Pain In The Heel: What Is Plantar Fasciopathy?

Plantar Fasciitis

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?

Acupuncture Camden pain relief

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:

AcupunctureDry 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.

Dry Needling Camden leg pain relief

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).

Gentle acupuncture wrist

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.

Acupuncture Dry Needling

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

Weight bearing exercise

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

  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]

Flat footed? Do you need treatment?

pes planus

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:

  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].

Pandemic Posture

Pandemic neck pain

It has been and continues to be, uncertain times for many of us as the COVID-19 pandemic continues to sweep across the globe. Lockdown has meant many of us have had to batten down the hatches and re-discover what it means to be ‘at home’. We ask you the question “how is your body being affected?” Are you suffering from Pandemic Posture?

Let us take you on a scan of the body, focus on some potentially problematic areas, and give you some advice to avoid any long-term issues.

Head and neck

The first stop is the very top! For all of you that normally head out to the office every day, the pandemic might mean you’ve had to start working from home. Not having your usual desk set up can place a great deal of stress on the neck region. Are you now working on a laptop instead of a desktop computer? Are you sitting on the sofa instead of an adjustable chair? Close your eyes for 30 seconds and hone your thoughts into your neck. Move it around… How does it feel? Is it tight, restricted or does your head feel heavier than usual? It could be that your new ‘desk’ set up’ is causing some strain in places it doesn’t usually. Think about the effect of having your head looking down at a laptop for 8 hours a day compared to straight up at a monitor set to the ideal height… Your poor muscles must be feeling the strain too.

We recommend trying to recreate your office space as close as possible to the real thing. If you don’t have a desk at home, a dining table may be more suitable than sitting on a sofa or armchair. You also need to ensure you are moving your neck and shoulders more regularly to avoid them being in a strained position for too long. Take a break every 30 minutes and move into a different position.

For more information to help combat pandemic posture, click here for a copy of our latest E-book “Working from Home: How to set up Ergonomically Set Up your workstation”.

Spine

Our spine sits at the core of the body, and we need good function throughout to ensure our limbs can also function with minimal effort and maximum efficiency. Are you used to an active job and now you find yourself homeschooling the children, or trying to break the day up with a bit of reading, gaming, TV or doing a crossword? Life is suddenly much more sedentary for most of us, so it’s important to avoid getting stiff. Sitting with poor spinal posture for extended periods, day after day can wreak havoc. Our spines curve ‘out  in the mid-back and ‘in ’ in the lower back. If we don’t look after those curves carefully by protecting our posture from excessive strains, then we leave ourselves open to sore backs and poor functioning limbs as a result.

We recommend avoiding long periods of sitting or lying down. Save it for bedtime! Try some standing spinal twists or bends (gently, of course), go for a walk around the garden, or do a session of yoga, Pilates or simple stretching through the day to mobilise your spine. If you have kids, get them to do it with you. They will enjoy a break from their school work, no doubt.

Hips

Anyone who works in a seated position knows what effect this can have on the hips. Having your hips in a ‘flexed’ or in a seated position for long periods of time can leave your hip flexor muscles tight and short. This decreases your ability to open the body out into a fully straight position, reducing flow of fluids through the central part of your body and leaving the back chain of muscles in a lengthened state, which can eventually result in the weakening of the chain.

We recommend lots of upright exercises for this one. Counteract the time spent seated working or binge-watching a TV series with some standing-based exercise. Jumps, skipping, walking, running or bridging is a nice way to open those hips and get the blood flowing.

Our underlying message through all of this is to move, move, move! You are a movement machine, so regularly start the ignition and go for a spin. Look after yourselves and please get in touch today on 02 4655 5588 or book now if you need help keeping your pandemic posture in check!

References

  1. Office of Industrial Relations. 2012.  Ergonomic guide to computer based workstations. [Online]. Available from: https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0006/83067/guide-ergo-comp-workstations.pdf. [Accessed 04 May 2020]

Fracture: Let’s ‘break’ it down

fracture

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

Causes

Fractures are usually caused in one of three ways:

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

Types of fracture: General description

Fractures are broadly classified into two main types:

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

We can also classify fractures on whether they are:

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

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

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

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

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

Stay safe, we’re here if you need any assistance.

References

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

Injury blog: Winging of the shoulder blades

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 46555 5588. 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. You can also book an appointment here.

