Neuromuscular Re-education (NMR) for the Neck and Shoulder
I have recently completed an intensive course on deep myofascial/muscular massage for the neck, shoulder and scapular (shoulder blade) region.
Although no therapy is ever 100% successful, I have been quite pleased with the results in reducing pain and improving mobility in the shoulder so far, particularly in those of my patients where I felt that we had hit a plateau, and had ceased to make further improvements.
It is certainly not a treatment for the faint hearted; deep soft tissue work, particularly on chronically tight, painful shoulders can be uncomfortable, as fibrotic muscle is very sensitive to work on.
It is imperative that the patient feels in control of the treatment and can say if it is becoming uncomfortable or too painful for them. Even if the area is very sensitive, the treatment can be adjusted to work within a patient’s comfort zone, although some stiffness and soreness can occur for 24-48 hours after treatment – I know it did on me.
In some ways this takes me back to my student days, when I had severe back and neck pain and was treated by a local Osteopath who had studied under Ida Rolf. Rolfing, is a total body, deep soft tissue treatment, very popular in the 1970’s. It certainly cured me, and I remained out of pain for many years, although decades of Osteopathy – and Morris dancing – have finally taken their toll on my shoulders and knees! I know that, for me, deep work on tight fibrotic muscles can be very effective and long lasting.
I will be introducing NMR alongside my Neil-Asher shoulder work, as I feel these complement each other well, and will be monitoring the patients who have opted for this treatment, to see if their response bears out the NMR claims, and my own experience.
Watch this space!
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Are you prepared for winter?
Vitamin D is the only vitamin that the body can make for itself. It is made when the sun acts on uncovered skin – even a low SPF sun cream will prevent vitamin D production.
Vitamin D can be found in small amounts in oily fish, egg yolks and cheese, but this can only provide about 10% of your body’s requirements. To get enough vitamin D without sunshine you have to take supplements.
Since the widespread use of sun creams on children, the incidence of rickets has increased seven-fold in Warwickshire, which is why the Government Health Department has advised that all children under 5 years take vitamin D supplements to prevent rickets. Gov.UK Website
The symptoms of vitamin D deficiency in adults are sometimes vague and can include tiredness and general aches and pains. Severe vitamin D deficiency can cause osteomalacia which causes pain and weakness in your bones, especially in the spine and hips. This can cause stiffness and difficulty climbing stairs or getting up out of a chair. You may also be susceptible to frequent infections. This is why people often feel so much better in the sunshine; you can make over 10,000 IUs of vitamin D in just 15-20 minutes of unprotected summer sunshine.
Vitamin D deficiency has been linked to a number of diseases including:
- Rickets in children
- Osteomalacia and osteoporosis in adults
- Multiple Sclerosis
- Alzheimer’s Disease
- Asthma
- Breast cancer
- Inflammatory bowel disease
- Fibromyalgia
- Hypertension
- Depression
- And many more
If you are concerned that you might be vitamin D deficient and would like to have your blood vitamin D levels tested, The Osteopathic Practice has vitamin D testing kits for £25.00
It is a simple pin-prick test and the small spots of blood are sent to the Central Hospital Birmingham to be assessed: the results are accepted by all GP practices.
Please telephone the practice on 01926 335932 if you would like a private blood testing kit. We are happy to do the test here at the practice if you would prefer, and we can post it to the hospital for you.
For more information about vitamin D, and up to date news on the latest research please visit The Vitamin D Council website
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Autumn Conference of The British Medical Acupuncture Society
I recently attended the Autumn Conference of The British Medical Acupuncture Society where I heard an amazing lecture on the complications of menopause and alternatives to HRT. A real eye opener. Research of the treatment of hot flushes with HRT or acupuncture or phytoestrogens.
Menopause is often linked with symptoms such as:
- Hot flushes.
- Night sweats.
- Sleep disorders.
- Mood changes.
It can also be linked to an increase in the risk of:
- Osteoporosis
- Atherosclerosis.
- Raised cholesterol levels.
- Cardiovascular disease.
- Memory loss.
- Type 2 diabetes.
