Osteopathy considers the patient from a mechanical and functional point of view to allow the body to work with minimal stress, strain and energy. The mechanical problems occuring within the body can create imbalances within the normal tension of the spine. Misalignments of spinal vertebrae may cause irritation to the nervous system and affect not only the functioning of the musculo-skeletal system but also the organs that drive our bodies.

Below is an overview of ailments that a patient can present with spinal misalignment.

Below is an overview of ailments that a patient can present with spinal misalignment.

A living curve – an osteopathic approach

Give a prescriptive list of areas to treat when faced with a patient with scoliosis is to do an injustice to both osteopathy and the scoliosis. After all, a scoliosis is a general term for a lateral curvature of the spine but a variety of scolioses exist, all of which have unique characteristics that are necessary for the osteopath to consider when assessing, diagnosing and treating.

Idiopathic scoliosis is a scoliosis that has no known pathological cause. Of all the scolioses it is the most worrisome due to its potential compression of the viscera; the lungs and pericardium. The scoliosis begins normally during childhood or adolescence and stops once spinal growth ceases. The scoliosis can be either thoracic, thoraco-lumbar or lumber. It is normally thoracic and is identified by the involvement of the ribs which which produce a so-called “high-side”, a phenomena in which the ribs are thrust backwards on the side of the convexity.

Compensatory scoliosis is one where there is nothing intrinsically wrong with the spine per se but rather external forces affect the spine, such as a tilted pelvis from shortened adductor or abductor muscles, a leg-length difference or a fixed abduction or adduction deformity of the hip. Usually, once the cause has been removed, the scoliosis dissappears unless the scoliosis has been left untreated for many years and resulted in tissue shortening around the spine.

Secondary scoliosis is normally secondary to an underlying pathology such as poliomyelitis or cerebral palsy where unequal muscular contracture as a result of the pathology results in extreme angulation of the spine.

Sciatic scoliosis is a temporary form of scoliosis which is normally a person’s attempt to protect oneself by reducing pressure on an irritated nerve. Once the acute phase is over the scoliosis normally disappears.

In the First phase of osteopathic consultation, Dr. Ravinder Kumar will start with a few questions to understand what has made you to the practice. In discussing your symptoms, the osteopath will firstly ensure that osteopathy is the only correct therapy for you. Otherwise you may be referred to another therapy like osteopathy, Chiropractor, Physiotherapy or health professional.

The osteopath may also carry out a physical examination, If you prefer, you can also wear shorts or loose trousers and a thin top. Don’t hesitate to contact to the osteopath if you have any concerns. The osteopath will perform various tests including blood pressure or neurological tests if he needs to be sure that osteopathy is safe for you and the only best option. He might then perform other orthopaedic and mobility tests on your symptomatic area and possibly at other parts of your body as the source of the symptoms may lie elsewhere.

After his examination, he will explain his researches to you and will work with you to prepare for best treatment plan. You can also ask questions any time during the consultation.

The osteopathic examination should focus on assessing the movement of the axial skeleton. The osteopath should try and determine to what extent the axial skeleton, that is, the sacrum, the spine, the ribs, the sternum and the cranium are being dragged away from the mid line. The osteopath needs to examine these areas both passively and actively in order to assess which of these areas show most restriction of mobility. It is often the case that the thoraco-lumber area and the cervico-occipital junction display most restriction.

Once the osteopath has observed the axial skeleton, the peripheral areas should be observed. For example, observation of the foot-arches, knees, hips, the pectoral girdles. Osteopathic examination should involve comparing the shoulders and the pelvic girdles, assessing inequality. The osteopath should be aware of the Adam’s test, a test which involves flexing the spine forward as if to touch the toes. This test exaggerates the high-side and shows the extent of the scoliosis.

Factors for the osteopath to consider:

The pelvis – The osteopaths needs to observe the pelvis for tilting. A tilted pelvis will result in a lateral curvature of the lumber spine. Therefore the osteopath needs to decide what is causing the imbalance in the pelvis and if necessary to treat the muscles that connect to the pelvis such as the hip adductors and abductors. Similarly the osteopath should check for a leg-length difference.

