Osteopathic manipulation, or HVT (high-velocity thrust) as it is more technically known, is the “click” that many people associate with osteopathic treatment.
It is by no means always used by an osteopath, but when it is, it can prove to be a quick, efficient, and pain-free way of restoring function to a joint.
Many patients’ conditions may not be suitable for HVT, and many may not be keen to have it done anyway. In these cases, the osteopath will treat with a whole collection of other highly effective ways. HVT should be seen as a useful tool in some circumstances, but not a be-all and end-all of osteopathy.
So how does it work?
HVT is placing a short sharp tug though a joint, most often a spinal facet (which is what we will concentrate on here), a click may or may not be heard. The noise itself is a bit of a by-product. What it is has been disputed a little but the generally accepted explanation is that when the joint is stretched, the synovial fluid inside the joint itself physically does not stretch, so gas is forced out of solution causing gas bubbles that allow the joint to gap slightly, causing the clicking noise. This also explains why another click cannot be produced for a little while until the gas has been reabsorbed.
The gapping of the joint is the key to the effectiveness of HVT.
What I must point out at this point though is that the click is not a relocation of a joint.
Barely a day goes past that someone doesn’t tell me their osteopath “clicked something back in” often assuming it was a disc. As much as it can feel miraculous like this sometimes, and a patient can often feel and be quite a bit straighter following treatment, the HVT is about restoring function to the joint, not putting it back in place. Discs especially do not just “pop back in”.
So what does the gapping achieve?
Well, here we have to get a little technical. There are three predominant effects caused by HVT as far as we can tell.
Firstly, post-contractile sensory discharge or PCSD.
Imagine that the brain keeps many muscles at a gentle tension, this allows you to hold your posture. When an area is identified as problematic (painful or inflamed etc), the brain may choose to cause the muscles around the area to spasm, often to protect the area. The spasm itself may cause further pain. This then becomes a vicious circle and dysfunction.
Tension in the muscles is controlled by spindle fibres. This is what detects the short sharp tug of the muscles in HVT. Imagine the short sharp tug as a reset for these fibres. The brain then has to determine the level of muscle tension required and often can reset to the original tension, immediately bringing the joint out of spasm.
Massage of muscles, slow stretching over a longer period, has a similar effect but unfortunately can’t be performed on the small, deep muscles directly around and holding the joint.
Secondly, pain gate theory.
Even when nerves are reporting pain in a certain area, it is important that the body can still detect a soft touch in the same area. To achieve this soft touch and position detecting nerves override deep pain detecting ones. Where you ever told to rub your knee or elbow after you bumped it and it hurt? That’s pain gate, the soft-touch overrides the deep pain. It won’t stop it completely of course but even a little relief will make it feel better. In turn, this may again stop the brain causing the area to spasm.
HVT moves the joint quickly and sharply. This causes the positional detectors to immediately report this to the brain, inhibiting the deep pain.
Thirdly, meniscoid theory.
In a joint, smooth cartilaginous surfaces rub together, but they may not be quite as smooth as we used to think. Small pieces of cartilage appear to be in the joint. Possibly to fill small gaps; craters on a moonscape is a good way to think of it. It has been suggested that when the joint spasms, these small bits of cartilage, which are attached to the capsule around the joint can become trapped out of place. Gapping the joint allows the tethers to the capsule to quickly pull them back into place.
It’s possibly worth pointing out before I finish, that although I said earlier that the click is an unnecessary by-product, I do wonder if it could be argued that the psychological effect of hearing the click could be put forward as a fourth effect. Hearing a click and knowing that it may have relieved a painful joint does often make a patient immediately relax. This may itself be part of the healing process.
Osteopathic manipulation is often a quick efficient way of relieving dysfunction of a joint. It is not a miracle cure. Many other things have to be taken into account for the osteopath to treat fully and effectively.
HVT will not immediately heal damaged tissue or disperse inflammation, but it often is a good way to kick start the process.
By Andrew Doody | Osteopath | August 2019
A good night’s sleep is essential to your health, and an important part of your overall well-being. Back pain can significantly affect a person’s ability to get the quality and amount of sleep they need. Furthermore, poor bed posture can worsen or even be the cause of backache in the first place. This is because certain positions can place unnecessary pressure on the neck, hips, and back. Here are some pointers of how to maximise the quality of sleep you get if you are suffering from back pain.
