Penarth Osteopathic Practice - What can we treat

“Whiplash” Injuries

“Whiplash” is a termed used to describe the mode of an injury rather than the injury itself. As such it can occur at any joint in the body, but is most often seen in the cervical and lumbar spines following a road traffic accident. At the time of impact, especially in rear end shunts the person is thrown forwards and then “whips” backwards as the momentum of the accident lifts their upper body forwards while the pelvis is left behind. The injury can be further complicated if the impact is either at an angle or the person has their head or upper body rotated at the point of impact.

This mode of injury mainly causes soft tissue injuries, but can on occasion result strain to the cervical spine or pelvis which are known to build up over a few days.

Osteopathy has been shown to help with “whiplash” associated disorders through the relief of muscle tensions and the prescription of gentle rehabilitation exercises to help the body return to normal and relieve the pain of the injury.

References:
Fernandez-de-las-Penas C, Fernandez-Carnero J, Fernandez A, Lomas-Vega R, Miangolarra-Page JC: Dorsal Manipulation in Whiplash Injury Treatment: A Randomized Controlled Trial. Journal of Whiplash & Related Disorders 2004, 3: 55-72.

Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al.: Treatment of neck pain: non-invasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 2009, 32: S141-S175.

“Tennis elbow / Golfers elbow” or Medial / Lateral epicdonylitis

The large muscles of the forearm and hand originate at the elbow where they blend together to form a tendon which then attaches onto the bone. It is at this point where the tendon attaches onto the bone that the body is vulnerable to type traction injuries. This traction can be brought on by such things as swinging a golf club or tennis racket or even from other repetitive and mechanically stressful tasks such as DIY. The inflammation of the tendon or 'tendinopathy' can be successfully treated using osteopathic techniques to help with the healing process by reducing the strain upon the tendon, and further benefits can sometimes be gained through the use of strapping or splints at night.

References:
Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B: Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006, 333: 939.

Shoulder problems

The shoulder is an inherently unstable joint due to its shallow socket and high degree of flexibility. As a result of this the body uses a series of muscles to help stabilise it: the four main muscles are called the rotator cuff muscles, but other muscles from the chest, scapular and upper arm help provide power and some stability as well.

These muscles of the shoulder can be vulnerable to degeneration as people get older but can also be injured when an imbalance of strength occurs within the shoulder muscles. Specific exercises and treatments can be done to help provide shoulder stability. Osteopathic treatment will also look at the function of the thoracic spine (middle back), cervical spine (neck) and ribs as well as the whole of the shoulder complex which can be affected by posture, age and other factors.

Osteopathic treatment of the shoulder will aim to reduce pain but also to maintain flexibility through the joint, and allow the individual to continue functioning with the aid of exercises.

References:
Bergman GJ, Winters JC, Groenier KH, Pool JJ, Meyboom-de Jong B, Postema K et al.: Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial. Ann Intern Med 2004, 141: 432-439.

Green S, Buchbinder R, Hetrick S: Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev 2003, CD004258

Lombardi I Jr, Magri AG, Fleury AM, Da Silva AC, Natour J. Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum. 2008 May 15;59(5):615-22

Senbursa G, Baltaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2007 Jul;15(7):915-21. Epub 2007 Feb 28.

van den Dolder PA, Roberts DL: A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain. Aust J Physiother 2003, 49: 183-188

Knee problems

The knee is a complex joint that is prone to injury as at is affected by strains from the hip and back as well as from the foot and ankle. This means that when looking at any knee problem a full examination of the whole of the lower extremity is necessary. Anterior knee pain or pain around the knee cap is most often caused by the knee cap being pulled to one side or the other because of an imbalance in the muscles of the thigh. This usually can be corrected through the prescription of exercises and specific stretching to reduce the strain upon the knee itself as well as treatment of other surrounding joints that may have an affect upon the knee's function.