Pelvic and Shoulder girdles – The osteopath can develop a good understanding of how the body is adapting to the scoliosis by observing the pelvic and shoulder girdles. Any raised shoulder could well be coming from a lateral curvature in the spine. So too a raised posterior superior iliac spine could be causing an imbalance in the spine and shoulders.

Occipital protuberance – The occipital protuberance should be directly above the gluteal crease. Any deviation from the line indicates a lateral curve in the spine.

The diaphragm – The diaphragm should be observed both passively and actively as the patient breaths. The osteopath should check the lower 6 ribs and the upper lumber spine where the crura of the diaphragm attach. A lateral curvature of the spine that involves rotation through the thoracic spine will inevitably affect the ribs and the diaphragm.

From a cranial-osteopathy view much emphasis is placed on a few areas:

The spheno-basilar-symphisis – the body’s attempt to overcome the scoliotic changes in the spine results in the cranium shifting in order to keep the vestibular and optic senses balanced. This may mean that the cranium is tilted slightly, causing alteration in the natural position of the occipital condyles. This will then be reflected in the movement of the spheno-basilar-symphisis. The osteopath needs to assess each person individually to check to what degree and in which direction the occipital condyles have adapted and so too, what type of strain is reflected through the spheno-basilar-symphisis.

The abdominal muscles are a doorway to palpating the viscera. So often the lateral curvature of the scoliosis results in compression and compensation of the visceral contents. Using cranial and visceral osteopathic techniques in particular, the abdominal muscles give a good indicator as to the internal changes occurring from the change in weight bearing.

The osteopath should mainly focus on the somatic dysfunction that occurs as a result of the scoliosis, paying particular attention to the postural decompensation that occurs. The treatment should then be aimed at focusing as much as possible on restoring the biomechanical changes and helping them do compensate. The osteopath should try to reverse the postural decompensation and try and strengthen any areas that will help strengthen the curve and prevent it from collapsing. Similarly, the osteopath will do well to pay attention to balancing the sacrum and pelvis and as much as possible restoring symmetry. Finally, the osteopath should include work around the neck and cranium in order to remove any possible dysfunction in the proprioceptive units within the cranium.

In Dr. Ravinder Kumar,Ortho Neuro Physiotherapy, chiropractic/chiropractor, Osteopathy Clinic, Ghaziabad The term scoliosis means a distortion of the body structure into a curvature. This is usually recognized in the spine but may also be found in the pelvis, and occasionally in the mechanism of the cranialbones. Spinal scoliosis may be structural dueto a bony developmental defect as for example the absence ofa rib on one side, or an incomplete development of a vertebra. It may be the result of a neuromuscular isease such as cerebral palsy in which the spinal muscles are more spastic on one side than the other or a paralytic condition in which the muscles are much weaker on one side. In these conditions the spinal muscles exert a greater contraction or side-bending force on one side of the spine than the other. Abdominal surgery in infancy or childhood may leave a scar on one side of the abdominal wall which may, as the child grows, cause a curvature in the back because the soft tissues around the scar are hardened with fibrous tissue and cannot lengthen equally with those of the other side.

But these structural causes of scoliosis are rare. Far more common are the idiopathic adolescent functional spinal curvatures. “Idiopathic” means that the cause is unknown, “adolescent” implies that it is most commonly found as the child enters the adolescent or teenage years; and functional indicates that there is no bony deformity.

There are however some causative factors recognized by the osteopathic physician that are responsive to osteopathic manipulative treatment. In order to appreciate them regard this patient as a dynamic unit of function from head to feet and not merely a vertebral column with an unusual curve in it. Examining the standing patient from the back the level of ears, the shoulders, the scapulaeor shoulder blades, the crests of the ilia are noted for their symmetry, is one side higher than the other. If the patient then bends one knee but keeps the weight equally on two feet it is possible to observe side-bending in the lumbar area – do they move symmetrically or is the side bending greater to one side. Next ask the patient to balance on one leg and note how far the pelvis drops on the opposite side. Is the range of motion equal to that when standing on the other leg. Less motion indicates restriction of physiological motion in the sacroiliac joint. How far can the patient bend forward toward touching the toes without bending the knees. As the patient uncurls note whether the rib cage is symmetrical on the two sides. Aprominence of one side may be the earliest evidence of a scoliosis of the spine. Is there freedom of motion to permit elevation of the straight arms beside the head.

