Osteopathy

What Physios don’t want you to know

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And osteopaths, chiropractors or any other manual therapist.

Unless they are making special claims for their technique,  which they can back up with evidence,  the truth of the matter is that all manual therapies are doing one of three things-

  • Breaking down adhesions, scar tissue and restrictions, whether in fascia, muscle or connective tissue
  • Resetting the joint position sense and neural signalling around the affected area
  • Improving fluid flow and drainage of the tissue.

That’s it, that’s all we do. However, the reason you need to keep a good osteopath or physiotherapist on speed dial is because the real trick is knowing which one needs to be done, what tools and techniques should be used when, how and where, as the true cause of the problem may not be at the place it hurts.

One classic example of this, that many have suffered from and lots fail to treat effectively,  is plantar fasciitis. The too familiar pain lancing into the sole of your foot when you first stand up, it is caused by inflammation and microtearing in the fibrous tissue running along the foot, generally near the heel. Traditional treatment is to brace, stretch and possibly inject cortisone, all of which take time and often fail to address the question why it failed in the first place.

A better complete approach, using the above concept,  is to not just treat the foot locally,  but look away for restrictions and signalling issues elsewhere as well. Only then,  once the underlying issue is addressed,  can real recovery and progress be made.

Gym free exercise of the day.

2 minutes breathing practice while swinging arms and legs to open the joints.

3 X 30 seconds skipping on the spot, imagining a rope if space / equipment restricts.

5 x 1 minute Burpee superman interupt. 30 secs recovery between sets.

Squat down, thrust legs back to pressup position,  lower your chest to the floor then take hands up above the head to full extension. Raise opposite hand and leg off the floor. Repeat for the other side, then hands to chest, push up, legs back in to squat position and jump up.

2 minute breathing practice, with stretching.

Notes-

The objective of the warmup is to check and prepare joints for range of motion,  followed by getting the cardiorespiratory system ready.

The core of the workout is to get every muscle in the body firing to stimulate a high level of intensity. By lifting the arms and legs off the ground,  you break the fascial tension that can be used as a spring rebound mechanism,  so it becomes harder.

Scaling if you are unable to do burpees or pressups would be 3 standing air squats with a pause at the bottom, followed by 3 kneeling pressups with hand / leg lift. If the pressups are still too challenging,  wall pressups (pushing off the wall) followed by arm / leg extensions. If in doubt, try the one you think you might fail at to push yourself.

Why walking in their shoes will give you new insights.

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To understand someone better, it is said that we need to walk a mile in their shoes.

This is perhaps a little extreme but as with many statements, there is a lot of truth buried in there.

Walking in their shoes, or at least picking them up and looking closely at the wear patterns, both inside and out, will tell you much about the person’s interaction with the world. Do they currently have a prescription orthotic, or some form of insole? How has the outsole worn? Are both sides worn in the same way? Can you see the way the foot turns and loads inside the shoe?

By observing and considering the information provided, it can be possible to start gaining a better insight into how the person moves and hence any potential issues they may be adapting for.

If necessary, stand up and attempt to physically mimic their movement, and what leads them to that positioning.

Feeling it in your own body can be an eye opening experience and one that may hugely enhance your own practice.

Pain is not normal

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Pain is the body telling you something is wrong. It is driven, as with most things, by only a few factors – Degeneration, disease processes or dysfunction. However, as we age, we tend to normalise it, put it down to getting older, one of those things or to be expected. We are even told this by medical professionals, which reinforces the myth.

Aging happens, it is better than the alternative. Some of the processes of aging are unavoidable but many are not. By attempting to eliminate those triggers we can control, through correction of function and awareness of degeneration, then the pain left is triggered by either a disease process or changes which have already occurred. With the miracles of modern medicine and the bodies inherent desire to heal itself, even the majority of these can be improved with time, patience and external intervention.

Prevention is always better than a cure and the necessary activities to prevent degeneration are all things that we know. Eat a nutritious, well balanced diet, maintain a sensible weight, exercise regularly and moderately including resistance work. Dysfunction can be reduced or prevented by considering the way we use our bodies and becoming aware of our senses more. We are sensory creatures and yet spend so little time in our bodies that we recognise only those signals that are big enough to break through to our conscious awareness.

You do not need to live with pain unless there is a known and unavoidable reason for its presence. Even then, osteopathy and allopathic medicine can both help, together with self driven changes to give you back control. With a good working diagnosis and a plan, the future can look far brighter.

5 points to being pain free:

1) Get a diagnosis of why you have pain. If you don’t understand why, you can’t change the triggers
2) Start a treatment plan that you are actively involved with
3) Get your life patterns in order. Change diet, exercise or other factors that can influence the pain
4) Engage with the pain and take control, mentally and physically
5) Practice mental and physical activities within a pain free framework every day

The Camford Clinic
http://www.the-camford-clinic.co.uk
01420 544408

Whats the difference?

