How walking can help chronic pain 

31.08.2022 Category: Osteopathy Author: Andrew Doody

How walking can help Chronic Pain 

Firstly, what is chronic pain?

Chronic or persistent pain can be explained as pain that carries on for longer than 12 weeks despite medication or treatment.

The root cause can vary person-to-person, with it sometimes due to illness or an injury. In other cases it can be due to being overweight, having years of poor posture or improper lifting of heavy weights. It can be debilitating but movement is known to help.

Exercise is a common treatment for chronic pain. Depending on your current state of health, it may help decrease inflammation, increase mobility, and decrease overall pain levels, with no additional medication required.

As an osteopath, the conversation I seem to have at least once-a-day is; how much exercise should someone who is in pain be doing?

As you can imagine every case is different, and exercise advice varies hugely from person to person and condition to condition. There is a big difference between chronic pain and recovery from injury pain. I am focusing on exercises for people with chronic pain conditions, specifically walking.

Many people with chronic pain are afraid that movement, including walking, will worsen pain. But as many have subsequently discovered, the opposite is very often true. Using your muscles and joints less can often cause pain to becomes worse. Gentle exercise like walking can really help to bring those pain levels down, as well as many other benefits like improving your circulation, strengthening your bones and of course helping to keep those extra pounds off.

Here are tips before you start: 

1. Talk to your healthcare professional first
You should always take the advice of a health professional before starting any exercise. They can ensure it is safe for you to start, and guide you with the types of exercises you should begin with. They will also help you understand your limits and outline suitable goals. As a rule of thumb, if you are in pain, stop!
I, or another osteopath, can check your posture and gait and give you tips on engaging the correct muscles.

2. Get the right shoes
A good pair of supportive trainers will prove invaluable. Walking boots that protect the ankle are only really required if you’re planning to walk on loose surfaces or heading off into the mountains. Otherwise, walking trainers will suffice. To find out more about choosing the right footwear, read our blog on How To Avoid Running Injuries.

3. Start slow
What we’re aiming for is about half an hour to an hour of physical activity five days a week, but this may take some time to achieve. There’s no rush! A good indicator that you are at the right intensity level is that even though your heart rate is up a little, you are still able to carry on a conversation while walking. When starting your walk don’t go full speed immediately. Allow your muscles and joints to warm up for the first few minutes before getting up to speed. This will help prevent damage and injuries.

4. Keep hydrated
You may need to carry a bottle of water, especially for walking in hot weather. If the weather is hot, make sure you also take sunscreen and a hat to stop sunburn.

5. Finally, try to enjoy it!
The more you enjoy it, the easier it becomes. Find somewhere nice to walk, even if that means
driving somewhere. Listen to music/ podcasts/ audiobooks, or even better get a walking buddy to join you for a chit chat along the route.

 

For more information on osteopathy services, visit the main page.

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OSTEOPATHY AT FLEET STREET CLINIC

Andrew Doody is an osteopath at Fleet Street Clinic and is fully registered with the General Osteopathic Council (GOSC).
Book an appointment with him if you have any musculoskeletal injuries by calling 0207 353 5678, email info@fleetstreetclinic.com or book an appointment online.

How To Avoid Running Injuries

14.07.2022 Category: Osteopathy Author: Andrew Doody

With (hopefully!) sunnier and longer days upon us, summer is a great time of year to get your running shoes on. As a keen runner myself, I understand the appeal; it’s pure, it’s meditative, and it gets your blood pumping like little else.

Unfortunately, for all its positives, running can be problematic for the body and it tends to bring out minor issues and turn them into major ones. These often include achilles tendonitis, shin splints, plantar fasciitis, ITB syndrome, stress fractures, hip and lower back issues, and more knee problems than I have time to list.

Many of the problems from running come from two areas. Firstly, heel strike which is where the heel hits the ground repeatedly and sends a shock through the whole skeleton which causes issues from the heel itself all the way up to the lower back. Secondly, gait – which is the way a person walks; the whole lower limb (especially the knee) is quite finely tuned to work in certain ways, and anything that affects that can begin to cause problems. A dropped arch, tight muscle, old injury, slight one-sidedness etc can bring these issues on.

What can be done to prevent these issues? 

Like always, the number one rule is to get any symptoms you are experiencing looked at as soon as possible. Early diagnosis, advice and treatment is vital.