Osteopathic treatment of the knee has been shown to be effective and involves soft tissue work (massage), articulation to help reduce the soft tissue irritation and exercises to help restore the correct bio-mechanical function of the joint. Some treatment will also be done upon the surrounding joints such as the hip or ankle in order to allow the body to compensate properly.

References:
Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE: Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebocontrolled trials. BMC Musculoskelet Disord 2007, 8: 51.

Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W: Manipulative therapy for lower extremity conditions: expansion of literature review. J Manipulative Physiol Ther 2009, 32: 53-71.

Fransen M, McConnell S: Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2008, CD004376.

Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL: Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med 2006, 166: 2533-2538.

National Institute for Health and Clinical Excellence. Osteoarthritis: National clinical guideline for care and management in adults. Clinical guideline 59. 2008.

Hip problems

Mechanical pain around the hip and groin can come from many areas such as the hip itself, the lumbar spine or the sacro-iliac joints. This is because it links the mobile lower extremities to the fixed pelvis and lumbar spine. Imbalances in the muscles of the pelvic / hip can then lead to hip pain, especially in those that are active or do a lot of exercise. The osteopathic treatment of the lumbar spine and sacro-iliac joints can also help reduce the symptoms in the hip.

Arthritis in the hip is relatively common as people get older but it does not mean that there is nothing that can be done about it. This is because the ligamentous and muscular pain that it causes can respond well to osteopathic treatment. And through the prescription of some simple exercises treatment may help delay the progression of the symptoms.

References:
Cibulka MT, White DM, Woehrle J, Harris-Hayes M, Enseki K, Fagerson TL et al.: Hip pain and mobility deficits--hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2009, 39: A1-25.

Hernandez-Molina G, Reichenbach S, Zhang B, Lavalley M, Felson DT: Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis. Arthritis Rheum 2008, 59: 1221-1228.

Hoeksma HL, Dekker J, Ronday HK, Heering A, van der LN, Vel C et al.: Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis Rheum 2004, 51: 722-729.

National Institute for Health and Clinical Excellence. Osteoarthritis: National clinical guideline for care and management in adults. Clinical guideline 59. 2008.

Neck problems

The neck or cervical spine is more commonly affected now than a generation ago; this is partly because we spend far longer sitting at computers, for example, without moving around. This results in an anterior shear through the neck as the thoracic spine becomes flexed from a reduction in mobility and the neck drops into extension to counterbalance the movement. As a result of this there are now more people present with pain in their necks which can in turn lead to other symptoms such as headaches or pain across the shoulders and down into the arms.

Osteopathic treatment can help to reduce the strain and tension through the cervical spine (neck) and muscles of the neck and shoulders, and the Osteopath will aim to correct any poor postural habits and/or give ergonomical advice to help people carry on with their lifestyles without risking the same mechanical problems/pain.

Strengthening and stretching exercises through the shoulders, chest and cervical spine can also help reduce neck problems and if done regularly help prevent them from recurring again in the future.

References:
Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD: Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther 2007, 87: 431-440.

Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega MR: Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2009, 39: 20-27.

Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P et al.: Manipulation and mobilisation for mechanical neck disorders. Cochrane Database Syst Rev 2004, CD004249.

Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al.: Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther 2009, 32: S141-S175.

Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Alburquerque- Sendin F, Palomeque-del-Cerro L, Mendez-Sanchez R: Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial. Man Ther 2009, 14: 306-313.

Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA: Randomized trial of therapeutic massage for chronic neck pain. Clin J Pain 2009, 25: 233-238.

Headaches

There are many different causes of headaches, but they are usually divided into three categories; ‘migraine headaches’, ‘tension-type headaches’ and ‘cervicogenic headaches’.

Migrainous headaches can be caused by many different factors of which a few can be helped through the use of gentle osteopathic techniques. The gentle treatment to the upper cervical spine can help reduce some of the irritation through the base of the skull and so reduce the intensity of the migraine itself. Other treatments that have been found to help are through the use of cranial osteopathy.

