Injury blog: Plantar fasciopathy or fasciitis

Image x-ray of a feet with red pain

It’s morning, and the alarm clock has just told you it’s time to get out of bed. Another few minutes won’t hurt. You check your emails, social media sites, and you even ring your mum to see how the dog slept last night… basically anything to delay putting your feet on the ground and taking those first steps to get the day started. And it’s because of this pain you’ve been getting on the bottom of your heel every morning for the last few weeks. And it’s getting worse… Time to see your osteopath!

There are a few things that can cause pain on the bottom of the heel, but the most common cause is a condition named plantar fasciopathy (pronounced ‘fash-ee-op-a-thee’ — previously known as plantar fasciitis (pronounced ‘fash-ee-i-tis’)).

What is plantar fasciopathy?

Plantar fasciopathy is an overuse condition affecting the plantar fascia. The plantar fascia is a layer of soft tissue that stretches along the bottom of the foot, from the heel bone to the metatarsal bones in the front of the foot. It helps to provide stability to the arch of the foot and is similar in make-up to a tendon (the things that attach muscle to bone). If too much stress is placed on this structure, over time the tissue can degenerate, weaken, and start to give you pain. The pain is commonly felt where the plantar fascia attaches into the heel bone.

Risk factors

Scientific research suggests there are a few groups of people who are more prone to developing plantar fasciopathy. These include:

  • Runners
  • People who are over-weight and lead a sedentary lifestyle and/or spend long periods standing for work (e.g. a factory worker)

Important things to consider with these at-risk groups include:

  • Foot alignment and arch height: Having a very low or high arch or having excessive or not enough movement in the foot joints can lead to the development of this problem.
  • Amount of training: Increased levels of training can place greater stress on the plantar fascia more regularly.
  • Footwear: Wearing certain types of footwear when training can lead to an increased risk of plantar fasciopathy (i.e. wearing athletics spikes, or the wrong footwear for your foot type).
  • Muscle strength and flexibility: Decreased strength in the muscles that control toe movement, as well as weakened and tight calf, hamstring and gluteal muscles are all associated with higher rates of plantar fasciopathy.

Signs and symptoms

The signs and symptoms of plantar fasciopathy include:

  • Pain at the bottom of the heel
  • Pain that appears as a gradual onset
  • Pain felt first thing in the morning (i.e. taking those first steps out of bed in the morning is classic!)
  • Pain that decreases with activity, but increases again afterwards (early stages)
  • Pain that increases with activity and pain felt at night (latter stages)
  • Pain felt after periods of prolonged rest during the day (i.e. being sat at your desk for 2-3 hours and then getting up again)
  • Tight calf, hamstring and gluteal muscles
  • Weak muscles that help to support the arch of the foot
  • Stiff or over-flexible foot and ankle joints

Diagnosis and treatment

First things first, if you have heel pain that sounds similar to the picture we have painted above, make an appointment with us now (you know what to do… call us on 9078 2455 Once we have asked the relevant questions, performed the necessary tests, and are convinced that  the issue stems from the plantar fascia, we will formulate a plan with you with short and long-term goals to reach within a set time.

Initial hands-on treatment will include a combination of massage, joint mobilisation and manipulation, and dry needling of the lower limb muscleswith the aim of correcting any mechanical issues that are playing a role in this issue. Depending on the presentation, we may also use tape around the foot and ankle to provide support and reduce the stress being placed on the tissues. Other treatment will include advice on weight loss (if required), training regimen, footwear, and exercise prescription that helps to lengthen and strengthen tight and weak muscles. Some cases of plantar fasciopathy may require a foot orthotic or in-sole to provide extra support to the foot whilst wearing shoes. We can advise on footwear too!

Plantar fasciopathy is a tricky condition to treat which may require ongoing treatment for several months. We will endeavour to get you pain-free in the shortest time possible, so we recommend following all advice to a T, which may include a reduction in the amount of training you are doing at present. When you start to hit goals and we see improvements being made, we’ll have you back up to your full training program before you can say “plantar fasciopathy”.

