Update of new COVID 19 Stage 4 restrictions to the provision of Allied Health Services.

We have seen some significant changes regarding the requirements for who may attend for osteopathic or acupuncture treatment. DHHS has provided updated information which now effects who we may provide treatment for.

The current guidelines are as follows:  
Our clinic is still OPEN to provide the services of Osteopathy, Dietetics, Chinese Medicine, and Clinical Psychology.  The Victorian Government today changed the GP referral rules released on Monday, so you no longer require a GP referral to attend for treatment.  It is now a mandatory requirement that we provide treatment to patients that are considered urgent only. This means routine treatments (or maintenance issues) to address minor pains, stiffness or similar cannot be seen during these stage 4 restrictions. Care must only be provided if the absence of, or delay of this care, would result in a significant change / deterioration in the patient’s condition and would result in an escalation of care (e.g. a requirement for specialist input / review, an increase in care needs, avoiding a hospital admission or emergency department presentation). 

If you are an existing client, you can travel beyond the 5km radius to attend our clinic. All new patients must live within a 5km radius of our clinic location. 

As a result of these new conditions for treatment, we must establish your eligibility for treatment. When you receive your appointment confirmation / reminder we will be sending you a form asking you to answer questions regarding the current state of your condition. This will help to form our decision regarding the need for ‘face to face’ treatment. Based on the answers you provide, we may need to contact you further to discuss your symptoms / condition. Alternatively, you can also call, email or arrange a short online Telehealth consultation with your practitioner prior to attending, if you are unsure whether treatment is appropriate at this time.



While we will do our best to contact each person individually over the next few weeks, clients with existing appointments are encouraged to get in touch with us regarding these new changes. 
  
The Victorian Government is obviously aiming to reduce any movement and face-to-face contact as much as possible. It has been made quite clear to us that they expect primary contact practitioners to be active leaders in reducing the spread of coronavirus.

We are still gathering all of the information from DHHS surrounding our practice, and we are truly sorry for the inconvenience. As always, if you have any questions at all please get in touch with us via phone – 9078 2455 or email – info@innerwesthealthclinic.com.au and we will endeavour to answer any questions you have (as best we can in these crazy times!). 

We would like to thank you sincerely for your understanding and assistance during this incredibly difficult time. 

COVID 19 – Stage 4 Restriction update.

Osteopathy Myth-Buster

As osteopaths, part of our job is to promote osteopathy to the masses. We do a lot of this by word of mouth, and we rely on our patients to also spread the word after they’ve received a successful treatment here at Inner West Health Clinic.  We and other osteopathic clinics also make use of the internet to help market and advertise our services. Despite all of our efforts, common misconceptions exist about osteopathy. We’d like to take this opportunity to debunk some of these myths now:

Osteopathy… that’s backs isn’t it?

One of the most common misconceptions out there is that osteopaths just treat back pain. Whilst back pain is the number one complaint that most osteopaths see daily, we treat pain all over the body. Osteopaths can treat a wide range of conditions including headaches, neck and shoulder pain, arthritic pain, hip, knee and ankle pain, as well as other conditions like vertigo, sciatica and pregnancy-related pain. If you need help with pain but are not sure if we can help, call us today on Inner West Health Clinic and we will discuss it with you over the phone.

Osteopaths just treat bones

You can be forgiven for thinking that an osteopath would specialise in treating bones. After all, the word ‘osteo’  translates from classical Greek into ‘bone’. Osteopathy founder, Andrew Taylor Still, even used to advertise his services as a ‘bonesetter’ (a person who would relocate dislocations and fractures). So, anyone who has done a bit of reading around the history of osteopathy may have come across these phrases and be led down the wrong path. But times have changed, and one of the fundamental principles of osteopathy is that the body is a unit. It is one being that needs to be treated as a whole in order to get well again. Yes, we treat problems associated with the bones, but we also treat joints and muscles and more. But when we treat these areas, we are treating all of the systems of the body. Our treatments aim to affect the blood, nerves and other connected systems in the body to restore balance and promote health. So in a nutshell, we treat all parts and systems of the body – not just bones!

Osteos, physios and chiros are the same

We commonly get asked what the difference is between osteopathy and other therapies like physiotherapy and chiropractic. We all treat the body with the same goal in mind – to help someone in need and improve their health. We can all treat similar conditions, and we all use similar techniques to do so. Within each profession you will always get some practitioners who lean towards a particular specialty, condition or area of the body they like to treat. Where we differ most is in the philosophy and approach of our treatments. Osteopaths are very holistic in their approach to treating the body. We always treat with the entire person in mind. The bottom line is, it doesn’t matter if someone is an osteo, chiro or physio, if they are good, they can all help you improve your life. We prefer osteopathy because we feel if offers the patient the entire package. Come and find out for yourself!

