What we treat
The most common causes of back pain will involve one or more of the following:
Facet joints at the back of the spine are commonly implicated in both acute and chronic back pain. Acute injuries to these joints can cause severe pain, sometimes after the simplest of movements. With careful management, acute symptoms generally settle quickly. These joints can also be compromised by wear and tear (arthritis), often exacerbated by poor posture. Chronic conditions can usually be helped by enhancing the quality of movement and stretching and releasing the back muscles.
Disc injuries can vary in severity from bulges and herniations, to prolapses. They may or may not be traumatic and may give long term pain or resolve reasonably quickly. Disc injuries can cause sciatica, as the herniated part of the disc can press on a nerve as it exits the spinal canal. Treatment aims to improve function with gentle spinal movements, stretching and massage.
The many ligaments of the spine and pelvis are often the cause of back pain. The ligaments provide the joints with stability and when injured, can result in acute disability and pain - careful management is required.
The back muscles can frequently be injured, becoming tight and painful from incorrect or repetitive use. Secondary spasm may be caused by protecting an injury. Many people suffer from muscle fatigue from daily activity such as computer use or long periods of driving. These muscles usually respond very well to treatment, for example with a combination of targeted massage and stretching.
and neck pain
There are many different causes of headache, but one of the most prevalent and easily treated is called 'tension headache'. It is called this because tight neck muscles grip the back of the skull (occiput) causing head pain. These muscles can pull on the connective tissues which run from the back of the head to the forehead causing pain in these areas. Treatment of neck stiffness and affected muscles can be very effective in improving these cases of chronic headache.
Muscle injuries can result from trauma, such as in a sports injury or road traffic accident. Muscle injuries can also occur over time by excessive or repetitive use. Sport, long periods of driving and computer work can also be a cause in these instances of fatigue and overuse. Muscles will 'spasm' as a protection when we are injured or in pain and while the body may repair a fracture or ligament strain, often the resulting muscle spasm is hard to get rid of without attention.
We place great emphasis on a patient's muscular state. This is accomplished by massage work and other release techniques to improve muscle function and aid healing. An important part of patient care is showing patients effective stretches.
Muscle stretches enhance flexibility and can easily be fitted in to an average day, either at work, at home or in conjunction with sport. Most stretching only takes a few minutes a day but can yield great benefits. Occasionally we may prescribe strengthening exercises but more often than not people need to stretch tight muscles rather than strengthen them - a tight shortened muscle does not have the stamina of a relaxed muscle. Improving muscle states is often the key to eliminating pain and enhancing the whole function of the musculoskeletal system.
Muscles move the joints and allow us to do everything from sport, dancing, to making facial expressions. The state of our muscular system is central to our health: physical, emotional and psychological. Tight muscles start to affect the range of movement of our joints and slowly but inexorably this may cause pain and damage. Tight muscles may cause other problems such as headaches and nerve entrapment.
The neck is part of the spine and therefore suffers from the same general problems as those covered under the section on back pain. The neck has far greater movement than the rest of the spine and its function is closely related to that of the upper back, ribs and shoulders. Muscle fatigue and tightness is a common complaint causing pain and restriction of movement. This may cause headaches.
Treatment of neck conditions (and any other compromised areas) aims to promote the quality of movement by moving the joints gently, combined with stretching and massage of the muscles. Simple exercises can also improve and maintain progress.
The shoulder is a complex joint. This is because it needs to have a very large range of movement to carry out its primary function of positioning the hand. This complexity means that if injury occurs, quite minor problems can escalate into major dysfunction and pain.
The shoulder is mainly held together by muscles, the rotator cuff enveloping the joint and larger muscles providing power. Its joint capsule is extensive and 'loose' to allow the joint freedom of movement. Like other areas of the body, the shoulder can suffer from ligament and muscle strains, dislocation, fractures, and joint inflammation. The most common injuries involve the muscles and tendons. One injured muscle, due to it's complex relationship with other muscles, can limit ranges of movement disproportionately to the actual injury.
Shoulder treatment requires careful diagnosis as well as realistic expectations about speed of recovery. The shoulder has muscles which come from the low back, the back of the skull and spine and down into the forearm and treatment also needs to take account of the relationship between the shoulder, arm, neck, spine and ribs.