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As a practitioner, I get asked this every week…

“So whats the difference between osteopathy, chiropractic and physiotherapy”

Once we’ve got the jokes out of the way (The spelling, 50 grand a year and a Porsche etc), I try to explain, which is far harder than you initially think, as there are a huge number of cross over points between each discipline.

My take is:

  • The philosophy behind each practice. Having evolved from similar roots, each form has taken on a different theoretical approach to treatment.
  • An Osteopath tends to look globally as well as locally, use soft tissue techniques in conjunction with appropriate manipulation and applies the osteopathic principles to diagnosis and treatment.
  • Chiropractors traditionally look at adjusting the spine to improve the health of the body, manipulate (or adjust) more often, use x ray and other interventional tests to aid a diagnostic process and feel able to treat far more frequently.
  • Physiotherapists use a range of soft tissue techniques and electrotherapy as well as some manipulations and tend to practice in a hospital environment, as well as having special areas of interest, for example pre and post operative, respiratory etc.

However, these days there are far more areas of commonality. All practices are protected by law (you are not able to call yourself any of the above unless on a legally defined register), have to regularly train and update their skill base, use palpation, active and passive movements for diagnosis and have access to a combination of techniques to achieve their therapeutic goal.

In the end, it comes down to personal preference and personal recommendation. A good practitioner of any discipline should be able to take the time to talk you through your presentation, give you the treatment options, the space to come to your own conclusions and help map out a treatment pathway.

Whoever you choose to help manage your health, consider it as a lifetime investment in yourself.

80:20

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There is an idea called the Pareto law. This says that 80% of the work takes 20% of the time. It can be used in almost any situation, from business management to problem solving, personal training to writing a book. I use it to illustrate a patients recovery plan (and will try to cover this in a post soon).
I also think it applies to our area, not just in terms of treatment processes, but in terms of techniques.Far too many people don’t use their training, expertise and experience sufficiently when working with clients. Instead they fall back on what they know works and do the same thing for everybody. (80% of problems can be solved with 20% of our skill). But every body is not the same. Each client is unique and each time we see them they have changed.

From a therapeutic perspective, this means that we need to reassess and reinterpret them each time, not just do the same thing and hope it will work.

When carrying out a fitness program, this also stands. We can draw up a framework for the series of sessions but need to be flexible enough to modify it as necessary. We should and need to concentrate on what they are saying, how they are responding and whether we are achieving their goals. In either mode, we especially need to take into consideration current research and thinking to ensure we are up to date with what the experts are doing. As with every other part of life, we need to remember the loop: observe, think, apply. Only then will we be doing the best for our clients and ourselves.

T4 / Rib 4 Problems

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I have recently been thinking about the connections between the ribcage and shoulder pain. From this, I have noticed a couple of connections.
The main one is dysfunction around rib 4 either side leading to pain in the same side shoulder and arm. This has typically presented as pain next to the scapula, tension in trapezius and radiating pain down the triceps into the forearm. The patient typically has a history of desk based work or driving, with the pain often coming on waking or after coughing / sneezing. Examination shows restricted thoracic spine and tenderness on the ribs, both sternally and on the spine. Having tried to research this, I struggled to uncover much that enlightened me, other than a chiropractic diagnosis of T4 syndrome, which doesn’t really match and often seems rather vague.
My view is that the symptoms are actually caused by fascial tension and pain related muscular spasm, so fascial release, gentle manipulation and soft tissue treatment can have an apparently miraculous effects on some people. I also do some cranial / functional work anteriorly to re-centre and balance the ribs / fascia.
From this, it has been useful to be able to rapidly assess the motion of the spine. Although a detailed examination is always important, it is useful to be able to have a rough guide as to where you should be looking.

Supine, where the patient lies passively and you use their bent knee to create rotation in the spine, blocking at the pelvis, ribs and shoulder to isolate the main sectors. This is following a simple standing active examination, where the patient attempts the main spinal movements of flexion, rotation and sidebending.As an extension of that, I started getting patients to attempt “monkey”. This is an Alexander technique standing posture, which is meant to demonstrate balance within the spine (my perspective). The most important thing to know about Alexander technique (other than it is really rather good and a couple of lessons from a good teacher is worthwhile, I recommend a number of patients to my local teacher) is that it is all about intention and the mind being in charge of the body, so speed is always controlled.To move into a version of monkey posture ask the patient to do the following:

1) Get them to stand comfortably, feet parallel (check, lots externally rotate to minimise loading in the glutes)
2) Bend the knees slightly
3) Bend forward at the waist, spine straight
4) Let the arms hang loose
This is a german video of a man sitting down, but if you stop half way, its monkey.
What I noticed is that most cannot bend solely at the hips without looking down and treating any thoracic restrictions allows them to move much better.
The reason for all of this is to demonstrate treatment further away from the area of complaint and to look for other areas of compromise in their movement patterns. They may also find cervical and lower limb problems start to surface. Once this has been physically demonstrated, it is easier to achieve compliance in terms of future treatments, exercise pescription and general understanding of their body.
And for a positive patient outcome, this can be used as part of their ongoing exercise plan.