The osteopath will crack your back

This is not necessarily so. Yes, we are skilled in the art of manipulation (or ‘cracking’) of joints and will use it (with your permission) if we feel it is necessary. Osteopathy is so much more than just cracking. We are proud of our toolkit when it comes to treating the body. We spend 4-5 years studying at university to become an osteopath, and we learn lots of amazing techniques along the way. There is every possibility you will receive a treatment from an osteopath without the hint of a crack. There are some conditions where cracking is not suitable. We know what to ask and what to look for to know when manipulation is or isn’t required. If you are worried or concerned about anything to do with treatment, our best advice is to simply ask your practitioner and have a discussion about it. We guarantee they will ease your mind. And it is always your choice if we manipulate or not!

Osteopathic treatment hurts

When it comes to having your body treated by another person’s hands, it can sometimes leave you anxious about what to expect. Being treated by an osteopath should not be a painful experience. Many of our techniques are incredibly gentle and our aim is to reduce your pain, not increase it. Yes, there are certain techniques we perform which can be uncomfortable… Have you had your deep hip flexor muscles released? If you have, you’re aware of the kind of discomfort we are talking about. But again, it shouldn’t be painful. If anything is painful during treatment, always tell your practitioner. There is a good chance we’ll know by the look on your face, but open communication is always best.

We hope this blog has been able to debunk some of the misconceptions surrounding osteopathy as a profession. If you have any questions, please come and see us, or give us a call – we’d love to help.

References
1. General Osteopathic Council. 2020. About osteopathy. [Online]. Available from: https://www.osteopathy.org.uk/visiting-an-osteopath/about-osteopathy/. [Accessed 02 Jul 2020]

2. Osteopathy Australia. 2020. About osteopathy. [Online]. Available from: https://www.osteopathy.org.au/about-osteopathy/what-is-osteopathy/treatment-faqs. [Accessed 02 Jul 2020]

3. Merriam-Webster. 2020. oste-. [Online]. Available from: https://www.merriam-webster.com/dictionary/oste-. [Accessed 02 Jul 2020] 4. Gevitz, N. 2014. A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation. The Journal of the American Osteopathic Association. 114 (1). 30-40. Available from: https://jaoa.org/article.aspx?articleid=2094619

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Injury blog: Dorsal scapular nerve entrapment

Has one of your shoulders been feeling a bit off lately? Is the neck and mid-back region around the shoulder blade feeling stiff and heavy? If this sounds like you, then you may have a problem with a nerve known as the Dorsal Scapular Nerve (DSN). This is a previously under-diagnosed cause of neck, mid-back and shoulder pain and dysfunction. With advances in technology and the development of knowledge and skills of treating practitioners, it has become apparent that this problem is much more common than originally thought. A great excuse for a blog topic!

Relevant anatomy

The neck is made up of a stack of seven bones known as vertebrae. These are numbered C1-7, where ‘C’ stands for cervical (i.e. the neck region of the spine). The vertebrae are numbered from top (near the skull) to bottom (where the neck meets the back). Between the vertebrae are little holes where nerves run through on their way to provide electrical signals to our muscles and other body parts. Between the 4th and 5th vertebrae, the C5 nerve root lives. The DSN is a little off-shoot of the C5 nerve root which runs from the neck to the back of the shoulder and mid-back.

The DSN provides electrical stimulation to three muscles in the neck/shoulder region, all of which attach to the shoulder blade (or ‘scapula’) at one end, and the spine at the other. On its way to these muscles, the nerve pierces through another muscle in the neck (one of the three scalene muscles if you’re really interested!).

Muscle function

Two of the three muscles that the DSN supplies help to move the shoulder blade inwards from its resting position, towards the spine. These are the Rhomboid Major and Rhomboid Minor muscles. The other muscle, the Levator Scapulae, as its name suggests, helps to elevate or lift the shoulder blade. The proper functioning of these muscles is important for us to be able to move our shoulder through its full range of motion. Injury or entrapment of the nerve can lead to poor muscle function and subsequently, poor shoulder movement.

Signs and symptoms

As previously mentioned, the nerve pierces through one of the neck muscles on its way to innervating the other three muscles. This creates a potential point of entrapment of the nerve and this can lead to signs and symptoms commonly experienced with DSN injury. People with DSN injury may present to the clinic with any or all of the following signs and symptoms:

  • Abnormal and/or reduced shoulder movement
  • Pain around the lower neck, upper/mid back and shoulder region
  • Winging of the shoulder blade (i.e. tilting of the blade away from the rib cage)
  • Difficulty with drawing shoulders backwards and together
  • Difficulty with raising the arm upwards to full range
  • Altered resting position of the shoulder blade on the injured side. Due to poor functioning of the rhomboid muscles, the shoulder blade may sit away from the spine compared to the non-injured side.
  • Weakness of the affected shoulder muscles
  • Stiffness in the neck / spine

Who does it affect?

