Do you get pain when playing golf?

At Back to Back we treat more than a few golfers and their injuries. An injury common to the golfer may be one of many…. But often a golfer presents with pain in their elbow, shoulder, their back, hip or knee. Pain is all too common in golfers!

Identifying with their pain can be the easy part. Working out why they have pain is often a little more challenging.

Assessment of injuries

Our AFS (or Applied Functional Science) team will be best to do this. Their aim is to track down the ‘why behind the what’. What I mean by this is … why has that particular area of your body failed? Which area in that person’s body is not working as it should and increasing the ‘load’ elsewhere?

I saw a patient last year and remembered this all too common story. He was in his late forties with a handicap of 4! He had been suffering with right shoulder pain for the previous 5 months! He had seen a few other practitioners before finding his way to the clinic.

To me, it was crucial to see him swing as if he was hitting the ball! Watching this and adapting the way he hit the ball, it immediately became apparent that he was restricted in his left hip. As he was halfway through his backswing the movement that should have been available at his left hip was not there and he was then using his upper back and right shoulder to do much more work than it needed or was build to do.

All that was happening was his shoulder was becoming strained because of his hip! Before coming to see us, this lovely patient had had his shoulder and surrounding area rubbed for 14 treatments. Working with his left hip and left foot and integrating them into his swing gave great results in 3 treatments and he was almost pain free at 4 treatments. He still has a small way to go, but it just goes to show that rubbing symptoms (in this case the shoulder) is not always the right answer. Getting fully assessed by someone that appreciates integrated movement and treats the body as a whole is critical.Get assessed properly and get properly fixed!

-James Dodd

Knee pain and running

Very recently, there was an interesting article in The Guardian on ‘runners knee’ and knee pain.  The link is here.  The article contains some great information.  But we feel where is does fall short is not mentioning how critical it is for the landing hip to work (not just your gluts) and how essential it is for the foot to be able to sustain the mass of your landing.   With knee pain, sometimes the last place you need to look at is the knee.  So many other factors can affect the knee.

Knee pain is certainly not just about ‘pronation’ or the ‘rolling in’ of your foot.  If you have a high arched foot your knee takes more hit as you are unable to react to the ground well.  Sometimes people need to pronate more!  Gary Gray from the Gray Institute coined the phrase ‘Everything changes when your foot hits the floor’ and he is so correct!  You also need to assess what happens to the ‘back leg or trailing hip.  If your left hip does not extend fully – the knee of your right leg will have to work harder.

I think it is critical to appreciate that everything is connected in our bodies.  How one area not working may or may not increase the load onto another and make the body compensate.    Then knee is stuck between your hip and your foot.  It is more likely that one of these is not working well and the knee pain is only the symptom.

Then the rehabilitation must then target the areas that are not working, rather than just the symptomatic areas.

If you are concerned about your running or indeed are suffering, make an appointment to come and see one of our great osteopaths.

Blog post by James Dodd

Ibuprofen and back pain

The Guardian recently reported ‘Anti-inflammatory drugs or NSAIDs (like Ibuprofen) are not much more effective than placebo and patients taking them are 2.5 times more likely to suffer from stomach problems’.  See the link to the article in The Guardian here.

All good points…. but two things need to be looked at here.

1.  There are many different reasons that people suffer with back pain (‘back pain’ is never that simple) and so when every patient comes into see an osteopath here at Back to Back, we take a comprehensive case history and they have a thorough examination.  This gives us a really good idea why they may be suffering.

There ARE inflammatory reasons why we can get back pain.  These people will most likely respond well to anti-inflammatory medication.  The back pain that is not inflammatory may not get the same level of relief.  Also, during an acute episode of back pain, there may well be an inflammatory phase as the body reacts to the injury.  These patients may also get some relief from ibuprofen.  Once back pain becomes CHRONIC or more longer term, often it looses its inflammatory nature and so these drugs will be less useful.

2.   Patients that take these medications for a short time only are less likely to suffer from stomach problems unless they already have a sensitivity to them.  If you take them for extended periods, it is very well documented that anti-inflammatory drugs (NSAIDs) can irritate your gut and cause other problems.  There are also different types of NSAIDs (varying in strength and mechanism) and some also have gut protecting properties.  So taking care with high doses or for extended periods is important.

Taking any painkiller does not sort out the cause of your back pain.  It is sort of like putting a plaster on it, but is does not sort out why it happened to you in the first place.  Often getting assessed first is a great place to start and work out why it happened.  Get the cause treated and then become empowered to move more efficiently and effectively.

It always depends why things happen…. bodies are super complicated.  There is never a straightforward answer.  If you are told it is straightforward, maybe look deeper.   So as ever….Get good advice from your health professional.

