Osteoarthritis

As an Osteopath, one of the common conditions that we see is Osteoarthritis or OA. OA is the most common type of arthritis which affects nearly five million Canadians or 1 in 6 people. So what is Osteoarthritis? OA is described as a progressive disease of the whole joint that leads to breakdown of joint cartilage and the underlying bone. And used to be described  as degeneration or “wear-and-tear”, but recent studies have described it as a result of the body’s failed attempt to repair damaged joint tissues, as the body lays down more bone to protect itself.

So who gets OA? Osteoarthritis does not discriminate against race or sex, however according to the World Health Organization, Women are more likely to get osteoarthritis than men at a 2:1 ratio. This is most likely due to hormonal and bio-mechanical differences.

There are a number of risk factors than may influence and increase the risk of a person’s chance of developing osteoarthritis beginning with; Age, sex, family history, excess weight, previous joint injuries, some occupations, Joint misalignment/deformities, muscle weakness and a sedentary lifestyle.

 

What are the signs and symptoms of OA?

The most common presenting complaint is pain, which generally gets progressively worse over months to years. The joint pain or joint stiffness may may last up to 30 minutes or until the joints warm up and is typically worse in the morning or after long periods of inactivity. The most common places of pain are typically weight bearing joint such as the knees, hips and spine, although OA can occur at any joint in the body. OA symptoms may also disrupt your sleeping patterns, which can make your symptoms feel worse, and alter your mood.

 

How is Osteoarthritis Diagnosed?

There is no specific test for the diagnosis OA. A diagnosis is made based off a patients extensive medical history and physical examination findings. However, there are imaging techniques such as x-rays that can be useful in determining the progression of a patient’s OA.

However, it is important to remember, that a patient’s symptoms do not always match what is found on x-rays. For example, in a patient with early OA, your x-ray may show no evidence that reflects the patients symptoms they are experiencing. On the other hand a patient can have severe OA on a x-ray, but present with minor pain. Which is why it is important to take an individual approach to every patient.

 

Is there a Cure?

There is currently no cure for OA. However, it is very important to remember that there are ways to manage a patients symptoms and improve their function. A treatment approach is generally centred around a combination of stretches/ massage, physical exercises, weight management and medications, which can be a useful way to help patients control there pain levels. In extreme cases a referral to a healthcare professional specializing in orthopaedic care may be needed.

Remember if you have any other questions please don’t hesitate to ask one of your friendly osteopaths

 

Written by: Brendan Ashman

 

Tennis Elbow

The most common elbow condition is tennis elbow,  also known as lateral epicondylitis,  is caused by overuse and excessive strain on the extensor muscles of the forearm resulting from wrist extension, such as in back hand tennis players, or occupations that involve repetitive wrist movement, such as carpenters or bricklayers. It may be provoked by any exercise that involves repeated and forcible extension movements of the wrist, like using a screwdriver or hammer.

Symptoms of Tennis Elbow

Tennis elbow usually has a gradual onset but it can also be sudden. There may be a constant muscular ache in the forearm and/or near the outer elbow. It is aggravated by movements that involve extension of the wrist, such as picking up bags or turning on taps and sometimes it may feel like there is less strength when grasping objects. The outer elbow can be tender to touch, is painful with resisted extension of the wrist and is painful when stretching the wrist.

Tennis Elbow Treatment

In the acute phase of the tennis elbow rest is vital. Apply ice 2-3 times daily to reduce inflammation and pain. Anti-inflammatory medication or gels can also work very well. Osteopathic treatment can help loosen and stretch the muscles involved and also reduce the amount of inflammation in the elbow. Your Osteopath will also check any other areas that may be affected, such as the shoulder or upper back and neck, and show you stretches you can do to reduce tension in the forearm muscles and also show you exercises you can do to strengthen these muscles.

Achilles Tendinitis

Achilles tendinopathy or generally known as achilles tendinitis is a common condition characterised by localised pain and swelling at the achilles tendon. The achilles is a large tendon connecting the major calf muscles, the gastrocnemius and the soleus, to the heel bone. During a calf contraction tension is put through the achilles tendon and if this tension is excessive due to too much repetition or high force, damage to the tendon occurs, leading to subsequent degeneration and inflammation.

Signs & Symptoms of Achilles Tendinitis

Pain at the achilles tendon is most commonly felt either at the mid-point of the tendon or at the portion where it joins with the heel bone. The pain can either be sharp or a dull ache. There may also be limited ankle flexibility, redness or heat over the painful area, a nodule (a lumpy buildup of scar tissue) that can be felt on the tendon, or a cracking sound (scar tissue rubbing against the tendon) when the ankle moves.

