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A professional woman with sacroiliac pain worsening over 10 months.
This lady came with pain in the upper buttock that started in pregnancy nearly a year before she came to our clinic. She'd seen a physio and did a strengthening programme, but her pain had been slowly getting worse.
The pain was aggravated by sitting, lying on her side, walking up hill or up stairs, carrying or vacuuming. And it often woke her at night.
On examination, several tests pointed indicated the sacro iliac joint as being the cause of her problems, but there was also a problem with her low back.
After six appointments the pain had disappeared with a combination of treatment, including for her low back, and specific exercises for the joint.
Woman in her forties with carpal tunnel in both hands at night.
The numbness started in the middle fingers of both hands before spreading to the whole hand. The problem had begun about 6 weeks earlier & came only when in bed. Movement quickly relieved it, but because it would return several times in one night, her sleep was very disturbed.
The fact that it was in both hands was unusual. On examination, the upper back was very stiff and restricted in its movement, whilst the wrists themselves seemed hypermobile - meaning that she had more flexibility there than your average person.
Asking the right questions is always helpful in making a diagnosis and finding out why things happen. In her case she had recently stopped work, and her problem had improved somewhat since. So work was obviously a contributing factor to the problem.
But of more importance was the fact that she had a habit of sleeping with one or other hand bent forward against her head. In this position the median nerve is compressed. In fact this is one of the tests commonly used to see if someone has carpal tunnel. So in effect she was sleeping in the test position, but for a lot longer than a test would be done for!
She responded very rapidly to treatment on the upper back with the attacks becoming less frequent from the first visit & disappearing completely after a couple of months.
Elderly lady with thigh & knee pain from an arthritic hip coming and going over several years.
This lady was waiting for a hip replacement on the same side, and this was obviously affecting the way she walked and used her knee. She also had pain running down the inside of her right thigh and into the same side of the knee, which was inflamed. Her pain was worse with walking, straightening her knee and at night.
Examination and tests suggested she had a Baker's Cyst (a localised swelling of the joint capsule behind the knee). This was irritating a small muscle in the area, causing it to shorten and resist being stretched when when tried to straighten the knee.
Not all arthritis results in pain & a lot of people who suffer from it can get significant relief with treatment. This was the case here, where tightness around the knee and in some of the related muscles was helping her arthritis to become more symptomatic from time to time.
She was treated with articulation (movement) to help with mobility and drainage of the knee, and lots of inhibition ( a kind of therapy using localised manual pressure) to stretch tissues and reduce pain behind the knee. Her treatment was interrupted by a holiday abroad, but her pain was just "occasional" after just three visits.
Inflammation from the arthritis was the cause of her night pain. Inflammatory pain is often worse at night or in the early morning. This is because we are relatively inactive at night, so inflammation has a better chance of collecting and causing pain than during the day, when movement helps flush it out.
Young electrician with debilitating upper shoulder pain.
This man's pain started gradually, and was worsening. It was also affecting the strength in his right (non dominant) arm. It seems to have been brought about by pulling cables and wires with the affected arm.
The arm tested weak for two muscles, which suggested some damage, & even gentle exercises to strengthen them just aggravated the problem. He was sent for an ultrasound which showed 'mild' changes at the point where a muscle attaches to the bone. Overuse and prolonged strain to muscles can cause them to pull at the point of attachment to the bone, causing inflammation and pain. And although the change was described as 'mild.' this was enough to cause the symptoms.
The patient learned to modify the way he used his arms for his job. And together with a lot of soft tissue work to loosen the shoulder & on the painful attachment of the muscle, he is gradually regaining his mobility with less and less pain. This improvement was despite the fact he has had no time off work & can not altogether avoid stressing the affected area.
Woman with daily headaches over 3 weeks and lasting for hours starting towards the end of the school day.
Headaches have many different causes including dehydration, meningitis, eye strain, sinusitis, concussion & wear and tear in the bones of the neck - to name just a few! However, many result from tension and tightness in the short muscles of the upper neck which then irritate the nerve that feeds into the back of the head. Trigger points (very tender & tight spots in muscles) can also cause headaches, and this was the case here.
The point is that your therapist needs to be aware of various causes for a problem and to exclude them before diving into treatment too quickly.
Three treatments was enough for her headaches to disappear and for her to be discharged.
Plumber, thirties, with central lower back pain spreading into the buttock & down to the knee after a lifting injury.