Blog post by James Dodd

Golf and the golf swing

At Back to Back we treat more than a few golfers and their injuries.  An injury common to the golfer may be one of many…. But often a golfer presents with pain in their elbow, shoulder, their back, hip or knee.  It could be their neck or other area.

Identifying with their pain can be the easy part.  Working out why they have pain is often a little more challenging.

Our AFS (or Applied Functional Science) team will be best to do this.  Their aim is to track down the ‘why behind the what’.  What I mean by this is … why has that particular area of your body failed?  What in that person’s body is not working as it should and increasing the ‘load’ elsewhere?

What encouraged me to write this was a patient that I saw just over 4 weeks ago.  He was in his late forties with a handicap of 4!  He had been suffering with right shoulder pain for the last 5 months!  He had seen a few other practitioners before find his way to the clinic.

To me, it was crucial to see him swing as if he was hitting the ball!  Watching this and adapting the way he hit the ball, it immediately became apparent that he was restricted in his left hip.  As he was halfway through his backswing the movement that should have been available at his left hip was not there and he was then using his upper back and right shoulder to do much more work than it needed or was build to do.

All that was happening was his shoulder was becoming strained because of his hip!  Before coming to see us, this lovely patient had had his shoulder and surrounding area rubbed for 14 treatments.

Working with his left hip and left foot and integrating them into his swing gave great results in 3 treatments and he was almost pain free at 4 treatments.  He still has a small way to go, but it just goes to show that rubbing symptoms (in this case the shoulder) is not always the right answer.  Getting fully assessed by someone that appreciates integrated movement and treats the body as a whole is critical.

Get assessed properly and get properly fixed!

Blog post by James Dodd

Your knee is your hip and your hip is your knee… it is joined by a big bone!

As we are entering spring, more of us are getting outside to enjoy some sun and take up those summer activities, tennis being one of them. So what does this mean for our hibernating bodies and how can your knee become a victim of your new interest?

The knee can be your best friend, but it can also take a ‘beating’ in games like tennis.

The primary purpose of the knee and its surrounding tissues is to absorb shock and propel us in movement. It is mostly known for its ability to flex and extend and allowing us to twist and turn.

To help you understand why the knee takes a beating, I would like to explain why and how you can give your knees a better start to the summer.

“The Knee is caught in the middle with few places to go and no place to hide”

What does this mean?

As we walk, run, jump or bounce, the foot reacts as it makes contact to the ground.  This pretty quickly feeds the information to the knee.  The knee will then go through an appropriate movement depending on what stage you are in gait: it will react to most of what the foot does.

Sounds easy enough, but what happens if you are the knee and your foot or your hip (or both) does not load or move properly?  Your knee may struggle to cope with the different movement above and below and this may be the start of your knee symptoms or dysfunction.

So what do we advise?

Great foot and hip motion is going to give the knee the best opportunity to work in all of its planes of motion and will facilitate the reaction of the proprioceptors, (information messenger’s found in joints, muscles and joints) and muscles.

We want to create an environment for the knee where the knee can twist, turn, bend, straighten at speed and adjust to different environments such as different terrain.

Does this sound familiar when playing a game of tennis?

By doing a simple matrix (an exercise to brilliantly allow the integration of the hip, knee and foot ) you will be providing a successful chain of movement which will help to provide stability for the knee and improve overall muscle control. See the videos below on how to do these.

Blog post by Annie Fonfe

Paracetamol for back pain

Do you take paracetamol for your back pain?

Have a look at this link on some of the more recent research about this.

This states…..

‘Paracetamol is ineffective at treating back pain and osteoarthritis despite being a recommended treatment, a group of Australian researchers has warned’.

One of the most important issues to understand here is WHY  you have pain in the first place.  WHAT has put your body  in a position where it feels under threat?  Pain is an OUTPUT from your brain and just by blocking that output you are not fixing WHY you have pain.  Would it not be far better to get the WHY addressed and sorted?

If you can, get properly assessed by a professional who has been fully trained to assess, diagnose and treat you appropriately.  Pain in your back may be due to another part of your body working less effectively and so your back ends up having to work harder.

Call us on 020 8605 2323 if you have any questions.

-James Dodd

ACUPUNCTURE – THE ONLY RECOMMENDED PROPHYLACTIC TREATMENT FOR HEADACHE

Suffering with a headache is unnecessary…

“Headache has been underestimated, under-recognised and under-treated throughout the world” WHO

Headache disorders are among the most common disorder of the nervous system. Nearly 50% of us have suffered from a headache in the last year and nearly 10% of those have reported migraine. Up to 4% of the worlds adult population suffer with headaches on 15 or more days a month.

Not only is headache painful, but it is also disabling.

