OsteoTobes

A student Osteopath's blog of all things health, fitness, rehabilitation, pain science and research

[osteotobes-blog]

Great illustration of how the recovery process can occur - patients (and many practitioners) expect a linear recovery and are often therefore fearful and fazed when they have a bad few days or feel slightly worse - it's important to educate patients that these fluctuations during recovery are completely normal, and although a nuisance, the overall trend should be getting better, even if this is a bit haphazard! - hopefully patients won't be so scared when it does feel slightly worse, more "ok it's feeling a bit worse today but I know that's normal, it's safe to keep moving and it's better overall" and less "OH NO IT'S BACK AGAIN IV'E DAMAGED IT!" ➡️ for more on this see David Butler's "therapeutic toblerone" - an analogy I use often with patients ➡️ https://www.google.co.uk/amp/s/noijam.com/2016/08/19/therapeutic-toblerone/amp/ ⬅️ #osteopathy #osteopath #rehabilitation #physicaltherapy #physiotherapy #chiropractic #patienteducation

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Today a patient presented to me with a long history of migraines 🤦🏻‍♀️. She had seen a number of other musculoskeletal practitioners who had addressed her neck and back with some success, however, she was frustrated that she wasn’t improving further. We can hopefully help migraine patients through this approach and there is (albeit modest) evidence to suggest that we might be able to reduce symptom severity; however, what else can we do…? There are many causes of migraine/headache and it is often multifactorial; therefore often requiring assessment of not just the musculoskeletal system but also patients’ lifestyle, support network, concurrent health conditions, medications… As physical therapists there may be a number of ways we can help and advise our patients beyond just hands on treatment and one of the key things is consistency: 1️⃣Regular mealtimes of a consistent size and no skipping meals – sudden raises or low blood sugars are thought to play a role in trigging some patient’s headaches 🍽 2️⃣Regular sleep pattern – going to bed and waking up at similar times, with sufficient sleep (sleep hygiene). Taking 1-2 hours to relax before bed can also be useful – this might include no phones or work! 😴📵 3️⃣Regular exercise and at a fairly consistent intensity, even if only gentle (eg a daily 20 minute walk). Gentle stretching for the back, neck and shoulders is often also useful to include 🏃🏻 4️⃣Identify and avoid too many dietary triggers, these can often include caffeine, cheese, chocolate and alcohol (I know… the best ones… sorry 😕) 🚫🍫🍷🧀☕️ 5️⃣Keep adequately hydrated 💧 6️⃣For females it may be of use to consult your GP on your contraceptive and other options for this, as hormonal changes can play a role in migraine generation 7️⃣RELAX! – Use of relaxation techniques or individual hobbies to relax and make time for yourself is important 8️⃣Be aware of any personal triggers and where possible try to develop coping strategies to avoid or reduce them – a migraine diary might be useful in identifying these Most importantly consider that everyone’s migraine is different – there is no one size fits all and it may take some trial and error!

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Posting has been poor recently due to revision for my last 3 exams ever!! 🤓📚 so here's a quick one on one of my favourite pieces of gym equipment - the kettle bell! Using these is an amazing work out for lots of reasons - it develops strength/power, works your abdominals (importantly dynamically, rather than classic exercises like crunches and planks) and burns a tonne of calories similar to interval training - basically the ultimate mix of cardio and strength - a recipe for great fitness and an athletic appearance! Some of these exercises (particularly the second to last) are also particularly good for rotator cuff/shoulder stability 💪 These are a couple of my favourite progressions of kettle bell exercises - it's important that before trying these exercise your technique is good - this can commonly lead to low back or shoulder pain when done badly or applying weight too quickly! The main thing for beginners to focus on when starting with kettle bells is 'thrusting' from the hips rather than pulling the weight from your back (think of squeezing your butt to get the bell up) - this has the added advantage of working your booty 😜 #🍑 #training #fitness #kettlebells #sweat #bootygains #gym #fitspo #gains #💪 #strength #conditioning

[osteotobes-blog]

#controversial topic - if placebos can perform equally well when compared to corticosteroids but with less side effects, should we use them..? "Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain" #osteoarthritis #corticosteroids #placebo #research #muddywaters #downtherabithole #grey

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First time I've had chance to sit down and read in months and what do I pick up? Another pain book... 🙄 #addict #pain #nerd #🤓 #📚

[osteotobes-blog]

First time I've had chance to sit down and read in months and what do I pick up? Another pain book... 🙄 #addict #pain #nerd #🤓 #📚

[osteotobes-blog]

