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How Are Feet Important To The Way We Move?

Teille Wickstein Biomechanics, Feet, Osteopathy July 20, 2021July 23, 2021

25% of the body’s bones, 18% of joints and 6% of the muscle are in the feet. People often disregarded their feet as an essential part of the body and pay no heed to issues that are concerning them. Injuries and damage to the feet can cause and lead to serious problems in the knee, hips, pelvis, spine and affecting the body as a whole.

How do ¼ of the body’s bones have such an impact? To answer this lets first discuss biomechanics.

Biomechanics

Biomechanics is the study of the structure, function, and motion of the mechanical aspects of biological systems, at any level from whole organisms to organs, cells, and cell organelles, using the methods of mechanics. So basically, for you this means how you move, what muscles, bones, ligaments, tendons, fascia is involved in the movement and how any change through this will affect the movement.

The foot biomechanics can be separated into static and dynamic elements. Bones, ligaments, fascia, and joint surface congruity form the static elements. While muscle function and arthrokinematics (movement of joint surfaces) of the tarsal bones the dynamic elements.

Static Elements

The static elements of the foot are the structure of the foot, they allow us to remain upright for a prolonged period without needing move. This is contributed to the passive ligamentous support of the plantar aponeurosis (fascia) and osseous (bony) support which maintains the arch in the static foot.

The plantar aponeurosis commonly referred to as the plantar fascia. Is a thick connective tissue, that functions to support and protect the underlying vital structures of the foot. The osseous support mainly comes from a beam like action of the metatarsals (long bones that connect ankle to toes).

These two components connect to help form the windlass mechanism. A windlass is a sailing apparatus used to haul or lift. The windlass mechanism of the foot describes the plantar aponeurosis tension ability to absorb increased stress. This occurs as the calcaneus (heel bone) and extension of the first metatarsophalangeal joint (MTPJ/big toe) move closer together.

Dynamic Elements

The dynamic elements work in combination and are reliant on the static elements. The foot and ankle movement are complex and highly involved. It can be defined as a closed kinetic chain the combination of movement of several sequential joints and tissue structures where the terminal segment is met with considerable resistance. In this chain the ankle and foot work in triplane movements called pronation and supination. Pronation is the simultaneous movement in a transverse, sagittal and frontal plane or a combination of abduction, dorsiflexion, and eversion. Supination works in the same three planes although it is a combination of adduction, plantar flexion, and inversion. Pronation and Supination are needed to achieve a ‘normal’ gait.

Normal Gait (Walk) & Feet

A normal gait cycle is measured from initial contact to the ground of one foot to the lift-off and recontact of the same foot. To walk the movement does not just happen at the feet, there is distinct movements in the joints of the feet, ankles, knees hips and pelvis. As well as substantial muscle and ligament involvement from the feet to the pelvis.

During the gait cycle, the feet have an important role, especially in the stance phase. When the heel strikes the ground, the ankle is in dorsiflexion as the movement continues the hindfoot (subtalar, talonavicular, and calcaneocuboid joints) starts to evert allowing the ankle to start plantar flexing. This creates a loading effect on the plantar aponeurosis as the foot pronates moving into the mid-stance phase.

In the mid-stance, the tension in the plantar aponeurosis decreases allowing the foot to be able to shock absorb and adapt through the midfoot. As the foot prepares for the toe-off phase, the big toe moves into extension, which tightens the plantar aponeurosis and assists with supination of the foot.

Any change to the biomechanics or injuries to the muscles, tendons, or ligaments will alter how you stand and walk. These compensations can create issues up the chain including ankle, knee, hip, and lower back pain.

Do you have any issues that you think might be steming from you feet?

Teille would be happy to assist you with this.

References:

Top Australian Made Mattress in a Box

Teille Wickstein Sleep July 14, 2021July 20, 2021

If you’ve been following our sleep series you’ll understand by now the importance of having good sleep hygiene, and how integral your mattress is to achieving this. So how do you know if your mattress is ok or not? And how do you chose a new one? Should you buy an Australian-made mattress?

We know how confusing mattress shopping is so your local Osteos have done the hard work for you. Both Reena and Teille have spent considerable time over the past few months researching, and then purchasing, new mattresses so that we could give you our honest opinion on one of our most frequently asked questions.

Ok, so what did we decide on? The Serenity HLP. Why?

1.They are the only Australian made truly zoned pocket spring mattress in a box.

Who doesn’t love the convenience of having a mattress delivered to your door, especially during a global pandemic and with increasing lock-downs?! If you’ve even so much as thought about a new mattress then your social feeds are probably filled with ads from Koala, Sleeping Duck, Ecosa or Emma. The question is – are these all-foam mattresses actually good for your spine?