Imaging?

People regularly ask if they need imaging for such an issue, but the majority of cases of plantar fasciopathy can be diagnosed with a thorough case history and physical assessment. This is where we excel! Imaging is there for cases that do not respond to treatment and for those instances where we need to rule out a more serious problem.

If you need help with heel pain, please call us today on 9078 2455 to book your appointment. Let’s have you putting your best foot forward, ASAP! 👌

Functions of the skin

Skin anatomy abstract blue design

Question… Which is the largest organ in the human body? A lot of people think the answer is the brain, lungs or liver when asked this question. When in fact, the answer is the skin. All of the skin combined in a big heap would weigh more than any other organ. The skin equates to approximately 7% of total body weight in an average adult. It’s an incredibly intricate structure that forms the outer layers of our bodies. But why do we have skin? Read on to find out all the cool things our skin does for us…

Functions of the skin

The skin has six main jobs to do on a day-to-day basis. These include:

  • Controlling body temperature: The skin does a fantastic job of keeping our body temperature stable. It does this in two ways: through sweating, and changes in blood flow, depending on the temperature of the air around us. If we are in a hot climate, our body releases sweat from glands in the skin. The blood vessels that run through the skin also get wider allowing increased blood flow, therefore releasing heat from the body. This process reverses in cold climates. We sweat less and the blood vessels get narrower, reducing the amount of blood flow which helps the body retain heat. Magic!
  • Storing blood: The skin acts as a reservoir of blood. Within the thin layers of the skin are lots of blood vessels which, at rest (i.e. sitting or lying down), hold somewhere between 8-10% of the total blood in the body. That’s a LOT of blood!
  • Protection: Our bodies are covered in one big protective coating. The skin protects us from the outside world and much of what it throws at us. Our skin is made up of very tightly packed, minuscule cells that produce a hardy protein known as Keratin. This protects the tissues inside us from heat, scratches, chemicals and any nasties that are floating around. Special glands in the skin produce an oily substance which covers our skin and hairs to stop them from drying out. Our sweat is also acidic and protects against nasty germs. Pigment in our skin protects us from the sun’s harmful UV rays. Finally, there are other special types of cells that recognise any nasties that have made their way through the skin layers and alerts our immune system to send in the soldiers to kill the unwanted guests. It really works hard to keep you safe!
  • Sensation: Within the layers of our skin there are thousands of tiny structures known as receptors, which help us to detect certain sensations. Nerve endings do a similar job. These sensations include touch, vibration, pressure, tickling, heat, cold, and pain.

Absorption and excretion: i.e. taking in and getting rid! Absorption refers to the movement of substances from the outside world, through the skin and into our bodies. We can absorb certain vitamins, drugs (think about a hydrocortisone cream), gases (oxygen and carbon dioxide), as well as many other substances through our skin. Many of these are good substances that we need to live. Others can be harmful to our bodies.

Excretion refers to the removal of waste substances from the body. Our sweat is one way we can get rid of these waste substances. We also lose water from the skin through the process of evaporation.

  • Vitamin D production: We need Vitamin D for many processes in the body. Vitamin D is produced when he sun’s UV rays hit our exposed skin. Vitamin D is used to help the body absorb calcium from food that we eat. Both of these substances are important for good bone and muscle health. Vitamin D also plays a major role in our immune system function when we need to fight off an invasion of microbes. It is also needed by the body to reduce levels of inflammation.

Impressed? We are. How cool is skin?! Or is it hot…? Oh, whatever ‘tickles’ your fancy! 😉

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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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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Safety at work

The great thing about Osteopathy is that it’s not just about ridding people of their pain. It is a way of life. Yes, people come to see us to get rid of pain, but once they are in our caring hands, our work doesn’t stop there. We are huge advocates of ‘prevention is better than cure’. So, we will delve deep into your life – your diet, sleep patterns, hobbies, job and more. We look at you and your life as a complete package and will help you work out what areas need adjustments so you can live a long and healthy life (which is as pain-free as possible!).

