Here at Herts Osteopathy we aim to look at the whole picture. This is why will often do a full assessment of your mechanics, feet, hips, spinal biomechanics, gait analysis and force production and absorption in order to get to the crux of your pain.
So many problems and pain patterns are caused by your feet, and your overall biomechanics.
This can be the turning point for most pain prevention and injury healing.
At different points in the gait cycle we have very different, and sometimes opposing, needs of our body. This is why running, and even walking in some people, can cause issues. Our muscles have to change jobs from lengthening under tension (eccentric loading), shortening under tension (concentric), or building up a kinetic potential energy in the form of a coil or spring at relative speed. The requirements are huge, and there is a whole chain of movements, force production, shock absorption, and the whole body working together (beautifully) to produce movement. Our bodies are amazing, and mostly this just goes on beneath the surface without us even really knowing about it. We never have to tell our body how to walk!!……..BUT sometimes a whole load of issues we may have compensated for throughout our lives, all come to the fore. And repetitive loading of the wrong tissues, or in the wrong way, can then lead to injury.
So where do we come in….????
We provide full biomechanical assessment, assessing the way you move through the foot, ankle, knee, hip, pelvis, spine…… We look for how you control forces at the feet, and then work through helping the foot to generate the correct amount of force, load, and at the right time in the gait cycle. It is so interesting, that at certain points we need stiffness and stability through the foot, and at other points we need mobility and supple strength. We need the foot to be able to supinate (roll outwards), and pronate (roll inwards) effectively.
YES, we do need PRONATION!!!!!!!!!
Pronation is actually a super important force required to get over and through the big toe correctly, without it, we get a super stiff big toe, too many forces through the other toes (that horrible painful numbness you can get: Morton’s neuroma and similar issues to this) and a whole host of other problems all the way up to the hip and spine, as the whole body is trying to compensate. As osteopaths we can use various exercises and hands on treatment methods to get your body moving through the correct mechanics. And our bodies are actually amazingly brilliant at adapting to this.
You may want this approach for injury prevention and also specific injury rehabilitation, like those who are suffering “shin splints” “plantar fasciitis” “heel pain” “lower back pain” “runner’s knee”……or those healing from ankle sprains, and other mechanical issues.
We can also help to get you a PB!! Love that this happened with one of our patients a few weeks ago who was coming in just because his wife said he hit his calf with his foot when he ran!!!
So this is fantastic for sports people and those who run and train hard.
However, it’s not just an exercising issue….. We encounter many pelvic issues here from excrutiating, debilitating pain, to low level constant SPD, (and everything in between) here at HO. I will often look at what is happening at the feet in these issues. Significant changes at the feet and force control at the feet are often common in pregnancy and postnatally, so by addressing these, we can usually make a much longer lasting effective change to the pelvis.
So looking at how your foot moves relative to the rest of your body is so important, whether you are pregnant and experiencing pelvic pain, whether you are training for a marathon, trying to get back to exercise postnatally, or a leisurely walker. We’re here for your #prehab and #rehab
You don’t need to be in pain to come and see an Osteopath. We look at prevention as well as long term cure. Here for you at every stage!!
So I have felt compelled to write a short blog post on this overused term “sciatica” and how frustrating it is when patients have been told this is what they have. As a patient it gives you no information other than telling you that your sciatic nerve is inflamed (at some point along its very long journey!!). And it absolutely tells you nothing about why it got there, and therefore you are completely disempowered to be able to do anything about it.
Unless you know the cause of your pain or issue, you will never be able to fix it, and escape from your “diagnosis”.
Often when people come to me in acute debilitating pain, they have been given the diagnosis of sciatica, often with a prescription for some high strength painkillers or anti-inflammatories and told to rest. Obviously you don’t want to be running any marathons at this time, but gentle mobility, movement, walking is needed.
So, what is it?
Hayley our senior osteopath has written a nice succinct article on sciatica in one of our other blogs so do take a quick read of this. But sciatica is when the sciatic nerve becomes inflamed, compressed, pinched, irritated or annoyed at some point along its journey. It exits the spine right at the bottom in the lumbar and sacral area at the base of the spine, so can get irritated at its point of exit, or along its path, through the buttock and down the leg. However, unless we know why the nerve has become irritated we cannot get rid of it.
