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].

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! ?

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]
https://fastgooderection.com/2020/05/03/viagra-purple-pill/ kidney stones and erectile dysfunction.

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

c’est intéressant: Quelle

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/

Die Top-Online-Shop für viagra – Cialis. Niedrige Preise und hohe Qualität!

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
Bei Erektionsstorungen muss irons sich behandeln lassen Lire la suite und bei Infantilismus ist es das, was es ist.

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

Farmacia Casa Online voor vrouwen bestellen