Experiment with different sleeping positions.
Finding the best sleeping positions can help ease your back pain. Make sure you have found one or two that are comfortable for you. Having more than one helps so that you are not stuck in the same position for hours on end. Everyone sleeps differently. So, there’s not one perfect position, but a good place to start is by making sure the head, shoulders, and hips are in alignment. The best way to do this is usually by sleeping on the back or side.
Lying on the back is probably the best all-around sleeping position for a healthy back. It ensures good spinal alignment from the head and cervical vertebrae, through the thoracic and lumbar, all the way down to the pelvis. Because the back is the body’s largest area, weight is most widely distributed in this position, minimising pressure hot spots. However, if you have any lumbar spinal issues, you may feel more comfortable with a pillow placed under your knees. This is because many areas that cause backache in the lumbar spine are at the back, the facet joints and nerve roots. Placing a pillow under the knees allows the lumbar spine to gently flex and gap posteriorly, taking the pressure off these joints and nerves.
Side-lying/ Foetal position
Many people naturally end up slightly flexing their spine for the same reason, by lying on their side with their knees towards their chest a little, the so-called foetal position. This may work well if your issue is more disc-related. Side-lying like this is often the position people find most comfortable. It can, however, twist the spine a little and put it out of alignment. To correct this, if you prefer sleeping on your side, place a firm pillow between your knees. This stops the upper leg falling forward and raises it. This will restore the alignment of the spine, hips and pelvis.
Try to avoid sleeping on your stomach if you can. This position puts a lot of strain on your back by over-extending it. Unfortunately, for a lot of people, it’s the only position they can fall asleep in, or any other position makes them snore. If you’re one of them, try putting a pillow under your stomach to take some of the pressure off your back. If you’re someone who falls asleep on their back or side, then rolls over in their sleep and wakes up on their stomach, try hugging a large pillow against your chest and stomach to keep you in position. Another reason sleeping on the front is considered bad is because the head is usually turned to one side. This twists the spine and places additional stress on the neck, shoulders, and back. To avoid this, you can try lying face down. Place a small firm pillow or tightly rolled-up towel under the forehead, or better still a face pillow, allowing room to breathe. In this position, you should still place a pillow under the stomach.
If all else fails, you can try sleeping in a reclined position. People with spondylolisthesis, for instance, may resort to this after finding it comfortable falling asleep in a recliner chair. There are beds available that can be sat up slightly. So, this is worth investigating.
Invest in a good mattress
It’s worth it! You spend about a third of your life on your mattress. Spend a little more money on the mattress and a little less on the car! You really do get what you pay for.
People generally find slightly firmer mattresses work well for lumbar spine problems. This is probably due to what we discussed earlier, in which, the lumbar curve is allowed to extend a little, taking the pressure off the facet joints and nerve roots. This only really follows if you sleep on your back though. People that prefer to side-lie may well find a slightly softer mattress allows your hips and shoulders to sink in a little. Therefore, helping to maintain spinal alignment. This is particularly important if your hips are wider than your waist. Also, for people suffering from upper back issues, too firm a mattress may put unnecessary pressure on the ribcage and therefore upper spine in any position. Perhaps a good compromise here is a ‘pillow top” mattress. This is a good supportive mattress with a softer layer on top. By all means, try different kinds of mattresses, but remember, one night is not enough to really judge. People often sleep in a hotel bed and find it comfortable so decide to buy it. Those mattresses are often designed for short term comfort, not long term support.
Be ‘Bed Fit’
The healthier and stronger your back is, the better night’s sleep you will get and the better your back will be when you get up in the morning.
Core strengthening exercises will help support the back during the night and prevent back spasms. Gentle stretching before bed can increase flexibility and help to relax the body and reduce stress.
Take care getting in, and especially out, of bed. Take your time. When you wake up in a morning, allow a few minutes to get your muscles and joints moving fully instead of leaping out of bed at the alarm. Roll onto your side then use your arms to push you upright while your legs drop over the side, the sit there for a minute moving gently before slowly standing up.
Perhaps most importantly, if you do have a back or musculoskeletal issue, get it checked. A health professional can assess why you’re suffering and help treat the symptoms. They can suggest the correct investigations, treatment and exercises, as well as further helping you to choose that all important correct mattress.