Is the scoliosis still evident when the patient is seated? Standing behind the seated patient place hands on the front of the chest or the sides of the chest to note whether the ribs move symmetrically.

Asymmetric expansion on one side may be due to scoliosis. The patient is then examined lying on the back, to evaluate leg length symmetry, pelvic balance, symmetrical motion of the sacrum within it, and to evaluate the spinal muscles for symmetrical tension or vertebral rotation.

The cranial mechanism is then palpated for distortion of position or asymmetry of motion. The question may be asked, what has the head to do with a spinal curvature. From a functional point of view the body hangs from the head and distortion of the cranial mechanism, commonly from a long or traumatic birth, predisposes to curvature in the spine by way of unequal fascial drags on the body. Orthodontic treatment which endeavors to change and intends to improve the relationship of the jaws may also induce or aggravate spinal curvatures.

The diagnosis will also include a standing X-ray which not only evaluates the nature anddegree of the spinal curvature, but also provides a study of the equality of leg lengths.

The treatment will include osteopathic manipulative treatment to the pelvis and the head, the rib cage, the abdominal wall and the fascial mechanism of the body as well as the area manifesting the spinal curve. If there is an anatomical shortness of one leg a corrective lift might be added to that shoe. In addition to, but not in place of the manipulative treatment some simple exercises may be given to perpetuate the benefit of the treatment.

Carrying a backpack must be carefully monitored. If used it must not be overloaded and must be equally balanced across both shoulders.

The fitting of a brace may be indicated in a severe structural scoliosis. Surgery may be indicated if the condition has rapidly deteriorated or structural anomalies exist. But in our experience if osteopathic treatment is administered first these more drastic measures are needed less frequently.

Many of know what stress is and know that it is detrimental to our health. It raises blood pressure, weakens the immune system and can result in headaches and IBS, but how does it affect our musculo-skeletal system (muscles and joints) and nervous system?

Breathing

When you breathe, do you take long calm breaths or short shallow ones? Many of us breathe shallowly from our upper chest, rather than from the diaphragm. If we’re breathing correctly, as we breathe in our tummy should expand and the diaphragm (the domed muscles under your ribs) should flatten as it contracts and pushes downwards on our abdominal cavity. This downward pressure helps with lymphatic drainage and circulation, stretches our lungs and draws in more air and also helps to massage and push food along the gut.

Digestion

Stress also results in a tightening of the circular sphincter muscles which line the gut which, in turn, restricts the ability for materials to pass along the gut. Gas and matter then builds up behind these restrictions leading to bloating and alternating constipation and diarrhoea and potentially Irritable Bowel Syndrome (IBS).

The nervous system

When you’re stressed the parasympathetic nervous system (part of the autonomic, non-voluntary, nervous systems) is switched off or dulled down together in favour of the sympathetic, fight-or-flight, nervous system, which slows down or halts the action of the reproductive and digestive systems. This happens because, when we perceive a threat, the body needs to focus on responding to the perceived threat with a fight-or-flight response – whether it’s a long or short term stress. Short term adrenaline is released as an appropriate response by the body. The problem is that a lot of us hold on to that perceived threat for a lot longer and continue on to a chronically stressed state. This weakens the immune system and, ultimately, can lead to adrenal fatigue where the adrenal glands become unable to respond, digestion problems like IBS and reproductive issues like infertility.

Posture

You raise your shoulders up to your ears, hunch forward, clench the muscles around your jaw, neck, shoulders, back and arms when you’re stressed. This long term tension requires a lot of energy throughout the day which leads to muscle fatigue and aching.

What’s the answer?

we get used to a certain level of stress and the adrenaline ‘hit’ it gives us and find it very difficult to slow down – perhaps by introducing exercise and relaxing things like reading and meditation into our lives. The key to effective stress management is to look at the situation long term and deal with the both the physical and mental aspects via a multidisciplinary approach. Osteopathy can help by rebalancing the fight-or-flight sympathetic nervous system and vegetative state parasympathetic nervous system mentioned above, to reduce muscle tension (particularly of the diaphragm), encourage joint mobility and improve motility in the digestive system which, in turn, leads to a better state of mind. You may not need that many sessions to ‘reboot’ the body and mind to a calmer, more contented, state. More advice and exercises can then be given for you to do at home to maintain the more peaceful equilibrium.