As Osteos we are advocates for a good-quality mattress that provides optimal support to your whole body, not just your spine, and generally speaking, this is best achieved with a mattress that contains a supportive inner-spring system. A spring system with individual “zones” ensures correct spinal alignment and provides variable support for different body parts: head, shoulders, lower back, thighs, and feet, for optimal sleep quality.

2. It’s different to the other “mattress-in-a-box” brands

It’s a therapeutic mattress. They have taken their existing high-quality therapeutic mattress that has been in production for 30 years, refined it and created an ‘in-the-box’ option. It has been designed with a team of allied health professionals to provide correct zoned support for the entire body, keeping the body balanced and upright and protecting the central nervous system.

Using the highest-grade Australian materials in their products, they have been able to incorporate a 9-zone pocket spring system that provides targeted support and pressure relief for an ideal sleeping posture, whilst ensuring that the manufacturing, compressing, and the delivery process does not compromise on the quality and lifetime performance of their mattress.

As a result, it has gained not only our endorsement but that of Osteopathy Australia.

See here for more information on how the Serenity compares to other similar mattresses.

3. It’s customisable: you get to choose your level of comfort

The Serenity mattresses come with interchangeable comfort layers for a firmer or softer sleep which can also be personalised for each side of the Queen or King Mattress meaning no more arguments between you and your partner as you try to find the perfect mattress. We’re pretty confident you’ll find a combination that works for you both!

Plus, the manufacturers of the Serenity HLP promise to work with you until your perfect sleep is achieved by allowing customers to choose different comfort layers and swap them over if they find the mattress they have chosen is too soft or too hard. Speaking from experience, the medium-density is perfect for most people, including Reena’s daughter, though Teille personally prefers the firmer density and had hers easily replaced by Serenity at no extra cost.

4. Its Australian made, using materials that have been chosen specifically for health and comfort

Serenity uses Australian Grade-1 steel springs manufactured using the right gauge wire and VPF manufactured foams that when unboxed are un-compromised.

The foams have been certified by the Good Environmental Choice Australia (GECA) using Variable Pressure Foam (VPA) technology. The VPF process is virtually emissions-free making it the most environmentally friendly process used to manufacture polyurethane foams worldwide. Better for the environment, and better for you!

Body temperature is critical to a good night’s sleep, and airflow is vital in managing your body’s nightly temperature. In addition to being earth-friendly, supportive and comfortable, foam made using the VPF method is also highly breathable. The mattress’s advanced open-cell structure lets air circulate throughout the mattress, keeping your nights pleasantly temperature-neutral.

In addition, VPF foams have virtually no height loss, guaranteed less than 2% in the first 10 Years. That is less than 2mm, not perceptible to the naked eye!

All this is covered with Australian Merino Wool which is hard-wearing and flexible with a textile strength comparative to steel. Wool has tiny air pockets which allow the fabric to breathe and insulate. This means it is an active fibre that reacts to changes in body temperature. It traps heat during winter and helps air circulate keeping moisture away in summer.

Merino wool is odour and stain resistant which means it absorbs moisture vapour and odour molecules from sweat and only releases upon washing. They have a natural protective outer layer that helps prevent stains and antistatic properties that attract less dust and lint. Merino fibres are extremely fine, making it feel soft and luxuriously gentle next to your skin. The Merino wool cover is removable and easy to keep clean with a cold machine wash.

5. Its backed by “The Serenity Guarantee“

Serenity HLP is a Melbourne based company. Their mattresses are made by hand, rolled on-site, packaged in an Australian made box and delivered to your door. Every Serenity HLP mattress comes with a guarantee that the mattress is chemical-free and crafted from the best Australian materials.

Endorsed by Osteopathy Australia
100 Day Trial and Money Back Guarantee
Customisable and Exchangeable Comfort System
Free Delivery and Free Returns
15 Year Warranty

We all know how hard it is to buy a new mattress, let alone one you can’t trial first so we particularly love that the Serenity HLP has a 100-day trial and money-back guarantee to give you peace of mind. Let’s be honest, lying on a mattress for 10 minutes in the store with everyone looking at you is hardly a good indication of comfort once you get it home. Plus, with our current offer, you’ll receive $150 off your purchase and free shipping.

So are you ready for a healthier night’s sleep? Click here for more information and to take advantage of this offer.

Here’s what some of our patients think of their new mattress:

“Thank you so much for suggesting the “Serenity HLP” Mattress, an Australian-made product. We’ve had our mattress for 8 weeks now and from day one it has been amazing. We purchased the Queen “Medium” which is perfect as we both have back problems.

We have recommended this mattress to our family and friends, some who have since purchased and are equally as happy as we are”.