It is mostly caused by a change in load through the spine and pelvis, and often over a period of time, so the altered mechanics place pressure through the nerve or the spinal segments repetitively, and over time they become inflamed. Sometimes we are able to withstand quite a lot of compensation for a long time until a very small event tips us over the edge “the straw that broke the camel’s back”…. Something small like a sneeze, or something more significant like the growing bump through pregnancy.
So we look at how you move, how you walk, how your spine moves, how your feet bare load. We assess how you sit, work position, how you carry your children, breathing, exercising….. We look at the mechanical causes to the sciatic nerve becoming irritated so we can remove these and give you the information about your body, and why it happened, to give you the knowledge of what to do to prevent it coming back.
As osteopaths we use hands on treatment involving massage, stretching, articulations, mobilisations, acupuncture when needed/desired, and taping. We give you advice and exercises to do to prevent it coming back. Our aim is to empower you with the knowledge of your body, not just to get rid of the symptoms (although we do this too!!).
Spinal and pelvic assessment
We treat a lot of people at the acute “agonising” point of sciatica and can make huge differences within one appointment for many people who walk (or hobble/crawl) through our door. It really does work, and the NHS and NICE also support this.
Come see an osteopath here and get to the crux of your pain. You will learn about your body, and what to do to prevent it coming back. We are on your side, and we absolutely love what we do.
Online bookings available 24/7
SPD is a debilitating condition, worsened by the hormonal and mechanical changes of pregnancy. In a past blog I have written about pelvic pain and dysfunction and how Osteopathy works so well to help.
In this post I have put together an advice sheet on what to do alongside and after your treatment, and to support ongoing treatment with us, in terms of reducing pain and getting the body back to normal more quickly and effectively. This will also help longer term.
1. Use frozen peas!!!!
Yes it really does work! Most of the pain experienced, especially at the pubic bone and sacroiliac joints (at the back of the pelvis), is inflammatory in nature. This means it responds really well to cold. Pop a handful of frozen peas in a freezy bag, tie in a knot, then use as your ice pack. 10 minutes at a time on all sore spots.
2. Pillow between the knees
Boring, but it does work. If you are sleeping on your side, make sure your hip bones are stacked on top of each other to prevent further misalignment.
3. No crossing legs
Try to avoid crossing one leg over the other, try to keep your pelvis in a neutral position. Thereby, sit with equal weight through both sit bones. Try to avoid twisting whilst you are in this position too.
4. Maybe ditch the stilettos??!!
High heels can push your weight even further forwards. If you are pregnant then you will be weight bearing more in this position anyway due to your bump. Try to wear good comfy shoes whenever a lot of walking is required. By supporting your arches you will be able to help reduce any poor loading through the pelvis.
5. Get strong!
Stronger glutes and core muscles (and of course pelvic floor muscles) are imperative in keeping out of pain more long term. This can be done whilst pregnant and after. Pilates works wonders. Ask us for some basic exercises to help you individually. Although best to avoid single leg exercises for now.
6. Don’t overstretch
So there are loads of little muscles and ligaments around your pelvis, both front and back, which are likely quite strained with SPD/PGP. If you open your legs too wide to get out of the car, do a box splits position or similar type stretch in a yoga class, or always sit with your knees together, and hips turned inwards (and feet/lower legs out), then definitely worth avoiding if possible. These types of positions take the muscles on too much of a stretch, so if they are inflamed they will be really sore. Swimming is amazing, but you may prefer back crawl or front crawl now as breaststroke can cause overstretching at the pubic symphysis area.
7. Avoid hip carrying other children
Try to carry your elder children centrally, like a monkey carry if possible. If you hitch your hip to carry a child, toddler or baby in this way, then you can cause a further disruption to the pelvic alignment, and put more strain on the ligaments, causing muscles to spasm, and further exacerbate a pelvic issue. Central carrying is a great habit to get into from a very early age.
I hope all of this information is helpful. Osteopathy is fab for realigning the pelvis, and calming down pain and inflammation and muscle spasm brought on by pelvic pain and SPD. SPD is predominantly a mechanical issue, whereby the load through the pelvis has been disrupted. Lots of women can be pain free after treatment, but do need to take care of themselves for the rest of their pregnancy to prevent the pain from returning. This advice sheet will help you to remember the important bits.
Please contact us if you have any questions:
The Mighty Iliopsoas*
(*AKA HIP FLEXORS!!!!)
So how many times have you been told your hip flexors are tight by one person or another???
It really isn’t that simple….unfortunately…..