Every week at the Not Just Backs clinic, we get patients complaining of headaches, neck strain, shoulder aches, tennis elbows, mid and lower back pain… but would you believe it if I said the most common root-cause is quite simply work stress?

Annually, 5 million people report suffering from work-related stress, which has physical as well as psychological effects. Combine this with poor work posture and it’s no wonder so many of us suffer pain.

Despite many people choosing to ignore or diminish the seriousness of stress, it is very much a real condition with numerous causes and symptoms.

Consider this scenario: you’re sat at your desk, and you have an important deadline looming at close of business today, which you and your colleagues have been straining towards for an entire week. Long days, short nights, breakfast on the go, packed lunches at your desk, late dinners, loads of coffee to keep you awake, water only when you think of it… sound familiar?

How does your body react to this pressure?

Maybe somewhat like this: your head is peering forward, neck craned and extended, your shoulders thrust up and forwards. Your ribcage is compressed as your back hunches, your lower back and pelvis compressed into the cushion of your chair, and maybe even your legs are crossed to relieve some pressure in the lower back…

Then add a layer of uneven muscle tension: extremely tight in the back of the neck, chest, abdominals and groin area; stretched and weak across the middle and lower back.

Osteopathic treatment is highly effective at addressing the symptoms of body stress at any point in time.

However the real challenge is managing these symptoms long-term, which shapes the way we help and support our patients here at Not Just Backs.

So if you suffer from workplace stress and it is manifesting itself as pain, do not put up with it any longer.

Headaches and osteopathy

Many people suffer from headaches and migraines, often for many years without finding a solution. A large proportion of these people also resort to headache pills and migraine preventatives which can build up stress within the digestive tract such as the liver and stomach.

The ‘mechanical’ causes of various types of headache are frequently overlooked. Muscular tension in the neck and shoulders can be a major factor and is often the underlying cause. This is usually a symptom of a joint problem in the neck that creates chronic muscular tension and can easily develop into a full blown headache. A history of neck pain is usually also present.

Stress and tiredness can also be a factor but this is more likely to lead to a headache when there is an underlying problem in the neck which has never been treated.

Causes of neck problems

• Trauma (whiplash, for example)
• Childhood injuries such as a fall on the head
• Lower back problems which create neck problems over years due to asymmetry
• Occupational – such as manual labour or poor ergonomics at the work desk
• Eyesight – particularly true when lenses are not properly adjusted and cause protruding of the neck
• Postural – rounding upper back and shoulders causing a kinking in the back of the neck

How Osteopathy can help

Osteopathy can make a big difference to a long term neck problem and alleviate a headache, even ones that have been troublesome for years. A medical history and osteopathic examination can discover problems in the body and check on spinal alignment. Treatment is then aimed at improving alignment, muscular imbalances and posture.

How osteopathy works

Osteopathy works by restoring normal mobility to joints and reducing muscular tensions. These two problems usually go hand in hand. This why massage on its own can be limited in its effects.

Long term joint stiffness also can compress or ‘pinch’ nerves which can then be the major source of a headache or migraine. By releasing pressure on a compressed nerve, the results can be almost immediate in relieving neck pain and stiffness.

What does osteopathic treatment involve?

You can expect some or all of the following during an osteopathic treatment:

• Soft tissue massage and stretching
• Joint mobilisation and/or manipulation to stiff areas
• Exercise advice – this can be what to avoid as well as what to do
• Postural advice
• Dietary advice when relevant (for example, avoiding foods that may trigger migraines)
• Suggested amount of treatment needed and optimal intervals between treatments
• Treatment addresses the body as a whole, not just the neck

So why not try it out? In one visit to an osteopath you can find out if your headaches or migraines have a deep cause from a neck problem.

At The Chelsea Osteopathic Practice, we have three registered osteopaths with appointments available from Monday to Friday. Early mornings and late evenings are available.

Migraine and osteopathy

Migraines, we never know what might set one off, but once it’s there, it’s persistent.

More than 80% of those with migraines never seek treatment although there are simple and quick solutions to be found!

It has to be said, are migraines doing your head in?!

