.

What happens in Osteoarthritis?

OA is a condition of cartilage. Cartilage cushions almost all of our major joints, but it has a poor blood supply. This means that it relies on nutrient exchange from surrounding fluid to stay healthy.

It's easier for cartilage to receive nutrients and flush out waste if it goes through compression and decompression. You can imagine it as a dirty sponge in clean water: pump it enough and it'll come out clean.

Early stages

During the early stages of osteoarthritis, the cartilage stops being properly pumped. This may be subconscious, and it may be the body's attempt at protecting itself from pain or injury. If this is not addressed, the cartilage begins to become unhealthy.

As the cartilage becomes more unhealthy, you may find there is more discomfort. This encourages further compensation to take pressure off the sore joint. Unfortunately, this means the cartilage is still not being pumped, and the cycle is not being broken.

The rest of the body continues to adapt, often without you noticing. If the hip is affected, your posture might change so you don't have to use the painful range of movement. This causes compensation elsewhere, leading to a hunched posture. Over time, this can also cause problems in the lower back and neck as their demand increases.

Late stages

If OA is not addressed, the cartilage continues to decline. The surface of the joint becomes more rough, and pieces of cartilage may become loose. Lost cartilage can be replaced by bone, and bone might grow around the edge of the joint, forming a "lip" visible on X-Ray.

By now, the joint is likely symptomatic. Crunchy, painful, or limited movement can all be signs of osteoarthritis. The body continues to try and protect itself, limiting movement by tightening surrounding muscles. It is not too late to seek treatment, as further restriction of movement will only speed up the degenerative process.

Beneath the cartilage, cysts can form within the bone. At this point there is only so much that can be done with manual therapy. By now, the joint is likely to be significantly painful, and a joint replacement may be the best course of action.

How can OA be treated?

The good news is that manual therapy has been proven to be effective in improving pain and mobility in arthritic joints. Thinking about how OA develops, it makes sense that hands on treatment and exercise would help.

Your osteopath can spot the early signs of osteoarthritis, possibly even before you have. In very early cases it may be possible to fully restore the health of the joint.

For most patients, treatment involves work to get the joint to a comfortable level, then exercises and longer term management to keep it happy. If there have been compensations elsewhere in the body, these can be addressed too.

Nip your osteoarthritis in the bud. Make an appointment in Naas here.

Osteopathy in Pregnancy

The body goes through changes at an unprecedented speed during pregnancy, so symptoms of lower back pain are unsurprising. However, you do not need to suffer through them.

Hormonal Causes of Back Pain

From early in the first trimester, the body begins to produce higher levels of the hormone “relaxin”. The purpose of this hormone is to increase movement within the pelvis by relaxing the ligaments around it in preparation for birth. Sometimes lower back pain can be one of the first signs of pregnancy for this reason.

Hormone levels peak again in the third trimester, at which point back pain may return or develop for the first time. If the joints of the pelvis are painful, they may be worse when:

• turning over in bed

• getting up from sitting

• walking

Your osteopath cannot reduce the effects of the hormone itself, but we may be able to help your body cope better with the changes.

Although effects of relaxin may be focused to the pelvis, there are systemic changes too. Relaxin affects the permeability of blood vessels, which can cause fluid retention. This may be mild, and only recognised later on when rings no longer fit comfortably. Alternatively, it may be significant, even causing carpal tunnel syndrome.

Mechanical Causes of Back Pain

As the baby bump develops, the centre of gravity shifts forwards. In order to keep balanced, posture needs to adapt. The typical adaptation is an increase in the curve at the bottom of the back. Directly, this encourages the muscles of the lower back to shorten and tighten. We also expect to see tightness in the buttock and hamstring muscles as they work to keep you upright.

When the lower back arches more than usual, the demand on the rest of the spine changes. The upper back may become stiff, and the angle of the neck needs to change to keep the head level. Some treatment methods are inappropriate during the later stages of pregnancy, but your osteopath will adapt their plan for you. Increasing movement through the neck and upper back, as well as managing associated muscle tightness can make all the difference.