Grateful Clients,
Ann & Greg, Wollongong

Is it time for a new mattress?

Teille Wickstein Osteopathy, Sleep July 7, 2021July 14, 2021

Our houses or apartments are full of furniture. Presumably, you have a lounge (or two), a dining table, and a bed at the very least. Modern conveniences designed to make our lives more comfortable. I wonder when you replaced your lounge? Perhaps when it started to sag in the middle and you had trouble getting up, or maybe when it no longer matched your decor? How about your mattress? On average we sleep 229,961 hours in a lifetime, that’s ⅓ of our lives spent lying down, on a mattress. When you last replaced the most important piece of furniture in your home?

Having the right mattress (and pillow) is imperative in obtaining a “good” night’s sleep. A night of good sleep not only has a direct impact on your mood and mental health – we have all woken cranky after a bad night’s sleep, it also helps your body recuperate, your muscles repair, but it also improves memory and focus, helps builds immunity, and helps control weight. So is your current mattress working for you or against you?

As a general rule, most mattresses will last 8-10 years. This is dependent on the quality of materials the mattress is made from, who uses the mattress, and how long per day. I once had a patient tell me they had been using the same mattress for 40 years! I highly doubt it was still supportive after almost half a century, and perhaps that was why I was providing them with treatment for musculoskeletal pain.

An old or poor-quality mattress can negatively affect your health, from short-term effects of drowsiness, headache, aches and pains to long-term effects such as respiratory problems, spine and back issues, and allergies. Most people think a good mattress is simply for comfort, a supportive mattress has a significant impact on your health – both physically and mentally.

Here is a list of seven things that may be seen due to an old or poor-quality mattress:

Pain: this is the most common complaint people have when sleeping and it can come down to your mattress. As mattresses age they start to lose their structure and support. An ill-supported, sagging mattress can lean to back and neck strains, sleeplessness, fragmented sleep, and daytime fatigue.

Microorganisms & Hygiene: dust mites multiply rapidly and find old mattresses in a haven. These microorganisms can cause skin conditions and respiratory problems such as allergies and eczema. Bed bugs love old damp mattresses and on average a person loses 0.5kg of sweat/night over time this creates a bed bug ideal habitat. Their bite creates health problems from sleep deprivation to anaemia. This damp environment is also perfect for bacteria, mould, and mildew, leading to skin and respiratory issues

Insomnia/Sleep Disturbances: waking still feeling tired, groggy, and grumpy. Your mattress may be the cause, an old mattress can reduce the quality of sleep you are getting, lowering your immune system. Over time issues like insomnia can lead to serious health issues like high blood pressure and other cardiovascular conditions.

Stress: inadequate sleep directly affects your day, after 1 sleepless night you are more irritable, short-tempered, and vulnerable to stress. High-stress levels can then affect sleep by increasing the body’s cortisol levels stimulating the brain to become alert and awake.

Snoring: mattresses are overlooked when it comes to snoring. An old mattress cannot support your spinal and head therefore the muscles in the jaw and throat can collapse which can limit your airway increasing snoring. Dust mites, mould, mildew and bacteria can also aggravate sinus issues and snoring.

Cardiovascular, Immunity & Obesity: If you do not sleep well your heart tends to work harder. A study conducted by the European Heart Journal showed that people who suffer from lack of sleep or poor sleep, have 48 per cent more chances of developing a heart condition such as high blood pressure, compared to those who sleep well. Sleeping on an old mattress prevents you from getting high-quality sleep, which weakens your immune system, increasing your risk of colds and flu and other bacterial and viral conditions. Sleep has been linked to metabolic and endocrine functions, this means that old mattresses promote sleep deprivation which in turn promotes binge-eating and overeating.

Mental Health: Sleep and mental and emotional health have an intimate and bidirectional relationship, poor sleep quality has been linked to depression, anxiety, bipolar disorder, etc. Given their strong association, it is believed that improving sleep can have a beneficial impact on mental health and can be a component of treating many psychiatric disorders.

So where do you begin in searching for a new mattress?

It’s a significant investment so take your time, do some research, compare the brands, look at the materials used, check out the manufacturer, their reputation, history, where they are made, have they had any changes in the manufacturing recently, do they get good reviews, and do you trust where the information is coming from.

Or you can just wait for our next blog for our recommendations. We’ve done the hard work and researched it all for you so you don’t have to!

References:

Do you have good “sleep hygiene”?

Teille Wickstein Sleep June 29, 2021July 7, 2021

Sleep hygiene is the term used to describe good sleep habits. Improving your sleeping hygiene is one easiest ways to help ensure a better night’s sleep. Good sleep hygiene means guaranteeing that your bedroom environment and daily/night-time routines promote consistent, uninterrupted sleep. Creating optimal “sleep hygiene” should be individualised to you and include: keeping a stable sleep schedule, making your bedroom comfortable and free of disruptions, following a relaxing pre-bed routine, and building healthy habits during the day.

