In Arsene We Trust….. Sort Of!

Being an Arsenal fan at this time of the season has of late become a harrowing experience, where we often see big name players being sold off, and relatively low profile players brought in, or extravagant claims made about a young prodigy being sensational in the pre season.

So it has been this year with Ade, Kolo & now Senderos leaving the Emirates, a new centre back brought in (Thomas Vermaelen) and a new wonder kid being hyped (Jack Wilshere).

I see from the betting exchanges that we are 8/1 for the title still, so someone must be keen.

Over breakfast this morning I was perusing the sport section of The Guardian and looking at the likely line ups for the Gooners, and I have to say that with Eduardo & Rosiky back we do have a very bright looking side. I am still not a fan of Gallas, but apart form that I like the look of a back four protected by Song or Diaby, wide players like Wallcott & Rosicky, forward thinking midfielders in Fabregas, Denilson and Arshavin and proven strikers in Eduardo & Van Persie (let’s not mention Bendtner here!).

So, In Arsene we trust indeed – especially if the big lad from Senegal/France can be persuaded to rejoin!

Chin chin – all comments welcome.

Open Golf

It was my pleasure to spend a few days in Turnberry watching the Open Golf Championship, which was eventually won by Stewart Cink in a thrilling play off with the old master Tom Watson.

Golf is a fantastic sport to be involved in, and for me I came to it late in life when I no longer possesed the capability to play football, and I can now be found taking divots from some of the best of my local courses as I challenge to drop down from a 28 handicap.

So with this in mind you can tell I was watching the professionals very carefully to try to pick up a few tips, but found my professional curiosity took over when it came to looking at how the body copes with the rigours, and none more so than the arms, wrists & hands.

The common condition for golfers is to damage the medial ligaments of the elbow, indeed this is known as golfers elbow (as opposed to tennis elbow which lies in problems with the lateral ligaments). However, the area that I saw most of the players apply self massage and mobilisation to were their wrists, especially after playing out of the tight rough.

The wrist is a fascinating structure, with the joint comprising of two rows of smaller bones (carpals), sitting between the bones of the forearm (radius & ulna) and those of the hand (meta carpals) which allows a mobile, but stable system when in equilibrium.

The problem comes from the fact that virtually all of the muscles for the hand cross over the carpal bones (with the exception of one – flexor carpi ulnaris) thus forces into the joint are not mitigated by muscular tenson (i.e. dynamic) but by ligamentous tension. In the case of a golfer who is swinging a club at full power at a ball lodged in grass there is tremendous kinetic force being generated which needs to be dissipated when the club head gets caught fast after contact with the ball.

This force tends to resolve through the carpal bones and is a common cause of dislocation of the bones, or fracture, both painful and debilitating since they prevent movement.

I spoke to some of the physios at the event who remarked about how much work the players put into building up strength and mobility in their wrists to avoid injury as well as improve their stroke.

In clinic I rarely see these type of injuries as a result of golf (most presentatios are as a result of falls) so I guess we club golfers are not so brave in our games as the pros – however, it has made me think that next time I’m up to my neck in some sort of diabolical cabbage that I’ll take a penalty drop rather than the speculative hack I would normally employ. As Peter Allis is fond of saying, it’s better to take your medicine early!

Happy hacking.

Kids & Knees….

Sorry for the delay in posting, but June has been a combination of vacations and busy!

Anyhow, I thought I’d open a conversation based around a few of my younger attendees to clinic over the past few weeks. I seem to have seen an increasing number of school age boys with problems with their knees.

The knee joint is actually the largest in the human body, but surprisingly acts as a sacrifice joint for activity below it in the feet and ankle, or above it in compensating for hip, pelvis or lower lumbar spine problems. What this invariably means is that pain in the knee is often not as a result of problems with the knee, and so any examination has to be fairly rigourous in determining the pre disposing and maintaining factors in the presentation.

In the case of the lads I’ve worked on, they have complained of a ‘tightness’ in the joint, with pain coming from ‘under the knee cap’, and activity exacerbating the condition.

There are two classic & common knee problems affecting (in particular) adolescents;

1) Osgood-Schlatters – where over recruitment of the powerful quadriceps muscles in the upper thigh, translates through the patella tendon into the knee, and more particularly in the inferior pole of the knee cap and point of tendon insertion into the tibia of the lower leg.

2) chondromalacia patellae – where the under surface of the knee cap becomes inflamed (or sometimes some of the structures close to it) and therefore very painful.

I have concluded, from my review of my patients cases, that what I have been observing is in fact a less dramatic presentation caused by three factors; firstly, the bout of supremely hot weather which tempted even the most trogloditic (not sure if a real word, but hey!) of kids away from their PSP’s/XBox/PC/DVD/TV existence; secondly, the Murray effect of Wimbledon which generated a brief euphoria amongst both kids & parents; lastly, the rapidly approaching football season, which has gathered pace as a result of high profile transfers and the England Under 21 adventure.