Acupuncture for headaches…

Research has shown that a course of acupuncture can reduce symptoms of headaches by more than 50% and in some people acupuncture has been reported to eliminate their symptoms altogether!!

Following this research the National Institute for Clinical Excellence (NICE) passed a Guideline for Headaches, CG15 in September 2012 declaring a course of up to 10 sessions of acupuncture over 5-8 weeks as the ONLY recommended prophylactic treatment that isn’t drugs.

There are many types of headaches, some chronic and some episodic. Like with any other aches and pain the longevity of symptoms can act as a general guide of how many treatments you may need to help with your headache management. The more acute headache sufferer may only need 1-2 treatments, but for the more chronic and long-term sufferers, more treatments will be necessary. What is clear is that acupuncture is very likely to help with fighting your headache.

What to do next?

Start by keeping a headache diary today – record the frequency, duration and severity of the headache. Contact us if you would like a simple spreadsheet to follow.

If you are suffering with headaches, call the clinic to book an appointment in with me.

Anja Davidson
Osteopath M.Ost

SHIN PAIN IN RUNNERS EXPLAINED

Lower limb injuries in runners are all too common and unfortunately hard to predict.  With the ‘Virgin Money London Marathon’ not too far off, we wanted to share some Back to Back thoughts on shin pain. 

Lower leg pain can come on for unseasoned runners or those that change their training routine too quickly without laying suitable foundations.  This could be switching to lots of hill running or adding in more speed work.

One or more of THREE pathological processes are often involved in shin pain.

Shin Splints or Medial Tibial Stress Syndrome/Inflammatory shin pain

This is normally pain on the front or inside of your tibia/shin bone.  It can wax and wane, but normally decreases as you warm up.  The runner can often complete their training but it can recur after exercise and be painful the following morning.  If left untreated, it can become worse.

It is generally agreed that if you have shin splints, you should stop running or alter your training depending on its severity. Reduction of the inflammatory response is key and it may be helped by rest, stretching, ice and soft tissue work.

Medical Acupuncture in the right places appears to be pretty effective. Off load your shins with alternative training methods or running in a pool.  When you return to running, do it gently and follow the 10% rule. Don’t increase your speed or distance by more than 10% per week.

Bone Stress Response
Pain in the shinbone may be due to a stress response/stress fracture of your tibia.  This without doubt is more serious than ’shin splints’ and needs to be ruled out if pain persists.  This sort of pain can be increasing or pretty constant.  It is often worse on impact or after use.  There may be some night pain.  Pain is normally more localised or acute than ‘shin splints’.

Compartment Syndrome
The muscles in your lower leg are separated into compartments.  Causes are not fully known, but as your muscles swell during activity, they create increased pressure in these ‘closed compartments’.  Signs and symptoms are directly related to use and intensity.  It increases with exercise and decreases with rest. Soreness can be minimal and diffuse. There may be muscle weakness and sensory symptoms into the foot and toes.

Seeking help is important if you have pain, especially if it does not go away.  Making sure you see an appropriate practitioner with suitable qualifications to enable a correct diagnosis or referral is important.

Dry Needling and Neck pain

A study (see link) published in 2014  in the Journal of Orthopaedic and Sports Physical Therapy has found patients who received dry needling for their neck pain showed significantly better improvement than the untreated group.  It was a small study, but always a good place to start.  The patients reported 33% less pain immediately after treatment and 66% less pain a week later.

Most of our osteopaths have completed their acupuncture training with the British Medical Acupuncture Society (BMAS) and it is a hugely effective method of treatment, especially when used in combination with osteopathy.  We often use this for neck and lower back pain, hip and shoulder pain along with many other injuries.

Hypermobility and the Gut

Hypermobility Syndrome and Gut Problems

A few years ago, one of our osteopaths Annie Fonfé did her final year dissertation on ‘Hypermobility Syndrome and Bruxism’ (teeth grinding or clenching).  One of her questions she asked the patients was ‘did they or had they ever suffered with stomach problems or been diagnosed with IBS’.  She found that a significant portion of hypermobile patients did indeed suffer with stomach concerns of some description.

A recent study lead by Professor Aziz (Professor of Neurogastroenterology at Queen Mary Hospital of London) found that patients with hypermobility syndrome/disorder often suffer chronic abdominal pain and a range of gut symptoms.  They are frequently misdiagnosed, undiagnosed or wrongly diagnosed and have poor quality of life said Professor Aziz.  He went on to say that this observation allows us to provide a better explanation of symptoms to our patients and tailor our treatments more effectively.

Hypermobility syndrome is a major problem and it is often undiagnosed and so the patients are mismanaged.  Hypermobility can be helped to a greater extent if clinicians are aware of the bigger picture it can present with.  If it was understood to a more fully, patients could be more empowered to create strategies for self help as well as directed help towards the correct therapists.