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

What are the benefits of fasting?

Diet fasting

In the last few years, fasting has been gaining popularity across the world as a way of improving human health. Did you know that fasting has been around for centuries and centuries? Humans have been doing it since time began and animals do it too. So let’s see what all the fuss is about…

What is fasting?

Fasting is a total or partial abstinence from food. In simple terms this means that for a period of time a person will not eat any, or certain types, of food and drink. It is carried out across the world for many different reasons including as part of religious ceremonies or rituals, as well as for health reasons.

Types:

There are many different types of fasting. We’ve broken down a few of the more popular ones below:

  1. Water fasting — definitely one for the purists. This type of fast involves drinking nothing but water for a set period of time with the aim of purifying the body and allowing our much-overused digestive systems a well-deserved break. This is apparently one of the hardest types of fasts to carry out.
  2. Juice fasting — this type of fast involves only drinking fruit or vegetable juices for a set period of time. Somewhat easier than the water fast due to all of the juicy goodness you are getting from the fruits and vegetables.
  3. Intermittent fasting — this appears to be the craze at the moment! This type involves not eating at certain times or days in the week and having an unrestricted diet for the remainder of the time. There are a few different types. These include:
    1. Alternate day — eating every other day
    2. 5:2 — eating a normal diet for 5 days of the week and having a drastically reduced caloric intake on the remaining two days (the two days are not allowed to be consecutive days)
    3. Time-restricted — eating only within a set time period, i.e. between 7am — 3pm with nothing but water outside of these times.

It is with intermittent fasting where most of the scientific research has been carried out and health benefits have been widely documented.

Benefits:

So, the big question is… Why fast? Below are some of the documented health benefits science has detected to date:

  1. Weight loss: It’s a great way of limiting calorie intake without having to be excessive. Fasting helps in the production of certain hormones which help to boost your metabolism. It has been seen to help reduce body fat whilst preserving muscle tissue.
  2. Reduces chronic inflammation: Studies have shown people who fast intermittently have reduced levels of inflammatory markers in the blood after one month. This could be great for a whole host of inflammatory conditions out there including rheumatoid arthritis and multiple sclerosis.
  3. Improves heart health: Current research shows benefits on the cardiovascular system including lowered blood pressure and cholesterol levels.
  4. Increases levels of Growth Hormone (GH: People who fast intermittently have been shown to have increased levels of GH after their fasting period. This hormone is important in growth, muscle strength, metabolism and aiding weight loss.
  5. Controls blood sugar: Promising for our type 2 diabetics out there, although larger studies are needed for this area of research as evidence is a bit mixed at the moment.   Watch this space!

There are also a whole host of other benefits starting to emerge from animal studies which could be bright for our human future when more research is carried out. These areas include benefits seen in brain function, delayed aging and prevention of cancer. This is exciting stuff!

We hope this has been a helpful insight. If you are considering doing a fast yourself or would like more information, please get in touch with us on 4655 5588 and we’ll be able to point you in the right direction. It is always safest to consult a medical professional before attempting any type of fast yourself as there are certain conditions with which fasting is not allowed. Here’s to a healthier life 🙂

References

  1. Dictionary.com. 2020. Fast. [Online]. Available from: https://www.dictionary.com/browse/fasting. [Accessed 08 Jan 2020] 
  2. Healthline. 2018. 8 health benefits of fasting, backed by science. [Online]. Available from: https://www.healthline.com/nutrition/fasting-benefits. [Accessed 06 Jan 2020]
  3. Harvard Health Publishing. 2018. Intermittent fasting: suprising update. [Online]. Available from: https://www.health.harvard.edu/blog/intermittent-fasting-surprising-update-2018062914156. [Accessed 06 Jan 2020]
  4. American Osteopathic Association. 2019. Intermittent fasting: can we fast our way to better health? [Online]. Available from: https://thedo.osteopathic.org/2019/01/intermittent-fasting-can-we-fast-our-way-to-better-health/. [Accessed 06 Jan 2020]
  5. British Institute of Osteopathy. 2020. What are the effects of fasting? [Online]. Available from: http://www.british-institute-of-osteopathy.org/articles/fasting.aspx. [Accessed 06 Jan 2020]

Students elbow (AKA ‘Olecranon Bursitis’)

Sore elbow

This month’s blog is about a common elbow injury. Ever heard of student’s elbow? “But I’m not a student!” we hear you say. Well you don’t have to be to fall victim to this condition. Students elbow, or ‘Olecranon Bursitis’ is a condition where a small sack of tissue over the tip of your elbow becomes inflamed and swollen. The pointy bit of bone at the end of your elbow is called the ‘olecranon’ and the small sack which sits between the bone and the skin is called a ‘bursa’. The ‘itis’ part of bursitis simply refers to inflammation of that bursa.

What are the causes?

