Osteopathy Blog

Scoliosis in Children. Is Osteopathy Treatment Effective?

What is Scoliosis?

Scoliosis is a medical condition in which a person’s spine has a sideways curve. The curve is usually “S”- or “C”-shaped. In some the degree of curve is stable, while in others it increases over time. Mild scoliosis does not typically cause problems, while severe cases can interfere with breathing. Pain is typically not present.

scoliosis

How could Osteopathy Help?

Osteopathy is less invasive than other interventions, safe and, being performed by the osteopath, independent of the parents’ compliance. Fine manipulative palpation techniques, which are individually adapted to tissue quality (Philippi et al. 2006).

How could Treatment benefit Infants?

Treatment could address any fetal muscle any imbalances during normal development of the spine. In particular, timing and nature of fetal muscle activity are critical influences on the normal development of the spine, with implications for the understanding of congenital spine deformities (Rolfe et al. 2017).

Is it Effective in infants?

Please bear aware that not enough robust research has been completed to show effectiveness of osteopathy  as treatment in infantile scoliosis. Though one study suggests that osteopathic treatment in the first months of life is beneficial for infants with idiopathic asymmetry, and that rehabilitation methods can be evaluated in this young age group (Philippi et al. 2006).

Why it is not effective in Teenagers / Adolescents?

It could be argued that scoliosis may have progressed to the point where it is no longer treatable. The research has indicated that osteopathy / manual therapy is not effective in teenagers / adolescents. The lack of any kind of serious scientific data does not allow us to draw any conclusion on the efficacy of manual therapy as an efficacious technique for the treatment of Adolescent idiopathic scoliosis (Romano and Negrini, 2008).

Is there any Evidence to support Osteopathy as treatment in Adolescent Scoliosis?

There is no evidence to support osteopathy in the treatment of mild adolescent idiopathic scoliosis. Therefore, we caution against abandoning the conventional standard of care for mild idiopathic scoliosis (Hasler et al. 2010).

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Reference List

Hasler C, Schmid C, Enggist A, Neuhaus C, Erb T (2010). No effect of osteopathic treatment on trunk morphology and spine flexibility in young women with adolescent idiopathic scoliosisJ Child Orthop. Jun;4(3):219-26

Philippi H, Faldum A, Schleupen A, Pabst B, Jung T, Bergmann H, Bieber I, Kaemmerer C, Dijs P, Reitter B (2006). Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial. Developmental Medicine & Child Neurology, 48: 5–9 5

Rolfe RA, Bezer JH, Kim T, Zaidon AZ, Oyen ML, Iatridis JC, Nowlan NC. (2017).  Abnormal fetal muscle forces result in defects in spinal curvature and alterations in vertebral segmentation and shape. J Orthop Res. Oct;35(10):2135-2144.

Romano M, Negrini S (2008). Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. Scoliosis. Jan 22;3:2.

Back Pain or Pelvic Pain Preventation on a Motorbike

How to Avoid Back Pain or Pelvic Pain on a Motorbike

Back Pain and Pelvic Pain can be quite common on a motorbike, especially on low rides. Particularly for long rides in a sustained riding position and to some degree the vibration coming from the engine could impack your back pain as as process called proprioception  which affect muscle control is affected by vibration.

Type of Motorbikes

It is important to consider that the riding position of various types of motorbikes will affect your back pain or pelvic pain. This is dependent on the type of motorbike you ride.

Supersports Bike, the  riding position involves the rider to be leaning forwards as this allows for greater aerodynamics and banking around corners. The problem with the position, it causes you to over stretch the muscles in your low back and over the duration of the ride, you can develop muscle fatigue and pain.

Sports Touring – Sports touring bike riding position can vary based on the configuration of the motorbike

Tourer – The riding position is usually more relaxed and upright and in some cases there maybe a back support attached to your seat.