Thus I think I have seen the perfect storm for knee problems – namely, generally inactive kids suddenly becoming active, with emphasis on jumping, running and rapid changes of direction, hot weather affecting fluid balance in the kids, but also in the ground, turning traditional June mud into concrete & direct trauma from tackles/falls/general beastliness!

So I say, thank God for summer – just keep plenty of ice in the fridge, not for the G&T’s but to make an ice pack and slap on the little darlings knees when they get in (5 mins on 5 mins off for 1/2 hour should surfice).

Simple health your way.

Back Pain – That’s NICE!

Forgive me the headline, I’m not suggesting that back pain is a good thing, just commenting on yesterdays announcement by NICE (National Institute for Clinical Excellence) concerning their guidalce for GP’s when dealing with patients with chronic back pain.

In their definition chronic pain means that the sufferer has endured for greater than 6 weeks and less than 12 months.

The guidelines allow GP’s to refer to accupuncturists and spinal manipulation practitioners such as osteopaths, chiropractors, physiotherapists and properly trained allopaths.

What they haven’t said is how this is to be funded.

At present, for a non NHS practitioner to be paid for NHS work, we have to register as a Willing Provider with the PCT, which quite rightly involves an appraisal of the practitioners work, qualifications, insurance, financial propriety & suitability of premises. However, not all PCT’s are opening their lists to accupuncturists, osteopaths, chiropractors etc etc.

As a result I think we have seen a good start made to opening proven and effective manipulative treatment out to the general population, but, I don’t think it will be all that easy for patients to access these services on the NHS.

The NICE guidelines can be found here http://guidance.nice.org.uk/CG88

Fibromyalgia

It’s one of those diagnosis that tend to get given out as a last resort when all else fails, but I had a patient today who had been told she had Fibromyalgia in her neck – and I am completely baffled as to how this could be.

In all the literature, trials and texbooks, this condition is described as affecting either the whole body or the patient doesn’t have the condition.

Many references will follow the general outline of;

“pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist, and pain below the waist. In addition, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) must be present. In this definition, shoulder and buttock pain is considered as pain for each involved side. ‘Low back’ pain is considered lower segment pain”

There are some great resources to help sufferers both at a national level e.g. The Fibromyalgia Association www.fibromyalgia-associationuk.org and at local levels, with the group operating in Nottinghamshire being particulary active www.fibrofuture.org.uk/

The condition responds to osteopathy & massage to varying degrees, but these therapies certainly seem to make a big difference especially when the therapist understands that it is not a condition which affects the musculo-skeletal framework, but one which is biochemical in its origin, especially around fluid balance and autonomic nervous systems.

Thus, when the diagnosis is accurate we can be effective.

Backache – The Gardeners Woe

As promised in an earlier post, I thought it might be a good idea to look at some of the common ailments and afflictions for those active in the garden at this time of year.

High on the list will always be that deep, boring, nagging pain into the lower back – the one you tend to feel after planting a couple of rows of potatoes or beans.

I guess you would expect an osteopath to be rubbing their hands whenever anyone mentions back pain, however, it is rarely a simple problem to diagnose or treat. The old tale that you simply have to ‘click’ the bones back into place and the pain goes away is founded more in myth than in fact!

The lower back and spine has many structures which can give rise to pain as a result of an intensive period of lifting, bending, turning or a combination of all three. Chief among these are the muscles which provide power and stability into the lumbar region, the abdomen and the buttocks. These major muscles are responsible for all movements and therefore it makes sense that they will be the ones to suffer if we do too much. Interestingly, most people tend to think of muscle pain as not being too serious, however, it is often the main component of pain the region – either due to damage to the muscles themselves, or more commonly, where the muscles enter a state of spasm in an attempt to prevent movement into areas which have become damaged.

Naturally, everyone tends to worry about damage to discs when they have a problem with their backs, and again the old thoughts about a disc becoming dislodged or displaced are often touted in the pub as the cause of pain. In reality the disc is an elasticated bag filled with a liquid jelly that is fixed to the vertebrae above and below it, thus it can’t move. What does happen is that the eleasticated bag can split and some of the fluid escapes, thus the disc is said to be ruptured.

This is a very serious condition, and requires a lot of input from the therapist and patient, often over many weeks, to correct.

In most cases the act of gardening doesn’t put the discs at too much risk, unless there is a lot of lifting and turning involved.

Lastly, the prime culprit for pain into the lower back are the ligaments. These are inelastic structures which fix across joints to help stabilise them, in structure they have a highly developed nervous supply, but very poor blood supply. Thus, if one becomes damaged or inflamed you very quickly know about it, however, wheras a muscle can be healed and pain free within 10 days, ligaments take 4-6 weeks to repair. These structures are the principle factor in ‘lumbago’ and will often cause the sufferer a high degree of pain, especially first thing in the morning.