Good quality sleep is important for both your physical and mental health, as well as your overall quality of life. Significant research has gone into developing guidelines and tips designed to enhance good sleep, and there is high-quality evidence to suggest that these strategies can provide long-term solutions to sleep difficulties.

What Are Signs of Poor Sleep Hygiene?

Having a hard time falling asleep,
Experiencing frequent sleep disturbances,
Suffering daytime sleepiness
Overall lack of consistency in sleep quantity or quality

How Do You Practice Good Sleep Hygiene?

Good sleep hygiene is all about putting yourself in the best position to sleep well each and every night. Optimizing your sleep schedule, pre-bed routine, and daily routines is part of harnessing habits to make quality sleep feel more automatic. At the same time, creating a pleasant bedroom environment can be an invitation to relax and doze off.

It is important to note that improving sleep hygiene will not always resolve sleeping problems, individuals with serious insomnia or sleep disorders like obstructive sleep apnoea may benefit from better sleep hygiene, but usually in conjunction with other treatments. If you have long-lasting or severe sleeping problems or daytime sleepiness, it’s best to talk with a doctor who can recommend the most appropriate course of treatment.

Tips for good sleep hygiene:

1. Have a regular sleep schedule:

Going to bed and waking up at the same time helps set your body’s internal clock’ to expect helping you keep a healthy routine. Keep it within a 20-minute window of the same time every night as consistent sleep can also help reduce daytime sleepiness.

2. Keep day-time naps to a minimum:

We all need a certain amount of sleep in a 24-hr cycle. If you are prone to have a nap during the day its important to know that this will take away from the total amount of sleep you require at night.
If you must nap keep it short (15-30min) and before 5pm as late-day naps decrease sleep drive.

3. Night Routine/Sleep Rituals:

Ease the transition between daytime and sleep time with at least an hour of wind-down activities. This may include: Light reading, a warm bath/shower, mediation, sleepy time tea, ASMR (Autonomous Sensory Meridian Response), sleep casts by headspace or nature sounds/sleep music before bed are all good ways to prepare yourself for sleep.
Avoid stressful, stimulating activities – work, high emotional discussions etc. Physically and Psychologically stressful activities cause the body to secrete cortisol (stress hormone) which is associated with increased alertness, not sedation.

4. Bedroom Setup:

A quiet, dark, cool environment can help promote better sleep.
Reduce noise – this includes outside noises, TV or electronics.
High-quality pillows and mattress
Pillow needs to suit your sleeping style – side, tummy, back.
We have compiled a comprehensive e-book to help take the confusion out of buying your next pillow.
Most pillows have a shelf life of 2-5years depending on the material used
Most mattresses have a shelf life of 10 years
Also, unsettled pets may also disrupt your sleep, ensuring their comfort will help keep your sleep undisturbed.
Limit your bedtime activities to sleep and sex – this strengthens the mental association between your bedroom and sleep.
Natural, bright lights stimulate the wake phase of the sleep cycle – avoid bright lights in the bedroom at night and use them to wake you up during the day.

5. Exercises:

Exercise can help promote restful sleep if completed at least 3hrs before bedtime. It can help you fall asleep faster and sleep more soundly
Exercise secretes cortisol which helps activate the alert mechanism in the brain. To get the positive effects of exercise on sleep it has to be in your daily/weekly routine for approximately a month, and be maintained.

6. Diet – Caffeine, Alcohol, Nicotine, etc:

Caffeine has the ability to decrease your sleep quality. It is found in coffee, tea (black, white & green), chocolate, sodas, and some pain relief (i.e., Panadol Extra).Research has shown that caffeine can affect the body 4-10hrs after consumption, with up to half the level of caffeine still present in the body at 6 hours after intake. So best to keep those long blacks just to the morning!
Alcohol may make you feel sleepy, but it is a stimulant promoting fragmented sleep – increasing the number of awakenings and decreasing the overall sleep quality. It is recommended to limit alcohol consumption and avoid drinking within 3 hrs of bedtime.
Try to eat a couple of hours before your bedtime and avoid foods that cause problems. Hungry at night? Try foods that are easily digested.

7. Stress:

Try writing down anything that is on your mind before bed, getting them down on paper and actively putting them aside can help overthinking when trying to get to sleep.