Enduro – you are usually sat upright

Back Protectors

You can even get armoured back protectors to help reduce the severity of back pain. Google them or find them on amazon.co.uk

Advice

Make sure you stop for breaks every 2 hours, maybe a short walk could a helpful to alleviate the pain associated with the muscle fatigue in the low back

You can even perform stretchs whilst sitting on the bike or off the bike.

Information and Appointments

For more tips and advice, keep reading our blog. Alternatively to find out more about your clinics go to the home page or to book an appointment with an osteopath at Cam Osteopathy, go to appointment bookings.

Alternatively Call us on 07982 432732 or Email bookings@camosteopathy.co.uk

We even offer a FREE 15 minute assessment to see if treatment is safe and suitable for you.

 

How Avoid Back Pain or Pelvic Pain whilst Operating a Car?

How to get in and out of a Car with Back Pain and Pelvic Pain?

Back pain and pelvic pain are quite common to occur when operating a car, especially on long drives.

Back Pain and Pelvic pain aggravation can avoided through doing very basic steps for getting in and out of the car.

Getting Out:

Make sure you use your arms to rotate your body inside the car and place both feet firmly on the ground. Use the inside of the car frame and handles to maneuve / pull yourself out of the car door. Avoid movements that involve any sidebending or rotation or stepping out using one leg after the other.

Getting In:

After you open the open the car door, turn your back on the seat and slowly lower your backside onto the seat. Then use your arms to rotate your body into the car. Try to avoid any sidebending or rotational movements.

Manual or Automatic Car?

With manual gearbox cars, you tend to be significantly be using, the accelerator, brake and clutch pedals, so over time the muscles around your pelvis and low back can fatigue and cause delayed onset muscle soreness

Whereas in an automatic car you, you dont have a clutch pedal and also tend to make use of either or both a speed limiter or cruise control, which makes you less reliant on using the acceletor and clutch pedals on a non-urban drive.

Therefore, people that suffer from chronic back pain or pelvic pain, may need to consider changing their manual gearbox car for an automatic gearbox car.

Is my Car Seat Setup in the Correct Position?

Seat position is important, try find a seat position that doesn’t aggravate for back pain or pelvic pain. There isn’t really optimum position as the back pain and pelvic pain can aggravate in any position.

If necessary you can use a back support to reduce pain aggravation shown in the diagram below

back pain support

Information and Appointments

For more tips and advice keep reading our blog. Alternatively if your back pain / pelvic pain is not getting any better, you can come for an appointment with an Osteopath at Cam Osteopathy.

Go to home page for more information about the clinic or to make an appointment go to appointment bookings

Alternatively Call on or Email bookings@camosteopathy.co.uk

We even offer a FREE 15 minute assessment to see if treatment is safe and suitable for you.

Irritable Bowel Syndrome (IBS) Treatment with Visceral Osteopathy, Dietary & Lifestyle Advice

What is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome is a group of symptoms—including abdominal pain and changes in the pattern of bowel movements without any evidence of underlying damage.These symptoms occur over a long time, often years. It has been classified into four main types depending on whether diarrhea is common, constipation is common, both are common, or neither occurs very often.

The causes of IBS are not clear. Theories include combinations of gut–brain axis problems, gut motility disorders, pain sensitivity, infections including small intestinal bacterial overgrowth, neurotransmitters, genetic factors, and food sensitivity. Onset may be triggered by an intestinal infection, or stressful life event.

There is no cure for IBS. Treatment is carried out to improve symptoms.

irritable bowel syndrome

What is Osteopathy?

Osteopathy is a manual therapy which places emphasis on normal mobility of tissues. For IBS, manual techniques are applied to the organs in the abdomenal cavity. There are various techniques that can be applied to the rectum and intestines to treat IBS.  Osteopathic treatment of IBS is a promising therapy in the treatment of this frustrating problem (Hundscheid et al. 2007). 

How can Osteopathy be applied to manage Irritable Bowel Syndrome?