Work is a big part of most people’s lives and is often a significant contributing factor to their pain. This month we’re giving advice on two key areas to ensure you are looking after yourself at work, so you can avoid injury and keep food on the table. All in the name of ‘National Safe Work Month’! Read on to ensure you are giving yourself the best possible chance of staying injury-free at work.

Lifting posture

We see lots of people coming in for treatment because they have hurt their back, neck or shoulders in a lifting-related incident. Our advice for you…

  1. Plan ahead to make sure you have a clear path from A to B for the object you are carrying. Make sure the object is stable and is not going to topple over whilst you are carrying it.
  2. Get close to the object and with your feet hip-width apart, and whilst keeping a straight back, bend at the hips and knees to get low to the ground (key words here – “STRAIGHT BACK”!).
  3. Ensure you have a firm grip of the object and whilst keeping your back straight (there it is again!), lift from your hips and knees until you reach an upright position.
  4. Always move using your feet rather than twisting or leaning through your back.
  5. Always keep the object close to your body. Never try to hold it out in front of you with your arms, as this places a great deal of stress on your shoulders, neck and back.
  6. Always get help from another person(s) if the object is too heavy for you alone. It is NEVER worth the risk of injury by tackling a task that may be slightly beyond your physical capabilities.

Desk set-up

Postural strain from a seated desk job is another common work-related injury we treat. To ensure you are sitting pretty, our advice to you is…

  1. Ensure the top of the screen is level with or just below the level of your eyes, and centred in front of you.
  2. Sit with relaxed shoulders, elbows bent at 90 degrees and avoid cocking the wrists back when typing (adjust your desk height to suit this if possible).
  3. Adjust the tilt of your chair to allow the hips to sit at an open angle of 100-110 degrees.
  4. Adjust the backrest of the chair to ensure you are supported in an upright position whilst seated.
  5. Avoid slouching back on to your tailbone. Instead, gently roll your pelvis forward to sit on your sitting bones and bring the curve of your low back into its natural position.
  6. Take regular breaks from sitting. Get up out of your chair every 30-45 minutes to allow your body to move and stretch.

So there you have it. Our skills are much more than just our hands. We’re full of good advice! No matter what job you do, we’ll help you break it down to make sure you are getting the most out of it and not putting yourself at risk of a workplace injury. Here’s to a happy workday, every day!

References

  1. Employsure. 2019. Reduce the risks associated with manual handling. [Online]. Available from: https://employsure.com.au/blog/reduce-risks-associated-manual-handling/. [Accessed 21 September 2019].
  2. The University of Western Australia. 2016. Computer workstation ergonomics. [Online]. Available from: http://www.safety.uwa.edu.au/topics/physical/ergonomics/workstation. [Accessed 21 September 2019].
  3. Safe Work Australia. 2019. National safe work month. [Online]. Available from: https://www.safeworkaustralia.gov.au/national-safe-work-month. [Accessed 21 September 2019].

Osteo Arthritis: aging and your body

Hello readers and welcome to October’s blog post! This month we are turning our focus to the elderly – an ever-growing population. Did you know that there are approximately 700 million people in the world aged 60 and over? And did you know that it is estimated that by 2050, there will be around 2 billion people on the planet that fall into this age bracket? That’s just over 30 years away! That’s quite difficult to comprehend, but with people beginning to work and live longer, it’s important that the elderly population get the attention and care they need to stay healthy and active; so they can enjoy the quality of life they deserve.