8. Clock watching, Electronic Devices:

Unplug before bed – screens and sleep are incompatible; the light disrupts your body clock and keeps your mind active, keeping you awake later than necessary. Try to keep the phone out of reach of the bed or turn it over so you are not disrupted by the light of the screen.
Using do not disturb or a sleep app or Apple’s Health App to set up wind down and bedtime routine may help to create good habits and work as a reminder to wind down for bed.
Frustrated that you cannot fall asleep? After 20min go to another room and try doing something relaxing (Eg. read a book) until you feel tired enough to go back to bed.
Stop watching the clock – this can increase stress. This is the same if at the start or in the middle of the night. If you cannot get to sleep within 20min go to another room, keep the lights dimmed and do something relaxing when your eyes start to droop go back to bed

Specific Sleep Hygiene Tips just for Kids:

3-5-year-old generally need 10-13 hrs/night
6-13-year-old generally need 9-11 hrs/night
Children sleep better when they stick to the same bedtime and wake time even on weekends
Staying up late and catching up on sleep can throw a child off their sleep routine for several days
Beds are for sleeping – iPad, tv or phone use in bed disassociates bed and sleep in your brain
A child’s bedroom should be quiet, cool, and comfortable
Enforce a good bedtime routine – this can include brushing teeth, putting on Pjs, and reading a book
Evening wind down should be quiet calm activities, listening to soft music or reading a book
Decrease stimulating activities 1 hr before bed
Avoid Caffeine in the late afternoon/evening i.e., soda, chocolate, as this can cause shallow and fragmented sleep
Put a child to sleep in their bed when they are drowsy but awake, allowing them to fall asleep in other places disassociating their bed and bedroom with sleep making it harder to get them to fall asleep in their bed.
If they do not fall asleep after 20-30min get them out of bed and to an activity that will help them get drowsy i.e., reading a boring book
Cuddle up with a soft toy of blanket, a security object can be a good transition to help them feel safe when you are there
Bedtime check-ups are short and sweet. When checking up on a child the main purpose is to let them know you are there and that they are alright. The briefer the better.

References:

Osteoporosis: Lets sort out the myths from the facts

Reena Exercise, Nutrition, Osteopathy December 7, 2020December 7, 2020

It’s no secret that as we get older, concerns about health start to grow for many. Chronic disease statistics within the global population increase with age. By the age of 75, there is a 60% chance of having developed two or more chronic conditions. By 85 this increases to a 75% chance. Some of the common conditions people associate with getting old are osteoarthritis, type 2 diabetes, dementia, hearing loss and eye conditions including cataracts and glaucoma. One very important condition that affects millions of people every year around the world is osteoporosis. Considering it affects so many of us as we age, it’s not always up there at the fore-front of people’s minds as one to watch out for.

We’ve put together this blog to inform you fully on some of the facts and myths surrounding osteoporosis and to let you know why it’s so important to act early in life to avoid this potentially debilitating condition.

What is osteoporosis?

Osteoporosis is a condition that affects the density of bones of the skeleton causing them to become weak and fragile to breaks. It occurs when bones lose high amounts of protein and minerals, particularly calcium. The internal structure of the bone changes (i.e. the amount of bone that makes up the structure decreases) and this weakens the bone. The condition mainly affects the elderly population, but this is a condition that can take years to develop with lifestyle decisions early on in life playing a major role in its development in some people.

Myths and facts

Let’s outline some of the myths (and debunk them with facts!) surrounding osteoporosis. We believe a healthy population can only come from being an informed population.

Osteoporosis only affects women: Stop right there! Yes, women are more susceptible to developing osteoporosis due to the hormonal changes they go through during menopause. The reduced production of oestrogen following menopause is one of the biggest risk factors for developing this condition because of the weakening affect it has on the bones. Make no mistake, men can also develop this condition. A fifth of men over 50 in the US will experience an osteoporotic bone fracture in their lifetime!
Osteoporosis only affects Caucasians: Osteoporosis can affect anyone regardless of race or ethnic origin. The stats show there are higher numbers of cases in white than black people. Research suggests black people tend to develop a greater bone mineral density during the growth stage of life than white people, leading to overall stronger bones. It also suggests black people lose bone at a slower rate than white people as they age. This condition should however be taken seriously by all.
Osteoporosis only affects the bones: Whilst osteoporosis primarily affects the strength of bones leading to increased fracture rates, this condition can affect the body in other ways as well. Recovery from hip fracture surgery due to a osteoporosis-related fall can be problematic and sometimes fatal due to other bodily complications such as immobility, heart and lung problems and increased infection rates following surgery.
You’re only likely to fracture if you have a fall: Falling down is a common way people fracture bones, particularly if you have a low bone mineral density or osteoporosis. Unfortunately for people with severe osteoporosis, even the smallest of movements could lead to a bone fracture. Sneezing, reaching to pick up an object from the floor, stepping off a pavement onto the road or even a sudden change in direction whilst walking are all movements that may trigger a break in someone with this condition.
Osteoporosis is painless: Many people believe that this condition is painless unless you physically fracture a bone. This may be true in the early stages of the disease as there may be no signs or symptoms of something changing in the bones until you experience your first fracture. As the disease progresses, chronic pain can be a big problem, particularly if there have been multiple fractures over the course of a person’s life. Osteoporosis is strongly linked with loss of muscle mass as we age, which leads to further deterioration of bone health. The body loses its ability to support the skeleton and various scenarios of pain states relating to posture and persistent pain following the healing of a fracture can exist.
I’ll worry about osteoporosis if it happens: Take no chances. How you live your life in the early stages will affect your body later on. Children and adolescents need to be active and eat a healthy diet consisting of the right vitamins and minerals because it is at this stage of life where our bones build in mass and strength. Females reach their peak bone mass around the age of 18 and males reach it around 20 years of age. After this, we start to lose bone as the years progress. Staying active and being healthy throughout life will help to reduce the loss of bone that occurs with age. The rule is to act early (teach your kids the importance of being active) and continue to act as the years go by!