DSN injuries are common throughout the general population. People whose occupation puts their posture in a compromising position every day and leaves them open to issues around the neck joints and muscles are particularly susceptible to this issue. It has also been seen in people who lift weights and after car accidents.

Treatment

Great news! We can help you get over this issue. Once we’ve been through our assessment and are happy with our diagnosis, we can get to work on you. Yes, this is a problem which primarily affects muscles that drive shoulder movement, but the root of the problem is usually down to poor function of the joints and muscles around the lower neck and upper back. Don’t be surprised if we direct quite a bit of our treatment at the spine. We will provide tight neck muscles with a soothing massage. Stiff neck and back joints will be mobilised and may be manipulated (i.e. cracked) if we feel it is required.

As with most injuries, there is an exercise element to recovery. Poor movement patterns in the spine and shoulder have to be corrected and re-trained over a period of weeks to months. This is to ensure we get to the root cause of the problem and don’t just bandage over the top of it. Strength and stability exercises of the trunk and shoulder will be on your to-do list.

As previously mentioned, your occupation may be driving a lot of these issues. We may suggest changes to your work (i.e. a desk set-up assessment) and other aspects of your lifestyle to ensure you’re hitting this issue from all angles. That way we have more chance that the problem will be resolved permanently.

First and foremost, if you think you have a problem, please get in touch today on 9078 2455 so we can start your journey to recovery.

References
1. Snell, RS. 2012. Clinical Anatomy by Regions. 9th ed. Philadelphia: Lippincott, Williams & Wilkins
2. Muir, B. 2017. Dorsal scapular nerve neuropathy: a narrative review of the literature. The Journal of the Canadian Chiropractic Association. 61 (2). 128-144. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596970/

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Exercises for ageing bones

Are you in (or approaching) your latter years and are wondering what you can do to ensure your bones stay strong through the next period of your life? As we age it is common to begin feeling the effects of years of ‘life’ on your body. Diseases like osteoarthritis (i.e. degeneration of joints) and osteoporosis (i.e. weakening of bones) are more common in the elderly population. But just because the figures show this, it doesn’t mean these diseases will affect your ability to lead a full and active life.

The good news is, there is plenty you can do now to reduce the risk of bone-related problems down the line. Read ahead for a few exercises you can perform regularly to keep you and your bones in tip-top shape!

Weight-bearing and resistance are key

It is widely accepted that to increase bone health, we need to stress the bones of the skeleton. The best way to do this is through weight-bearing exercises (i.e. exercises performed in an upright position with our legs impacting the ground). Resistance-type exercises are also beneficial in protecting the skeleton against the effects of ageing. ‘Resistance’’  implies an exercise that is performed against a force acting on the body. A simple example would be to compare walking through your house to walking through strong head-on winds. The wind pushing against the body is the resistance aspect.

When we exercise, forces acting on our muscles help to build strength. The forces placed upon the skeleton through the muscles help to activate special bone-building cells within the bones, and these help to maintain or build strength in the bones depending on the intensity of the exercise. In order to increase bone strength, we need to regularly push our bodies beyond the intensity of simple everyday tasks, like walking.

Age is a factor

Now, if you’re worried, we’re going to suggest a new gym membership and intense weight lifting program, then rest easy. There are lots of things to consider, and age (as well as medical history) is a big factor when it comes to prescribing exercise. Someone who is 80 will need a different exercise regime compared to someone who is 55 when it comes to targeting bone health.

Exercises to try

The following are simple weight-bearing exercises you could have a go at doing:

  • Walking or jogging uphill
  • Hiking across the countryside
  • Stair climbing or step-ups
  • A friendly game of tennis, badminton or squash
  • Aerobics or dancing

You can add resistance to your exercise program by:

  • Lifting weights (always start light so as to not overload the body)
  • Exercising using cables or resistance bands (again, use light resistance to begin with)

Everyone has different requirements, so we suggest giving us a call on 9078 2455 so we can create an individual a program that is perfect for you.

References

  1. Hong, AR. and Kim, SW. 2018. Effects of resistance exercise on bone health. Endocrinology and metabolism. 33 (4). 435-444. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279907/
  2. Benedetti, MG. et al. 2018. The effectiveness of physical exercise on bone density in osteoporotic patients. BioMed research international. v. 2018, 4840531, 10 pages. Available from: https://www.hindawi.com/journals/bmri/2018/4840531/cta/
  3. Osteoporosis Australia. 2013. Exercise – consumer guide. [Online]. Available from: https://www.osteoporosis.org.au/sites/default/files/files/Exercise%20Fact%20Sheet%202nd%20Edition.pdf. [Accessed 06 Jun 2020]

Injury blog: Winging of the shoulder blades

Hey everyone! We hope you are keeping well. We’re carrying on with life as close to normal as possible, so here is your monthly reading material. Perfect time for a tea or coffee we say! This month we’re taking a close look at the shoulder, specifically a condition that affects the shoulder blade. Do you have, or have you ever seen someone whose shoulder blades stick out on their back and look a little bit like wings? This condition is aptly named ‘winging’ of the shoulder blades.