Booking an appointment with an osteopath could be the start of ending your back pain for good!
By Andrew Doody | Osteopath | July 2019
So you’re back to work and the tree’s on its way back to the loft. Time to come through on all the New Year’s resolution bravado. Here are a few tips about how to do just that.
Create a plan
Decide what it is you’re wanting to achieve and tailor your program towards it. Do you want to lose weight? Get fitter? Tone up? All three? Don’t just choose the new fitness regime trend, think what you enjoy to do and go with that! You stand much more chance of continuing if you do. Identify times of day when you can exercise and which days you will do it. It’s much harder to stick to a regime that is just squeezed in when and if you have the time (not to mention inclination!)
Determine your readiness
Make sure you are mentally and physically ready to start, and more importantly ready to stick to, a regime. Check with your GP if you have any concerns about your health before you start. A good proportion of my new patients come from people who have caused injuries in the first few weeks, or even days sometimes, of starting a new regime. If you have any niggles, get them treated, and get advice on how to prevent them from recurring.
Set goals that are achievable and realistic. To lose a stone or be able to run 10k by Easter are realistic. To decide you are going to the gym every day before breakfast probably won’t last long. Fitness needs to be built gradually with a good base. Get advice on what exercise you need to do. Just running will help cardiovascular fitness somewhat, but needs to be part of a balanced all-around program if you want to be healthier generally. To maintain it, alone, running will also soon start to cause musculoskeletal problems.
Talk a friend into joining you
There will probably be no shortage of people thinking along the same lines as you. Teaming up hugely increases the chances of you both sticking to a program and makes it much more fun and less painful than trying alone. Even just planning together and talking about what you’re doing, (even if diaries don’t allow actually exercising together), is really encouraging.
Don’t look at this as a quick fix just to drop a few pounds. Take it easy and don’t rush. Tailor your plan around becoming more fit and healthy permanently. If you do it will help with so many other things, from energy levels to less aching joints or back, to stress relief and better sleep.
By Andrew Doody | Osteopath
Andrew is available for pre-exercise assessment, advice on exercise/regime planning, and diagnosis/treatment of outstanding or new issues, as well as advice on injury prevention. You can book an osteopathy appointment online.
As it’s backcare awareness week, let’s talk about back pain at work.
Back pain can be the result of heavy lifting, repetitive movement or simply by sitting at your desk all day.
We know how hard it is to live and work in pain and back pain is no exception. By now I’m sure we all realise that sitting for long periods is bad for you. But just how bad have our habits become? And what can be done about it?
Sitting in an office chair for long periods of time can wreak havoc on your lower back. In addition to many other joints and muscles. Simply stated, our bodies weren’t made to sit for prolonged periods of time. In fact, our bodies developed a heck of a long time before chairs were around at all.
According to research, the average office worker spends an average of 5 hours and 41 minutes per day sitting at their desk. The same study also found that those who sit longer at work are more likely to sit more outside of work as well.
Overall, sedentary jobs have increased 83% since 1950. With physically active jobs now only make up about 25% of the workforce. That’s 50% less than in 1950. Additionally, the average working week is longer. We now work an average of 47 hours a week, 164 more hours a year than 20 years ago.
On top of the time spent sitting in the workplace, on average, we spend 7 hours sleeping and 4.5 hours watching tv a day.
So should we be standing?
A recent study in the European Journal of Preventive Cardiology found that standing for almost six hours a day instead of sitting not only prevents weight gain — it can help people shed pounds.
They calculated that standing burned 0.15 calories more per minute compared to sitting. If an average person stood for six hours a day instead of sitting, they would burn an extra 54 calories a day. Some studies had it even higher.
In addition, muscle activity from standing is also associated with lower risks for strokes and heart attacks. Quite a few studies have shown that a single day of breaking up sitting with standing or short walks seems to have a beneficial effect on health parameters. Which include blood sugar control, blood pressure, and feelings of pain and fatigue.
However, before we all decide to stand all day instead, let’s look at the downsides. There’s a confusing array of conclusions from recent studies involving the health implications of standing vs sitting for long amounts of time. There have been studies, for example, that have concluded that people who primarily stand for long periods of time during the day, instead of lowering their risk for heart disease, maybe up to twice as likely to develop it. Perhaps long periods of standing are not the answer either. It has also been pointed out that standing for extended periods of time isn’t safe for all people, such as those with joint or vascular issues.