There is so much more we could discuss on this topic, but we’d be here all day! We hope this has given you a sound understanding of what osteoporosis is and the importance of acting early in life to avoid this condition. If you would like to know more, feel free to ask us next time you are in for a treatment or a chat, or check out Osteoporosis Australia. Stay safe everyone!

References

National Osteoporosis Foundation. 2020. General facts. [Online]. Available from: https://www.nof.org/preventing-fractures/general-facts/. [Accessed 03 Sep 2020]
GP Online. 2017. Comorbidities in older people. [Online]. Available from: https://www.gponline.com/comorbidities-older-people/elderly-care/article/1440520
Hochberg, MC. 2007. Racial differences in bone strength. Transactions of the American Clinical and Climatological Association. 118. 305-315. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1863580/

Paolucci, T. et al. 2016. Management of chronic pain in osteoporosis: challenges and solutions. Journal of pain research. 9. 177-186. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824363/

Why is our skin so important?

Reena Massage, Osteopathy September 28, 2020September 17, 2020

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

This organ 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 our skin also get wider allowing increased blood flow, therefore further 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 also acts as a reservoir for our blood. Within the thin layers there 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 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 its layers, 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 surface through the process of evaporation.

Vitamin D production

We need Vitamin D for many processes in the body. It is produced when the sun’s UV rays hit our exposed skin. Vitamin D helps us absorb calcium from the food that we eat. Both of these substances are important for good bone and muscle health. This essential vitamin 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 that?! Or is it hot…? Oh, whatever ‘tickles’ your fancy! 😉

References

Tortora, G. and Derrickson, B. 2011. Principles of Anatomy and Physiology. 13th ed. Asia: John Wiley & Sons, Inc

InformedHealth.org. 2019. How does skin work? [Online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279255/. [Accessed 15 Jul 2020]

Pain In The Heel: What Is Plantar Fasciopathy?

Reena Dry Needling, Exercise, Massage, Osteopathy September 21, 2020September 17, 2020exercise, heel pain, osteopathy, plantar fasciitis, plantar fasciopathy

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. It is similar in make-up to a tendon (the things that attach muscle to bone). If too much stress is placed on it over time the tissue can degenerate, weaken, and 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. For example: 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.

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 02 4655 5588. 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 muscles with 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, and may even get you back into our favourite type of thongs!

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 02 4655 5588 to book your appointment. Let’s have you putting your best foot forward, ASAP! 👌

References
1. Thompson, JV. et al. 2014. Diagnosis and management of plantar fasciitis. Journal of American Osteopathic Association. 114 (12). Available from: https://jaoa.org/aoa/content_public/journal/jaoa/933660/900.pdf
2. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education
3. Harvard Health Publishing. 2007. Easing the pain of plantar fasciitis. [Online]. Available from: https://www.health.harvard.edu/newsletter_article/Easing_the_pain_of_plantar_fasciitis. [Accessed 15 Jul 2020]
4. Orthoinfo. 2010. Plantar fasciitis and bone spurs. [Online]. Available from: https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs. [Accessed 15 Jul 2020]

Dry Needling vs Acupuncture: What’s the difference?

Teille Wickstein Acupuncture, Massage, Osteopathy July 31, 2020August 5, 2020

Both Acupuncture and Dry Needling involve the insertion of a filiform stainless-steel needle through the skin to alleviate pain, but are they different and if so, how?

