Osteopathy Journals and Research by Darren Chandler

 

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  1. Contents

    • What is the sciatic nerve
    • What is sciatica
    • Can sciatica be cured?
    • When to see your doctor
    • What osteopathic manipulative treatment can do

    What is the sciatic nerve?

    The sciatic nerve is the largest nerve in the body. It starts from the bottom of the back, travels through both buttocks, down the back of both legs to the feet.

    What is sciatica?

    Sciatica is when you trap the sciatic nerve. There are 7 different categories of injury that can trap the sciatic nerve. Only a handful of these are really common though.

    Pain, pins and needles, numbness, burning or a ‘pulling’ sensation can be felt in either or both buttocks, back or outside of the legs and/or feet.

    Sciatica can also be used as a more general term where the sciatic nerve isn’t trapped. This is also known as ‘pseudosciatica’. In this type of sciatica an array of different muscles, joints and ligaments in the low back, pelvis and leg give referred pain that can mimic the symptoms of sciatica. These can all be loosened by your osteopath.

    Can sciatica be cured?

    YES. Most cases of sciatica are easily treatable. The NHS recommends for non-complicated causes of sciatica(1)

    1. Most cases of sciatica pass in around six weeks.
    2. Home management including over-the-counter painkillers, exercising and using hot or cold packs. 
    3. A structured exercise programme.
    4. Prescribed painkillers.

    In private practice we see patients who this standard advice hasn’t worked for. In these cases your osteopath will perform a thorough examination of all the nerves, muscles, ligaments and joints. This will decide what to treat using a hands on approach and home exercises. Occasionally your osteopath might examine you and think a referral to your doctor is more advisable.

    When to see your doctor

    Most cases of sciatica are easily treatable by your osteopath. This is a list of the most common conditions and the most common symptoms that I see in clinic and would refer to the GP. It does not constitute a complete list of all symptoms and all conditions. If you have any of these symptoms and require a second opinion please consult with your GP.

    It is important to remember just because you have any of the following symptoms it doesn’t necessarily mean you have a particular condition. However it is important to see your GP or osteopath to see if you have a condition that needs further investigations or something more minor and easily treatable.

    1. Cauda Equina Syndrome (trapped lower part of the spinal cord):

    • Tingling or numbness between your legs, around your buttocks, around the genitals and pelvic floor.
    • Alterations in the passage of stools or urine (incontinence, difficulty stopping and starting, changes in frequency, etc).
    • Difficulty contracting your pelvic floor muscles (the muscles you tense to stop yourself going to toilet).

    When experiencing any of these symptoms it is important you consult a doctor as soon as possible

    2. Slipped disc

    • Numbness in the leg or foot.
    • Weakness in the foot (difficulty lifting or taking weight on the foot).
    • Pain worse on coughing, sneezing or straining.

     3. Vascular claudication (poor circulation):

    • Pain down the leg on walking immediately relieved by resting.
    • Coldness in the foot or leg.

     4. Spinal stenosis (excessive wear and tear – not exclusive to elderly):

    • Pain in the leg(s) on walking upright eased by walking bent forward.

     5. Systemic illnesses:

    • General symptoms of ill health: fevers, night sweats, unexplained loss of appetite, loss of weight, etc.

    What osteopathic manipulative treatment can do

    Most cases of sciatica are easily treatable using a combination of various different treatment techniques and home exercises. Because sciatica is such a general term encompassing such a varied range of conditions standard advice whilst good for one condition may aggravate the other with potentially serious complications. Therefore before taking any advice you should be assessed by an appropriate healthcare practitioner.

    References

    (1) http://www.nhs.uk/Conditions/Sciatica/Pages/Introduction.aspx#treatment

  2. Content

    • Introduction
    • Types of headaches
    • Other causes of headaches
    • What can be done

    Introduction

    Headaches regularly affect more than 10 million people in the UK(1). Most cases are easily treatable by simple measures. These are listed below under the title ‘what can be done’.

    If your headaches aren't relieved by over-the-counter treatments or impact your daily activities it’s a good idea to see your GP(1).

    Types of headaches(1)

    Tension headaches

    These "everyday" headaches give a constant ache on both sides of the head,

    The causes can be many and interlinked. Typically they’re associated with stress, neck and shoulder tension (aka cervicogenic headache), skipping meals and dehydration. Don’t forget tea and coffee won’t rehydrate you!

    Migraines

    Migraines usually present as a severe throbbing pain at the front or side of the head. Additional symptoms can sometimes include flashing lights, nausea, vomiting and increased sensitivity to light or sound.