Osteopathic treatment for IBS focuses on the nervous and circulatory systems, spine, viscera, and thoracic and pelvic diaphragms in order to restore homeostatic balance, normalize autonomic activity in the intestine, promote lymphatic flow, and address somatic dysfunction. Lymphatic and venous congestion are treated by the lymphatic pump techniques and stimulation of Chapman׳s reflex points (Collebrusco and Lombardini, 2014).

It respects the interrelationship of mind and body and recognizes that the human body functions as a dynamic unit. This fits perfectly with the concept of the biopsychosocial model and the brain-gut axis. It seems likely that the different osteopathic treatment modalities are able to intervene at different levels of this brain-gut axis. (Florance et al. 2012).

Is Osteopathy an Effective Treatment for Irritable Bowel Syndrome?

Visceral Osteopathy improves short-term and long-term abdominal distension and pain, and also decreases rectal sensitivity in IBS patients. The effectiveness of visceral osteopathy on treatment for two cardinal symptoms of IBS (bloating and abdominal pain) (Attali et al. 2013). Osteopathy improves the severity of IBS symptoms and its impact on quality of life (Florance et al. 2012).

What is the current evidence base for Irritable Bowel Syndrome treatment with Osteopathy?

Currently the evidence base is limited for this area of practice within osteopathy. Though one systematic review of 5 RCTs indicated favorable results for osteopathy compared with standard medical therapies or sham interventions in the management of IBS (Müller et al. 2014).

What dietary and lifestyle advice should I consider for Irritable Bowel Syndrome?

The other important considerations is changing your diet and lifestyle to reduce the severity of irritable bowel syndrome. The National Institute of Clinical Excellence (NICE, 2017) provides guidelines to achieve this:

People with IBS should be given information that explains the importance of self‑help in effectively managing their IBS. This should include information on general lifestyle, physical activity, diet and symptom‑targeted medication

Diet and nutrition should be assessed for people with IBS and the following general advice given.

  • Have regular meals and take time to eat.
  • Avoid missing meals or leaving long gaps between eating.
  • Drink at least 8 cups of fluid per day, especially water or other non‑caffeinated drinks, for example herbal teas.
  • Restrict tea and coffee to 3 cups per day.
  • Reduce intake of alcohol and fizzy drinks.
  • It may be helpful to limit intake of high‑fibre food (such as wholemeal or high‑fibre flour and breads, cereals high in bran, and whole grains such as brown rice).
  • Reduce intake of ‘resistant starch’ (starch that resists digestion in the small intestine and reaches the colon intact), which is often found in processed or re‑cooked foods.
  • Limit fresh fruit to 3 portions per day (a portion should be approximately 80 g).
  • People with diarrhoea should avoid sorbitol, an artificial sweetener found in sugar‑free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
  • People with wind and bloating may find it helpful to eat oats (such as oat‑based breakfast cereal or porridge) and linseeds (up to 1 tablespoon per day)
Cam Osteopathy

For more information about our clinics go to the home page or to book an appointment go to appointment bookings.

Alternatively call on 07982 432732 or email bookings@camosteopathy.co.uk

We even offer a FREE 15 minute consultation to see if treatment is safe and suitable for you.

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Reference List

Attali TV, Bouchoucha M, Benamouzig R (2013). Treatment of refractory irritable bowel syndrome with visceral osteopathyshort-term and long-term results of a randomized trialJ Dig Dis. 2013 Dec;14(12):654-61

Collebrusco L, Lombardini R (2014). What about OMT and nutrition for managing the irritable bowel syndrome? An overview and treatment plan. Explore (NY). Sep-Oct;10(5):309-18

Florance BM, Frin G, Dainese R, Nébot-Vivinus MH, Marine Barjoan E, Marjoux S, Laurens JP, Payrouse JL, Hébuterne X, Piche T (2012). Osteopathy improves the severity of irritable bowel syndrome: a pilot randomized sham-controlled studyEur J Gastroenterol Hepatol. Aug;24(8):944-9

