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.

Click here to make an appointment for your tennis elbow in Naas

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.

Your Baby’s Milestones

Health professionals use milestones, among other things, to monitor your baby’s progress. “Normal” is a broad range, so try not to get too hung up on specific numbers. Sometimes, delays in hitting milestones can be down to mechanical reasons such as tight muscles. In these cases, your osteopath may be able to help.

Head control

From the first few days and weeks of life, baby will begin to show interest in holding their head up. At first, this is only really possible when they are positioned upright and their head is easily balanced. With time and practice, they will begin to be able to turn both ways when upright or laying down. Around the same time, they’ll start getting stronger and find it easier to lift their head from more reclined positions.

Some babies struggle to turn both ways. It might be a subtle problem, as they might be able to function without going into their unfavoured side. For breastfed babies, the first sign might be that they are less efficient or tolerant of feeding on one side. You might also notice that when you lay baby on their back, they always turn the same way. Repetitive pressure on the same area of the head can lead to a flat spot. You can read more about plagiocephaly here.

The restriction of neck rotation can be due to torticollis. This is a condition that can be present from birth, or might arise later on. Tightness in a muscle on the front and side of the neck can limit movement in much the same way we suffer from a cricked neck in adulthood. This tightness is usually quite a simple problem that is well within your osteopath’s remit.

Sitting

Although sitting sounds quite straight forward, there are a few common issues that can arise. Practice often makes perfect, so ensuring baby has time to work on sitting, in a lace where falling over won’t cause an injury is important. A good selection of toys or anything that they might want to safely explore will help with motivation.

Some babies throw themselves back when they get into a sitting position. Typically, this is due to an imbalance in strength between the muscles on the back and the abdomen. These babies might be really good at tummy time and have great head control. As a result, they might be reluctant to sit, and prefer to spend more time on their front, which means their sitting doesn’t improve.

Your paediatric osteopath can help to encourage your baby to work on their core muscles during appointments. We can also give you ideas of how to help their development at home.

Becoming Mobile

Not all babies crawl before they walk and stand. “Bum shuffling” is the preferred method of getting around for about 20% of babies, and is nothing to worry about. Crawling, shuffling, and standing to walking require strength in a lot of different muscle groups. This is achieved from building on previous milestones and again: plenty of practice.

You might notice that your baby seems to be continuously struggling with particular movements. These might be transient, or they might be limiting or affecting their ability to get to the next step. If this seems isolated, your osteopath can assess your baby and offer advice.

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

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.

Plagiocephaly

Plagiocephaly refers to a misshapen head in infanthood. This is typically not something that a baby is born with, but develops in the early weeks of life. More specifically, plagiocephaly is when one side of the head becomes more flat than the other. If the back of the head is flatter than normal, it is brachycephaly.

It may coincide with torticollis, where muscles in one side of the neck are tight. This can limit movement, and encourage baby to keep their head turned to one side. As a result, the same side of their head is always in contact with the surface upon which they are laying.

Anatomy

The skull is made of a number of flat bones, and in adults they are strongly connected by joints known as sutures. Unlike ball-and-socket joints or hinge joints, these are not made for movement. Newborns have a lot of growing to do, so their skull bones are soft and the joints are made of cartilage.

Repeated pressure on one joint or bone will cause a change in shape.

Effects of Plagiocephaly

Plagiocephaly is not a painful condition, and in most cases there is no effect on the brain. The NHS recognises that very few children are teased at school due to their head shape- most cases improve on their own over time, and hair will disguise it to some degree.

Research is sparse, but some scientists link plagiocephaly to developmental delays. This study does not clearly identify whether the children in question also had craniosynostosis, which is a more serious cause of plagiocephaly.

Your osteopath will be looking for signs of craniosynostosis. Whereas plagiocephaly and brachycephaly are relatively benign and caused by positioning, craniosynostosis is a rare condition of the joints in the skull. Symptoms can initially be identical to those of plagiocephaly- the head may be asymmetrical or their forehead might be particularly prominent. In craniosynostosis, the joints of the skull fuse early. This is more evident when the baby is slightly older, as their soft spot may become solid before their first birthday. Not all cases need intervention, but more severe ones need to be referred on.

Treating Plagiocephaly

More severe cases are typically managed with a helmet. This is a tailor-made device that needs to be worn nearly 24 hours a day to reshape the head. In contrast, the most mild cases might be left to resolve themselves as the head grows and baby becomes more mobile.

It is important not to react to a diagnosis by sacrificing safe sleep. Current guidance is to put your baby to sleep on their back, as this position has the lowest association with infant mortality. Whereas a baby sleeping on their front is more likely to suffer SIDS, a flat head is not life-threatening.

Osteopathy can help if the root cause is tightness in the neck. Some babies are at higher risk of plagiocephaly because of a reluctance to lay on their front. This may be due to reflux, or sometimes a musculoskeletal issue, such as muscle tightness, that we can help with.