An argument for good early patient education... "Results from the present study suggest that individuals exposed to an inflammatory challenge show greater neural sensitivity to both positive and negative social feedback...This heightened sensitivity to social information makes sense from an adaptive perspective, as when in a vulnerable state, individuals should be especially attuned to cues of possible additional threats (i.e., negative social feedback), but also to signals of possible help or support (i.e., positive social feedback)." #pain #education #neurology

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Exercise isn't just good for physical health a lot of recent evidence has suggested that exercise can be used as a safe and effective intervention for both prevention and treatment of some mental illnesses, particularly when combined with other interventions such as CBT. Just some of the conditions where exercise has been shown to be effective as a treatment option are diagnosed Depression (in adults, children and post-natal), PTSD, social phobia, panic disorder and OCD. There are a number of theories to explain how exactly exercise helps these conditions including social interaction, endorphins, self-efficacy, confidence and 'safe' exposure to the physical symptoms of anxiety. Exercise may also improve both cognitive and social functioning in psychosis and schizophrenia. This evidence is of importance as these conditions have very severe consequences on patients quality of life and general health - exercise can be a safe, inexpensive intervention with no side effects which we can use alongside other interventions. Exercise may also be an important adjunct to mental health treatments for a number of other reasons - for example, in some mental health disorders general health can also be lower, with life expectancy up to 17 years less - exercise to improve general health is important to help tackle systemic complications. Medications for some conditions can also increase risk of falls (particularly in the elderly) - continued physical activity to maintain balance and coordination is very important. #mentalhealth #depression #ptsd #ocd #panicdisorder #schizophrenia #psychosis #exerciseasmedicine

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💡A brief introduction to pain and the brain (I didn't narrate as my voice sounds worse than I first thought 😕😂): 1️⃣A-delta (myelinated) and C (unmyelinated) nociceptive fibres detect stimuli (which may or may not be harmful). These synapse in the dorsal horn and ascend in the spinal cord via the spinothalamic tract. 2️⃣Signals reach the brain and via the thalamus project to a number of brain areas - for example, the somatosensory cortex identifies the physical characteristics of the stimulus, the neocortex focusses on cognitive and contextual factors and the limbic system uses past experiences, memories and emotions to evaluate and contextualise the stimulus. 3️⃣ Integration of information from these areas is used to answer two main questions - "Is this stimulus a threat to me? And if so what do i need to do to protect myself?". If threat is perceived, activation of a number of protective outputs occurs - one of these is the sensation of pain (pain is a protective output from the brain in response to threat perception, not necessarily an immediate consequence of tissue damage or stimuli) 4️⃣ Depending on the brain's evaluation of need for pain and protection, descending projections modulate dorsal horn synapses (facilitate or inhibit transmission) - the best analogy for this is turning the volume up or down on the signals coming into the spinal cord - dysfunction of descending pathways is often part of chronic pain conditions, where tissues can be hypersensitive, even to non-noxious stimuli such as light touch (the volume is turned up) #painscience #pain #explainpain #neurology #nervoussystem

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I spent today revisiting recent literature on tendinopathies – I thought the above quote summarised our current understanding quite well – unfortunately we do not know what exactly causes tendon pain and no one treatment is particularly effective… However, there are a number of hypotheses surrounding the pathophysiology as well as a number of treatment options which may be of use: 1️⃣Pathophysiology – The most recent literature highlights that tendinopathy is quite a complex, multifactorial condition – a number of findings contribute towards the symptomatology, these include cellular matrix changes, neovascularisation and central pain mechanisms associated with load and threat perception. Tendinopathies most commonly occur from either repetitive overuse or sudden overload, however, some authors propose a continuum model of tendinopathy, which I feel is more appropriate – cumulative stress from overuse, degenerative changes, poor function, sudden overload, genetic influences, systemic pathologies and secondary hyperalgesia all contribute towards reaching a symptomatic threshold – a useful analogy for this is continually adding individual measures of water to a glass until water overflows (and symptoms ensue) 2️⃣ Presentation – Patients most often present with local pain over the tendon, which may be worse in the morning and is particularly painful on load or palpation. They may also display signs of central changes such as hyperalgesia, allodynia and sensory changes like increased two-point discrimination (interestingly these may be found bilaterally…) 3️⃣ Treatment – First-line conservative treatment for up to 24 weeks often improves symptoms – of note isometric or eccentric exercises are particularly useful – both local (increased adaptation and change in matrix) and central (Hypoalgesia, CNS reorganisation and reduced cortical inhibition) hypotheses have been proposed as the mechanism of these. Relative rest, reassurance and education are also important. In absence of response to conservative management extracorporeal shock-wave therapy or surgery may be performed. #tendinitis #tendinopathy #tendons