This was a recurrent problem that originally started with another lifting injury, suggesting an underlying weakness in his back. This episode was the worst, and the patient came in on his first visit standing very lopsided in an effort to avoid his pain.
The problem was diagnosed as nerve root irritation. The root is the start of the nerve as it leaves from between the vertebrae of the spine. Nerve root irritation can happen chemically as the result of inflammation around it (e.g due to some damage to the nearby disc), or because the disc is bulging (from damage & weakness) and actually pressing against it. In the elderly, this can happen because the bony tunnel through which the nerve root exits becomes narrowed, which can then pinch the nerve.
This patient was treated 9 times over a 3 month period over which time he became pain free and was able to start summer soccer. Part of his recovery was a programme to improve his lower back stability, which had been compromised by repeated episodes of pain and his job as a plumber which put a lot of stress on an already weakened and unstable back.
Lower back pain and sciatica in a middle aged man after a small fall.
This patient fell a short distance off his bed without making actual contact with the floor. Since then he had experienced pain when lifting his right leg, going downstairs or walking. He had no history of lower back injuries and did not have a heavy manual job.
In his case, the sciatic symptoms were caused not by the lower back from a damaged disc, (as sometimes happens), but by spasm in a buttock muscle. As a result, his symptoms cleared after just the first treatment. Had a disc been to blame, the recovery period would have been weeks, if not months as discs have a much slower repair time than muscles, and are much more prone to inflammation. The low back pain also cleared after treatment for a mid lumbar restriction during the same visit.
This shows how, as osteopaths, we take the time to look at the bigger picture rather than just treating one little bit of the body. This is necessary as there's often more than one thing contributing to a problem.
Woman, mid fifties, with shoulder pain radiating to the front of the chest.
This lady's problem began after moving a heavy piece of furniture, resulting in a pain that kept her awake in any position. She had a history of neck and back problems, but nothing serious. The problem turned out to be a strain and restriction to the 6th rib on the left, with muscle spasm in the overlying tissues of the back. Whilst her symptoms were initially worsened, she was pain free on her third session, after which she was discharged.
Ribs are often overlooked as the cause of a problem in people with mid back pain & may lead to irritation of the intercostal nerve, running along between the ribs from the back to the front. Localised spasm in the short muscles between the ribs (the intercostal muscles), can also happen and needs treating.
A trained therapist needs to keep in mind the possibility of other causes of this kind of pain, such as shingles or angina.
45 year old woman with lower back pain.
This lady's pain had been going on for 2 weeks after doing some heavy lifting, with pain starting from the low right back spreading to the left hip joint and making her feel as if she was hobbling. She was having discomfort when lifting, standing for long and getting up.
The problem was coming from a restricted joint in the middle of her lower back, with some shortening of the muscles on her right side. She was better after her first visit and had no more pain after her second.
65 year old man with low left back pain spreading around the waist and abdomen
This man's pain started after lifting 20 Kg on his left side, although not immediately. It was something he had experienced before & had got better by itself. The pain could be made worse by getting up, sitting, turning in bed, bending, lifting his leg or coughing.
Most of this gentleman's problems were due to compressive irritation of the joints in his mid and lower back. He also had spasm in a major muscle on his left side. A lot of his discomfort was indirectly due to tightness in the hamstrings & hip flexors (muscles used to lift your thigh up) - which have a major effect on the mobility and compression of the lumbar spine.
Most of his treatment consisted of stretching the muscles and improving the mobility in his mid and upper lumbar spine. He improved from his first visit on, with fewer and fewer twinges. His flexibility also improved, from being able to bend forward only about 40 degrees, to being able to touch his toes. He was discharged after his 9th visit.
54 year old woman with upper back pain, neck pain and headaches
There was no sudden cause for this lady's pain, but she spent most of her working day sitting in front of a computer. As with so many people with neck pain, the muscles of her neck and shoulders were particularly tight, with spinal restrictions in the upper right neck and in the upper back.
This young woman had a chronic stiff and achy back which interrupted her sleep and was also noticeable when bending after sitting.
She had worn a back brace for 12 weeks after her accident, which probably contributed to stiffness and immobility in the area and in the lower ribs. The muscles of her back were also shortened. She had been having physio, but these symptoms were not improving.
Treatment was focused on improving the mobility of the lower back and ribs so that the spine was not hinging excessively at one point when she used her back. By the 4th treatment she was often not noticing her back anymore She was discharged after her 11th session, by which time she had been coming for treatment only once a month.