You can book an appointment in Naas with our paediatric osteopath here.

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.

Reflux and Silent Reflux in Babies

New parents expect their baby to regurgitate a fair amount of their milk or formula in the early days. But there is a line between the normal spit-up and reflux.

What is Reflux?

Reflux in both adults and babies, is the return of stomach contents through the sphincter between the stomach and oesophagus (food pipe). Babies are particularly prone to this as their sphincter is less developed than that of an adult. This is why the vast majority of young babies spit up frequently- although this is typically outgrown relatively quickly. Babies with low muscle tone may be more predisposed to developing reflux. Reflux in adults is often associated with diaphragm dysfunction- osteopaths can help with this. Some babies may also have tightness in the diaphragm alongside their reflux.

There is a grey area between spit up and reflux. Generally speaking, if the baby is upset by their regurgitation, we need to start thinking about reflux.

When considering reflux, bear in mind that it is difficult to measure by eye the amount of fluid regurgitated. Try dropping a tablespoon of yogurt on a surface and you’ll see that it looks like a lot. You can gauge better the amount of food baby is taking on board by monitoring weight gain, and production of wet and dirty nappies.

Symptoms

The tissue that makes up the oesophagus is not equipped to deal with stomach acid. The alternative name we give it in adults (heartburn) describes the sensation well. Babies may not be able to communicate their discomfort in a particularly precise way, but there are a few clues.

During a feed, a baby with reflux may continually latch and unlatch. This may coincide with gulping air or burping. Alternatively, baby may cough a lot while feeding. Increased fussiness after feeding, especially if laid down soon after a meal, could also be a sign.

The textbook sign of infant reflux is the arching back (illustrated). Combine this with the other signs mentioned above and it should definitely be considered.

Silent Reflux

Silent reflux is so named because of its more subtle symptoms. Here, the stomach contents re-enters the oesophagus, but is not expelled from the body. It may not even reach the mouth, but that doesn’t mean it is not a problem. The irritation comes from stomach acid returning through the sphincter at the top of the stomach. Regardless of how much further it travels beyond this, the irritation has occurred.

When To Seek Help

Sometimes reflux can be a sign of something more serious. You should seek urgent medical attention if any of the following apply:

• there is blood in baby’s vomit or faeces

• baby is inconsolable

• baby can keep no fluids down at all

• their abdomen is distended or tender

• they have a fever alongside reflux symptoms

• their sick is yellow or green

You should also contact your doctor if baby’s weight gain is not as expected, or if symptoms persist after their first birthday. Symptoms typically resolve spontaneously in the first year of life.

To book an osteopathic appointment in Naas, click 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.

Naas Osteopaths - Reflux and your baby

What is Reflux and should you be concerned?

Reflux is a common occurrence in baby’s and normally begins around 8 weeks of age and gradually improves as the baby gets older. Reflux occurs when some of the contents of the baby’s tummy return back up into their mouth. This usually occurs because the baby’s food pipe (oesophagus) is still growing and developing. The ring of muscle at the bottom of the oesophagus develops over time and this will prevent stomach foods from leaking out. It is a common and usually affects up to 40% of babies.

Signs and symptoms

Your baby may show no signs or they may show the following signs

- Regurgitating or spitting up milk during or after feeds.

- Refusing feeds, choking or gagging.

- Continuing hiccups or coughing.

- Excessive crying or crying while feeding.

- Repeated ear infections.

There is no real concern about reflux if your baby is feeding well, happy and gaining weight as normal.

Reflux - Osteopathy and your baby

When should i seek medical advice

Contact your GP, public health nurse or midwife if reflux starts after 6 months of age and continues beyond 1 year, or your baby has any of the following problems:

• Spitting up feeds frequently or refusing feeds.

• Coughing or gagging while feeding.

• Frequent projectile vomiting.

• Excessive irritability or crying.

• Green or yellow vomit

• Vomiting blood.

• Blood in their faeces or persistent diarrhoea.

• Swollen or tender tummy.

• High temperature (fever) of 38C (degrees Celsius) or above.

• Failure to gain much weight, or losing weight.

• Arching of their back during or after a feed, or drawing their legs up to their tummy after feeding.

Osteopathy For Your Baby

Whilst reflux can be a common problem for babies it can also prove to be a distressing time for both mother and child. A careful expert assessment can often find where troubles occur with feeding and offer advice on what can be done about it.

This can often be common sense advice or working in conjuction with other professionals like the lactation consultant and tongue tie specialists. Osteopathy may help the neck and diaphragm of baby relax, so that feeding time is more comfortable and efficient. The digestive system generally responds to soothing and relaxation , so that milk is naturally absorbed and processed.

A combined professional approach can often lead to a breakthrough for feeding comfort and success, allowing parents and baby to relax. To find out more information get in touch with us at Naas Osteopaths by emailing us at info@naasosteopaths.ie