Anatomy

Osteopaths love a bit of anatomy! The shoulder blade or ‘scapula’ is a largely flat bone that sits on the back of the rib cage and is an important ingredient in what makes up the various joints of the shoulder. As well as the larger flat part, a few extra lumps and bumps makes for a very odd shaped bone when looked at in isolation. One of the bony protrusions actually makes up the ‘socket’ part of the ball and socket joint in the shoulder. The ‘ball’ part being made from the head of the upper arm bone (aka the ‘humerus’).

Interesting fact… There are 18 muscle attachments on the shoulder blade. It is through fine balancing of these muscles which keeps the shoulder blade stabilised and flush to the back of rib cage and allows us to move our shoulders through an extremely large range of motion. As you can imagine, keeping all of these muscles in full working order takes a bit of co-ordination. And with so many players involved, there is room for dysfunction to creep in and movement to become affected. Sometimes the dysfunction is great enough to cause the shoulder blade to flip outwards from the rib cage, and this is what we refer to as ‘winging’.

Causes of winging

The causes of shoulder blade winging can be broadly broken down into:

  • Muscular: As we previously mentioned, lots of muscles are responsible for controlling the position and movement of the shoulder blade. Injury to these muscles, or an imbalance in the strength, length and function of the muscles over a prolonged period may lead to this issue. The main muscles involved here are the Serratus Anterior (a muscle which attaches to the ribs and the underside of the shoulder blade), and the Trapezius (a kite shaped muscle which covers the back of the neck, shoulders and upper back… Aka ‘traps’). It’s more complex and there are more muscles involved, but these are the key players when it comes to winging.
  • Neurological: Muscles require a nerve supply in order to move, so if any of the nerves that supply the key players (i.e. Serratus and Traps) are injured, this can stop the muscles from being able to perform their job. Nerves can be injured through entrapment, where something presses on a nerve as it travels from the spine down to the muscle it supplies. Other causes may be from acute traumas as seen with car or sporting accidents where the shoulder takes a direct blow while the arm or neck are suddenly pulled.

Other ways these injuries may come about include prolonged wearing of a heavy backpack, complications following surgery, or as a result of a viral infection that affects the nerve.

Signs and Symptoms

The main sign is a shoulder blade that doesn’t sit snug to the rib cage, particularly when trying to move the arm upwards in front of the body or out to the side. Many people with scapula winging feel no pain whatsoever, but this can be a very painful condition if the cause is from a severe nerve injury. Another key sign is the inability of a person to lift their arm above their head.

Treatment

The treatment of shoulder blade winging very much depends on the cause. If the shoulder blades are winging because of a muscular imbalance, these are a little easier and faster to rehab. After careful assessment of your shoulder, neck and other spinal movements, we will aim to restore full functioning of the muscles that control the position and movement of the shoulder blades. This might include techniques which aim to lengthen short or tight muscles which are pulling the shoulder blade out of position. If there is a weakness to a particular muscle or group of muscles, we will also prescribe you strengthening and movement re-training exercises which aim to return the shoulder blade to its functional position.

Winging caused from nerve entrapment or injury is notoriously harder to treat. If entrapment of the nerve is caused by muscular tension in another part of the body, or because you’ve been carrying a heavy backpack for too long, then we will work on the relevant muscles and nerves to release the entrapment and pressure. We might also need to adjust how you wear your backpack and how much weight is inside while we focus on improving your physical impairments. Nerve-related injuries can take much longer to resolve. Winging caused by paralysis of the nerve which supplies the Serratus Anterior muscle has been known to take up to two years to resolve. The good news is, most people will make a full recovery in this time with surgical procedures saved only for more complex or unresolved cases. Which if you ask any Osteo, is always the goal!

If you notice winging of the shoulder blades, or difficulty with achieving full shoulder range of motion, then get in touch today on 9078 2455. We would love to chat to you about your issue in a phone or video consult and get you on the road to recovery as soon as possible.

References

  1. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education
  2. Snell, R. 2012. Clinical Anatomy by Regions. 9th ed. USA: Lippincott Williams & Wilkins
  3. Magee, D. 2008. Orthopaedic Physical Assessment. 5th ed. USA: Saunders Elsevier
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Flat footed? Read on…

Feet of woman doing exercises with rubber ball in clinic

Have you ever been told you have flat feet? Or have you noticed that the arches in your feet are not quite the same as others? Although we are all a part of the same species, many of us have variations in our anatomy that make us unique. Look at a crowd of people and you’ll notice many different shapes and sizes. Our feet are the same. Some people have very developed arches in their feet, others have under-developed arches and have an almost ‘flat’ look to their feet. This phenomenon is known as ‘pes planus’.

Why does it occur?

