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.

Joint Replacements and osteopaths

There are a number of patients who often present to our Osteopathy clinic for the treatment and management of arthritic conditions that may eventually require a joint replacement.  Often these clients will ask the Osteopaths for their opinion on this and whether it is the right thing to do.  This is often a difficult question to answer because every individual is different.  Arthritis can affect people both physically and mentally and the pain it may cause can be extremely draining.

Other than advice from a health professional, it is also important to speak to others that have also had the same procedure.  These are big operations and the ‘pros’ and ‘cons’ must be looked at.  Most importantly, if you do decide to undergo an operation like this, you must be prepared to do the rehabilitation afterwards.  This gives your body the very best chances of healing well and coping with your new joint.

Femoral Anteversion and Retroversion

This one is often so overlooked and surgeons often suggest that there is no clinical consequence…..and so don’t worry!

For the office worker or the sedentary person that does not have large physical requirements of their body, it may just be the silent hip that may or may not give rise to any symptoms.

BUT for the person that does a very physical job or the person who partakes in sport or the hard training athlete…. the apparent symptoms may be very different!

Normal hip internal rotation should be about – 35 degrees

Normal hip external rotation should be about – 45 degrees

It is important that when testing the ROM available of the hip, it should be tested in normal function, upright (not just lying on a plinth) and with the hip in a flexed and extended position, since movement may be possible in one motion, but restricted into the other.

One possible cause of increased hip internal or external rotation may be femoral neck anteversion or retroversion.

The normal neck of the femur is angled at 15 degrees anterior to the long axis of the shaft of the femur and the femoral condyles.  An increase to this anterior angulation results in greater internal rotation (anteversion) available at the hip.  Often the patients are seen to be ‘toeing-in’  Conversely, a decreased anterior angulation (retroversion) results in a greater amount of external rotation.  Patients that ‘toe-out’ may have a retroverted hip.

One thing we as clinicians need to be aware about when seeing patients is that either of these can create neck pain, lower back pain (or many others) as well as hip, knee and foot pain.  Looking for this does not take long and can be part of your normal thorough examination.

Imagine the runner that toes-in due to a right anterverted hip.  As he runs he needs internal rotation at his hip and by toeing-in, he  uses much if this internal rotation up.  This would tighten up the frontal plane of the hip and further load your knee as it tries to cope with the lack of available motion at the hip.  Also, as the toes points inwards, your knee is not aligned in the sagittal plane.  The creates excessive load at your knee too!

So be aware of this as a potential problem and check out some great and simple tests that may give you a hint as to whether this may be the root of your patients symptoms.

If you are concerned about your gait or hips, give Back to Back a call on 020 8605 2323 and one of us can have a look.

Could your groin injury be coming from your hip?

Groin pain can be a difficult problem for patients as well as their clinicians. Part of the problem is that the location of the pain is often a poor indicator of the where the pathology actually lies. Additionally, when the pain becomes chronic, multiple pathologies can be generated, adding a further layer of complexity.

It is very important to make a clear diagnosis, and we should seek to look beyond merely labelling the problem as a ‘groin sprain’. There many causes of pain in the groin, but approximately 50% of groin pain can be attributed to pain generated by the hip joint; a surprise, perhaps, for younger patients. As in any medical condition, the patient’s history will give us many clues. It is extremely important to rule out sinister ‘red flags’, such as night pain, severe pain on loading the leg, weight loss or systemic symptoms, and we need to be mindful of conditions which may occur in certain age groups, such as slipped epiphysis in teenagers.

Common causes of groin pain besides the hip, include those generated by the lumbar spine, pubic overload (osteitis pubis), iliopsoas and adductor tendon pathologies and stress responses in the femoral neck in runners. Abdominal wall hernias may cause pain which is a little higher in the groin, and less commonly, younger patients can experience the rectus femoris pulling away from its attachment at the anterior inferior iliac spine. Testicular tumours and avascular necrosis can present insidiously and we need to be on the lookout for them.

A big proportion of patients who present with groin pain as a result of hip pathology, have an underling condition known as ‘femoral acetabular impingement syndrome’, or FAI. This is essentially a problem resulting from a tear in the acetabular labrum, usually caused by repetitive trauma due to a ‘bump’ or ‘CAM’ on the head neck junction of the femur, which may be genetic.

This can cause groin pain which is worse with exercise, sitting or standing, and the pain can be brought on by putting the patient in the ‘impingement position’ of hip flexion + internal rotation + adduction. In the long term, we believe that the tear in labrum causes changes in the acetabular articular cartilage next to it, and over many years, this may lead to osteoarthritis in the hip.

FAI can affect people of all ages, and is often missed in 30-40 year olds. Taking a careful history, and carrying out a thorough examination can help identify the likely cause. Imaging, such as MRI arthrogram of the hip, can help confirm the underlying diagnosis (as X-Ray cannot rule out FAI), but it should be remembered that imaging needs to be interpreted in light of the history and examination findings. FAI may require treatment with hip arthroscopy surgery, but in some cases injection therapy and robust physiotherapy or osteopathy may be enough to get a person back to full activity.

Sports Physicians and Osteopaths are ideally placed to identify the underlying cause of unexplained groin pain, and are skilled in directing the rehabilitation necessary to resolve the problems.

If you have any problems at all and would like in to see James Dodd or one of the team at Back to Back, please call 020 8605 2323.