However, swapping out some sitting time for standing time is not only about heart disease.
One variable that makes sitting for extended periods damaging to the spine is the sustained contracture of the abdominal and hamstring muscles. This creates an imbalance. This, in turn, creates affecting the mechanics of the lower back. It also increases the load on the lumbar discs.
Using a standing desk, even for a portion of a workday, can minimise this imbalance. This helps maintain better spinal alignment and muscle symmetry.
So is a combination of sitting and standing the answer?
A recent study was performed where office workers of varying ages and body masses used a sit-stand desk where they alternated between sitting and standing throughout an 8-hour workday. The study found that the participants reported a 31.8% reduction in standing desk back pain when compared to sitting for the entire workday.
But just like sitting and leaning forward for extended periods can increase pressure on the back, the same applies to standing with poor ergonomics. Maintaining good posture and taking frequent breaks is the best way to ensure you’re standing or sitting optimally.
Try not to wear high heels (you can swap out for flats or slippers while at your desk if needed). Have the top of the computer screen at about eye level, and vary posture. When you’re in a sitting phase of your day make sure your chair and workstation have been fully ergonomically assessed. Discuss any conditions with your osteopath. They can advise how to adapt both the sitting and standing phases to suit you better. Have regular breaks from your desk altogether when you walk around the office.
And then of course if you really want to blow the budget there are treadmill desks…
If you’re experiencing back pain you can book an appointment with our Osteopath, Andrew Doody, online.
Massages are known to reduce stress and help you relax but they are often overlooked as part of an extensive exercise recovery plan. Not only are they important throughout marathon training programmes but are an essential part of recovery.
Recovering from a marathon is a critical component to a perfect training plan that runners often neglect. Post marathon massages are known to prevent injury, help repair injured muscle tissue and decrease recovery time to help you get back to your training regime quicker. Unfortunately, if you don’t properly recover from a marathon, it will be harder to break your PR and stay healthy.
It doesn’t matter if you’re a professional runner or if it’s your first marathon, the impact of running such a distance has undoubtedly put your body under enormous stress and physical duress.
The most obvious physical impacts are muscle soreness and fatigue which cause damage. It will take your muscles approximately 2 weeks post marathon to return to full strength.
It is essential for marathon runners to have considered a 2-3 week marathon recovery protocol that focuses on rest and rejuvenation and we’d recommend 2 sports massages within that time frame to assist recovery.
It is never recommended to have a massage on the day of a marathon or the day after as your body firstly needs to rest and heal the muscular damage and correct any inflammation.
Day 1 – 3 Post Marathon
A light massage or using a roller massage stick to help loosen and stretch your muscles from any delayed muscle soreness. A deep tissue massage isn’t recommended just yet.
Day 4 – 7 Post Marathon
You should consider booking in a deep tissue sports massage. Point out any areas that are really bothering you and use massage to help prevent injuries. Your osteopath can also help identify any injuries you may have and the best action to recovery.
- Effects and benefits of sports massage
- Pumps blood and fluids around the body.
- Helps stretch muscles and improve elasticity.
- Helps get rid of lactic acid build up.
- Breaks down scar tissue.
- Reduces pain.
- Relaxes muscles, body and mind.
- Can help reduce anxiety.
Combining recovery massages with a good diet and plenty of water will help you recover much more quickly.
If you would like to incorporate recovery massages into your marathon training or book in for a post-marathon massage, you can book an osteopathy appointment online. Learn more about our osteopathy services here.
Although fibromyalgia has long existed, it has only recently been accepted as a chronic, debilitating condition.
The NHS and the Department of Work and Pensions now list fibromyalgia as ‘real’, which is a step in the right direction.
So what is fibromyalgia?
The exact cause of fibromyalgia is unknown, but it is thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system (brain, spinal cord and nerves) processes pain messages carried around the body.
It may connected to other conditions, including various arthritis’s and may be genetic but even this is unsure. We do know it can be triggered after a traumatic or stressful event; anything from a virus to a divorce. Anyone can develop fibromyalgia at any age, but it predominantly affects women between the ages of 30 and 50. Some studies believe up to 1 in 20 people may be affected.