There are two main reasons a person may develop flat feet. They are:

  • Congenital: A person is born with it and the feet fail to develop an arch through childhood into adulthood. A small percentage of the population have a connective tissue disorder which can leave the joints in the body less stable and more mobile. These conditions (namely Ehlers-Danlos and Marfans Syndromes) are also associated with having flat feet.
  • Acquired: A person develops flat feet as a result of trauma, tendon degeneration, or through muscular or joint disease.

Most babies will have a flat foot at birth, but usually by the age of 10, a strong and supportive arch has developed. For some people, the arch simply does not develop, and this may or may not lead to problems down the line.

Signs and symptoms

The obvious sign to look for is a flattened arch of the foot. If you look at someone from the front or slightly to the side, you may notice that the majority or whole of the inside border of the foot is touching the ground, as opposed to there being a clear space between the heel and ball of the foot.

What effect can this have on the body? It is quite possible and very common, for someone to have flat feet and have no symptoms at all. This is known as being ‘asymptomatic’. It may surprise you to know that only 10% of people with flat feet experience symptoms. These people are known as ‘symptomatic’.

People who do experience pain as a result of this condition do so because the lack of arch supporting the inside region of the foot has a knock-on effect to the mechanics of the rest of the limb. This then affects how the pelvis and spine function too. Pain in the middle part of the foot, heel, knee, hip and lower back are all common complaints. It is also not uncommon for someone with flat feet to experience recurrent ankle sprains, where they regularly ‘roll  the ankle.

Treatment

Do I need treatment if I have flat feet?” If you have no symptoms and having flat feet does not affect your life in any way, the answer is simply ‘no’.

If you have pain caused by this problem, then this is where we (and other professionals) come in. Pes planus is a great example of how a problem in one part of the body may lead to pain and dysfunction in a completely different part of the body. It’s an osteo’s dream! Not your pain, of course… However, we are experts at recognising the root cause of a problem and putting a plan in place to get it resolved fast.

Techniques we use may include soft tissue massage, joint mobilisation of the foot, ankle, knee, hip or spine and strengthening exercises. Exercises will aim to strengthen the arch itself, but may focus up the chain to the thigh, glutes and trunk as well. A large part of our job here is to also educate a patient on which footwear to use and whether or not they require the help of orthotics (these are special insoles for your footwear). Some children and adults may need some extra support inside their shoes to help reduce the effect of mechanical change up the limb. We may decide that you will benefit from seeing a podiatrist or other foot specialist who is able to design and supply you with insoles that are unique to you and the shape of your foot. Being obese can also increase the load on the lower limbs, therefore increasing the effects of pes planus in the process. In these cases, we can help to advise on how you go about losing weight through changes to your diet and exercise regimes.

For the majority of cases, a combination of these treatments above will result in improved mechanics and reduced pain, allowing the patient to continue doing the things they love. For the very few people who do not respond to treatment, an orthopaedic specialist’s opinion may be required for long term management. This is always a last resort.

Check out your feet. Do you have a flattened arch when you stand up and weight bear? Is there any associated pain? If so, call us today 9078 2455 and we’ll tell you what needs to be done to beat the pain! Arch you glad you read this now?! 😉

References:

  1. Radiopedia. 2020. Pes planus. [Online]. Available from: https://radiopaedia.org/articles/pes-planus. [Accessed 08 May 2020].

2. Raj, MA. et al. 2020. Pes Planus. Stat Pearls. [Online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430802/. [Accessed 08 May 2020

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Fractures Let’s ‘break’ it down

Have you ever broken a bone? We hope you haven’t, but it’s a common injury that happens to people every day! Any break in the structure of a bone is known as a ‘fracture’. We’ve written a quick guide to understanding all the lingo relating to fractures below. Let’s check it out!

Cause

Fractures are usually caused in one of three ways:

  • Excessive force: This can be through either a direct force to a body part (i.e. a high tackle in football which breaks the shin-bone) or an indirect force (i.e. having your foot planted and twisting your leg which leads to a fracture of the shin-bone).
  • Repetitive stress: These result from repetitive, strenuous activities like running or jumping.
  • Other disease: These are fractures secondary to another disease process in the body which leaves the bone more prone to breaking. This may be a hereditary disease like Osteogenesis Imperfecta (aka Brittle bone disease) or as a result of cancer or infection.

Types of fracture: General description

Fractures are broadly classified into two main types:

  • Closed: The bone fractures and the overlying skin remains intact.
  • Open: The bone fractures and protrudes through the skin exposing the bone and other tissues to the elements. These types of fractures are prone to becoming infected, which complicates everything.

We can also classify fractures on whether they are:

  • Complete: A clean break of a bone into two or more pieces
  • Incomplete: The bone is not completely broken with some of the outer structure of the bone remaining intact.

Types of fracture: Now let’s REALLY break it down!

