Terry Sutcliffe
Osteopathy for Bath and Bristol

Back pain, sciatica and 'slipped disc'.

Back pain is a condition that just about everyone experiences at some time in their lives. It may be just a passing niggle after an activity like gardening, D.I.Y., a long period of driving or sitting at work. But for many these episodes give a more acute and persistant pain inolving the muscles, spinal joints or nerves and interferes with normal daily living in both small and larger ways. Lets face it, back pain is an unpleasant experience and can be both frustrating and stressful, especially if home and working life are disrupted. These are the back pains that osteopaths are well used to diagnosing and treating.
Sciatica is a particular form of back pain where the sciatic nerve is irritated and refers pain from the spine, down into the buttock or down the leg, sometimes as far as the toes. Sciatica is often associated with a bulging disc (often inaccurately called a 'slipped disc'). The disc is a cartilage like pad between and firmly fused to the vertebrae. The disc doesn't 'slip' out of place but the walls can weaken and bulge out to one side or the other and irritate or press on the passing spinal nerves. This is experienced as a toothache like pain (sometimes sharp and shooting), pins and needles or numbness in buttock, thigh, calf or foot.
In times gone by osteopaths have perhaps over simplyfied the condition by saying the treatment 'puts the disc back'. In reality treatment is aimed at restoring normal spinal joint movement, relaxing and releasing tight muscles and 'decompressing' the lumbar area using gentle stretching techniques. In addition I feel it is important for people to know what activities are likely to help or hinder recovery and which specific exercises are appropriate.

Neck pain

Neck pain as with back pain can take different forms depending on which structures in the neck are predominantly affected. Muscle tension and tightness can cause aching, restricted movement and sometimes headaches. The causes are many and various and include both mechanical strain such as spending long periods at the computer or driving, and equally emotional stress such as anxiety, frustration and poor sleep all which have their own causes. Osteopathy can provide relief through massage, stretching and sometimes joint manipulation, along with self help measures.

The facet joints are the joints that link a vertebra to the ones immediately above and below. When they become inflamed they can give a toothaching soreness in the neck particularly if turning or bending to one side. Neck movement becomes both painful and restricted so the neck is held rather stiffly. There may be some nerve sensitivity. Without treatment the neck may fail to regain its former mobility. Because the neck can feel a rather vulnerable area I tend to favour gentler stretching techniques rather than what we call 'high velocity thrusts' (bone cracking!) especially with the over 50's. I also like to instruct the person in self massage, stretching, posture and discuss the use of aids such as wheatbags and corrective pillows.

Neuritis in relation to the neck refers to irritation of the nerves that exit the spine in this region. This is the necks equivalent of sciatica in the low back with pain referral down towards the shoulder blade, upper back/arm and sometimes right down to the hand. There may be a nagging ache in the neck or sharp shooting pains along the nerve when moving in a particular way. For some there are pins and needles or numbness in some of the fingers. This treatable condition needs prompt osteopathic help in order to diagnose and treat the problem earlier rather than later.


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Shoulder pain and 'frozen shoulder'

Shoulder pain may result either from a disturbance directly in the shoulder joint, pain referred from a neck problem or sometimes both.

Pain directly in the shoulder joint can be a result of an injury that has wrenched or jarred the joint thereby straining tendons and muscles, spraining ligaments, or even loosening the ball and socket arrangement. The shoulder movement may be relatively free but is not possible without discomfort. Treatment is aimed at maintaining muscle power and mobility of the joint whilst relieving pain. As an osteopath I would also look at associated areas such as the neck and thoracic spine for possible secondary complications.

A 'frozen shoulder' can be a complication of injury or can develop on its own without an ovious cause. The capsule that surrounds and supports the joint is normally pliable and elastic allowing a wide range of movement. With a 'frozen shoulder' the tissues tighten and contract (adhesions) severely limiting the upward and backward movements of the arm. General activities that we normally take forgranted like brushing ones hair, dressing, washing and many daily habits become impossible without considerable thought and adaptation. Osteopathy can help by stretching and strengthening the soft tissues that are restricting movement, relieving pain and mobilizing the joint. Home exercise and self treatment to develop strength and flexibility are an essential part of recovery. With this condition ones capacity for patience and persistence are equally exercised!

In the over 50's and later decades there is likely to be a certain amount of natural 'wear and tear' associated with a lifetime of use. Previous injuries, sporting activities, hobbies and work history may have had an impact specifically at one or both shoulders leading to osteoarthritic changes. The bones can develop small spurs, or the tendons may have calcium deposits within them. A bursitis may develop which is an inflammation of the sack of fluid within the shoulder joint that normally prevents friction and allows free movement. Osteopathy can help diagnose and treat these painful conditions. Where appropriate an X-ray may be arranged with your agreement through your GP and occasionally referral on to an orthopaedic consultant if needed.