Hundscheid HW, Pepels MJ, Engels LG, Loffeld RJ (2007). Treatment of irritable bowel syndrome with osteopathyresults of a randomized controlled pilot studyJ Gastroenterol Hepatol. Sep;22(9):1394-8

Müller A, Franke H, Resch KL, Fryer G (2014). Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: a systematic review. J Am Osteopath Assoc. Jun;114(6):470-9

National Institute of Clinical Excellence (NICE, 2017). Irritable bowel syndrome in adults: diagnosis and management. NICE: London

Guide to Carpal Tunnel Syndrome Osteopathy and Prescriptive Exercise

Carpal Tunnel Syndrome Treated with Osteopathic Manipulative Treatment

Carpal tunnel syndrome (CTS) is 1 of the most common peripheral nerve entrapment disorders. Osteopathic manipulative medicine can be invaluable in diagnosing and managing CTS. Combined with a patient’s history and a standard physical examination, an osteopathic structural examination can facilitate localizing the nerve entrapment, diagnosing CTS, and monitoring the disease process. Osteopathic manipulative treatment is noninvasive and can be used to supplement traditional CTS treatment methods. The authors also review the relevant anatomy involving CTS and the clinical efficacy of osteopathic manipulative medicine in the management of this disorder.

Carpal Tunnel Syndrome

 

Carpal Tunnel Syndrome

What is the Purpose of Prescriptive Exercise?

There are a number of theories regarding how exercise and mobilisation interventions are effective in reducing the symptoms of Carpal Tunnel Syndrome. Gliding exercises can potentially reduce tenosynovial oedema, improve venous return from the nerve bundles, and reduce pressure inside the carpal tunnel.

Whereas stretching may relieve compression in the carpal tunnel, improve joint posture and decrease nerve compression, and improve blood flow to the median nerve. Stretching exercises for Carpal Tunnel Syndrome have been prescribed for the same reasons, and also to mobilise the median nerve within the carpal canal if it is adherent (Page et al. 2012).

What is the Purpose of Osteopathic Manipulative Treatment

When osteopathic structural examination reveals somatic dysfunction associated with Carpal Tunnel Syndrome, osteopathic manipulative treatment may be used to manage the somatic dysfunction. Specifically, OMT may be used to stretch soft tissues, release tissue adhesions, eliminate restricted motion of carpal and metacarpal bones, increase the length of the TCL to enlarge the carpal tunnel and lower intratunnel pressure transmitted to the median nerve, increase range of motion, strengthen muscles, and reduce edema (Siu et al. 2012).

Resultant improvements in circulation and joint function will allow for normalization of nerve function. As described in the following paragraphs, several techniques can be used to manage somatic dysfunction in various parts of the wrist and hand that are associated with Carpal Tunnel Syndrome (Siu et al. 2012).

What Techniques can be applied to Carpal Tunnel Syndrome?

Myofascial release technique—The physician places his or her fourth and fifth digits of both hands between the patient’s fourth and fifth digits and first and second digits of the palmar surface (Siu et al. 2012).

Opponens roll maneuver—This maneuver involves lateral and axial rotation of the thumb, which creates substantial traction on the attachment of the opponens pollicis muscle. The muscle originates from the transverse carpal ligament and tubercle of the trapezium bone. This maneuver stretches the muscle and transverse carpal ligament, releasing pressure within the carpal tunnel and unloading pressure on the median nerve (Siu et al. 2012).

High-velocity, low-amplitude technique (mobilization with impulse)—The physician’s hands grasp the patient’s hand and wrist where the technique can be either directed at Carpal Bones, Metacarpophalangeal Joint, Carpometacarpal Joint, Radius and Ulna (Siu et al. 2012).

Muscle energy technique for pronation and supination dysfunctions—To manage pronation dysfunction, the physician holds the patient’s hand in a handshake position while the palm of the free hand contacts the posterolateral aspect ofthe radial head to be treated. Supination is applied to the patient’s forearm until a restrictive barrier is reached (Siu et al. 2012).