It was assumed that the hormonal changes of menopause was the sole cause for these changes, but, following recent research by the Obstetrics and Gynaecology clinic at the University of Genova, Prof. Cagnacci and his team discovered that the increased rates of chronic disease were linked to the frequency and severity of the hot flushes and nights sweats, rather than just the loss of oestrogen at menopause.
Women who suffered from frequent and/or severe hot flushes were much more likely to develop the symptoms of these chronic diseases than women who had very few/light hot flushes.
It was the flushes that were creating the health changes.
Following a hot flush a woman’s cortisol levels rise for about 20 minutes, with multiple flushes this cortisol level can be almost persistently raised in the blood, leading to:
Collagen loss which is linked to:
- Osteoporosis
- Weakened pelvic floor.
Insulin resistance which is linked to:
- Increase in visceral fat
- Metabolic disorder
- Type 2 diabetes
- Cardiovascular disease
Increased oxidative stress which is linked to:
- Reduced defence against free radicals.
- Memory loss.
The standard treatment to prevent these symptoms is HRT, but some women are unable or unwilling to take hormone replacement therapy due to the risks of breast cancer.
In this study Prof. Cagnacci and his team compare the response to HRT, or phytoestrogens (soy products) or acupuncture. Each group was treated for 12 weeks then the treatment was stopped and the women were monitored for another 12 weeks.
Findings after12 weeks of treatment:
Hot Flushes: The acupuncture group had a slightly greater reduction in hot flushes than the HRT group which was significantly greater than the phytoestrogen group.
Blood pressure: The HRT group had a slight increase in blood pressure, whereas the acupuncture and phytoestrogen group had reduced blood pressure.>
The phytoestrogen group had the most marked drop in LDL cholesterol. Acupuncture and HRT produced slight drops in LDL cholesterol.
HRT and phytoestrogens both gave measurable increase in insulin sensitivity, with acupuncture producing a slight improvement.
At the 12 week follow up after all the treatments had ceased:
The benefits were maintained with acupuncture, and to a lesser extend phytoestrogens, but were almost totally lost 12 weeks after the cessation of HRT.
They concluded that acupuncture and phytoestrogens were effective alternatives to HRT.
Palma, Federica & Fontanesi, Francesca & Facchinetti, Fabio & Cagnacci, Angelo. (2019). Acupuncture or phytoestrogens vs. oestrogen plus progestin on menopausal symptoms. A randomized study. Gynecological Endocrinology. 35. 1-4. 10.1080/09513590.2019.1621835.
Jane O’Connor ADO DO has been registered with the British Medical Acupuncture Society since 2008
Appointments available, telephone: 01926 335932
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Cranial Osteopathy
After reaching a peak with Jake’s behaviour one Saturday evening, we felt that we needed to try and help Jake with any problems that he may be experiencing. Although he was only five, he had experienced many stresses in his life which we felt had contributed to his erratic behaviour including extreme temper tantrums and a poor sleep routine.
In fact, Jake had not slept an entire night since he was born, and was a very restless sleeper. Jake had also suffered with recurring ear infections including a perforated ear drum. I had heard from my Health visitor, following the birth of our second son, that children who had had a traumatic birth and delivery sometimes show signs of erratic behaviour patterns. This was the case for Jake and with this in mind I set about researching this. To my surprise there were many pieces of research linking these two areas along with how it could also relate to recurring ear infections. My research pinpointed me to cranial osteopathy and how this could help children who were experiencing problems similar to Jake.
I then set about trying to locate a paediatric cranial osteopath and my research found Neil Lunt. I phoned the osteopaths on the Monday morning and spoke to Bruce and relayed my findings in relation to Jake. He was very informative and explained that it was Neil that I needed to see and made me an appointment for the same week. When the day of our appointment arrived I explained to Jake what would happen in order to prepare him. However, I had no need to worry, on arrival we were greeted superbly by Bruce who I had spoke to on the phone. Shortly after, Neil invited us in for our first treatment. He was wonderful with Jake-very calm and reassuring. I was amazed-Jake laid on the couch and allowed Neil to treat him for a considerable amount of time without moving- a rarity with Jake! Neil was very informative explaining what he had found and how he could help him. Jake immediately liked Neil and looked forward to his next treatment.