Well today we will teach you the osteopathic methods to treat this very common condition

Symptoms of migraine

• Only on one side, the right or the left
• Who evolves by crisis
• That changes with each event and can last up to 72 hours if left untreated
• The migraine is pulsatile, meaning that you can feel your heart beating in your head
• The pain increases during physical activity
• This pain can be accompanied by nausea or vomiting
• You become more sensitive to light or noise

5 common causes of migraines

Biomechanical cause

You can suffer from a migraine following a severe trauma such as a car accident, a concussion, or a fall from a bicycle.

This, or these traumas create muscular, joint or skeletal biomechanical tensions in the regions of the spine or skull.

These biomechanical tensions are equally found in osteopathy after a series of wrong moves, poor posture, poor ergonomics that can in the long-term cause you to have recurring migraines.

Nervous cause

Because of a pinching of the nerve

This is the case in occipital neuralgia, which, if it is pinched, will create a burning sensation or electric discharges that go from the nape of the neck to the top of the skull and sometimes to the eye.

Other nerve compressions can also be found in the origin of neurological migraines such as:

• Great auricular neuralgia

• Neuralgia of the lesser occipital nerve

Biochemical cause

In women, menstruation can bring on head pains due to hormonal changes, most notably in response to a lowering of oestrogen levels and/or tensions in the lower pelvic organs (via the fasciae).

Vascular cause

This cause is linked to a reduction in intra-cranial circulation of blood. Remember that the arteries and veins play an important role in the distribution of oxygen and the nutrients necessary for proper functioning of the organism.

Ophtalmic cause

In this case there are visual symptoms that appear first and foremost. There is usually a spot of light that slowly gets bigger and occurs in both eyes. This can last for anywhere between 10 minutes and a half-hour.

Osteopathy treatment

Osteopathy is used to treat the patient in a holistic manner, that is, globally. This takes into account the symptoms evoked by each individual and adds to this the results of a manual examination to propose an optimal therapy that is customized to the patient.

The aim of the treatment, if it is complete and well done, is to avoid recurrence or to increase the period of time between events.

For migraines, a belief that was handed down from the founder of osteopathy, Andrew Taylor Still applies “The Rule of the Artery is Supreme”. In fact, migraines are generally linked to defective cranial vascularization. The intention is therefore to reset the circulation at the level of the various arteries by various methods.

The treatment can also be multidisciplinary with the intervention of another discipline to best optimise treatment; notably the neurologist or the orthoptist.

Whether it be posture related issues or pain, spinal injury, bulging disc or pain in the spine or from the nerves originating at the spine our osteopaths are your spinal technicians and we can help.

Our Osteopaths will work to assess your problem area by performing any relevant tests and examination in the consultation. This will allow them to come to a diagnosis and they will then provide relevant hands on treatment during your consultation, which may include massage, stretching, joint mobilisation or loosening, and ligament work.

You may then be given some tips or further rehabilitation exercises for at home to speed up your recovery.

Our Osteopaths are able to refer you for X-ray or MRI if required to get the answers needed.

Things the osteopath will consider when working with you are:

• Why did this problem start?
• Is there other areas in the body affecting or contributing to the issue?
• How can we resolve the pain or problem area and help the results to last?

Cervical spine (neck)

“Ipad neck” forward head carriage

Forward head carriage or as we like to call it “ipad neck” is the posture of the head jutting forwards in front of the shoulders from hours spent everyday looking down at mobile phones and ipads or sitting at a computer based work station. This in turn stretches the spinal cord, nerves, important ligaments and muscles which can then refer pain to the head.

. Neck pain/strain, Disc bulge, Wry neck, Pins and needles or numbness in the arms or hands

. Headaches associated with neck,Muscle tightness

Thoracic spine (mid back)

. Pain, Rib pain, Disc bulge, Postural tension, Muscle tightness,Pins and needles

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Lumbar spine (lower back)

Pain, Strain, Sciatica, Muscle tightness, Disc bulge/slipped disc

Pins and needles or numbness in legs, Arthritic pain

AS- Ankylosing spondylitis

Back Pain

Back pain is very common and is the main reason patients consult osteopaths. We see a lot of low back pain patients. Jerry has a particular interest in it and completed his Doctorate on it and the different factors that may influence it.