One thing that can really help heel strike and gait is by getting the right trainers. Here’s a few things to consider:

  1. Don’t confuse fashion and effectiveness. Good running trainers generally don’t look cool! Some of the bigger brands will advertise to you that they are great for sports but do your research. I would usually recommend Asics or Brooks.
  2. Replace your shoes regularly. The soles of most trainers are good for about 200-250 miles maximum. So, if you’re running 20 miles per week, you’ll probably need to replace them after 4-6 months.
    The shoe may still look okay after that but there is an increased risk of injury. It is, therefore, important to ensure that you are replacing your trainers as regularly as required.
  3. You don’t need to buy the most recent model. Many of the best running trainers are on their 20th/30th or so iteration. When a new model is released the price of the last couple of iterations will drop quite significantly, and will still be an excellent option.
  4. Good arch support. Trainers largely work on preventing pronation etc. by the way they flex. Many have little if any arch support, even with good ones you may need an additional orthotic insole made for your specific needs. This may also mean you need half a size bigger.
  5. Speak to the experts. A running machine in a shoe shop is useful, but remember the shop assistant has probably only had a brief introduction in what to look for, and no idea of your other contributing factors. Speak to a specialist – an osteopath, podiatrist, or physio.

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OSTEOPATH AT FLEET STREET CLINIC

Andrew Doody is an osteopath at Fleet Street Clinic and is fully registered with the General Osteopathic Council (GOSC).
Book an appointment with him if you have any musculoskeletal injuries by calling 0207 353 5678, email info@fleetstreetclinic.com or book an appointment online.

The best positions for cycling

03.07.2021 Category: Osteopathy Author: Andrew Doody

SUMMER CYCLING

Summer is the perfect opportunity to dust off your bike and think about turning that commute into an opportunity to get fitter or shed a few pounds!

Cycling – a low impact sport

Compared to many sports, cycling is one with a relatively low injury rate. Crashes and collisions apart, cycling is impact free – good for your joints and muscles. In addition, if you select the correct gear to match the terrain, it means that you can avoid overloading your muscles and joints, keeping the cranks spinning rather than pushing a big gear.
Also important is that because your feet are fixed in place, spinning the cranks requires very little coordination, which also reduces the risk of injury due to poor technique, which is very common while running. Still, despite all these advantages, cyclists can, and regularly do, suffer overuse injuries.

Fix a good riding position:

One of the main issues is the set up of the bike itself. Here are a few pointers as to how to best achieve a good riding position:

SADDLE HEIGHT

This should be positioned so that when the pedal is at the bottom of the stroke and the ball of your foot is on the pedal, your knee should have a slight bend in it. If you want to get technical, saddle to pedal distance should be 109% of your inside leg measurement. Hips shouldn’t move sideways during crank rotation and you shouldn’t have to stretch at the bottom of the pedal stroke. Don’t be put off by feeling you have to come off the saddle to touch the floor.

SADDLE ANGLE

This should be in a horizontal position, parallel with the floor when viewed side on (but sometimes a very slight downwards tilt can be helpful for those who experience a lot of pressure in the perineum area. However, don’t do this just because it feels more comfortable, as this can cause lessen support and affect riding position).

POSITION OF THE SADDLE

With the pedals adjusted so that they are at the three o’clock and nine o’clock positions, a vertical line dropped from the kneecap of the forward knee should pass through the axle of the pedal.

HANDLEBAR POSITION

This is where opinion varies a little. Racers want the handlebars low to lower wind resistance, climbers want the handlebars low so they don’t feel too high when the bike’s angled up. The rest of us want them higher than this. A good rule of thumb is that you don’t want to be leaning on the handlebars too much, only holding them. If it feels like your upper bodyweight is being supported by the handlebars, try them up a little. Not all bikes are adjustable enough at the front but a stem raise is a cheap efficient way of remedying this. A bit more height in traffic is safer anyway.
And if you haven’t bought your bike yet, put a bit of research into what frame/wheel size you need before you do.
Cycling is a great way to get fit and works well with core stability, however, if any injuries do niggle don’t push through and do get them checked out!

Osteopath at Fleet Street Clinic

Andrew Doody is an osteopath at Fleet Street Clinic and is fully registered with the General Osteopathic Council (GOSC).

For more information on our osteopathy services, click here.

Book an appointment with him if you have any musculoskeletal injuries by calling on 0207 353 5678 , email info@fleetstreetclinic.com or book an appointment online.

Osteopathy: What's In A Click

19.08.2019 Category: Osteopathy Author: Andrew Doody

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.

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By Andrew Doody |  Osteopath | August 2019