Causes of Achilles Tendinitis

Achilles tendinitis commonly occurs in both recreational and professional sports athletes, usually involving running and jumping type activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. It can also be caused by adverse lower limb biomechanics, tight or fatigued calf muscles, previous calf strain/ tear and ankle sprain, weak muscles, overtraining, increasing training load too quickly, excessive hill running or speed work, overpronation and inappropriate footwear.

Treatment, Management & Prevention of Achilles Tendinitis

If you start experiencing achilles pain, then stop doing the activity that started the pain and rest. Ice the area for 10-15 minutes multiple times a day, until the swelling subsides. Take some anti-inflammatory medication is the pain persists for more than 2 days.

Manual therapy such as osteopathy can help with the pain, muscle tightness, joint mobility, body alignment, inflammation and swelling. This may include techniques and modalities such as  soft tissue massage, manipulation, dry needling, electrotherapy and taping.

Shock wave therapy has also shown to be effective, especially more for insertional achilles tendinopathies.

A strengthening program should be implemented once the swelling has gone down. This exercise program should consist of eccentric exercises, but also exercises such as concentric strengthening and other exercise to address possible functional deficits (ie. weak gluteals). One of the most useful strengthening technique for the achilles is the heel drop. This is where you lower yourself from being up on your toes and allow your heel to slowly drop down and off the level of a step. This exercise should be done slowly and it can be normal it feel some pain, but as long as it doesn’t stick around longer than the exercise (irritable). From this exercise once it becomes easier and less painful, load can be added (ie. a backpack), increased repetitions, increase in range, and increase in speed (much later). Although this is one exercise it is best if you consult your osteopath or physiotherapist to rehab your achilles tendon correctly.

If you are a runner, you can start running once there is no pain on calf raises, heel drops or hopping. Make sure that there is no speed or hill work in these run sessions and there is at least one rest day between each run. Once there is no pain during or between runs you can gradually increase your volume.

Plantar Fasciitis

Plantar Fasciitis and Running:

The Plantar Fascia is a broad, dense fibrous connective tissue that runs across the bottom of your foot and connects your heel bone to your toes. The plantar fascia is designed to support the foot and form the arch. Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

Plantar fasciitis is one of the most common causes of heel pain and it commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis is particularly common in runners. In addition, people who are overweight, women who are pregnant and those who wear shoes with inadequate support are at risk of plantar fasciitis. It is also common in occupations that require you to be on your feet and especially if the surface you are standing on is hard, such as factory workers. Other factors that can have an influence are improper shoes and faulty foot mechanics.

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking. Common problems including shin splints, patella tendonitis and ITB syndrome. Continuous pulling of the fascia at the heel bone eventually may also lead to the development of bony growth on the heel. This is called a heel spur.

Running Injury Management Tips:

  • Put your feet up. Stay off your feet for several days when the pain is severe.
  • Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper or foam cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.
  • Decrease your distances. You probably won’t have to permanently retire your running or walking shoes, but it’s a good idea to cover shorter distances until pain subsides.
  • Take up a no- or low-impact exercise. Swap swimming or bicycling in for walking or jogging. You’ll likely be able to return to your regular activities as heel pain gradually improves. However, some people find that the only way to avoid a recurring problem is to give up high-impact activities, such as running and some forms of dance.
  • Add arch supports to your shoes. Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock, or if you want to invest more in a good pair of custom orthotics go see your local podiatrist. Also make sure that your runners are not too worn out as they will generally cause you more problems; general rule of thumb is 600km until a new pair is required.
  • Stretch.Simple exercises using household objects can stretch your plantar fascia. Also try using a rubber bouncy ball or a golf ball to help release certain tension points in the muscle. Simply do this by having the ball on the ground and apply pressure directly onto it where it is sore. Also stretch your calfs and hamstrings as these muscles will have an impact on the plantar fascia.
  • Treatment. Go see your local osteopath for pain relief and for a speedy recovery.

Prevention of Plantar Fasciitis:

You can take some simple steps now to prevent painful steps later:

  • Maintain a healthy weight. This minimises the stress on your plantar fascia.
  • Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don’t go barefoot, especially on hard surfaces.
  • Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 600 kilometres of use, as uneven wear can develop.