Is Treatment Effective for Carpal Tunnel Syndrome?

One trial showed Osteopathic manipulative treatment effectively managed Carpal Tunnel Syndrome symptoms and disability in 9 participants.  However,
median nerve function and morphology did not change as measured before and after 6 weeks of OMT (Burnham et al. 2015).

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Reference List

Burnham T, Higgins DC, Burnham RS, Heath DM (2015). Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project. J Am Osteopath Assoc. Mar;115(3):138-48

Page MJ, O’Connor D, Pitt V, Massy-Westropp N (2012).  Exercise and mobilisation interventions for carpal tunnel syndromeCochrane Database Syst Rev.  Jun 13;(6):CD009899

Siu G, Jaffe JD, Rafique M, Weinik MM (2012). Osteopathic manipulative medicine for carpal tunnel syndrome. J Am Osteopath Assoc. Mar;112(3):127-39

Lumbar Disc Herniation or “Slipped Discs” Osteopathy and Prescriptive Exercise

What is a Lumbar Disc Herniation or Slipped Discs?

Lumbar Slipped Disc Injuries or disc herniation  is a condition that affects the spine where a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings. Disc herniation can be age-related degeneration of the outer ring, known as the anulus fibrosus, although trauma, lifting injuries, or straining have been implicated as well. Tears are almost always postero-lateral (on the back of the sides) owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of chemicals causing inflammation, which may directly cause severe pain even in the absence of nerve root compression.

Types of Lumbar Slipped Disc Injuries

Slipped Disc Injuries

There are 4 typesof disc hernation that can occur in the spine as shown in the picture above. You can see that severe of the disc injury increases going from left to right in the picture

Can a Slipped Disc Cause Sciatica?

Depending on the severity of the discal herniation, Yes it can, but not always

What Treatment does the National Institute of Clinical Excellence Recommends for Low Back Pain and Sciatica?

NICE (2016) recommends manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy. Which Osteopaths are perfectly qualified to offer in a clinical setting.

How can Osteopathy Help?

The manual therapy approach of osteopathy can be applied either reduce the severity of discal pain by treating the surrounding soft tissues (muscles, tendons, ligaments and facet joint capsules)

How Can Prescriptive Exercise Help?

Exercise maybe required either to increase core stability or lengthen the muscles that attach to the spine and intervertebral discs in an attempt to either stabilise the disc herniation or reduce muscle loading on the discs.

Will I need to be referred to the GP or Specialist Doctor?

If the lumbar disc hernation is severe then the osteopath you would need to be referred to GP for either further investigation (MRI scanning) or Orthopaedic surgery (i.e. a Diskectomy) or spinal injections maybe required to treat the disc hernation.

Cam Osteopathy

For more information on how osteopaths can help treat and manage lumbar disc injuries please go to our home page or click on appointment bookings

Alternatively, Email bookings@camosteopathy.co.uk or call on 07982 432732

Reference List

National Institute of Clinical Excellence (2016). Low back pain and sciatica in over 16s: assessment and management

Lateral Epicondylitis Osteopathy and Prescriptive Exercise by Osteopaths

Lateral Epicondylitis (Tennis Elbow)

Massage for Lateral Epicondylitis (Tennis Elbow)

Deep friction massage is an effective treatment for lateral epicondylitis and can be used in patients who have failed other nonoperative treatments, including cortisone injection (Yi et al. 2017).

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Reference List

Yi R, Bratchenko WW, Tan V (2017). Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand (N Y). Feb 1:1558944717692088

Osteoarthritis Osteopathy and Prescriptive Exercise by Osteopaths

What is Osteoarthritis?

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone.[5] The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become constant. Additionally, symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs.The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knee, and hips. Joints on one side of the body are often more affected than those on the other. Futhermore the symptoms come on over years. It can affect work and normal daily activities. Unlike other types of arthritis, only the joints are typically affected. Osteoarthritis osteopathy maybe beneficial.