References:
Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV: The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headaches. J Manipulative Physiol Ther 1998, 21: 511-519.

Lawler SP, Cameron LD: A randomized, controlled trial of massage therapy as a treatment for migraine. Ann Behav Med 2006, 32: 50-59.

Tension-type headaches are the most common form of headaches and they are usually caused by an irritation in the neck which can then refer pain into the head itself. This is usually as the result of poor posture or stiffness further down the spine itself. Tension-type headaches usually respond well to osteopathic treatment through changing posture and releasing some of the tension in the cervical and thoracic spine. Then with a few simple self-help exercises long term relief should be possible.

Anybody who does not however respond to treatment or shows abnormal neurological signs will be referred immediately to their GP or a specialist for further investigation and treatment as necessary as the correct management of headaches are essential.

References:
Bove G, Nilsson N: Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. JAMA 1998, 280: 1576-1579.

Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ et al.: Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004, CD001878.

Cervicogenic headaches are specific headaches that are caused by an irritation of the trigeminal nucleus by an irritation of one of the joints in the upper cervical spine; this can then cause pain and other symptoms into the head and sometimes even the face. These headaches are relatively rare but if correctly diagnosed can respond well to osteopathic treatment because by reducing the irritation of the nerve root in the upper cervical spine the pain is reduced.

Refernces:
Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ et al.: Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004, CD001878.

Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K: Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. J Orthop Sports Phys Ther 2007, 37: 100-107.

Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D et al.: A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002, 27: 1835-1843.

Nilsson N, Christensen HW, Hartvigsen J: The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997, 20: 326-330.

Ankle and foot problems

The ankle and the foot take a lot of strain when walking and running, and as such they are prone to many problems, such as from an abnormal gait or inappropriate pressure upon specific joints. The foot and ankle are usually able to cope with these problems for a while, but could get to a point where they become overloaded or an injury causes more specific damage. As a result of falls, strains and sprains of the ankle can occur which may then require further intervention. Osteopathic treatment of the foot and ankle will help to reduce specific restrictions through the foot, but by also helping improve overall balance and foot control falls may be less likely to occur again.

Exercises to help with pain in the Achilles tendon have been shown to reduce the pain as it helps the tendinopathy heal and return normal function to the ankle.

Limping as the result of an ankle or foot problem for extended periods of time have been shown to cause an abnormal gait at the knee, hip and lumbar spine which can then lead to problems further up the biomechanical chain. As a result of this resolving the problem with the feet and ankle is essential to maintain a normal gait.

References:
Brantingham JW, Globe G, Pollard H, Hicks M, Korporaal C, Hoskins W: Manipulative therapy for lower extremity conditions: expansion of literature review. J Manipulative Physiol Ther 2009, 32: 53-71.

Cleland JA, Abbott JH, Kidd MO, Stockwell S, Cheney S, Gerrard DF et al.: Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther 2009, 39: 573-585.

Handoll HH, Rowe BH, Quinn KM, de Bie R: Interventions for preventing ankle ligament injuries. Cochrane Database Syst Rev 2001, CD000018.

Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42-7.

Silbernagel KG, Thomeé R, Thomeé P, Karlsson J. Eccentric overload training for patients with chronic Achilles tendon pain--a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports. 2001 Aug; 11(4):197-206.

Lower back problems

The lumbar spine pain is one of the most common causes for time off work and is experienced by most of the population at some time in their working career. As a result of this it is essential to not only the individual but also their employer to help prevent problems with the lumbar spine. The most common cause of this pain is muscular and ligamentous irritation as the result of an abnormal movement or from lifting badly and these types of injury should respond successfully to nothing more than gentle exercise within a few days. If however these symptoms persist or keep recurring then there may be an underlying problem that needs to be looked at to help resolve the symptoms and prevent them for coming back again in the future.