Each fracture can also be given a more specific description based on where exactly the bone is broken and in what way it has broken:

  • Transverse: A horizontal break across the shaft of a bone.
  • Linear / fissure: A vertical break along the shaft of a bone.
  • Oblique / spiral: A diagonal, or as the name suggests, spiral type fracture around the shaft of a bone.
  • Greenstick: One side of a bone has broken but the other side remains intact. This is common in children where bones are much more flexible than adult bones.
  • Comminuted: The bone is broken into more than two pieces, possibly into several fragments
  • Impacted: Two parts of a bone fracture are forced into one another
  • Crush: Usually seen in the spine caused by vertical and forward bending forces down through the vertebrae
  • Hairline: A tiny crack in the bone — these are so small that they are commonly missed on an x-ray!
  • Avulsion: A piece of bone is ripped away from the main bone by way of tendon or ligament injury. (Remember tendon attaches muscle to bone and ligament attaches bone to bone).

Which type of fracture have you had in the past? We hope this guide will help you work it out. Next time you come across a fracture (fingers crossed you don’t) you’ll know exactly what the doctors are talking about!

Stay safe!

References

  1. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education
  2. Xui, P. 2012. Pathology. 4th ed. UK: Elsevier Mosby
  3. Tortora, G. and Derrickson, B. 2011. Principles of Anatomy and Physiology. 13th ed. Asia: John Wiley & Sons
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Vertigo: symptoms and treatment

Welcome back readers! This month we are switching focus to the head, and specifically a condition which causes a person to feel dizzy. We welcome you to the world of Benign Paroxysmal Positional Vertigo (BPPV). In simple terms, a non-serious sudden attack of dizziness brought on by a change in head position.

What is vertigo?

Vertigo is a type of dizziness where a person experiences the sensation of whirling, spinning or swaying. A person will usually feel that they, or objects around them are moving when they are not. There are several causes of vertigo, with the most common cause being BPPV. Other common causes include Ménière’s disease (vertigo with hearing loss and ringing in the ears) and labyrinthitis (inflammation of the inner ear).

The ear is made up of an outer, middle and inner section. The outer ear is the ear that we see on the head and the opening that leads into the head itself. This connects to the middle ear — a small area inside the head which houses the ear bones, connects to the inner mouth and also the inner ear. The inner ear is the section which houses our hearing and balance organs — the cochlea and the vestibular system. It is this most inner section which is involved with BPPV.

What causes BPPV?

The structure of the inner ear is quite complicated. It is a maze of hollow chambers and canals all connected together and filled with fluid. There are three semi-circular canals which are expertly positioned to detect movement in the 3 planes that our head can move (nodding up and down, tilting left and right, and looking left and right). Inside the chambers live tiny crystals which, when movement of the head occurs, move and send important information to the brain about what type of movement is occurring. Sometimes these crystals become detached from the chamber and move into the canals where they can play havoc.

Basically, the crystals move through the fluid which stimulates nerve endings in the canal. The nerves then send a message to the brain which the brain perceives as movement, even though the head isn’t actually moving. Because this information doesn’t match with what the eyes are seeing and the ears are detecting, we experience vertigo. It is one big mismatch of information which is tricking the brain. And the effect is quite unpleasant!

An attack of BPPV can be brought on by a quick change in head position, when rolling over in bed, sitting up from lying down, or when looking up to the sky. A recent head injury or degeneration of the inner ear system can precede episodes of BPPV.

Signs and symptoms

The main symptoms as discussed include a sensation of spinning or swaying. People may also experience feelings of light-headedness, imbalance and nausea. Attacks will usually only last a period of a few minutes and may come and go. It is not unusual for a person to have a period of symptoms followed by a period of no symptoms for months at a time. If symptoms persist for longer than a few minutes at a time, then it is likely the vertigo is from a different cause.

Some conditions that cause vertigo can also give symptoms of headache, hearing loss, numbness, pins and needles, difficulty speaking, and difficulty coordinating movements. Episodes of vertigo may also be much longer or constant. If you experience any of these symptoms they should be reported immediately as they could be signs of more serious issues, which will need to be investigated.

Can it be treated?

BPPV is very treatable. Many people with dizziness end up seeing their GP first, but it is common for a GP to refer these cases to us here at Inner West Health Clinic for ongoing management. After a thorough session of questioning and assessment, if we are happy with our diagnosis of BPPV, then we can get to work right away.

BPPV can affect any of the semi-circular canals mentioned above. For treatment, we need to first bring on the symptoms. It sounds sadistic, but it is necessary to ensure we resolve the symptoms for you. Treatment for BPPV consists of a series of head and body movements where you start seated, move into a lying down position and end sitting upright again. This series of movements is known as the Epley Manoeuvre and is used to treat the most common form of BPPV. If the source of the problem is coming from a different canal, then the treatment will be slightly different.

We then send you away with some general do’s and don’ts. You may have to keep your head relatively still for the rest of the day (sorry, heavy exercise is not recommended at this stage) and to sleep propped up for the first night after treatment. We will then organise for you to come back in within a few days to reassess and if necessary, continue with another treatment.