22 year old male student with generalised back pain going back more than 2 years
This young man described his pain as sharp, achy or cramping. He had had a long history of spinal discomfort since the age of about 10. Although the problem had started gradually, but he felt it had been aggravated by long working days - up to 12 hours - working as a butcher, bent over a low cutting table.
The pain had been worsening over the previous 6 months and usually got worse as the day progressed - often a sign of muscular fatigue. He had never had any treatment.
His main problem was due to hypermobile joints generally (joints which move more than in the average person), and poor muscle tone, especially in the lower back. Some people have hypermobile or very 'loose' joints because the ligaments holding the joints together are not as tight as in most. These patients tend to be prone to more muscular pains as the muscles have to work overtime to help stiffen or stabilise the joints. And if the muscles are weak or de conditioned, then they will end up becoming sore under the extra work they are having to do.
A combination of treatment and home exercises to improve his muscle strength in specific areas significantly reduced his pain to the point that he felt he no longer needed treatment after his 6Th visit.
8 year old boy with right front thigh pain making it hard to walk
Sudden pain for no obvious reason in a child should always be taken seriously, but in this case further questioning revealed he had just had a big sports day during which a ball had hit him on the thigh. Pain when straightening the knee also indicated that his quadriceps muscle had been irritated by the bang. One treatment to the irritated muscle was sufficient to get rid of the pain.
27 year old woman with right sided rib pain
This started when she twisted her back in bed, the pain being worse when breathing in deeply, sneezing, coughing or twisting to the left. The problem was a joint strain where the 7th rib attaches to the spine. Some of the vertebra in the area were also restricted. These were freed through gentle manipulation, and work was done to restore movement in the affected rib and to calm the overlying tissues.
Only one treatment was needed.
Man, aged 61, complaining of periodic sharp and localised central back pain
This gentleman came in just a day before a long haul flight.
He had had these pains every 3-4 months, but in this instance the problem was not going away. He had suffered sciatica from a herniated disc in his lower back many years earlier, an event which leads to early wear and tear & loss of movement in the affected vertebrae on either side of the damaged disc.
In this case his lower back problem was made worse by an exaggerated forward curve of the upper back and a relatively immobile section between his lower and mid back. The issue here was one of limited flexibility in some sections of the spine aggravating pressure on an already compromised area.
He was treated just once before his flight, but on his return said his journey had been pain free and that he had only minor problems with bending forward. He was seen 2 more times before being discharged with no pain. He returned some time later for treatment to help with residual stiffness, but was still pain free.
Man, late sixties, with wrist pain shooting up the forearm.
This gentleman had a fall some months earlier on his hand with his arm outstretched to protect himself. X rays showed nothing, although a fracture was suspected. In some cases, a healed fracture can go undetected on x ray. His pain came when he twisted his right hand clockwise, as when tightening something with a screwdriver.
My assessment was that he had sprained the muscles at the front of the right wrist as his hand was forced backwards during the impact. These muscles would have been trying to resist that backward motion of the hand as he fell on it. Some of the small wrist bones were also found to be restricted in their movements.
These were treated to improve their mobility and the affected muscles were stretched and worked on to improve their tone and elasticity. He was also advised how to stretch them for himself. His symptoms were much better when he returned for his second treatment, which was his last as he was leaving Auckland.
Man in late twenties with low back pain and front thigh pain after weight lifting.
This young man had a history of low back pain, though not like this. His problems started with lifting a 20 kg weight from the floor and to one side, and he was aware of feeling something wrong in his back at the time. The next morning he woke with low back stiffness which became pain as the day developed.
His thigh pain was from irritation of the femoral nerve which is responsible for feeling over much of that area. This irritation was part of a problem from a restricted joint in his mid lumbar spine, although there was another restriction at the base of his spine.
He was discharged after his fourth session as he was pain free. As always with osteopathy, the treatment was not just focused on the immediate problem, but also on other areas that were helping to stress the affected area. In his case this meant looking at the loss of mobility in the area where the lumbar spine meets the rest of the spine.
The patient had recently returned to weight training, and it is quite possible that going back to weights after a long break from them contributed to his injury.
Lifting in this way (lifting while bending forward and twisting to or from one side), is one of the most likely to cause disc injuries. In fact, he had a long history of pins and needles in his left foot, possibly the result of an old disc problem from heavy manual work in his previous job as a builder.