Welcome to Your Osteopath Newsletter
Every two months we will bring you the latest news from the osteopathic profession as well as up-to-date advice on health topics relating to osteopathy. It won't be too technical; it will be straightforward, informative and - we trust - useful. If you have questions about any of the treatments mentioned below, then just contact us. We hope you enjoy it.
Pregnancy
We have written before at Your Osteopath about the benefits of osteopathic treatment during pregnancy, but what about during the actual childbirth? This is a topic that is complicated by the fact that it is a legal requirement in the UK that nobody except for a registered midwife or doctor can "attend a woman in childbirth".
A recent article in The Osteopath magazine asked a QC to provide some legal advice on what this means in practice. One issue is how ‘childbirth' is actually defined - does it mean the birth itself or does it cover also the run-up to the birth, the pregnancy in general. The QC is clear that childbirth in this context has its natural meaning, which means the process of giving birth and not the entire pregnancy.
What, then, does it mean to "attend" a woman during childbirth? Is it legal for an osteopath - who might be a friend or a family member - to be present during childbirth? Here, the QC advises that the presence of an osteopath at a birth being supervised by a doctor or midwife is quite legal.
The QC adds that, on balance, osteopaths can lawfully give advice and care during a birth that is being supervised by a midwife/doctor, however this is a grey area and the magazine concludes that it may or may not be legal.
If a patient asks for an osteopath to help during a home birth, the law still applies and actual treatment to assist the birth may or may not be legal, exactly as it is in the case of a hospital birth.
The conclusion is that osteopaths can treat women during their pregnancy, but that care needs to be taken during actual childbirth. For advice on osteopathic treatment during pregnancy, visit the General Osteopathic Council's website: www.osteopathy.org.uk
Case Study
The Case: Roddy, a 42 year old health worker, begins to experience right sided low back pain for no apparent reason. The pain is initially mild, but after a few days he feels pins and needles radiating into his right buttock, thigh, calf and into his foot. His symptoms are becoming more intense and he is now having difficulty in all his normal day to day activities. He sees his doctor, who signs him off work and suggests some pain killers and rest. Three more weeks pass and his symptoms remain unchanged. His wife suggests he tries an osteopath.
The Diagnosis: After taking a full case history and making an initial examination, his osteopath is able to diagnose a prolapsed disc at the base of his spine.
In most cases a prolapsed disc can be diagnosed without the need for a scan. Osteopaths are trained to differentiate between the various causes of back and leg pain. By assessing all your symptoms, reflexes, muscle strength, limb sensation and examining your standing posture and active movements, your osteopath is able to make an accurate diagnosis.
Occasionally if a prolapsed disc does not respond to treatment, your osteopath will probably refer you for further investigation, usually resulting in a MRI (magnetic resonance imaging) scan. Unlike an x-ray, a MRI scan can picture soft tissues, and therefore can show the bulge on a prolapsed disc. According to NHS figures approximately 1 in 10 cases of a prolapsed disc requires surgery, although this does not work for everyone and should only be considered as a last resort.
The Treatment: Roddy's osteopath uses direct soft tissue, articulation and manipulation techniques to try to stimulate healing in the affected area. He was given some advice on exercises and what to avoid in his daily routine.
In some cases it may be necessary for total bed rest until the initial acute spasm eases, usually two or three days. After this it is considered best to try to keep moving, but all individuals are different and your osteopath is best positioned to give you this personalised advice.
The Outcome: After two days Roddy's pain had started to improve, and after a further three weeks of treatment he was pain free.
Prevention: Exercise helps keep your supporting back muscles strong and supple, and can slow the rate of your discs age related degeneration. Correct lifting and handling are vital to your backs long term health.
Supportive seating and work station analysis. Now even more important that so many of us spend our working lives at a computer or driving. Take regular breaks to get up and move around, altering the pressures within your spine.
A good quality mattress providing support from where you will spend around one third of your life.
Your osteopath can give you strengthening exercises and advice for your backs specific requirements.
Body Talk
In our previous newsletter we discussed the structure and function of intervertebral discs. To those of you who can't quite remember it all, here's a very brief catch up summary.