Osteoarthritis osteopathy

Osteoarthritis Exercise and Osteoarthritis Osteopathy

We recommend and support the use of TE (on their own or combined with manual therapy), especially strengthening exercises and general physical activity, for patients with OA, particularly for the management of pain and improvement of functional status (Brosseau et al. 2005).

Also, Exercise therapy is effective for reducing pain and improving function in patients with knee OA, some evidence that exercise therapy is effective for hip OA, and early indications that manual therapy may be efficacious for hip and knee OA (Abbott et al. 2009).

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Reference List

Abbott JH, Robertson MC, McKenzie JE, Baxter GD, Theis JC, Campbell AJ and the MOA Trial team (2009). Study protocol Open Access Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol. Trials, 10:11

Brosseau L, Wells GA,  Tugwell P,  Egan M, Dubouloz CJ, Casimiro L, Robinson VA, Pelland L, McGowan J, Judd M, Milne S, Bell M, Finestone HM, Légaré F, Caron C,  Lineker S,  Haines-Wangda A, Russell-Doreleyers,  Hall M, Lamb GAM (2005). Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises and Manual Therapy in the Management of Osteoarthritis. Physical Therapy . Volume 85 . Number 9 . September

Knee Osteoarthritis Osteopathy and Prescriptive Exercise by Osteopaths

Knee Osteoarthritis

Knee Osteoarthritis is a disease that affects your knee joints. The surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should. The condition is sometimes called arthrosis, osteoarthrosis, degenerative joint disease or wear and tear. (AR, n.d)

Knee Osteoarthritis

What are the Symptoms of Knee Osteoarthritis

The symptoms of osteoarthritis can include:
• pain
• stiff ness
• a grating or grinding sensation when
the joint moves (crepitus)
• swelling (either hard or soft).
Sometimes the knee may either lock or give way when you put weight on it. (AR, n.d.)

Who gets Knee Osteoarthritis?

Almost anyone can get osteoarthritis,
but it’s most likely if:
• you’re in your late 40s or older
• you’re overweight
• you’re a woman
• your parents, brothers or sisters
have had osteoarthritis
• you’ve previously had a severe
knee injury
• your joints have been damaged by another disease, for example rheumatoid rheumatoid arthritis arthritis or gout (AR, n.d.)

The National Institute of Clinical Excellence Reccomendations

NICE (2014) advises people with osteoarthritis to exercise as a core treatment, irrespective of age, comorbidity, pain severity or disability. Exercise should include:

  • local muscle strengthening and
  • general aerobic fitness.It has not been specified whether exercise should be provided by the NHS or whether the healthcare professional should provide advice and encouragement to the person to obtain and carry out the intervention themselves. Exercise has been found to be beneficial but the clinician needs to make a judgement in each case on how to effectively ensure participation. This will depend upon the person’s individual needs, circumstances and self-motivation, and the availability of local facilities.
  • Manipulation and stretching should be considered as an adjunct to core treatments, particularly for osteoarthritis of the hip. 

Manual Therapy for Knee Osteoarthritis

Manual therapy provided significant, clinically important and sustained improvements in symptoms for patients with OA of hips or knees (Abbott et al. 2013).

Short term effect of Manual Therayp for Knee Osteoarthritis

Manual therapy improves pain and physical function, in the short and long-term, compared with exercise for those with hip OA, and massage therapy providesshort-term benefit in pain and function over no treatment for those with knee OA (French et al. 2011).

Long Term Effect of Manual Therapy for Knee Osteoarthritis

After 3-months an 8-session multi-modal treatment of exercise, OA education, manual-therapy and taping that was targeted to the PFJ and tailored to individual patients resulted in superior outcomes for patient-perceived change and pain compared to OA-education alone in people with predominant PFJ OA (Crossley et al. 2015).