Final comments…

Interestingly, we often get patients come in who think they have vertigo, but in fact, it’s other structural issues contributing to their dizziness (which we diagnose and treat). That’s why it’s so important that we have a thorough consultation, to ensure we develop the right treatment plan for you. If you think you are experiencing vertigo, please come in and speak to us. Osteopaths are highly trained medical practitioners who can help treat more than you think. Call us today on 9078 2455 to book your consultation.

References:

  1. Vestibular Disorders Association. 2020. Benign Paroxysmal Positional Vertigo (BPPV). [Online]. Available from: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo. [Accessed 28 Feb 2020]
  2. Healthline. 2018. Benign Positional Vertigo (BPV). [Online]. Available from: https://www.healthline.com/health/benign-positional-vertigo. [Accessed 28 Feb 2020]
  3. HANDI project team. 2013. The Epley Manoeuvre. Australian Family Physician. 42 (1). 36-37. Available from: https://www.racgp.org.au/afp/2013/januaryfebruary/the-epley-manoeuvre/
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The effect of obesity on the body

Obesity is, and has been for a long time, a hot topic. The stats on obesity are startling… The World Health Organisation (WHO) report that global obesity rates have tripled since 1975. In 2016, it was estimated that 1.9 billion adults were overweight across the world, with a third of those being obese (this stat rose to 2.1 billion in 2019). In that same year, 41 million children under 5 years of age were classified as overweight or obese. This is worrying stuff. But what is obesity, and what does it mean to be obese?

What is obesity?

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Obesity (and being overweight) is defined by the WHO as “the abnormal or excessive fat accumulation that presents a risk to health”. Obesity is traditionally measured using a person’s Body Mass Index (BMI), which is calculated by dividing their weight by their height (in metres) squared.  A BMI which equates to 25 or over is classified as overweight… 30 or more equals obese. Due to the inability to distinguish gender and fat from muscle, the process is flawed. The Relative Fat Mass index (RFM) which takes into account someone’s gender, height and waist circumference is a more accurate tool in measuring someone’s fat mass and their risk of developing health problems from it.

Effects of obesity on the body

Now we know what obesity is, let’s explore what this means for the body. These are some of the known negative side effects of being obese:

  • Increased risk of numerous diseases: With obesity comes an increased risk of developing high blood pressure, heart disease, type-2 diabetes, stroke, respiratory conditions including sleep apnea, osteoarthritis, gallstones, menstrual issues, incontinence, many types of cancer, and mental illness (e.g. depression).
  • Increased risk of death: Being obese puts you at increased risk of death from all causes, but especially relating to cardiovascular disease (e.g. heart attack/failure).
  • Complications during pregnancy: Mother and baby are both at risk. Mothers are more likely to develop high blood pressure and gestational diabetes, as well as difficulties during labour and retaining weight post-pregnancy. For the baby, the risk of late fatal death increases, as does the risk for developing neural tube defects (e.g. spina bifida).
  • Increased levels of pain: Evidence suggests obesity puts the body in an inflammatory state causing pain. Increased load on the joints leads to breakdown of cartilage which drives more inflammation. There is an increased rate of depression which exacerbates the pain experience as well. People then become afraid to move through pain and being sedentary means lack of movement through the joints, and they continue to degenerate. It’s a vicious cycle!
  • Poor quality of life: Obesity makes life hard. Carrying out everyday tasks becomes laborious. All of a sudden, hanging out the washing and cleaning the house or car can seem harder than they should do. It can also affect people’s desire to go out and be social. People who are obese are also at risk of developing undesirable body odour which can make social situations difficult.

The side effects of being overweight, especially obese, are many and very serious. It is simple… Being obese will increase your chances of serious disease and death, as well as impact your life negatively in many other ways.

It is daunting and challenging trying to lose weight. If you need help, please talk to us during your next visit here at Inner West Health Clinic and we will be happy to discuss options with you. We can work alongside your GP, or other health professionals, to help work out what the best and safest option is for you – getting you on the right track to a healthier, happier self.

References

  1. World Heath Organisation. 2020. Obesity. [Online]. Available from: https://www.who.int/topics/obesity/en/. [Accessed 01 Feb 2020]
  2. Kobo, et al. 2019. Relative fat mass is a better predictor of dyslipidemia and metabolic syndrome than body mass index. Cardiovascular Endocrinology & Metabolism. 8 (3). 77-81. Available from: https://journals.lww.com/cardiovascularendocrinology/Fulltext/2019/09000/Relative_fat_mass_is_a_better_predictor_of.4.aspx
  3. National Heart Lung and Blood Institutes. 1998. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obese Adults: The Evidence Report. National Institutes of Health. No. 98-4083. Available from: https://www.nhlbi.nih.gov/files/docs/guidelines/ob_gdlns.pdf
  4. McVinnie, DS. 2013. Obesity and pain. British Journal of Pain. 7 (4). 163-170. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590160/
  5. NHS. 2019. Body Odour. [Online]. Available from: https://www.nhs.uk/conditions/body-odour-bo/. [Accessed 01 Feb 2020]
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Should I see an Osteo if I have a headache?