Intervertebral discs are the soft cushioning pads the separate the individual vertebra (bones) in the spinal column. They act as shock absorbers, helping carry the downward body weight and allowing the spine to move, bend, twist and rotate. Each disc has a strong elastic layered wall and a soft nucleus in the centre allowing a disc to change shape through the spinal movements.
A prolapsed disc is often referred to as a slipped disc. Although both of these terms refer to exactly the same condition, "slipped disc" is a very misleading term as the disc itself cannot slip, as it is attached to the vertebra above and below it, and to the ligaments that surround it. Therefore "prolapsed disc" is used in all medical references.
What is a prolapsed disc?
A prolapsed disc occurs when the outer elastic wall of the disc ruptures allowing the soft gel like centre to push out through the tear between the vertebrae. Sometimes the term herniated or bulging disc is used, and although there is a slight debate within medical circles about the use of these terms, they can be thought of as the same condition.
What is the cause?
It is not always clear what causes a disc to break down, but as we get older and our discs lose their flexibility they are more likely to tear. Some people seem to have an increased susceptibility to damaging discs, even when doing similar activities and jobs to other non sufferers. Heavy lifting, awkward and repetitive bending, jobs involving prolonged sitting (particularly driving), and being overweight all involve an increased risk. So greater loading and strain is a significant factor in many cases.
Prolapsed discs are most common in the low back and to a lesser degree the neck. A prolapse is possible in any disc, but is infrequently found in the upper and mid back.
Who gets it?
Slightly more men are affected than women, and it is most common in the 25 to 50 age group. Low back pain is extremely common but only about 1 in 20 episodes are thought to be related to prolapsed discs.
Symptoms include back pain, usually easier when lying down flat. Other symptoms include nerve root pain and pain along the nerve that is being pressed on by the prolapsed disc. Hence the symptoms may be in the leg or arm, but the source of the problem is in the back or neck. Other nerve symptoms such as pins and needles, numbness, or weakness in an arm, hand leg or foot.
The symptoms may occur suddenly or build up over several weeks. In some cases the symptoms are mild or not at all. This is because the prolapse is small and is not pressing on any nerves or spinal cord.
In extremely rare cases a disc prolapse can cause a clinical emergency. Known as cauda equine syndrome, pressure from the disc prolapse into the nerves at the bottom of the spinal cord needs urgent medical attention. Classically these cases present with problems with bowel and/or bladder function and numbness around the groin, rectum and inner thigh area.
Diagnosis and Treatment are discussed in this issue's Case Study
Osteopathy in the News
The Sunday Times reports that a UK osteopath, Matt Walden, is importing to the UK a five-toed running sock that "mimics the sensation of running barefoot and could be better for you than conventional running shoes." The idea behind the US product, called FiveFingers, is that running shoes can be actually be bad for you by being so good at masking pain. The newspaper reports that the socks force a runner to land on the middle of the foot rather than the heel. Mr Walden also uses them to help the rehabilitation of patients who have suffered serious injuries.
What causes that cracking or popping sound that you sometimes hear when your osteopath is manipulating your spine? A recent research article in The Osteopath magazine tries to throw some light on the subject, and it can't be blamed too much for the rather technical explanations. These include: "the release of intra-articular material such as synovial folds or meniscoids"; "relaxation of hypertonic muscle by sudden stretching"; and, best of all, "unbuckling of motion segments that have undergone disproportionate displacements." I think this can all be neatly summarised as follows: it isn't the sound of your bones breaking.
Were you one of the 8000 osteopathic patients interviewed over the summer as part of a General Osteopathic Council (GOsC) research project into patient expectations? The aim of the study is to gain a deeper understanding of patients' expectations and the extent to which they are being met. The results of the study - which is being carried out on behalf of the GOsC by the Clinical Research Centre for Health Professions at the University of Brighton - are expected to be published before the end of the year. Your Osteopath will report on the findings.
Osteopathic and Health Links
General Osteopathic Council
British Osteopathic Association
Members Association
Osteopathic Sports Care Association (OSCA)
The Health & Safety Executive (HSE) back injury site.
The British Association of Sport & Exercise Medicine (BASEM)
BackCare
European Agency for Safety and Health at Work
The Osteopathic Centre for Children
The Prince of Wales Foundation for Integrated Health
Working Backs Scotland