Osteopathic treatment of lower back pain aims to help reduce the muscular spasm and to release any areas of the spine which may have become restricted due to abnormal strains. Through the prescription of exercises to help strengthen the spine and the ‘core muscles’ the patient should be able to be keep their problem under control. A full bio-mechanical assessment of the individual is normal done to discern if there are any problems that may be contributing towards the lumbar spine pain, so treatment of the hip, knee and ankle may also occur. There is good evidence to show that osteopathic treatment of lumbar spine is effective when combined with exercise therapy in adults with lower back pain.

Posture, lack of exercise, obesity and the increased amount of time that is spent sitting are greatly contributing towards the incidence of lower back pain, and as such our treatment sessions usually include some form of preventative advice to help reduce these factors.

When there is also referred pain down into the leg, this is often a sign that there may be pressure upon on of the nerves in the lumbar spine. The cause of this can be from local joint inflammation which is putting pressure on the nerve, or from a strain or even a bulge of the disc itself. The treatment given will always depend upon the cause of the symptoms and a correct diagnosis is paramount to a good recovery. But the best form of treatment is prevention in the first place, so by keeping the back healthy and strong and not doing things that may cause these symptoms in the first place is the best treatment in the long run.

Rarely people may need to be referred back to their GP or to a specialist for further investigations or interventions.

References:
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs et al.: Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006, 15 Suppl 2: S192-S300.

Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG: Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev 2004, CD000447.

Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr., Shekelle P et al.: Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007, 147: 478-491

Chou R, Huffman LH: Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 2007, 147: 492-504.

Furlan AD, Imamura M, Dryden T, Irvin E: Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group. Spine 2009, 34: 1669-1684.

Hondras MA, Long CR, Cao Y, Rowell RM, Meeker WC: A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. J Manipulative Physiol Ther 2009, 32: 330-343.

Lawrence DJ, Meeker W, Branson R, Bronfort G, Cates JR, Haas M et al.: Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis. J Manipulative Physiol Ther 2008, 31: 659-674.

Savigny P, Watson P, Underwood M: Early management of persistent nonspecific low back pain: summary of NICE guidance. BMJ 2009, 338: b1805.

van Tulder M, Becker A, Bekkering T, Breen A, Del Real MT, Hutchinson A et al.: Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006, 15 Suppl 2: S169-S191.

Wrist, hand and Carpal Tunnel pain

The hand and wrist are prone to injuries, especially when of a repetitive nature. This is can be due to the position of the hands and wrists whilst using a keyboard or from falls, repetitive strain injury and so on. ‘Carpal tunnel’ syndrome is a specific diagnosis where the median nerve becomes compressed when it passes through a narrow 'tunnel' within the writs. This can be treated osteopathically by helping improve the movement of the elbow and wrist which may help to decrease the compression of the nerve and allow proper function.

References:
McHardy A, Hoskins W, Pollard H, Onley R, Windsham R: Chiropractic treatment of upper extremity conditions: a systematic review. J Manipulative Physiol Ther 2008, 31: 146-159.

O'Connor D, Marshall S, Massy-Westropp N: Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003, CD003219.

Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L et al.: A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil 2007, 21: 299-314.

Thoracic Spine and Ribs

The thoracic spine (middle back) and ribs can become injured for a variety of reasons, such as during fast ballistic movements such as sneezing or repetitive coughing; the ribs can become strained with spasms through local musculature. The thoracic spine can also become dysfunctional because of increased amounts of time leaning forward over a computer, causing a chronic restriction of movement through the upper thoracic spine. Osteopathy can improve function of the thoracic spine and ribs as well as from some simple exercises to improve & maintain the mobility of the area and increase the strength of the muscles of the upper back and shoulders.

The thoracic spine is not only the site of pain but is also a common cause for pain in the cervical spine. This is because a restriction in the thoracic spine leads to an increase in the strain upon the cervical spine and so increase the chance of injury.

References:
Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD: Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther 2007, 87: 431-440.

Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega MR: Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2009, 39: 20-27.

Schiller L: Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: a pilot randomized clinical trial. J Manipulative Physiol Ther 2001, 24: 394-401.