Hello readers! It’s a new month which can mean only one thing… It’s time for a cuppa and a sit down so you can read our new blog. This month’s blog topic is one that millions of Australians (and billions around the world) can relate to. Have you ever had a headache? We’d be surprised if you said no, because a headache is one of the most common symptoms experienced by our species. Nearly everyone at some point in their life experiences a headache. If you or someone you know is part of the minority that has never had one, then come forth… Medical researchers will want to get their hands on you!

The list of headache types is as long as the distance between your shoulder and the tips of your fingers! Some types of headache are very common, others very rare. Some of the different types of headache include:

  • Tension-type
  • Migraine
  • Cervicogenic (i.e. something in the neck leading to pain felt at the head)
  • Eyestrain
  • Withdrawal
  • Dehydration
  • Temporomandibular joint dysfunction (i.e. a problem with the jaw joint causing head pain)
  • Many others of non-serious and serious causes

The burning question

If you have been a headache sufferer for a long time, there is a good chance you have tried every remedy out there. Finding the solution is hard, but fear not, help is at hand! We regularly get asked “can you help me with my headaches?” The answer is always “maybe”, but there is a good chance we can. So why see an osteo over another medical professional? The short answer is we’re awesome! The long answer is we are experts of anatomy of the human body (4-5 years of study!), we sit and listen to you tell your story, we have excellent problem-solving and clinical skills, we have magically soft, caring hands, and we are highly trained to help people get to the bottom of their ailments, headaches included. Other medical professionals are also awesome, we just love the osteopathic philosophy of treating the person and the body as a whole.

What to expect from your osteo

The reason a person is in pain is usually down to many factors. It is therefore very important to get a full story from each patient that presents with a problem. This is where we shine. Your initial consultation will entail a very thorough questioning session where we ask you lots of questions about your current issue, the history surrounding it, and other questions relating to your medical, lifestyle and work history. From the word go, we will be painting a picture of what is going on with you. From the information you give us and the questions we ask, we will be ruling in or out which type of headache you could be experiencing.

Some types of headache have very specific features, and we may be able to come to a conclusion quite quickly. Other types may be less easy to recognise, but by the end of the questioning we will have a list of conditions in our mind that we need to test for. This is where we perform our clinical tests. Some of the more common types of headache are due to problems relating to the muscles and joints around the neck and head region, so we’ll ask if we can have a good feel of these areas. We’ll watch you move, then we’ll move you around, feel and compare between the two. We may need to test the nerves that give your head and neck their function, or we may need to take your blood pressure… Either way, we can do it all.

For headaches, we will be particularly interested in what your head, neck, mid-back, shoulders and general posture look and feel like and how everything moves together. We will always be looking at the bigger picture though, so if you’re wondering why we’re checking the levels of your pelvis or the length of your legs, it’s because we’re searching for every possible reason as to why your headache is occurring. After careful consideration and once we are happy with our diagnosis, we will sit and have a chat about what is going on and what the plan is to get you feeling good again. At this point we’ll get to work on your body using the many techniques we have at our disposal. We will also offer advice on any lifestyle changes you may need to make to ensure the headache is being attacked from all angles. A headache diary is often a suggestion so we can keep track of your headaches from week to week. However, this will be discussed in your initial consultation.

Sometimes a headache can be the sign of a more serious problem that we may not be able to help you with. If this is the case, we will ensure you are directed towards the right people for the job. This may entail us writing a letter to your GP with our findings and recommendations. Whether we treat or not, you will receive the highest level of care from us. We pride ourselves on it!

Final comments

If you or anyone you know is experiencing headaches, please pick up the phone and call us on 9078 2455.  Now you know what we can do to help, we hope the next time you are asked the question “Should I see an osteo if I have headaches?” your answer will be a solid YES!

P.s. We can even help with ice cream headaches (a.k.a ‘brain freeze’)… Our advice is simple—slow down and enjoy it! (we get how hard that is)

References:

  1. Migraine & Headache Australia. 2019. What is headache. [Online]. Available from: https://headacheaustralia.org.au/what-is-headache/. [Accessed 15 Jan 2020]
  2. Migraine & Headache Australia. 2019. Headache types. [Online]. Available from: https://headacheaustralia.org.au/types-of-headaches/. [Accessed 15 Jan 2020]
  3. Biondi, BM. 2005. Cervicogenic headache: a review of diagnostic and treatment strategies. The Journal of the American Osteopathic Association. 105 (4). 16S-22S. Available from: https://jaoa.org/article.aspx?articleid=2093083
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