Foam Rolling For Runners

FOAM  ROLLING FOR MYOFASCIAL RELEASE

The foam roller can be a great tool, especially for runners who cover a lot of kilometres per week. This simple tool acts as a deep-tissue massage, working out kinks in over used muscles. It is especially effective to release myofascia, such as the iliotibial band or ITB. If all runners would spend just 10 minutes with a foam roller a few times a week, they would restore the structural integrity necessary for optimal performance.

There are many causes that can lead to a problem in the body’s kinetic chain,  such as work, stress, gravity and pattern overload. The more you run, the more you’ll experience pattern overload. It can place a lot of stress on the body’s systems. Any dysfunction in movement as a result of myofascial tightness, can ultimately lead to an altered gait, tissue trauma, loss of range and eventually injury.

ITB exercise

To massage the ITB, lie on the foam roller on the side. Start at the hip and work your way down to the knee and then back up to the hip. Repeat the process and stop at tender points to allow a release. You can use your arms to control how much body weight you put down on the foam roller.

FOAM ROLLER FOR STRENGTH

Balancing on a foam roller requires your body to recruit more muscles, especially in your core, to perform the move. Here are some simple exercises that you can do at home. Try doing these exercises two to three times a week to build total body strength that will help improve performance and guard against injury.

 

Plank

Works abdominals, glutes, back & shoulders

To do:  Place your palms shoulder width apart on the foam roller. Keep your elbows slightly flexed, your back straight, and your neck neutral. Stabilise the foam roller in this position, and hold for 30 seconds. Repeat three times.

Push-up With Leg Lift

Works chest, triceps, abdominals, glutes

To do: Start in foam-roller plank. Lower your chest toward the roller, keeping your elbows in. Lift your right leg up, then lower it. Repeat the push-up, then lift the left leg. Alternate for three sets of eight to 12 reps.

 

Wall Squat

Works quadriceps, glutes, abdominals

To do: Stand with a foam roller between your midback and a wall and your feet shoulder width apart. Slowly squat down toward the floor until the foam roller reaches your shoulder blades. Stand and repeat eight to 12 times for three sets.

 

Bridge With Leg Lift

Works glutes, hamstrings, quads, abdominals

To do: Lie on your back, heels on a foam roller. Raise your hips up toward the ceiling, then extend your right leg. Bring your right leg down and hips back to ground. Do three sets of eight to 12 on each leg.

 

Rotator Cuff Injury

Many common shoulder ailments can be caused by underlying shoulder impingement syndrome.  In fact, it is the most common problem in the shoulder and it is thought that up to 20% of people will suffer symptoms at some time!Shoulder impingement, or better described as subacromial impingement syndrome (SAIS), can contribute to a spectrum of shoulder pathologies, such as:

  • Partial thickness rotator cuff tears
  • Tendinopathies – Irritation to the tendons of the rotator cuff and/or biceps leading to inflammation (tendonitis) and/or degeneration (tendinosis)
  • Calcific tendinitis
  • Subacromial bursitis

 

Signs and symptoms of impingement

Shoulder pain, weakness and loss of shoulder range of motion are of the most commonly reported signs and symptoms.  Pain is often exacerbated by over head activities.  Many patients report pain in the upper arm, which occasionally can radiate into the forearm and hand.  Shoulder pain at night is common, particularly when a patient lies on their affected shoulder.

The onset of symptoms may be acute, following an injury, or gradually worsening over time, particularly in older patients with no specific history of injury.

 

Who is at risk?

SAIS most commonly occurs in people who engage in repeated overhead movements.  Sports that require repetitive overhead motions include tennis, swimming, baseball and volleyball and are thus common culprits for impingement syndromes if shoulder biomechanics is suboptimal.  In the workplace, painting, carpentry and construction work may contribute.  But even after years of seemingly normal use, older individuals may gradually develop impingement syndromes too.

How does it occur?

The ball and socket style shoulder joint (glenohumeral joint) requires a great deal of dynamic stabilisation from the muscles of the rotator cuff.  The rotator cuff consists of four short muscles originating on the shoulder blade, with the tendons of each attaching to the head of the humerus (upper arm bone) close to the glenohumeral joint.  When the shoulder is in motion, it is primarily this muscular cuff that stabilises the ball of the humerus within the socket of the shoulder blade.

 

As you raise your arm the space between the humeral head and the acromion (outer most tip of the shoulder blade) naturally reduces.  If this space reduces beyond its normal range it can eventually cause pain and pathology by compressing the structures that pass through the subacromial space.