Safety of Manual Therapy for Knee Osteoarthritis

Manual therapy might be effective and safe for improving pain, stiffness, and physical function in KOA patients and could be treated as complementary and alternative options (Xu et al. 2017).

Hip Mobilisation for Knee Osteoarthritis

Patients experienced increases in ROM, decreased pain, and fewer subjects had painful test findings immediately following a single session of hip mobilizations (Currier et al. 2007).

Combining Manual Therapy With Exercise for Knee Osteoarthritis

Manual Therapy appears to be moderately effective for improved function, specifically as an adjunct to another treatment and versus comparators of no treatment or other treatments (Salamh et al. 2016).

Exercise therapy plus manual mobilisation showed a moderate effect size on pain (0.69) compared to the small effect sizes for strength training (0.38) or exercise therapy alone (0.34). Supervised exercise treatment in physiotherapy and manual therapy should in our opinion include at least an active exercise program involving strength training, aerobic activity exercises, and active range of motion exercises. To achieve better pain relief in patients with knee osteoarthritis, physiotherapists or manual therapists might consider adding manual mobilisation to optimise supervised active exercise programs (Jansen et al. 2011).

Knee Osteoarthritis Exercise

Among people with knee osteoarthritis, land-based therapeutic exercise provides short-term benefit that is sustained for at least 2-6 months after cessation of formal treatment (Fransen et al. 2015).

Non-Elastic Tapping for Knee Osteoarthritis

Therapeutic taping seemed to be superior to control taping in pain control for knee osteoarthritis. Non-elastic taping, but not elastic taping, provides benefits in pain reduction and functional performance (Ouyang et al. 2017).

How Many Maintenance Appointments will I need for Knee Osteoarthritis?

Distributing 12 sessions of exercise therapy over a year in the form of booster sessions was more effective than providing 12 consecutive exercise therapy sessions. Providing manual therapy in addition to exercise therapy improved treatment effectiveness compared to providing 12 consecutive exercise therapy sessions alone (Abbott  et al. 2015).

Cam Osteopathy

For more information or to book an appointment with an osteopath then click on the home page or book an appointment

Reference List

Arthritis Research (AR) UK (n.d.). Osteoarthritis of the Knee

Abbott JH, Chapple CM, Fitzgerald GK, Fritz JM, Childs JD, Harcombe H, Stout K. (2015)The Incremental Effects of Manual Therapy or Booster Sessions in Addition to Exercise Therapy for Knee Osteoarthritis: A Randomized Clinical Trial. J Orthop Sports Phys Ther. Dec;45(12):975-83

Abbott JH, MC Robertson m MC, Chapple, Pinto CD (2013). Manual therapy, exercise therapy, or both, in addition to usual care, for osteoarthritis of the hip or knee: a randomized controlled trial. 1: clinical effectiveness Osteoarthritis and Cartilage 21 525e534

Crossley KM, Vicenzino B, Lentzos J, Schache AG, Pandy MG, Ozturk H, Hinman RS (2015). Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: a blinded, randomised clinical trial. Osteoarthritis Cartilage. Sep;23(9):1457-64

Currier LL, Froehlich PJ, Carow SD, McAndrew RK, Cliborne AV, Boyles RE, Mansfield LT, Wainner RS (2007). Development of a Clinical Prediction Rule to Identify Patients With Knee Pain and Clinical Evidence of Knee Osteoarthritis Who Demonstrate a Favorable Short-Term Response to Hip Mobilization. Physical Therapy, Volume 87, Issue 9, 1 September, Pages 1106–1119

Fransen M, McConnell S, Harmer AR ,Van der Esch M, Simic M, Bennell KL. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic reviewBr J Sports Med. Dec;49(24):1554-7

French HP, Brennan A, B White, T Cusack (2011). Manual therapy for osteoarthritis of the hip or knee–a systematic review. Manual therapy

Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJM (2011).  Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review Journal of Physiotherapy Vol. 57 

National Institute of Clinical Excellence (NICE) (2014). Osteoarthritis: care and management

Salamh P, Cook C, Reiman MP, Sheets C (2016) Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta-analysis. Musculoskeletal Care. Nov 18.