Let’s begin by having a brief look at the two modalities:

Acupuncture	Dry Needling
Originated in China about 6000 BCE. Based on the theory of meridians, Qi, Yin/Yang and 5 elements (fire, water, wind, earth, metal) and aims in restoring balance. The knowledge of health and disease in China developed purely from observation of living subjects because dissection was forbidden and the subject of anatomy did not exist	Origins are from western medicine based in scientific principles. It aims at improving function by releasing myofascial trigger points (tender points) Came about by using hypodermic needle (used to draw blood) to decrease pain, and came about by experiment of injecting saline into muscles
Needle placement follows the meridians of the body and will not necessarily be placed in the area of pain. There are 12 meridians with a connection to internal organs	Needle placement is in the region of pain, trigger points in muscle, tendon and fascia
Used in the management of a broad range of conditions, including pain, menstrual issues, infertility, gastric complaints and more.	Used to treat musculoskeletal conditions and dysfunction
Used in daily practice by TCM practitioners as a primary modality, commonly the only technique	Used as a supplementary tool in some treatments
Minimum 4-year bachelor’s degree with 100s hour supervised clinical experience	Usually a 48-72-hour course with minimal supervised clinical experience
Must be registered through a Chinese Medical Board and Australian Health Practitioner Regulation Agency.	No regulatory body needed – although usually completed as an adjunction therapy
Must complete mandatory continued professional development for registration	No required continued professional development
Professional indemnity insurance is compulsory	May not be covered by professional indemnity insurance

Now that you have a brief overview, let’s do a deep-dive into the history and philosophy of each approach to gain a better understanding of the difference between Acupuncture and Dry Needling.

Dry Needling:

Dry Needling (DN) is described as “the insertion of needles into tender point in the body without the injection of any substance to treat painful musculoskeletal disorders”⁽¹⁾ and was tied to the discovery of myofascial tender points and pain referral patterns.

History:

It began in the late 1930’s with John Kellgren who was the first to publish that pain from muscles if often referred in a specific pattern to the individual muscle, and that pain could be relieved by injecting procaine into an acutely tender point which were often some distance from the site of pain outlasting the effects of anaesthetic⁽²⁾.

Over the next few years, an interest in pain relief from needling grew with many people experimenting with tender points, but it wasn’t until 1942 that Janet Travell and David Simmons’s research that Myofascial Trigger Points became a common term. Myofascial Trigger Points are defined as an “hyperirritable spot in skeletal muscle that is associated with a palpable nodule in a taut band. The spot is tender when pressed and can give rise to characteristic referred pain, motor dysfunction and autonomic phenomena”⁽¹⁾.

Needling without injection of a substance was first mentioned by Ernest Brav and Henry Sigmond in 1941 who proclaimed that pain could be relieved by simple needling without injecting anything, however the first sentence of their paper references a James Churchill’s publication on acupuncture from 1821^{(3, 4)}. The term ‘Dry Needling’ was coined in 1947 by J D Paulett who also established the relationship of effective treatment, deep needling, tender points and a reflex spasm (fasciculation/muscle twitch) ⁽⁵⁾. This was built upon by Karel Lewit in 1979 who stated that acupuncture needles had the same therapeutic results with less pain, bleeding and bruising then hypodermic needles⁽¹⁾.

This is how DN that is known today came about, with the use of acupuncture needles and the insertion and manipulation of the needle that creates a fasciculation to help reduce pain in musculoskeletal complaints.

Acupuncture:

Acupuncture is a key component of Traditional Chinese Medicine (TCM) to help balance the flow of energy known as qi (chi) which flows through medians in your body. By inserting filiform needles through a person’s skin at specific points along these meridians, to various depths, acupuncture practitioners believe that your energy flow will re-balance⁽⁶⁾. Other methods may be used to stimulate the acupuncture points, including acupressure, moxibustion, cupping, laser therapy, electro-stimulation and massage, in order to rebalance the flow of qi⁽⁷⁾.

History:

Acupuncture is generally held to have originated in China, with instruments dating back to 6000 BCE being interpreted as acupuncture treatment⁽⁸⁾, however this is widely debated.

1600-1046 BCE the Shang Dynasty linked Chinese medicine to the beliefs of ancestors, who were capable of endangering or even destroying human life, therefore healing practices attempted to restore not only the living but also the dead. This belief gave way to magical, demonological or supernatural beliefs, that demons caused disease such as swellings, and the insertion of needles or stone lancets etc., could be to kill or expel them⁽⁹⁾. Meridians were first mentioned in 198 BCE in writings found in Ma-Wang-Dui tomb⁽⁸⁾, however they differ from the ones commonly seen in TCM today.