We noticed a dramatic change in Jake after the first visit. He was very tired and slept for a long time the first evening but woke very refreshed. After 48 hours Jake was explaining that his head felt much better and that he could hear everything we were saying. As the days passed Jake continued to improve in his sleep patterns, behaviour and calmness. We have now completed our course of three treatments and have seen a drastic improvement in Jake which both other family members and friends have also noticed. Although Jake is not perfect it has made a drastic difference to the balance in our family life.
Mrs S B.
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It had to happen sooner or later!…
It had to happen sooner or later!… Over the years my mountain biking pastime has been getting more serious; getting quicker, riding rougher, tougher terrain and taking more risks… I’ve fallen off numerous times before, but this time I didn’t bounce! I went over the handle bars and landed on my shoulder, snapping my collarbone.
I heard of low-level laser surgery whilst on mountain bike training course I did a couple of years ago. The coach’s son had broken his hand and with the help of the surgery was making a speedier than normal recovery. So I decided it would be worth looking into. I am self employed graphic designer so getting back to work ASAP was a big concern.
I found Jane O’Connor & Associates Osteopaths via a Google search and gave them a call. After a half hour consultation I decided to give it a go. I booked six 20 minute sessions spread over two weeks. My first session was around a week or so after the injury. Each treatment was completely painless and actually felt quite good as it helped massage the muscles around the break which obviously had had substantial trauma to them.
I actually managed to get back to work after the 1st or second treatment (by getting taxis & lifts from friends), as I work at a desk I could use this to help support my arm… after the 4th session I was out of my sling! I felt comfortable and strong enough to support my arm myself and the bruising around the break was starting to disperse.
I had another X-ray after around 6 weeks after the injury at the hospital to see how things were going, although the bones were still in their early stages of regenerating, the surgeon was quite surprised I had so much movement & strength back in my shoulder.
I really think the Low Level Laser & Ultrasound treatment helped with the healing process of my injury. I would highly recommend it to anyone involved in a similar accident, be it mountain biking, motorcross or any sport related misdemeanour! Although I wasn’t back riding for around 2 months after the injury, it helped me get comfortable enough to get back to work swiftly and keep earning while my bones repaired themselves in due course.
Mr M S Leamington Spa
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Ladies: the type of car you drive could be giving you back or neck pain!
Driving can cause back pain to both men and women, but as most cars are predominantly designed for men, many smaller women are suffering and don’t realise why.
The pedals
Most men can easily change gear by leaving their heels on the floor and swivelling their foot from the accelerator to the brake. Ladies with smaller feet can’t do this, and have to pick their foot off the floor and place it on the brake pedal. If they are changing gear at the same time, they could end up with both feet off the floor momentarily, which puts a lot of strain through the lumbar and lower abdominal muscles in supporting the weight of both legs. Commuting through town can involve repeating this bilateral leg lift tens (or even hundreds) of times every day.
Seat position
Research has shown that sitting with the back of the seat reclined to about 135o reduces the weight and strain through the base of the spine. If you are short, you may want to sit upright to be able to see over the dashboard clearly, but this will put a lot of pressure through the lumbar spine and can cause back pain.
This can be corrected by raising the seat base (if the adjustment is available) or by adding a firm cushion to raise up the seat, so that you can recline the back of the seat and reduce the pressure on the lumbar spine. 135o may be a bit extreme for some people, but reclining the back of the seat even a few degrees at first can often ease low back pain.
Three door versus five door cars
It may seem counterintuitive to have a five door car if you are small, but two door cars have larger doors, to allow passengers to get into the back of the car.
This means two things:
- These doors are much bigger and heavier, particularly if the camber of the road is against you. This can strain the shoulder and elbow because of the extra force need to push the door open.
- The door pillar is much further back, making it difficult to reach the seat belt. The driver has to twist hard to the right to reach the seat belt which can aggravate the low back if they reach with the left hand, or cause rotator cuff problems in the right shoulder if they try and reach backwards with the right hand,
A five door car will have doors that are smaller and lighter. The door pillar will be just behind the driver’s seat, so easier to reach the seat belt with less rotation to twist behind you.
Manual versus automatic
As previously mentioned, ladies with small feet have to lift both legs simultaneously to brake and clutch, which is hard work for the low back muscles. An automatic car allows one foot to be constantly on the floor, as you don’t need to declutch. Allowing more stability and support for the base of the spine.