The most common way to develop student’s elbow is repetitive trauma to the tip of the elbow which slowly irritates the bursa and causes inflammation over time. Think of a student who sits for hours, day after day writing at a desk with their elbow resting on the table. The constant pressure on the tip of the elbow could be enough to kick things off. Anyone whose elbows are subject to repetitive pressure could develop this problem; plumbers and office workers are other good examples.

Other causes include:

  • A single blunt force trauma or fall onto the tip of the elbow
  • Infection
  • Having an olecranon spur (an extra small bony growth which rubs against the bursa)
  • Having an extra pointy olecranon (some peoples skeletons are just a bit different)

This condition may also develop as part of having another medical condition, such as Diabetes Mellitus, Gout, Rheumatoid Arthritis, HIV or alcoholism.

Signs and symptoms

So, what does student’s elbow look like? Signs and symptoms include:

  • A painful or (often) non-painful swelling on the end of your elbow
  • Pain with leaning on your elbow
  • Painful elbow movement
  • Restricted elbow movement (although this is often unaffected)
  • Redness, warmth and a fever (if associated with infection)

Will I need to have any tests done?

Possibly. As with all lumps on the body, your practitioner will want to rule out anything serious going on first. We ask lots of questions so we can paint a picture of what’s going on in our clinical head. Depending on your signs and symptoms, if you have a history of cancer or if infection is suspected, you may be directed to your GP for tests. This is to make sure you are receiving the best treatment in the best time frame. Your doctor may need to take a sample of the fluid inside the swelling to be sent off for lab testing. This will be able to tell us if infection is playing a part or not.

Treatment

The treatment of bursitis is very much dependent on the cause. If the cause is infection, then your GP will start you on a course of antibiotics and anti-inflammatories to fight it off and control the pain. Other treatment may include the use of ice or contrasting hot/cold bathing to help reduce the swelling. In severe cases, your elbow may need to be splinted or elevated in a sling. Elbow pads and changes to your general activities may also help to protect the elbow from further injury. Your GP may offer to drain the swelling (this is called ‘aspiration’ and requires a needle to remove the fluid), and this can help to provide relief by reducing pressure around the elbow.

Once clear of infection, or if you have a non-infective bursitis, then your superhero osteo can step in and work their magic. Abracadabra!

During the inflammatory process, swelling and pain may have affected how you use your arm. With pain, people often stop using that part of the body and swelling can affect the joint’s ability to move smoothly through its range of motion. This can have a knock-on effect on the muscles and other tissues which surround the elbow joint. Many muscles which cross the elbow and are involved in elbow movement also cross the shoulder and wrist to aid in their function. So, you can see how a problem at the elbow could affect the whole limb (and beyond).

Here at Completely Aligned, we will get to work at restoring full function to the shoulder, elbow and wrist. We will look at your spinal movements too to see if they have been affected. You can expect to be mobilised and massaged and we may also perform some lymphatic drainage techniques to help restore fluid movement through the limb (which may have stagnated during the injury process). Your biceps, triceps and other arm/forearm muscles may have shortened over time so we may perform some stretching techniques and will give you some exercises to do at home to back up what they do in the clinic room. If necessary, strengthening exercises may be given to reduce the risk of future episodes.

If your bursitis doesn’t resolve with the above treatments or keeps coming back, a decision may need to be made on whether the bursa should be removed surgically. This is called a ‘bursectomy’ and is usually a last resort. Extra pointy olecranons or spurs can also be treated surgically if needed.

Back to school… And work!

Now that the festive season is over, the kids will be back to school and the parents back to work. Normality resumes. Keep an eye on those elbows people! If you think you are developing an elbow problem (or any body part for that matter) then please call us on 02 4655 5588 or book now and we’ll get working on it straight away.

References:

  1. Blackwell, JR. et al. 2014. Olecranon bursitis: a systematic review. Shoulder & elbow. 6 (3). 182-190. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935058/
  2. Lockman, L. 2010. Treating nonseptic olecranon bursitis: a 3-step technique. 56 (11). 1157. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980436/

Putting a stop to incontinence

Putting a stop to incontinence

Do you leak when you laugh? Its time to raise awareness for the 5 million+ Australians who experience bladder or bowel incontinence. Yes, it really is THAT common! This can be a very debilitating condition, but unfortunately, a lot of people suffer in silence through fear of speaking out, due to the embarrassing nature of the problem.

What you may not realise is that the majority of incontinence cases can be treated, and a lot of the time, stopped completely. So, to try and help break the silence surrounding incontinence, we are going to give you a little run down on what it is, who it affects, and some tips on what you can do to help.

WHAT IS INCONTINENCE?