Ouyang JH, Chang KH, Hsu WY, Cho YT, Liou TH, Lin YN (2017). Non-elastic taping, but not elastic taping, provides benefits for patients with knee osteoarthritis: systemic review and meta-analysis. J Orthop Sports Phys Ther.  Jun;45(6):453-61

Xu Q, Chen B, Wang Y, Wang X, Han D, Ding D, Zheng Y, Cao Y, Zhan H, Zhou Y (2017). The Effectiveness of Manual Therapy for Relieving Pain, Stiffness, and Dysfunction in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Physician. May;20(4):229-243.

 

Coccydynia (Coccyx / Tail bone pain) Osteopathy and Conservative Treatment Advice by Osteopaths

Coccydynia

Coccydynia, or coccygodynia, is pain in the region of the coccyx (Lirette et al. 2014).

coccydynia

The Coccydynia

The coccyx is the terminal segment of the spine. The word coccyx is derived from the Greek word for the beak of a cuckoo bird because of the similarity in appearance when the latter is viewed from the side. The coccyx is a triangular bone that consists of 3 to 5 fused segments, the largest of which articulates with the lowest sacral segment (Lirette et a. 2014).

The Function of the Coccyx

The coccyx has several important functions. Along with being the insertion site for multiple muscles, ligaments, and tendons, it also serves as one leg of the tripod—along with the ischial tuberosities—that provides weight-bearing support to a person in the seated position. Leaning back while in a seated position leads to increased pressure on the coccyx. The coccyx also provides positional support to the anus (Lirette et al. 2014).

What can predispose you to Coccydynia?

There are factors associated with increased risk according to Lirette et al (2014):

-Women are 5 times more likely to develop coccydynia than men.

-Adolescents and adults are more likely to present with coccydynia than children.

– Rapid weight loss can also be a risk factor because of the loss of mechanical cushioning when seated

Mechanism of Injury that can occur with Coccydynia

The mechanism of injury can either be external or internal trauma. External trauma usually occurs due to a backwards fall, leading to a bruised, dislocated, or broken coccyx. The location of the coccyx makes it particularly susceptible to internal injury during childbirth, especially during a difficult or instrumented delivery. Minor trauma can also occur from repetitive or prolonged sitting on hard, narrow, or uncomfortable surfaces (Lirette et al. 2014).

Non-Traumatic Coccydynia

Nontraumatic presentations can result from a number of causes, including degenerative joint or disc disease, hypermobility or hypomobility of the sacrococcygeal joint, infectious etiology, and variants of coccygeal morphology (Lirette et al. 2014).

Conservative Coccydynia Treatment

Conservative treatment is successful in 90% of cases, and many cases resolve without medical treatment. Relatively simple measures are sufficient in most cases. Modified wedge-shaped cushions (coccygeal cushions) canrelieve the pressure on the coccyx while the patient is seated and are available over the counter. Circular cushions (donut cushions) have been suggested for the treatment of coccydynia but they can place pressure on the coccyx by isolating the coccyx and ischial tuberosities and are more useful for treating rectal pain (Lirette et al. 2014).

Manual Therapy for Coccydynia

For the few cases that do not respond to these conservative treatments, more aggressive treatments may be indicated. Pelvic floor rehabilitation can be
helpful for coccydynia that is associated with pelvic floor muscle spasms. Manual manipulation and massage can be both diagnostic and therapeutic. Intrarectal manipulation can identify and potentially correct a dislocated sacrococcygeal joint. Manual manipulation and massage can help relieve associated
muscle spasms or ligament pain (Lirette et al. 2014).

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Reference List

Lirette LS, Chaiban G, Tolba R, Eissa H (2014). Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. Spring;14(1):84-7