You might think that as people get older, they become less active and therefore are less likely to injure themselves. This may be true to a degree, especially once reaching retirement age, but the elderly population are generally an active population and are just as much at risk of injury as the next person. A 60-year-old person might not play footy or run around the basketball court as much as a teenager might, but they have other things to contend with – an ageing body with years of gradual degenerative change and weakening that we all experience at some point as we go through life. One of the most common causes of injury in the elderly is falling. Unfortunately, as the body ages, it becomes more prone to falls. This usually boils down to a combination of individual factors (i.e. having multiple diseases, poorer eyesight, or general weakening of the body) and environmental factors (e.g. trip hazards around the home setting). Some of the most commonly seen injuries sustained from falls include fractured hips, arms and forearms, cuts and lacerations, as well as head injuries.

In a clinical setting, us osteos see our fair share of older patients. It’s less likely we’ll see someone in the acute setting immediately following a trauma like a cut, laceration or in many instances where a fracture is suspected, but it does happen. It is much more likely however, that we will see patients experiencing pain related to postural strain (think about the retiree who sits around a lot), or from degenerative changes in the body. A common degenerative condition affecting the elderly population is osteoarthritis (OA). This most commonly affects the joints in the hips, knees and spine – particularly those of the neck and lower back. It’s no coincidence that these are the main weight-bearing joints of the body.

So what is OA?

OA is a condition affecting the synovial joints in the body (the joints between two bones in the body that have a lubricating fluid between them). It is characterised by changes to the cartilage and underlying bone, as well as inflammation and irritation to the soft tissues that help to hold the joints together – known as the synovium – it’s the tissue that forms the lubricating fluid that sits between the joints.

Primary OA refers to changes in the joints that relate to the ageing process. It will often run in the family, so if your granny or dad has it, you may be more at risk to develop it. Secondary OA is arthritic change from any other cause. For example, following on from trauma, repetitive stress, poor posture, or from diseases such as gout.

Signs & symptoms

The main symptoms (things the person experiences) of OA include pain, stiffness, poor joint function and muscle weakness. Signs (things we look for in the clinical setting) that a joint is degenerated include popping and clicking, poor range of motion, bone and joint swelling, deformity and instability.

What to do if you have or think you have OA

First things first, book an appointment to see your local osteo. After questions and assessment, we’ll get to work on your body and putting you on a pathway to moving better. There is a good chance your arthritic joint is paining you because you aren’t moving well, and the joint is being loaded incorrectly. The good news is, we know how you should be moving, and what needs to be done to get you there. We’ll aim to reduce your pain down by releasing tight and over-worked muscles and mobilising your stiff joints. Mobilising the joints helps to increase range of motion and will help promote production of the lubricating synovial fluid that sits between the joints to allow smooth fluid movement. You should get off the treatment table feeling less pain and moving better. There is a good chance you’ll need to do some form of strengthening to the surrounding weakened muscles, so the joint is more supported when you move it. More good news, we know which exercises will be beneficial to get you on the path to stronger muscles. Unfortunately, we cannot claim to cure your OA, but we can certainly get you moving with less pain or in an ideal situation, no pain at all.

What’s the outlook with OA?

More often than not, if caught early, significant changes can be made to stunt the progression of this degenerative condition. So, don’t ignore pain, it’s your body’s way of telling you something isn’t right. With early treatment, the best possible outcome will be achieved. If you pop into the clinic and we determine your issue is not OA-related, we can provide you with a sense of relief and get you on the right track for your situation (a positive outcome, either way!). In severe cases, you may require the opinion of a specialist orthopaedic surgeon. Sometimes people require joint replacements and can go on to live a very good quality of life with a new hip or knee for example. Always see your osteo first though. Using our skills, we can possibly keep you from having to go under the knife a bit longer, and maybe even at all. Worth a shot don’t you think?!

References:

  1. United Nations. 2019. International day of older persons – 1 October. [Online]. Available from: https://www.un.org/en/events/olderpersonsday/. [Accessed 04 Sept 2019].
  2. Medscape. 2017. Falls in the elderly: Causes, injuries, and management. [Online]. Available from: https://reference.medscape.com/features/slideshow/falls-in-the-elderly#page=1. [Accessed 04 Sept 2019].
  3. Arthritis Australia. 2019. Osteoarthritis. [Online]. Available from: https://arthritisaustralia.com.au/types-of-arthritis/osteoarthritis/. [Accessed 04 Sept 2019].