Some gear sticks can be sprung to third and fourth gear so that, to reach first or second gear, you have to push the gear stick away from you by rotating and abducting the shoulder, this can lead to repetitive strain injuries to the shoulder and neck, if repeated multiple times in an urban commute.
An automatic car allows you to have both hands on the steering wheel at all times, which is much easier on the neck and shoulder.
Automatic cars are now almost as fuel efficient as manual cars, the gear changing is smooth and they are very reliable. Patients sometimes make the excuse that you can’t push start an automatic car – but realistically when WAS the last time you push started a car? Most cars have antilock brakes and numerous improvements.
If you have back or shoulder/neck problems, try an automatic car, it will make your driving so much easier.
Short drivers can be injured by the air bag
If you are short and sit close to the steering wheel so that you can reach the pedals, you are at risk from injury from the airbag.
In an automatic car you don’t have to compress a clutch pedal flat to the floor, so you can sit a little further back from the steering wheel and reduce this risk.
The Effect of Height on Injury Outcome for Drivers of European Passenger Cars
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217531/
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Varifocals and Neck Pain
Varifocals are a Jack-of-all-trades and master of none!
Although many people find that Varifocals improve their lives tremendously, there are two large groups of people who can have real problems with them:
Computer and Laptop use.
The lower part of the lens is for close work, such as, sewing or reading, but a computer screen is placed to be viewed straight ahead of you. You are then viewing it through the mid to long range part of the lens.
When using a computer or laptop, Varifocal users often tip their head backwards to be able to see the screen through the lower part of the lens, rather than just raise their eyes as they would normally do. Sitting with their head tipped back for long periods can cause neck pain and headaches.
This can be corrected by having a pair of Computer glasses just for keyboard work. The focal length can be optimised for seeing the screen and the keyboard clearly, by just moving the eyes up or down while keeping the head upright and in the correct postural alignment.
If you wear Varifocals and get you neck pain or headaches after using a computer, it might be helpful to get some glasses specifically for computer use. This can save you paying out for a lot of unnecessary treatments.
Walkers and those walking on slippery surfaces like icy pavements
As previously mentioned, the lower part of the lens in a Varifocal is designed for close up work like reading. Many people find that, when walking on a rough or slippery surface, they can’t see the ground clearly by just looking down with their eyes; they have to tip their head down to see the ground clearly. This can be uncomfortable and can make you more likely to fall – especially going downhill. This can mean that you can miss your footing as you can’t see where you are placing your feet, or you might miss a patch of slippery ice, as you won’t be able to see the shiny surface.
If you enjoy walking and hiking, it may be helpful to have Varifocals for that purpose, with the focal length at the bottom of the lens suitable for seeing the ground in front of you without having to tip your head down. This may make map reading a bit harder, but you could take a flat, plastic magnifier to help with that.
If you need to see the ground clearly when you walk, or have a fear of falling over – particularly if you have already fallen and broken a wrist or hip – it may be advisable to have Varifocals for walking. Some people with arthritis of the neck just don’t have the range of movement required to allow them to see through the best part of the lens and this can mean that they are either walking not being able to see their feet clearly, or they are aggravating their cervical arthritis trying to look down too far. Neither of these are ideal or helpful, and can be quite dangerous in icy weather.
If you want more information about Varifocals and neck pain, or if you have neck pain and need treatment, please telephone the practice on 01926 335932.
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Hot Desk Syndrome
Employees are now encouraged to use laptops at undesignated desk sites in the office or at home, called ‘hot desks’. It is also known as ‘Hot Desking’.
Unfortunately, laptops are poorly designed for use as the main work interface; if the laptop keyboard is in a good position to type, then the screen is far too low to view it properly. If you sit with your head bent forward looking down at a screen it will, in time, cause chronic neck pain and headaches: ‘Hot Desk Syndrome’
When treating Hot Desk Syndrome, I always advise my patients to request the following:
- A laptop stand, to raise the screen to a comfortable viewing height.
- A Trackball mouse
- A keyboard
- A footrest.
If you have to work at a ‘hot desk’ or if you have to travel to different offices, you could provide your own laptop stand, keyboard and mouse. They need not be too expensive to buy, or heavy to carry around and they will definitely help the health of your neck and shoulders.