Unfortunately there is no specific test for fibromyalgia, so diagnosis is made purely on presentation and history. This makes life difficult as the symptoms of fibromyalgia vary according to the person, both in specifics and intensity. Symptoms may be aggravated by many things, from stress to the weather.
If you have fibromyalgia, one of the main symptoms is likely to be widespread pain. This may be felt throughout your body, but could be worse in particular areas, such as your back or neck. The pain is likely to be continuous, although it may be better or more severe at different times.
The pain could feel like:
- an ache
- a burning sensation
- a sharp, stabbing pain
Fibromyalgia can make you extremely sensitive to pain all over your body, and you may find that even the slightest touch is painful.
If you hurt yourself – such as stubbing your toe – the pain may continue for much longer than it normally would.
You may hear the condition described in the following medical terms:
- hyperalgesia – when you’re extremely sensitive to pain
- allodynia – when you feel pain from something that shouldn’t be painful at all, such as a very light touch
You may be sensitive to things such as smoke, certain foods and bright lights. Being exposed can cause your other fibromyalgia symptoms to flare up.
Cognitive problems (‘fibro-fog’)
Cognitive problems are issues related to mental processes, such as thinking and learning. If you have fibromyalgia, you may have:
- trouble remembering and learning new things
- problems with attention and concentration
- slowed or confused speech
Other symptoms that people with fibromyalgia sometimes experience include:
- dizziness and clumsiness
- poor sleep quality
- feeling too hot or too cold – this is because you’re not able to regulate your body temperature properly
- restless leg syndrome (an overwhelming urge to move your legs)
- tingling, numbness, prickling or burning sensations in your hands and feet
- in women, unusually painful periods
- IBS developments
If you think you may be depressed, it’s important to get help from your GP or your fibromyalgia healthcare professional, if you’ve been seeing one.
So what can be done to help?
First and foremost you need a good diagnosis from your heathcare practitioner to make sure they think you have fibromyalgia and not other conditions that may need treating differently, or more importantly investigating differently to be safe.
Once this is done and other conditions have been ruled out, and fibromyalgia has been diagnosed, you may need to try a variety of treatments to find a combination that suits you.
Fibromyalgia has numerous symptoms, meaning that no single treatment will work for all of them. Treatments that work for some people won’t necessarily work for others.
These treatments include medication, lifestyle changes (from diet to identifying and avoiding trigger factors), exercises, physical treatment, relaxation techniques, counselling and CBT.
Article by Andrew Doody – Osteopath for Fleet Street Clinic
There are many helpful bodies out there who can help and support if you are concerned you may suffer from fibromyalgia including UK Fibromyalgia, Fibromyalgia Action UK and the Fibromyalgia Association.
HOW TO BOOK AN APPOINTMENT
Arthritis and Osteopathy
Are you living with arthritis or know someone who is? Many people have experience of arthritis – there are currently 10 million people in the UK affected. Sufferers can often resign themselves to living with the pain, without realising there are a number of ways to manage it. For World Arthritis Week, we take a look at arthritis and the benefits of using osteopathy to help treat the condition.
What is arthritis?
Arthritis is a common condition which causes pain, swelling and inflammation in the joints of the body.
The most common types are osteoarthritis and rheumatoid arthritis. Osteoarthritis is a result of wear and tear of the joints in the body. It is common in people over 50 and can affect the knees, hips, neck and back, feet and hands.
Symptoms of Arthritis
Arthritis may be hereditary but can often be caused by poor posture, heavy manual work and previous injury, symptoms include:
- Hip / Knee Pain
- Neck Pain
- Lower back pain
- Early morning stiffness
- Joint Pain
- Swelling and Inflammation
- Referred muscle pain
What can osteopaths do to help with arthritis?
The Institute of Osteopathy purports osteopathy as a way to manage arthritis and the associated symptoms. Mobilising arthritic joints and treating surrounding muscles can help reduce pain. Osteopaths work on the general mobility of the other joints and muscles in the body to improve overall function. Osteopaths may advise on posture, diet, exercise and health improvements.
Osteopaths in Central London
Top Osteopath, Andrew Doody works at Fleet Street Clinic in London and is able to treat arthritic conditions and help to alleviate pain. Osteopathic treatment can be used in conjunction with help from a dietitian, use of acupuncture and support from your GP to ensure a holistic treatment of the condition.