So, having given a brief insight into back pain, the next post will discuss what can be done about it – not by me but by you! After all, health has to be your way.

Osteoporosis – A Treatment Dilemma

A few days ago an elderly lady presented at clinic with pains in her back, hip and shoulders.

She had suffered this pain for several months and had found no relief from prescription pain killers or postural supports & walking aids; so had come to see me on the basis that I had helped several of her friends with problems with their backs.

When I talked with her it became apparent that she had discussed visiting me with her GP, who had advised against it because all I could do would be to ‘crack her bones’, and this wasn’t suitable for the disease which was affecting her skeleton. This tends to summarise several factors about being an osteopath;

1) As a profession we haven’t really developed an identity beyond the cracking of bones, even though this forms a minor part of my, and many other practitioners approach to dysfunction. The concept that manipulation is the only course of treatment is certainly not one that resonates with me, not least because it tends to take the body back into a defensive state as the sympathetic nervous system kicks in.

2) Again, as a profession we are making very slow headway with the allopaths (GPs & hospital specialists) in proving where our skills lie. Through the regulatory body – General Osteopathic Council (www.osteopathy.org.uk) and our professional body – the British Osteopathic Association (www.osteopathy.org) there are initiatives to develop this understanding, and even the government drafted a document to promote the use of complementary practitioners in patient care called the Musculo-skeletal Framework Document (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4138413). However, there is so much more to be done.

I say this not as a way to generate income, necessarily, but also to develop a closer and integrated response to helping people to overcome problems.

3) The amount of information that patients are given about their conditions is often lacking in detail – and ususally lacking in support. Now, I am definitely not criticising GPs in this respect, merely noting that within a 10 minute appointment it is impossible to properly engage with and inform the patient. See point 2) above.

As it became apparent this poor lady had advanced osteoporosis and had sufferd a collapse fracture of several vertebrae in her spine – a condition without a quick cure, in fact the considered approach is to offer pain relief and home help if needed.

Whilst I was researching the condition I came across the following which summarises the treatment options for the condition, and shows how these diminish with age;

In the event, I was able to help with the patients pain through very gentle massage and cranial techniques, and more importantly gave her a series of simple exercises which would help her maintain mobility and health.

I talked to her about Osteoporosis and how she could help through her diet and activity, in addition we discussed how she could use the swimming pool (as she was a avid swimmer up until her back hurt) to help her maintain her flexibility. The benefit of a pool is that her body becomes non weight bearing so that she is able to work to increase her range of movement. Then by continuing with the weight bearing exercises she improves her bone structure.

The effect of weight bearing and non weight bearing exercise being combined is that she maintains her range of mobility as well as stregthening her muscles and bones.

The effect of seeing this patient has sent me scrabbling back to research to try to understand more about the condition, which can affect men as well as women, and help me to improve the way I can help sufferers achieve more without risking them.

‘Cracking their bones’ indeed!

Health, as always, your way.

Wembley Woe

The pain of being in Wembley, on a glorious day and then seeing your team play well below par and get mugged out of the oldest cup competition in the world wasn’t even eased by the result from the following day.

Sometimes the emotion of football seems to hit the most primitive of neural systems, evoking the true sympathetic ‘flight or fight’ response, and Saturday was one of those days – I so wanted to see an Arsenal victory, that the result really left me down. Maybe it was just a factor of being carried by media hype, or the fact that we were on such a run of form or even just misguided loyalty, but I really thought we would win.

Hey-ho always the Champions League to look forward to!

The Village Site

Over the past few days I have been speaking to the wonderful folk who manage and maintain our local village website – and it is a real pleasure to be able to agree a sponsorship with them for the site.

I have a passionate belief in the value of strong communities, and try to help out where I can. Of course, my clinic relies on those in the immediate area seeking us out to help with the aches & pains of life, so I see this as a win-win opportunity.

For those who are new to this blog, scroll down to find a few health related articles – and feel free to comment.

Spring is now well and truly upon us, so in the next few weeks I will be putting a few posts up about looking after yourselves when the rising sap makes us believe that we can spring into action without a warm up.

You know who you are – health has to be your way!

Penalties & Cardiac Arrest

Ok, so it was never in doubt….. much!

I watched the Sky Sports News team for the closing period of the Arsenal/Roma game last night, and whilst thoroughly enjoying Merse’s irreverant and forthright comments (e.g. How does Eboue get in the team, he’s rubbish), I shared the obvious concern that Champagne Charlie Nicholas had about our side.

And then….. the penalties. Ye Gods being an Arsenal fan was never an easy option, even when we were invincible (those last minute Tel goals to draw etc etc) but that was a real nail biter.

Still the medics tell me that they may be able to uncross my fingers within a week, but my toes will definitely need the attention of a osteopath!

Bet we get Man U next round!