 

Possible causes of SAIS

The possible causes of SAIS may be many and varied, ranging from boney spurs which reduce the subacromial space, poor dynamic stabilisation of the shoulder joint by the rotator cuff muscles, or an unstable shoulder joint with ligamentous laxity.  It is very important to determine the cause of the impingement in order to effectively reduce it!

 

Although the rotator cuff muscles are capable of generating torque (creating shoulder joint rotations), they also depress the humeral head.  Without an intact or effectively working rotator cuff, particularly during the first 60 degrees of arm elevation, the upward directed muscular pull of large shoulder muscles may cause the humeral head to jam upwards underneath the bony acromion. An effective rotator cuff will act to depress the humeral head to limit its superior migration as the arm is elevated above the head.

Diagnosis

The diagnosis of SAIS is usually made from a detailed history and a physical examination.  During the physical examination, an Osteopath will use a variety of orthopaedic tests in which your shoulder is manoeuvred into a range of motion whereby the subacromial space is reduced to assess for replication of your signs and symptoms.  Furthermore, neck, upper back, and rib mobility, as well as stability and muscular control of the shoulder blade and shoulder joint are often assessed to ensure optimal stability during movement.

Diagnostic imaging such as x-ray and ultrasound may be utilised to assess the integrity of the subacromial space and its contents if deemed necessary.

 

Treatment

Conservative treatment with manual therapy is often sufficient to treat SAIS.  Importantly, this involves resting from aggravating activities!  To help restore your shoulder’s natural mechanics, an osteopath will use a variety of manual techniques, including a specifically tailored exercise rehabilitation program to improve muscular control and stability of both the shoulder blade and the shoulder joint.

Medications such as anti inflammatories may be used for a short period of time to reduce inflammation of impinged structures.  In more severe cases, or if conservative management fails, cortisone injections may be considered.

 

In Summary

Shoulder pain can be caused by a number of different pathologies, and an osteopath can help determine the precise reason for your shoulder pain! Subacromial impingement syndrome is one very common reason for shoulder pain in many populations and whilst it can be debilitating for some, it is also very effectively treated using osteopathy.

TMJ

Tempromandibular Disorder (TMD) refers to problems that stem from issues with either the jaw, the muscles in the face surrounding the jaw or the jaw joint known as the temporomandibular joint (TMJ).
The jaw or temporomandibular joint (TMJ) acts like a sliding hinge, connecting your jaw bone to your skull. The joints are flexible, allowing the jaw to move smoothly up and down and side to side. The TMJ allows you to talk, chew and yawn. Muscles attached to and surrounding the jaw control the position and movement of the jaw. Pain can be experienced in and around the jaw from the cartilage covering the joint, it ligaments, disc or muscles. Often as a result, there is a dysfunction in movement.

TMJ disorders can occur if:

–       The disk erodes or moves out of its proper alignment

–       The join’s cartilage is damaged by arthritis

–       The joint is damaged by a blow or other impact

Unfortunately, the cause of TMJD is not black and white and symptoms could arise from problems with the TMJand/or the muscles responsible for jaw movement. Whiplash, blunt force and any other trauma involving the neck or head can cause TMJD. Also, bruxism (teeth grinding/clenching of jaw) habits can put unusual pressure on the TMJ resulting in TMJD.

The TMJ has an inter-articular disc which separates the joint cavity into two and it is made of fibrocartilage allowing a certain degree of trauma and regeneration. The TMJ functions for so many of our daily activities, the most significant of which is eating which requires tremendous leverage and strength. It is the disc that is often the bane of most the TMJD pain.  It is the structure most likely to be giving the clicking sound that patients hear when chewing. This occurs as a result of disc displacement. The disc can be displaced at various places along its length and this can interfere with the smooth gliding of the mandible on the articular surface of the temporal bone. The most common problem is for the disc to be displace medially as a result of the action of the masseter muscle (the main chewing muscle) straining and lengthening the lateral TMJ ligaments and allowing excessive medial movment.

Problems with any part of normal jaw function can quickly become annoying, painful and in severe cases, even prevent a person from being able to eat. TMJD can occur on either one side or on both sides of the jaw. The symptoms associated with TMJD can either be temporary or chronic. The following is a list of common symptoms of temporomandibular joint disorders:

  • Audible pops or clicks with jaw movements such as speaking or chewing
  • Unable to open mouth as wide as it should be able to or limited jaw movement
  • Jaw gets locked/stuck in place
  • Chewing is not a fluid movement, i.e. feeling of jaw catching or bumping
  • Face feels weak or tired, especially after eating a meal or having prolonged conversation
  • Pain in the face, jaw joint, teeth, ears, neck or shoulders
  • Swelling on one or both sides of the face
  • Headaches/dizziness
  • Other common symptoms include neck pain, hearing problems and ringing in the ears (tinnitus).