The Huangdi Neijing (The Yellow Emperor’s Classic of Internal Medicine) is an antediluvian text on health and disease with an organised system of diagnosis and treatment. It is thought to be written in approximately 2600 BC by Emperor Huangdi. It is presented in the form of questions by the Emperor and learned replies from his ministers and is likely to be an accumulation of traditions handed down over centuries presented in terms of the prevailing Taoist philosophy. By this time the concept of meridians in which the Qi (energy/lifeforce) was established the precise anatomical locations of acupuncture point developed later^{(8, 10)}.

During the Han Dynasty (202 BCE – 220 CE) Chinese medical traditions flourished as Chinese health care started to follow theories to categorise phenomena into a limited number of causes and effects. Natural laws, conceptualised in doctrines such as ‘Yin‐yang’ and ‘Five elements (fire, water, wind, earth, metal),’ were used to explain health and disease, and to devise preventive and therapeutic strategies⁽⁹⁾. However, these theories were not commonly accepted or consistent.

The development of acupuncture and the accumulation in texts over the next centuries gradually made acupuncture one of the standard therapies used in China, alongside herbs, massage, diet and moxibustion (heat)⁽⁸⁾. Bronze statues from the 15th century show the acupuncture points, and were used for teaching and examination purposes⁽⁸⁾. During the Ming Dynasty (1368–1644 CE), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture, in which clear descriptions of the full set (365 points) that represent meridian apertures in which Qi could be accessed via a needle. These points are still points used in modern acupuncture.

Several of our team practice Dry Needling for musculoskeletal complaints, including Teille, Amy, and Yahana. If you are interested in learning more about the various needling approaches, and which style might be best for you see Dr. Teille Wickstein. She is our go-to practitioner for all things needling related! You can read more about her below.

Author Bio:

Dr Teille Wickstein is a dual-qualified Osteopath and Acupuncturist. She first obtained a degree in Chinese Medicine/Acupuncture, before undertaking a further 5 years of University training to become an Osteopath. Teille (pronounced “Teal”) is passionate about improving health and wellbeing, and truly believes in the holistic approach of treating the body as one unit.

Teille has an interest in treating both acute and chronic conditions through osteopathic treatment .
Teille uses a variety of different treatment techniques, from myofascial release to manipulation.
She aims to provide her patients with the knowledge required to not only treat their pain, but to understand it and subsequently prevent it using postural advice, ergonomic advice and strengthening techniques.

Teille is available for consultations from Tuesday – Saturday. She offers late afternoon and evening appointments.

For more information or to make an appointment call (02) 4655 5588 or click here to book an appointment now.

References:

1. Legge D. A History of Dry Needling. Journal of Musculoskeletal Pain. 2014;22.

2. Kellgren JH. Referred Pains from Muscle. Br Med J. 1938;1(4023):325-7.

3. Lu DP, Lu GP. An Historical Review and Perspective on the Impact of Acupuncture on U.S. Medicine and Society. Med Acupunct. 2013;25(5):311-6.

4. Brav EA, Sigmond H. Low Back Pain and the Needle. The Military Surgeon. 1942;90(5):545-9.

5. Paulett JD. Low Back Pain. The Lancet. 1947;250(6469):272-6.

6. Clinic M. Acupuncture: Mayo Clinic; 2017 [updated March 2020. Available from: https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763.

7. AACMA. Acupuncture 2020 [Available from: acupuncture.org.au/acupuncture-and-chinese-medicine/acupuncture/.

8. White A, Ernst E. A brief history of acupuncture. Rheumatology. 2004;43(5):662-3.

9. Ramey D, Buell PD. A true history of acupuncture. Focus on Alternative and Complementary Therapies. 2004;9(4):269-73.

10. Curran J. The Yellow Emperor’s Classic of Internal Medicine. BMJ : British Medical Journal. 2008;336(7647):777-.

Strong bones

Reena Exercise, Osteopathy, Uncategorized July 13, 2020June 26, 2020

Exercises for ageing bones

Are you in (or approaching) your latter years and are wondering what you can do to ensure you maintain strong bones 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 strong 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:

Osteoperosis — Woman training with exercise band during rehabilitation

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 4655 5588 or book in now so we can create an individual program that is perfect for you.

References

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/
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/
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]

Flat footed? Do you need treatment?

Reena Massage, Osteopathy June 29, 2020June 10, 2020

Have you ever been told you are flat-footed? 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 look flat-footed 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 am flat-footed?” 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 look flat-footed when you stand up and weight bear? Is there any associated pain? If so, call us today on 02 4655 5588 or book now and we’ll tell you what needs to be done to beat the pain! Arch you glad you read this now?! 😉

References:

Radiopedia. 2020. Pes planus. [Online]. Available from: https://radiopaedia.org/articles/pes-planus. [Accessed 08 May 2020].
Raj, MA. et al. 2020. Pes Planus. Stat Pearls. [Online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430802/. [Accessed 08 May 2020].

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