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Probably not the best lay-terms to use with patients 😉 but a great summary of how emotions can modulate both spinal transmission of nociceptive transmissions and supra-spinal perception/processing of them! #nopainwithoutthebrain #🤕 #Repost @osteojorge with @repostapp ・・・ Emirates Medical Association Physiotherapy Society seminar on #pain #emotionalprocessing #osteopathy #manualtherapy #biopsychosocial #chronicity #ohcdubai @ipiaget #dubai #uae

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This one goes out to my man @jakealsop1 😉 for his question earlier - 'how do corticosteroids cause osteoporosis?' ⬇️ Corticosteroids are commonly prescribed for a number of conditions due to their anti-inflammatory and immune-mediating effects; however, one of their most well-known side effects is increased risk of osteoporosis, an important consideration for us as osteopaths. This is not the result of one physiological pathway but is multifaceted (partly why it is so common): Corticosteroids have direct and indirect effects on bones which eventually leads to more bone loss than formation. 1️⃣ Firstly, corticosteroids increase osteoclast (the cells which break down bone tissue) numbers and activity by altering gene expression. They then inhibit new bone formation through decreasing osteoblast (the cells which build new bone) numbers by reducing replication and differentiation, increasing apoptosis and indirectly inhibiting their function by modulation of growth factor expression and receptor binding. 2️⃣ Secondly, they disturb serum calcium levels by increasing renal calcium excretion and decreasing gastrointestinal calcium absorption. Reduced serum calcium causes increased parathyroid hormone secretion whist glucocorticoids increase sensitivity to PTH, which stimulates osteoclast activity 3️⃣ Thirdly, they inhibit sex hormones, which are usually protective against osteoporosis. ❗️Another important consideration for us as osteopaths is that corticosteroid medications are merely synthetic forms of our own adrenal cortex (glucocorticoid) hormones. This means that conditions causing prolonged elevation of these can have similar effects to those above, these include pathologies such as Cushing’s disease/syndrome but also chronic stress – a number of animal and human studies have suggested the role of chronic stress in reducing bone mass and quality through activation of the hypothalamic-pituitary-adrenocortical axis and other neuro/endocrine/immune factors. #pharmacology #osteoporosis #corticosteroids #💊#healthcare #osteopathy #osteopath #physicaltherapy #manualtherapy #medicine #physiotherapy #physiology #psychology (photo credit: www.nursingguide.ph/)

[osteotobes-blog]

Yet another example of the influence of psychosocial factors on pain - Maclachlan et al., (2017) recently found that anxiety, depression, catastrophisation and poor coping strategies influence patellofemoral pain - adding to the abundance of literature on psychosocial factors and spinal pain, as well as other areas - for example Wylie et al., (2016) found that mental health had a stronger association with shoulder pain and function than muscle/tendon tear size, even in patients with full-thickness rotator cuff tears!! Conclusion: treat the person not the joint... #osteopathy #painscience #pain #osteotobes # #Repost @bjsm_bmj with @repostapp ・・・ The psychological features of patellofemoral pain: a systematic review by Liam R. Maclachlan, Natalie J. Collins, Mark L.G. Matthews, Paul W. Hodges, Bill Vicenzino What is the psychology of PFP? Does it impact upon pain and physical function? This FREE paper has all the answers! Link in Bio! #health #knee #injury #injuries #infographic #sport #sports #sportsmed #sportsscience #sportsmedicine #physio #physiology #physiotherapy #physicaltherapy #BJSM #research #rehab #psychology

[osteotobes-blog]

Following my post yesterday a great demonstration of how walking impacts the brain #osteopathy #health #healthy #wellness #healthyliving #healthylifestyle #moveitorloseit #physicalactivity #osteotobes #Repost @trustmephysiotherapist with @repostapp ・・・ Go for a walk! Your brain will like it! 😊 #trustme #physiotherapist #physio #physiotherapy #physicaltherapy #physicaltherapist #physioterapy #fisio #fisioterapia #fisioterapeuta #fisioterapeutas #fisioterapiaesportiva #physiotherapie #movement #rehab #rehabilitation #exercise #walk

[osteotobes-blog]