More Severe Pelvic Joint Pain

SPD stands for Symphysis Pubis Dysfunction, which can be agonising. In this condition, the combination of hormonal and mechanical changes causes irritation of the large cartilage joint at the front of the pelvis. If left unmanaged, this can impact birth itself, as birthing positions with legs apart are not recommended. Some women also require the use of crutches during the later stages of pregnancy. Symptoms may clear up spontaneously at birth, but there are things we can do to help you manage in the meantime.

Make an appointment online to manage or prevent back pain in pregnancy.

Lower Back Pain

Osteopaths are well known for treating lower back pain. But what kinds of back pain are there? There are a number of different structures within the back, and any of them can cause pain. Some of these behave very similarly, whereas others might stand out dramatically.

Sciatica and Intervertebral Discs

Patients are often worried when it appears that their pain may have something to do with a disc. There is a disc between each vertebra, and it plays a number of roles. They are squishy enough to allow movement of the bones above and below them, and they help to shock absorb as well. They are very firmly attached to their neighbouring bones, and as a result will never actually slip. They can, however, bulge.

By the age of 40, most people will have at least one bulging disc. But most people over 40 do not have lower back pain. This is because a disc bulge is not inherently painful. The NHS advises against the routine imaging of patients with lower back pain. If the back pain is simple enough and can be managed conservatively, there would be no benefit on blaming it on a disc that may or may not be playing a role.

Discs can degenerate over time, and they can be associated with chronic pain. Repeated or constant irritation of the disc can encourage new nerves to grow into the disc, therefore making it more sensitive.

If a disc bulges into a nerve that feeds into the sciatic nerve, it can cause pain. This is often felt as a shooting pain along the back of the thigh and calf. It may also affect the buttock or sole of the foot. Sometimes it is accompanied by other neurological symptoms, such as:

• pins and needles

• numbness

• weakness
  

There are a few places where the nerve can be irritated, so your osteopath will work to find out where your problem is. We look to resolve the underlying issue as well as managing your symptoms.

Joint Pain

Another common cause of lower back pain is osteoarthritis. Despite what a lot of people think, a diagnosis of osteoarthritis (or just arthritis) is not the end of the road. In the early stages especially, the affected cartilage can be very responsive to efforts to get the joints moving properly again. Your osteopath can help with this in the treatment room and with exercises for you to continue at home.

Signs of arthritis in the back can include pain that might spread from the centre of the back to one side, stiffness, or a feeling that movement is no longer smooth. There may be additional stiffness first thing in the morning, but this passes quickly. Sometimes arthritis in the back is a secondary effect of arthritis elsewhere. For example, if the hip loses movement, the back has to compensate.

Not all joint pain in the lower back is caused by arthritis. Your osteopath will examine you to determine the cause of your symptoms.

Inflammatory Back Pain

As we are often the first port of call for people with lower back pain, we also need to be able to recognise what it out of our remit. Research into inflammatory back conditions such as Ankylosing Spondylitis (AS) and AxSpA is improving, although there is still typically an 8 year delay for diagnosis. AS is a rheumatoid condition in which the joints of the lower back and pelvis become inflamed. After an inflammatory episode, the body attempts to heal the damage done. Unfortunately, when it lays down new bone, it fuses the joints together.

This can be easily mistaken for typical lower back pain in the early stages. Early intervention, including formal diagnosis by a rheumatologist, is key for a good outcome. Modern medications can slow the progress of AS, limiting the fusion between joints. Some patients also find that gentle osteopathic treatment helps them to manage their symptoms, although it is important to recognise that this is not a cure. Inflammatory back pain is aggravated by too much activity, and the same effect can be caused by excessive treatment.

If we suspect that your back pain is out of our remit, we can support you in referring you back to the GP for further investigation or treatment.

These are not the only causes of lower back pain. You can make an appointment with one of our osteopaths using our online booking system here.