Incontinence is the term used to describe the uncontrollable loss of urine from the bladder or faeces from the bowel. It ranges in severity from losing only a very small amount of urine, to a complete void of the bladder or bowel. If you’ve never experienced this, you can only imagine how distressing this must be. There are different types of urinary incontinence, including:

  • STRESS INCONTINENCE, where small amounts of urine leak due to small increases in pressure on the bladder during physical activity, or from coughing, sneezing or laughing.
  • URGE INCONTINENCE, where you get an unexpected, strong urge to urinate with little to no warning. This is usually as a result of an overactive bladder muscle.
  • INCONTINENCE ASSOCIATED WITH CHRONIC RETENTION, where your bladder cannot empty fully, and you get regular leakage of small amounts of urine. There are many causes for this, including an enlarged prostate in men, or prolapsed pelvic organs in women, as well as medications and certain conditions, such as diabetes and kidney disease.
  • FUNCTIONAL INCONTINENCE, where you are unable to get to the toilet, possibly due to immobility, or wearing clothes that are not easy to get off in time.

Faecal incontinence is when you have a lack of control of bowel movements and you may accidentally pass a bowel movement, or even pass wind without meaning to. This may be due to weak muscles surrounding the back passage (Unfortunately ladies, this is common following pregnancy and childbirth), or if you have severe diarrhoea.

TAKING THE STRESS OUT OF INCONTINENCE

For all those suffering in silence, it is time to speak out.  There is no need to be embarrassed, it is surprisingly common – and like we have already mentioned, help is out there! You may not need to look very far. Being your local Osteopath, we may be able to help.

The most common type of incontinence that we see and treat is stress incontinence. Although seen across both sexes, women are three times more likely to experience it than men. It is very common in women following pregnancy and childbirth (when the pelvic floor muscles get over-stretched, and sometimes even damaged), during menopause (due to hormonal changes) and in the elderly. It commonly affects men who have had prostate surgery.

The pelvic floor muscles sit at the bottom of the pelvic bowl, spanning from the pubic bone to the tailbone (front to back) and from one sitting bone to the other (side to side). Imagine a tarpaulin stretched out with a person holding each corner and you kind of get the gist. When these muscles are strong, they help to support our internal pelvic organs (i.e. the bladder, bowel and the uterus in women) and wrap around the openings of the front and back passages, allowing us to control when we decide to do a number one or two. Following pregnancy for example, they may become weak and dysfunctional, and we can lose that ability to control voiding. It only takes something as small as a cough, or an activity like jumping or running (things many of us take for granted) that may cause a person to lose a small amount of urine.

WHAT WE CAN DO TO HELP

The most important thing to point out is that not all types of incontinence will improve or resolve with just strengthening of weak pelvic floor muscles. So, it is very important to get an accurate diagnosis, because there will likely be other factors that need addressing too. For instance, losing weight, stopping smoking, and making other lifestyle changes are just as important in the management of these conditions, if relevant to the person of course. Some people may also require release of tight and over-active muscles.

Once you have your diagnosis, then strengthening may well be a part of your therapy. In order to strengthen, you need to know where the muscles are, and how to activate them. Below is a little step by step guide to getting a grip on those pelvic floor muscles (we don’t mean literally!):

  1. Get in a comfortable position – try sitting or lying on your back and take a few breaths to relax.
  2. Imagine you are trying to stop yourself from urinating mid-stream by squeezing for about a second. If this is not easy to feel, next time you are on the toilet emptying your bladder, have a go at stopping mid-stream and then relaxing again to finish emptying (don’t hold it for too long please – just enough to feel which muscles you need to use).
  3. Do the same as step two for the back passage – this time imagine you are trying to stop yourself from passing wind by squeezing.
  4. Do these quick squeezes 3 x 20 reps a day. Once you’re comfortable, you can do it sitting or standing. Make it routine… Do it when you’re brushing your teeth, eating lunch, or in the ad breaks of your favourite TV show.

These two contractions together form the basis of what you need to be able to do to begin your pelvic floor muscle training. If you struggle to feel this, then ask for help from your therapist. They will be able to help you perfect the activation of the correct muscles.

We hope you have found this blog interesting and helpful. If you, or someone you know is looking for answers to questions and advice on the management of these conditions, then please get in touch. We are ready to offer advice and/or treatment. 

References

  1. Continence Foundation of Australia. 2019. World Continence Week. [Online]. [Accessed 07 May 2019]. Available from: https://www.continence.org.au/events_calendar.php/482/world-continence-week
  2. Continence Foundation of Australia. 2019. Laugh Without Leaking. [Online]. [Accessed 07 May 2019]. Available from: http://www.laughwithoutleaking.com.au
  3. Continence Foundation of Australia. 2019. Key Statistics. [Online]. [Accessed 08 May 2019]. Available from: https://www.continence.org.au/pages/key-statistics.html
  4. Milsom, I. and Gyhagen, M. 2018. The Prevalence of Urinary Incontinence. Climacteric. 22(3). 217-222. DOI: 10.1080/13697137.2018.1543263
  5. Continence Foundation of Australia. 2019. Pelvic Floor Muscles in Women. [Online]. [Accessed 08 May 2019]. Available from: https://www.continence.org.au/pages/pelvic-floor-women.html