It's been a month since I posted because I've taken a few weeks off of osteopathy to recover before the final last term! 🗓😴 I saw this rather fitting graffiti whilst away walking for the easter weekend and it prompted me to write something quick and relevant on the health benefits of walking 🚶🏻 There is an abundance of indisputable evidence on the health benefits of exercise, however, this does not necessarily need to be anything vigorous; just a brief search of the literature reveals that less that 2 hours of walking a day (in some papers just 30 minutes) reduces risk of chronic disease and death and lowers healthcare costs - although 2 hours may sound a lot, accumulated through the day this is not difficult and many easy strategies can help reach this - getting off the bus a stop early, getting outside for 20 minutes at lunch... One of my favourite reviews but Pedersen and Saltin (2015) demonstrated that there is sufficient evidence for physical activity in 26 chronic diseases (both physical and mental) - if you could reduce your risk of this many diseases by using just 7-14 hours of your 168 hour week for gentle walking would you get up and get moving? 🚶🏻🤔 #walking #health #exercise #greenprecriptions #osteopathy #physicaltherapy #wellness #healthy #prevention #preventitivemedicine #fitness #healthylifestyle #healthyliving #keepmoving #getmoving #moveitorloseit #skeleton #graffiti #grafittiart #❤️ #👟 #🚶‍♀️ #🚶 #🏃‍♀️ #🏃 #💀

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Want a change from your usual post-workout protein shake? 🤔 How about trying refreshing beetroot juice and coconut water? 🍹 (its nicer than it sounds...) ☝️Beetroot juice (reportedly Leicester city's "secret weapon"!) has recently been suggested to have positive effects on cardiorespiratory performance, blood pressure, exercise tolerance and possibly even inflammation; thought to be in part due to its nitrate content ❤️. It is also rich in a number of other vitamins and minerals useful for recovery (Bond et al., 2014; Jones, 2014; Pinna et al., 2014; Clifford et al., 2015; Lee et al., 2015). ✌️Coconut water, often referred to as "nature's sport drink", has all the electrolytes necessary for post exercise rehydration and in higher quantities than traditional sports drinks, particularly magnesium, calcium, sodium, potassium and phosphorous, as well as having less than half the sugar 👍⚠️... Some recent research has suggested that coconut water is as good as sports drinks and superior to plain water in post-exercise rehydration 🥛 (Ismail et al.m 2006; Kalman et al., 2012), as well as potentially lowering blood pressure and triglyceride + LDL levels (Alleyne et al., 2002; Anurag & Rajamohan 2003; Sandhya & Rajamohan 2006) #exercise #recovery #hydration #electrolytes #nutrition #vitamins #minerals #health #wellness #exercise #sport #fitness #beetroot #nitrates #juice #juiced #coconut #coconutwater #🏃‍♀️ #🏃 #💪 @beetit_sport @beetitjuice

[osteotobes-blog]

Today's revision topic - the effect of stress on pain - A topic we discuss a lot as Osteopaths and with a move towards patient evaluation emphasising identification of psychosocial factors alongside physical examination it may be of importance to appreciate the mechanisms of how these factors might influence pain. There is good evidence that psychosocial factors such as stress, alongside factors such as catastrophisation, anxiety and negative beliefs regarding symptoms can contribute towards pain (van Hecke et al., 2013) So how does this happen? Well there is evidence for a number or mechanisms, which would take more than one post to discuss! Just a few of my favourite ideas from recent research are: 1. Stress may increase sensitivity to pain (stress-induced hyperalgesia) - thought to be due to reduced function of descending inhibition in the central nervous system. This might be related to altered neurotransmitter activity in brain areas involved in pain processing and emotion (i.e. your nervous system is more sensitive to stimuli, which are consequently perceived as painful) (Quartana at al., 2009; Hayati & Zakarla, 2015) 2. Hormonal changes in chronic stress can have widespread effects on physiology. One of particular interest is that cortisol might facilitate formation of fear based memories as a protective survival mechanism. Sustained endocrine stress may also increase responses to evoked pain in areas involved in emotion and memory (i.e. In an attempt to protect your body from further "insult" cortisol facilitates your brain in assigning a "fear memory" to certain actions, stimuli or situations - evolutionary protective, but not always useful...) (Vachon-presseau et al., 2013; Hannibal & Bishop, 2014) How is this useful for practitioners or patients? Well in short, acknowledging and educating patients on the role of stress in pain and developing individual coping strategies might be one area where we can help - Research from Louw et al., (2011) and van Oosterwijck et al., (2013) has begun to demonstrate that education and stress reduction can have positive effects on pain, disability and descending inhibition... #stress #osteopathy #pain #painscience