Injuries occurring from trauma or overuse often cause tendon tears or irritation which can give rise to inflammation and muscle spasm. In some cases this can lead to frozen shoulder (adhesive capsulitis) a condition characterised initially by severe pain and stiffness of the shoulder. This combination of pain and spasm is extremely debilitating.
Recovery time is variable, some people improving relatively quickly over 1-3 months, whilst some may take 6-12 months. There are generally 3 stages, first acute pain followed by a stiff or 'frozen' phase and lastly a period of 'unfreezing'. Early intervention in shoulder injuries can reduce the risk of frozen shoulder occurring. Why some conditions develop further is poorly understood.
Osteopathic treatment aims to encourage the range of movement, improve muscle tone and circulation; reducing pain and inflammation. Patients are encouraged to stretch and mobilise the shoulder; this is vital in increasing range of movement and starting the healing process.
Patience and stoicism are desirable virtues, but a good outcome is generally achieved.
Sciatica is an irritation of the sciatic nerve. This is the longest nerve in the body and supplies the whole of the leg and foot as well as the back of the thigh. Symptoms will give pain and/or pins and needles and/or numbness in these areas and, if severe, may cause muscle weakness.
The two main reasons for impingement of the sciatic nerve are a disc injury in the lower back (lumbar spine), or tightness of the posterior hip muscles. If a disc injury is implicated there is likely to be acute low back pain with the condition, whereas entrapment in the hip muscles may be accompanied by posterior hip pain.
Hip muscle spasm or tightness irritating the nerve is the most common reason for sciatica. It can be treated by massage and other muscle release techniques, easing pressure on the nerve. Disc injuries can take many weeks to settle but most will respond with conservative treatment, such as gentle spinal movement and measures to reduce inflammation. In some cases decompression by a surgeon is required and this is often performed by keyhole surgery.
Prognosis after a disc injury is usually good. Occasionally there may be some chronic level of back pain and/or tightness of the hamstring muscle group at the back of the thigh. Treatment and rehabilitation of any lingering symptoms or muscle tightness is very important for the proper function of the lumbar spine and lower limb, reducing the risk of any future injury.
Arthritis means inflammation of a joint. There are two main groups. First, osteoarthritis, the wear and tear of the joints from overuse or trauma. The early effects of osteoarthritis (pain and restriction), may be helped by osteopathy. Except for the very young, we all have joints which may show some evidence of wear and tear and it is important to encourage the quality of movement and relieve any muscle tightness over joints which could lead to further damage. Joint health and flexibility go hand in hand and the maxim 'use it or loose it' is often true.
Secondly, autoimmune arthritis such as rheumatoid arthritis, is where the immune system can target a person's own joints. There are very many kinds of autoimmune arthritis which can be helped conventionally by medication. Osteopathy can help in maintaining as good a function of the joints as possible and relieving associated muscle spasm.
Treating the early stages of osteoarthritis by maintaining and improving overall musculoskeletal health may prevent or delay deterioration. If pain and loss of function require it, some joints (most commonly the knee and the hip) can be replaced by surgery. Osteopathy is also of benefit in rehabilitation following joint replacement, by encouraging optimum recovery and function.
Carpal tunnel syndrome
Carpal tunnel syndrome is an entrapment of the median nerve by inflammation or swelling in the confined spaces of the wrist, usually around the tendon sheaths. It causes pain, pins and needles or numbness and sometimes loss of power in the thumb, index and middle finger. It may also cause weakness and wasting of the muscles in the area.
Carpal tunnel problems may be caused by injury to the wrist, repetitive strain, arthritis and it can also appear for no discernible reason. It can also occur during pregnancy. Occasionally, similar symptoms are caused by tightness of the forearm muscles irritating the nerve.
Treatment aims to improve circulation, reducing inflammation using gentle articulation of the wrist and massage of the forearm muscles to loosen the tendons as they pass through the tunnel, allowing decompression of the nerve and healing to begin.
Other conditions include...
Back pain associated with pregnancy
Childhood musculoskeletal conditions
Hip, knee and foot problems
Muscle and ligament strains
Rehabilitation after hip and knee replacement and other orthopaedic operations
Elbow and hand injuries