    Cluster headaches

    Cluster headaches are acutely painful. They tend to localise around one eye and will frequently cause other symptoms such as a watering or red eye and a blocked or runny nose. They’re called cluster headaches because they occur in clusters for a month or two and be gone for long periods. They tend to occur at the same time of year. Standard headache and migraine medication won’t help these types of headaches and your GP needs to prescribe you specific medication.

    Medication and painkiller headaches or ‘rebound’ headaches

    1 in 10 headaches occur from taking pain killers – for headaches! So you get a headache for whatever reason take some pain killers and the pain killers stop the headaches from getting better! Although coming off your medication may make your headaches initially worse for a few days they should improve there after.

    The most common pain killers that cause headaches are:

    • Codeine
    • Paracetamol
    • NSAID’s e.g. asprin and ibuprofen
    • Triptans used for migraines e.g. sumatriptan

    Hormone headaches

    Many women notice a link between their headaches and periods, menopause, HRT or use of hormone contraception. In these cases it is advisable to consult your GP and take standard measures for the treatment and prevention of headaches.

    Other causes of headaches(1)

    • Alcohol consumption
    • Head injury or concussion
    • Infections including sinusitis
    • Jaw or temperomandibular joint disorders (TMD)
    • Sleep apnoea 

    What can be done?

    Headaches and migraines can usually be cured, managed or at the very least improved. Like with all conditions this isn’t always the case but it can be surprising how some simple lifestyle changes can have a major impact on your symptoms.

    • Stay hydrated & don’t let your blood sugar drop. Simply drinking a glass of water with breakfast, lunch and dinner can be enough to keep you hydrated. You may need to drink more than this if you eat foods high in salt (including processed foods and meats) or drink caffeine or alcohol. To keep your blood sugar levels stable eat small frequent amounts over the day avoiding high sugar foods.
    • Relaxation. For most of us a siesta would be nice but not always possible! Slowly rotating your shoulders and relaxing tension in your shoulders and jaw will be enough to drop some of that held tension that can cause headaches and migraines.
    • Ergonomics. A recent research has shown a link between posture and migraines(2). This research didn’t specifically look at posture at the workstation or while sitting. However any faulty posture will put strain on the muscles that can trigger headaches and migraines. Follow these simple measures to help your sitting posture:
      • Make sure your workstation is properly measured up (we’ve previously blogged on this). If you use a lap top get a docking station.
      • Whenever you’re sitting down especially on a soft chair like a sofa push your hips back so they’re resting against the back rest of the chair. This will put your neck and shoulders in a far more comfortable position.
    • Phones. Use a loudspeaker and headset when possible. Never cradle a phone between your shoulder and ear.
    • Avoid certain foods. Classic triggers for headaches and migraines can be alcohol, caffeine, the food additive tyramine, chocolate, citrus fruits and cheese. However this is not always the case and individual people can have individual food triggers.  To complicate matters more sometimes food triggers can develop over time so just because coffee never triggered a migraine in the past it doesn’t mean it won’t now.
    • Supplements. Supplements are always being advertised for headaches and migraines. They have different degrees of credibility and shouldn’t be taken in certain patients with certain conditions or if you’re on certain medications. If you’re not sure what is safe and effective for you to take check with your local pharmacist and take a full list of your medication.
    • Side effects of medication. We’ve already listed what pain killers can cause headaches (see medication/pain killer headaches). Other medications can also cause headaches. These should be listed under ‘side effects’ on the documentation that comes with your medication

    As osteopaths we always look for signs of postural changes and tightness that can cause headaches and migraines. Research has shown this to have a positive impact(3,4,5) but interestingly there has also been research conducted showing a link between posture and migraines(2).

    Obviously headaches and migraines are a complicated subject and research is being conducted all the time giving us a deeper understanding as to their cause and treatment. Along side this osteopaths are constantly learning from this body of research about the different things we can do using osteopathic manipulative techniques that can positively affect our patients’ quality of life.

    References

    (1)http://www.nhs.uk/conditions/Headache/Pages/Introduction.aspx. Accessed 24.7.2016

    (2) Body posture changes in women with migraine with or without temporomandibular disorders (2014). Mariana C. FerreiraDébora Bevilaqua-GrossiFabíola É. DachJosé G. SpecialiMaria C. Gonçalves, and Thais C. Chaves

    (3) A comparison of selected osteopathic treatment and relaxation for tension-type headaches (2006). Anderson RESeniscal C.

    (4) Pilot trial of osteopathic manipulative therapy for patients with frequent episodic tension-type headache. (2014). Rolle GTremolizzo LSomalvico F, Ferrarese CBressan LC.

    (5) O054. Osteopathic manipulative treatment of headache in a polytrauma patient: case report (2015). Vito AdragnaSimona Piazzola, and Giacomo Lo Voi