If you want more information about Hot Desk Syndrome, or if you have pain and need treatment, please telephone the practice on 01926 335932.
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The Fear of Back Pain
You are going along perfectly happily and then, suddenly, you’re in acute pain – it stops you in your tracks – you can hardly speak!
Over the next couple of weeks, the pain gradually subsides, although a couple of times you do something silly and it catches you again – agony! This happens once or maybe twice a year, without warning, but you never see a doctor or seek any medical advice or treatment. Why? Because you’ve accidentally just bitten your tongue while talking or eating. It happens to almost everybody at some time or other.
The resulting swelling on your tongue or inside cheek feels like a golf ball in your mouth and you are aware of soreness all the time, but on closer inspection, in a mirror or with a finger, there is almost nothing to see or feel at all. How can such a tiny sore create so much pain and feel so large in your mouth? How can it ever heal when it constantly catches or chafes when you eat and talk? But it does heal, and we all know that accidents happen: we will be sore for a few days or weeks, then it will heal on its own, or with a simple antiseptic gel or mouthwash. We accept that there is nothing ‘wrong’ with our mouth, we just didn’t coordinate everything properly while chewing or talking – it just happens sometimes.
So why is there so much fear about a similar incidence of back pain?
Occasionally, the joint capsule or synovium, or a small muscle fibre can get pinched, pulled or caught. It just didn’t coordinate properly when making a sudden or unprepared movement. It can be acutely painful and feel as if something huge is blocking the joint, although there is nothing to see on an Xray or scan. It is acutely painful, but improves over a few days to totally recover within a week or two. It might occur once or twice a year and be perfectly normal the rest of the time. A story that seems remarkably similar to biting your own tongue.
The inside of the small facet joints of the spine and the inside of the mouth are not so dissimilar, they are both highly sensitive (especially to pain), have a good blood supply (can become inflamed if injured), and have to finely coordinate hundreds of micro-movements to allow everything to glide relative to each other without pinching or straining. Occasionally, the coordination isn’t perfect, and we accidentally pinch the synovium or capsule of the facet joint, or knee, or shoulder – or we bite our tongue or the inside of our cheek. Both are very painful, both heal fairly quickly, both needing a little care and thought in how we function while they heal.
If a mouth ulcer doesn’t heal, gets larger, or starts to bleed, or if a back pain causes other, remote symptoms or fails to recover within a week or so, then investigation and intervention may be needed. If you constantly keep biting your tongue, or the back repeatedly goes into spasm, further investigation would be necessary to find the cause. The majority of the time, they are simply minor accidents of poor coordination; isolated incidents, a painful nuisance, and certainly nothing to be worried about.
Part of my job as an Osteopath is to remove the fear and apprehension following acute back pain and to encourage a speedy return to normal activity and exercise.
I have the luxury of treatment time, to explain the cause of the pain and so allay a patient’s anxiety; to empower them to take control of their spine and not let their fear of pain limit their potential.
Yes, you bit your tongue, it’s painful, but you don’t stop eating or talking – you know it will heal.
Yes, you injured your facet joint, it’s painful, but you don’t stop walking or moving about – you know it will heal.
I find this analogy of biting your own tongue and not being frightened of it helpful in understanding that the body sometimes just gets it wrong, and minor injuries can – and do, randomly occur. It’s a nuisance, it’s painful – but it’s harmless!
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It’s that time of year again!
This is the time of year when we all promise ourselves that, THIS time, we will become slimmer, fitter, healthier and less stressed than last year. So, here are some tips that might help you go some way to achieve it THIS time!
Don’t try to change everything at once. Don’t expect to meditate for 20 minutes twice a day, stop all junk food, eat 7 portions of fruit and veg daily, and go to the gym 5 times a week – you know that you just won’t keep it up. Pick one small thing and concentrate on that for the month.
Eating healthily
Take vitamin D supplements through the winter (you can’t get enough vitamin D from your diet alone) 1,000 – 2,000 IUs a day. (Available at the practice)
If you take sugar in your tea and coffee, try reducing it by just half a teaspoon for a month, then reduce it by another half the following month.