When might I need an x-ray?

Confused by all the different types of imaging out there? We get it. There appears to be an endless list of devices that can take a picture of our insides. This is because our body is made up of different materials, and the different materials show up differently on certain imaging types. We are very fortunate that technology has advanced enough for us to have pretty much any type of imaging available to us for all types of injuries and diseases.

Types of imaging

Following is a list of commonly used types of imaging. You may be familiar with some of these already if you have ever injured yourself:

  • X-ray
  • Ultrasound
  • CT scan (or Computed Tomography)
  • MRI scan (or Magnetic Resonance Imaging)
  • PET scan (or Positron-Emission Tomography)
  • DEXA scan (or Dual-Energy X-ray Absorptiometry – i.e. bone density scan)

But today, we’re going to focus on the most common – the x-ray.

X-ray

Nearly everyone on the planet will know what an x-ray is by the time they are 5 years old. And a large percentage of those will have had one done on them by too. X-ray imaging was one of the first types of imaging, discovered back in the late 1800s. X-rays work using electromagnetic radiation (don’t worry too much about the science) to create a picture of the tissues deep inside us. This allows us to see if there is a problem under the skin that we wouldn’t otherwise be able to see.

X-rays are a simple, cheap and a widely available imaging type. Although each image taken uses a small dose of radiation, it is a relatively safe form if imaging to use for most people.

What are x-rays used for? 

The most common use of x-ray imaging is to diagnose a problem with the skeleton. If you were to come off on the worse side of a 50/50 tackle in a football or rugby game, and it was suspected you had broken a leg bone, the first port of call would be an x-ray. Fractures are one of the number one reasons an x-ray would be used in a hospital or other imaging clinic. X-rays show excellent detail in bone tissue, so are perfect to see the fracture that has caused your complete bone to become two (or more) separate pieces.

Because they show such good detail of our bone tissues, an x-ray is also the go-to imaging type if we need to have a look at the state of a joint in the body. If someone had terrible knee pain for years that was caused by degeneration of the joint surfaces, and it hadn’t responded to osteopathic (or any other form of) treatment, then a knee specialist may decide to take a look at an x-ray of the knee joint to see the severity of damage. The information gathered from this image could then be used to help decide whether the patient may require a joint replacement. The knee is just one example where it can be used to look at a joint – it can be used all over the body.

Other interesting uses

You may not know this, but x-rays can also be used to help diagnose problems in the lungs and the digestive system. Chest x-rays will have been extremely helpful recently in diagnosing the location and severity of pneumonia in COVID-19 patients.

If your doctor suspects a problem in the digestive system, like a blockage or splitting of the intestines, then an abdominal x-ray is a quick and easy way to assess this issue. Has your child ever swallowed something they shouldn’t have? Like a coin or other metal object? The hospital can use x-rays to help with such a problem, even if the outcome is to wait for the object to pass through the system on its own!

We hope this was a helpful lesson on what x-rays can be used for. Stay tuned in future to find out about other types of imaging and their uses. Hopefully you’ll never need them!

Stay safe everyone.

References

  1. Inside Radiology. 2017. Plain radiograph/X-ray. [Online]. Available from: https://www.insideradiology.com.au/plain-radiograph-x-ray-hp/. [Accessed 06 Jul 2020]
  2. RadiologyInfo.org. 2020. Bone Densitometry (DEXA, DXA). [Online]. Available from: https://www.radiologyinfo.org/en/info.cfm?pg=dexa. [Accessed 06 Jul 2020]
  3. Ausmed. 2018. Medical Imaging Types and Modalities. [Online]. Available from: https://www.ausmed.com.au/cpd/articles/medical-imaging-types-and-modalities. [Accessed 06 Jul 2020]
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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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