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Muscle aches and pains

Muscle tension and soreness are common symptoms that are frequently treated at the clinics and may be the primary concern or secondary to other conditions such as sciatica, neuritis, arthritis, joint sprain, RSI etc.

The potential causes are manifold. Following unaccustomed exercise, postural imbalances, repetitive activities, prolonged static activities (eg. computer work), sleep disturbance, and not forgetting emotional factors such as stress.

I like to use massage to examine the muscle groups involved and relieve tightness. 'Muscle Energy' techniques help to relax and stretch relevant areas. Time is also spent identifying possible contributing factors and looking at how these sources might be worked with. Ergonomics is the study of humans in relation to the work they do and in particular how to fit the job to the person (rather than the reverse!). Self help measures are discussed and agreed upon and may include self massage, posture awareness, remedial exercises, the use of hot or cold packs, relaxation/meditation practice and incorporating other measures such as Pilates or Yoga.

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Headaches and migraine

Headaches and migraine are another common group of symptoms that often respond well to treatment where the primary cause is posture, fatigue, poor sleep or stress as is often the case.

There may be associated muscle tension and stiffness in the neck and across the top of the shoulders (the trapezius muscles) as well as under the base of the skull (sub-occipital muscles). Trigger points are often found here. These are discrete areas within the muscles that are very sensitive and may refer sensation to other areas when pressed.

Effective treatment in my experience involves massaging the tight areas of muscles, desensitizing active trigger points and articulating joints to relieve stiffness. The upper neck is often helped through 'decompression' techniques that restore some of the elasticity to the spine.

Self help is similar to that for neck pain, with self massage, stretching exercises, hot packs, posture awareness and relaxation techniques where appropriate.

There are many other conditions for which headaches are but one symptom. Osteopaths are trained to recognise when medical help is more appropriate.

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Whiplash injuries

Whiplash injuries can be a painfull and serious consequence of a car accident or fall. The kinetic energyof the impact travels quickly and powerfully through the body throwing the spine forward, backward or sideways (like a whip!) depending upon the direction of the force. The muscles that normally stabilize the back and neck contract violently in an attempt to protect the body from injury causing multiple areas of tissue microtearing. Unable to fully contol this excessive movement strain then falls onto the ligaments that are designed to provide a natural limit to joint motion.They often become over stretched and their associated spinal joints can become hypermobile (excessively loose) and damaged as a consequence.

Osteopathy can help in the early stages by identifying and treating the damaged joints and tissues. This requires in my opinion a detailed examination of the spine and any related areas followed by a thorough but gentle treatment using techniques that takes into account the sense of vulnerability that one may feel in the wake of and accident. If starting treatment has been delayed and the condition is more chronic (ie. has been around for more than 3 weeks) then stiffness may have set in and will require gentle but firm encouragement towards normal movement always working within the limits of the individual.

A home self help programme is esential in order to reduce recovery time and is likely to involve stretching and strenghthening exercises, self massage and the use of hot pack (wheatbags).

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Arthritic conditions

Arthritic conditions fall into the two distinctly different categories of osteoarthritis and rheumatoid arthritis.
Rheumatoid arthritis is a chronic inflammatory disease affecting the bones of the joints and their cartilage. The changes in the architecture of the bones causes deformation of the joints particularly in the hands resulting in varying degrees of disability. The causes are not yet fully understood but it is thought to be a disorder of the autoimmune system where the body mistakenly attacks itself. Treatment is aimed at giving comfort and relief to the secondary inflammation in the soft tissues around the affected joints and other areas of compensation and uses massage and gentle stretching movements to ease pain.

Osteoarthritis is the more common 'wear and tear' process that affects all of us as the decades accumulate! It can develop in any of the joints of the body, and is commonly found in the knees, hips and spine. Its causes are many and varied. Some have a body type that is prone to stiffness and a degree of rigidity which may run in the family. Others may have had specific injuries in the past from sports or accidents that act as a focal point for excess wear and tear. And for others it is simply the natural accumulation of a lifetime of work and postural habits.
Treatment can help firstly by identifying the problem area (not all hip pain is caused by the hip for example!) and then by mobilizing the joints and their related soft tissues, and giving advice on how best to improve strength and flexibility. Taking an active role in remaining physically independant and relatively pain free throughout ones later years can contribute greatly to ones enjoyment and quality of life and I for one consider it a worthwhile investment of time, energy and resources. You're worth it!

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