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

To brace an injury: when it is helpful and when it isn’t

To brace an injury: when it is helpful and when it isn’t

A very common question we get asked at Completely Aligned is “Do I need to wear a brace to help with my injury?” Well this is very much a ‘depends’ sort of answer. It depends on the injury, where along the injury process you are and your personal circumstances.

Let’s first outline the advantages of wearing a brace and give some examples of when you might need to wear one.

Braces are items we place on a body part, usually over and around a joint, to provide extra stability to that area. They come in different forms but are generally quite flexible and elastic to ensure they move with the body, whilst being strong enough to protect the joint simultaneously.  Some braces are quite movable whilst others can lock a joint in a particular position.

When is it helpful?

The advantages of bracing include:

  • Providing stability to an injured body part to aid with treatment, rehabilitation and return to sport or work scenarios
  • Allowing faster healing by limiting movement at an injured body part
  • Reducing pain by de-loading injured structures
  • Can be easily put on and removed for any given situation
  • Are widely available and affordable

A common injury where you may need to use a brace is in the early stages of a moderate to severe medial collateral ligament (MCL) sprain of the knee. Imagine your knee has been forced inward whilst your foot is planted on the ground. If the force is great enough, the ligament stretches, tears and the stability of the knee is compromised. In this case, a brace is helpful to stop the knee from falling inwards again, which would interrupt the healing of the ligament. As healing progresses, the brace can be used less frequently or removed altogether to allow for more movement and activity. Other examples where a brace may be required include:

  • Wrist and ankle sprains
  • Tennis or golfer’s elbow (see recent blog for more info)
  • Knee cruciate ligament sprains
  • Pelvic instability (these are particularly helpful during pregnancy)
  • For stabilisation and re-training of scoliosis cases (i.e. abnormal spinal curves)

When isn’t it helpful?

One of the most common negative effects of bracing that we see is over-reliance. When someone has injured their ankle playing netball, part of the rehab process to get them back on the court quickly may be to wear a brace to provide them with the confidence to play to their full potential without fear of re-injury. This is all well and good as long as they wean off using the brace as rehab progresses. Many people end up wearing the brace as a safety net for 6 months, a year, or even longer because they are scared of re-injury. If you rely on a brace for support, it means the body part that was injured won’t have the necessary forces placed through it to ensure a full recovery to a pre-injury state. This could affect many factors including muscle strength, ligament stability and the body’s ability to know where the joint is in space (a.k.a ‘proprioception’). In order to return to that state, it’s necessary to move and exercise completely unaided.

Other disadvantages include:

  • Failure to achieve full joint range of motion post-injury
  • Possible muscle wasting
  • Increased loads placed on other body parts, which can risk another injury elsewhere

Our best advice to you is to never see a brace as a replacement for good movement and rehab. Always follow the advice of your practitioner as to when you should and shouldn’t wear a brace. If you have any doubts or questions, please call us on 02 4655 5588 to discuss, or book an appointment with one of our Osteo’s here. 

References

  1. Chen, L. et al. 2008. Medial collateral ligament injuries of the knee: current treatment concepts. Current reviews in musculoskeletal medicine. 1 (2). 108-113. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684213/
  2. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education

Vertigo: dizziness symptoms and treatment

Vertigo: dizziness symptoms and treatment

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

What is vertigo?

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

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

What causes BPPV?

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

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

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

Signs and symptoms

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

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

Can it be treated?

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

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

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

Final comments…

Interestingly, we often get patients come in who think they have vertigo, but in fact, it’s other structural issues contributing to their dizziness (which we diagnose and treat). That’s why it’s so important that we have a thorough consultation, to ensure we develop the right treatment plan for you. If you think you are experiencing vertigo, please come in and speak to us. Osteopaths are highly trained medical practitioners who can help treat more than you think, find out more here. Call us today on 02 4655 5588 to book your consultation with one of our Osteopaths, or click here to book online now.

References:

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

Should I see an Osteo if I have a headache?

Headache

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

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

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

The burning question

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

What to expect from your osteo

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

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

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

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

Final comments

If you or anyone you know is experiencing headaches, please pick up the phone and call us on 02 4655 5588 or book online to see one of our Osteo’s today. Now you know what we can do to help, we hope the next time you are asked the question “Should I see an osteo if I have headaches?”, your answer will be a solid YES!

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

References:

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