Osteopathic medicine is a great choice to treat temporomandibular joint disorders because a skilled osteopath can examine a patient with TMJ complaints and likely find and fix the root of the problem. Other areas, which can often be associated with TMJ disorder and treated, are the neck, shoulders and upper back.

Self Management

–       eating soft foods

–       avoiding hard and crunchy foods (like hard rolls and raw carrots), chewy foods (like chewing gum and steak) and larger foods (like apples).

–       avoid clenching

–       avoid extreme movements

–       wearing a night guard can help, if grinding is known to occur.

–       Stretching exercises for the jaw and neck

–       Strengthening exercises for the jaw

Shin Splints

Medial tibial stress syndrome or Shin splints is a term commonly given to pain at the front of the lower leg. The term does not imply a specific diagnosis, rather it is a symptom of pain over the front of the tibia (shin bone). The pain can be due to either problems of the muscles, the bone, or the attachment of the muscle to the bone.

Shin splints are most commonly due to overuse, where repetitive traction forces of the tendon (tibialis posterior) cause inflammation of the sheath that surrounds the tibia (known as the periostium). This condition is called medial tibial stress syndrome and it is usually what people are talking about when they use shin splints as a diagnosis. It is most commonly the result of athletes who suddenly increase their duration or intensity of training, such as marathon runners.

The tibialis posterior muscle can be strained more if the person overpronates, meaning that the foot becomes too flattened out causing the foot to roll inwards. As a result of this overpronation it causes an increase demand on the muscle and furthermore causing stress of the attachment muscle onto the tibia leading to inflammation of the periostium. The tibialis posterior is the key stabilizing muscle of the lower leg.

Patients with medial tibial stress syndrome typically have a dull, aching type of pain on the inside of their tibia. On examination, patients will often be tender over the inside of the tibia. Patients may or may not have a small amount of detectible swelling over this part of the tibia. Some specific maneuvers, especially resisted plantar flexion (pushing down of the foot against resistance), typically causes an increase of symptoms.

If symptoms persists an x-ray or even a bone scan can be a good idea to detect any stress fractures or ‘hot’ areas that indicate stress fractures or other bone problems. Patients with medial tibial stress syndrome may also have an abnormal bone scan, but there is usually a difference that can be detected to differentiate medial tibial stress syndrome and stress fractures.

Treatment of Shin Splints

The following can help with the recovery of shin splints:

  • Applying ice packs or performs ice massage for up to 20 minutes, three times a day.
  • Make sure that you have the correct footware. See your podiatrist as orthotics may need to be prescribed, especially if you overpronate your feet.
  • Adjust your training accordingly, by avoiding weight-bearing or excessive impact activity. Swimming and cycling are excellent activities.
  • See your local osteopath to correct pelvic alignment, improve ankle and foot mobility, and loosen the muscles in the lower leg and foot.
  • Taping the lower leg can help ease the pressure of the muscle pulling on the bone.
  • Shockwave Therapy can be helpful for those really stubborn shin splints

 

Shin Splints Prevention

Shin splints are usually as a result of increasing your training by too much too soon. Be smart with your training and have it planned out. Stick to the rule of increasing your training by only a maximum of 10% per week. You may also want to mix up your training with some low impact activity. Make sure that you have the proper footware and make sure that your runners are not too old and overused. If you are training daily you may need to replace your runners every six months. Most running shoes have a life span of about 800km.  Running on softer ground such as grass or gravel travels will be less impact on the legs compared to running on a concrete sidewalk.

Below is an exercise which can help strengthen the muscles in your lower leg and it can help in the prevention of shin splints, especially if you are considering an event like a marathon.

Pole pulls
Set up a pulley or resistance band about waist-high. Stand barefoot on one foot next to the band, with a slight bend in your knee and your core muscles tight. Pull the band so that your hands are in front of your belly button and the band is parallel with the floor. Move the band slowly from side to side, in and out or in small circles. If you’re on the outside foot (away from the pole), the tibialis posterior muscle along the inside of your shin works, balancing you against the upper-body resistance. To strengthen the peroneal muscles on the outside of the shin, switch feet and stand on the inside leg.