Use a smaller plate, mug and glass. The bigger the plate, the more you will pile on it, the bigger the glass, the more you will drink. If you look at Georgian or Victorian tableware, they were so much smaller than those we use today. Remember, one 250ml glass of wine is one third of a bottle; two glasses is TWO THIRDS of a bottle of wine!
Don’t buy biscuits or chocolates for the rest of the family, then have the daily challenge of not eating them yourself. Just don’t buy them – you’ll be helping the rest of the family get healthy too.
Need a quick snack in the car? Get some nuts and raisins, rather than a bag of sweets. They will keep in a zip lock bag or small Tupperware box.
Don’t drink cola drinks – even the sugar free ones, they are linked to obesity and Type 2 Diabetes. Drink water or have a little fruit juice diluted with water instead.
Exercise
Don’t look for the nearest car parking space to your work or supermarket entrance, park a little further away and walk.
Place your waste paper bin on the other side of the room and get up to throw things away.
Go for a 15-20 minute walk at lunch – even 10 minutes of brisk walking would help. The latest advice is to walk for one minute every hour.
Get a Balance Cushion to sit on at work. It is a wobbly air cushion, that makes you use your core muscles to balance while you sit. Start with an hour or so, then build up to all day. It’s great for chronic back pain. (Available for £19.00 at the practice).
Try a few simple exercises at home, they don’t have to take long. A simple routine of hamstring and spinal stretches, Theraband resistance exercises for your upper body, and some step ups on the bottom stair, or try The Plank Challenge for core strength (check with your Osteopath first). Even 10 minutes could make a difference. For more information about a simple exercise routine, ask your Osteopath.
Meditation
Proven to have benefits on reducing pain, calming stress and combating anxiety and high blood pressure.
A simple technique is called the Mindfulness of Breathing. There are many versions of this, but one way is to concentrate on your breathing, focusing on where you feel the air come in to your nose, or feeling it as it fills your diaphragm. Breathe in slowly, breathe out slowly, count one. Breathe in slowly, breathe out slowly, count two. Do this until to get to five then go back to one again. As thoughts appear, let them pass and just gently return to counting your breathing again. This can be done for 5 -10 minutes, if that is all the time you have. I’ve even grabbed a few minutes of this standing in the checkout queue at the supermarket. You don’t even have to close your eyes. But don’t do it when driving!
Not enough time at work?
Turn your email notifications off. Check them at the beginning of the day, then concentrate on working. Check again at lunchtime and again towards the end of the day. The flashing up of an email causes you to lose concentration and will slow down your work. Most of these emails will not be essential, but will drag your concentration away from the job at hand. Research has proven that multitasking is NOT an efficient way to work, it is slower, and you will make more mistakes. And stop checking your Facebook page!
The Principal of One Minute
A Japanese method called Kaizen, Perform a specific task for exactly one minute at the same time of day. If you feel you really don’t have time to do anything, then pick a time and do your task for just one minute every day.
If it’s exercise you need, then march on the spot for a minute, or hop on your right leg for 30 seconds then your left leg for 30 seconds (recommended for improving the bone density of the hips), or step ups on the bottom step of a stair. If you’re fit enough, try jumping jacks – but spend 20 seconds of that warming up first.
If it’s meditation, then meditate for just one minute.
Balance not brilliant? Stand on one leg for 30 seconds then change legs. Make sure you stand near something stable that you can get hold of if you start to topple. If that’s too easy, try doing it with your eyes shut, but you definitely need something nearby to hold on to for that one.
Kaizen will enable you to start doing want you want, you can build on it as you take more control of your time. But everyone can find just one minute!
Taking control of your back pain.
Everybody underestimates how quickly time passes. Many of our patients telephone to say that their last appointment was about 3 months ago, only to find that it was nearly a year ago, and their healthy intention of regular, treatments has fallen apart – as has their back!
If you have arranged with your Osteopath to have a maintenance treatment every one to two months, it is better to make the appointment in advance, even if you are not sure what you will be doing; you can always change it nearer the date if you find it inconvenient. We will always send you a text reminder the day before, so if you have completely forgotten and find you can’t come the next day, we can easily change the appointment for you – but at least you will be reminded that your maintenance treatment is due.
Our six treatment discount cards are ideal for those who would like a regular treatment every two months – they can also save you £25. A year’s treatment for just £269. Please ask at reception for more information.
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