Look how beautifully they weave from the spine and the diaphragm, across the ribs, through the abdomen, the pelvis, and then into the hip, groin and thigh. Affects everything, and can be affected by everything from the breath, to the bowels, the pelvis, the foot, and everything in between. Cheeky little thing! Always involved but not necessarily ever the “answer”. Stretching “tight” hip flexors often told that this is your issue from prolonged sitting for example is not often what you need. In fact, look at all of the things that can affect it, or affected by it……Phenomenal!
Sitting for prolonged periods will compress and compromise the lumbar spine, the ribs and diaphragm, shortening the space for them to move freely, and setting up a shortened chain reaction of muscles and fascia, which over time is quite hard to alter. Pelvic and abdominal viscera are “squashed” into a smaller cavity with less mobility and freedom to move as needed. The iliopsoas group are inadvertently altered but not necessarily “tight”.
As osteopaths we will look at the body as a whole, and get to the crux of the issue from the outside in. By getting to the cause, we affect the symptoms.
When we walk, we require a loading effect through the iliopsoas which loads like a coil to allow it to contract purposely and as it should. This group of muscles have a different job, and effort requirement throughout the gait cycle. We need them to load and then explode correctly and efficiently in order for everything else to do the same. For example, if the iliopsoas muscles are too short, they will produce a rotational force through the hips which counteracts that of the glute muscles (main muscles in the buttocks). This means that we do not allow the glutes to load up and then explode and activate properly and effectively. And of course these issues can be caused from the ground upwards, if we are not loading correctly through the foot and ankle this will place the wrong force through the pelvis, iliopsoas, glutes…. And also from above.
The diaphragm is also super important. This provides a tension from above which will preload the iliopsoas group effectively too. Don’t you just love how everything is connected!!??!! So if we have any postural compensation which will restrict how beautifully we can use our ribs and diaphragm to move whilst we breathe and try to expand our rib cage, then this in itself can affect the iliopsoas.
So just remember this when you are sat hunched over a phone, computer, or steering wheel for hours on end….when you spend hours on a road bike without an equal amount of time spent looking upwards, opening up, standing, walking, running… There are a good many issues contributing to your back pain, hip pain, “hip flexor pain” and it may not just be coming from one place. Come and see us and get a full biomechanical assessment. We can help get you out of pain, but also moving, breathing, training better.
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Do you have a rib head subluxation??
Oooh sounds a lot worse than it is.. Honestly!
Do you have pain at the base of the neck coming into the shoulder, by the upper spine, or even described as being behind the shoulder blade, worse with particular positions and neck movements? These are often signs that a rib is “out”. This can then develop into headaches or radiating symptoms down the arm and around to the sternum depending on how long they have had it for.
This must be something that I “adjust” or “put back in” on a daily basis. But many don’t even realise they have it.
Here is a great little article about it and a useful picture below taken from :
People come in with pain at the points circled in red, but often slightly higher in the shoulder too. This can come on from daily activities which may put it at a vulnerable position in some, but also through trauma for example a RTA or a fall. More often than not these areas of pain are indicative of a rib head out of place (popped out, or subluxed). See in this picture below of the rib head and how it connects to the spine :
Once found, these can be relatively easy for us to adjust back to where they should be, but quite often hard to keep there from a patient’s perspective. We would always address the issues that have caused it in the first place which can involve the mechanics of the entire rib cage, shoulder position and mobility, restrictions in the neck and upper back are common features and causes. These will help but there are a number of activities that may predispose us to pop our ribs back out again whilst they are still healing:
~Carrying a child or heavy bag on one side
~Sitting over a computer with rounded shoulders and head forward for long periods
~restrictions through the upper back and neck (place altered forces through the joints with the ribs)
~Walking around typing on a phone in one hand.
~Poor or uncomfortable feeding positions in new mums
Interestingly I have found this to be most common in postnatal mums due to the change in ligamentous laxity but also due to the altered mechanical demands on the body, feeding for hours on end in the early days, along with increased weight of breast tissue. So advice on the correct feeding position is always part of the after care advice here, along with ice and mobilisation exercises.
Healing can take up to six weeks due to the ligament strain associated with the rib subluxation. So although the initial acute pain can be reduced significantly after one appointment you need to follow advice in the following weeks to prevent it from coming back to often.
So great advice as per the linked article above. Use frozen peas, think about not sitting for too long in one position, avoid spending too much time with your phone in one hand, and stay mobile!
Come and see us if and when you need us.