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MY PAINFUL EXPERIENCE – DARREN MCCALL

I’ve had my fair share of injuries over the years, usually due to football or cricket. From a few concussions to a bit of back pain, I speak from experience when I’m talking to clients about their aches and pains! But there’s one injury that stands out – mainly due to how and where it happened…

As some of you would be aware, we like to have a bit of fun at Pakenham Osteopathy and when we’re not in the midst of a pandemic, we usually get together for the odd social event throughout the year. I have a notorious record when it comes to our social events and our ‘Amazing Race’ inspired event last year was no exception.

To cut a long story short, we split into two teams and each team was given a balloon we had to protect. Not one to shy away from competition, I went after the other team’s balloon and successfully managed to pop it. This enraged a few of the opposition, none more so than Tom and Hayley who decided to chase me through the streets of Melbourne. They were unsuccessful until “TWANG” – the old hamstring decided to give out. I still managed to hobble away and even attempted to run through Tom and Hayley at the finish line, but with no luck. The balloon popped, my shirt was ripped and I was left feeling sore and sorry for myself for the next few hours.

I know what some of you might be thinking – I tore my hamstring yet still tried to run?! Sometimes the advice that we give our clients is the hardest to take ourselves!

So what did I do about it?

Of course, I sought the expertise of our osteopaths. Luckily, my hamstring tear wasn’t severe so it meant a relatively short recovery. However, regardless of grading, muscle tears and strains require rehabilitation to ensure that the risk of recurring injury is kept low and the muscle returns to full strength.

Manual treatment included soft tissue massage, manipulation, articulation and some dry needling over a period of 3-4 weeks. The main rehabilitation exercises I focused on were standard and nordic hamstring curls, clams, glute raises and crab walks.

I began running again after 3 weeks, starting with smaller runs and slowly building to longer runs.

We, as Osteopaths have all had our fair share of injuries and we know how confusing and frustrating recovery can be. At Pakenham Osteopathy, we always try to explain the cause of your injury in laymen’s terms so that you are fully informed. We also provide every new client with a management plan detailing what is going on, how long you can expect recovery to take, how many treatment you will require and what exercises or stretches will aid your recovery. For exisiting clients, we ensure we take the time to listen so that we can work towards your goals together – which might be getting back to the training track, getting up and down off the floor to play with the kids, or to play a round of golf.

The moral of my story – don’t keep running after you strain your hamstring and don’t let your competitiveness get the better of you!

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HOW CAN OSTEOPATHY HELP MY SHOULDER PAIN?

Our shoulder joints are one of the most flexible joints in our body and for good reason; we use them in almost everything that we do, which is why it can be so limiting and debilitating when something goes awry. When we talk about the shoulder, we often immediately think of the ball and socket joint (aka the glenohumeral joint) because that’s the one that provides us with most of our movement. In this article we’ll also discuss the acromioclavicular joint and scapulothoracic joint.

THE GLENOHUMERAL JOINT – STRUCTURE

The glenohumeral joint is comprised of the head of the humerus and the glenoid fossa of the scapula (your shoulder blade). Together, they form a ball and socket type joint which allows for a great range of motion and flexibility. This unfortunately comes at the cost of stability, which is why we have ligaments, muscles (namely the rotator cuff) and tendons to reinforce this joint and help keep everything together and functioning well.

The rotator cuff is an umbrella term for a group of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) that surround the shoulder and provide us with stability by compressing the head of the humerus into the glenoid fossa. So it makes sense that if we keep these muscles strong it’ll go a long way to keeping our shoulders stable, healthy and most importantly pain-free.

The muscles of the rotator cuff attach themselves in and around our shoulder via tendons which allow us to throw our arms about. Protecting these tendons from rubbing up against bone and each other are fluid filled sacs known as bursa – namely, the subacromial and subscapular bursae.

Another structure that aids in creating stability is the glenoid labrum, which attaches to the margins of the glenoid fossa and creates a deeper socket for the head of the humerus to sit in.

THE ACROMIOCLAVICULAR JOINT – STRUCTURE

The acromioclavicular (AC) joint is formed by the acromion process of the scapula, clavicle (collar bone) and ligaments that keep them together. As opposed to the glenohumeral joint, the movement available at the AC joint is far more subtle.

THE SCAPULOTHORACIC JOINT

The scapulothoracic joint is formed by the scapula and the thoracic spine and cage (ribs). Whilst it technically isn’t a ‘true’ joint like the glenohumeral and acromioclavicular joints, it simply refers to the articulation between the aforementioned structures.

The muscles attaching to the scapula and thoracic cage are key to maintaining healthy function of the scapulothoracic joint and there are plenty of them. These include the trapezius, serratus anterior, latissimus dorsi, deltoid and levator scapulae muscles just to name a few.

I’m not overstating it when I say that optimal movement and function of this ‘joint’ is absolutely vital to maintaining the health of not just your shoulders but your spine and ribs too. This can be achieved in various ways with an array of mobility and strengthening exercises that your osteopath at Pakenham Osteopathy will be able to prescribe for you.

COMMON CAUSES OF SHOULDER PAIN

Rotator cuff strain/tear
Rotator cuff tendonitis/tendinopathy
Subacromial impingement
Subacromial bursitis
Labral tears
Arthritis
Adhesive capsulitis
Acromioclavicular joint sprain
Glenohumeral joint dislocation/subluxation
Referred pain from the neck

Shoulder pain can be complex and often the exact source can be difficult to identify. It’s important to be proactive and seek the best possible management to get you back to full health and ensure you can continue doing whatever it is that you love; be it sport, work or just playing with the kids!

WHAT IS AN OSTEOPATH AND WHAT CAN WE DO FOR YOU?

QUALIFICATIONS & TRAINING

Osteopaths have 5 years of University training under their belt where they learn to master the difficult task of assessing, diagnosing, treating and managing musculoskeletal injury.

THOROUGH HISTORY & ASSESSMENT

Initial consultations with our osteopaths are 60 minutes long to ensure your story is heard. Every person’s pain is different, so our osteopaths take the time to understand your history and the circumstances surrounding your pain. Our questioning is thorough, ensuring we can tailor an efficient assessment to pinpoint the cause of your pain and develop an individualised management plan based on your goals.

HANDS ON TREATMENT APPROACH

Pain is often the most common reason people seek osteopathic treatment. Therefore, there’s no surprise that osteopaths continue to employ a hands on approach to help decrease pain and get you moving better. There are a vast range of hands on techniques that an osteopath will use including:

Soft tissue massage & stretching
Joint mobilisation
Joint manipulation
Rigid and kinesio taping
Dry needling
Shockwave therapy

INDIVIDUALISED TREATMENT PLAN

Here at Pakenham Osteopathy, we strongly believe that your understanding of your condition or pain plays an important part in your recovery. That is why we take the time to explain your pain and provide you with a written management plan outlining your diagnosis, why it has occured, expected recovery time and anything else that is required to reach your goals.

HOLISTIC APPROACH

For many people, shoulder pain can become a recurring annoyance and can affect more than just your work. We believe in long term success and therefore adopt an holistic approach to your injury by not only treating your pain, but also addressing the root cause of your problem. This will reduce the likelihood of pain returning in the future so that you can live a healthy and active life moving forward.

WHY SHOULD I SEE AN OSTEOPATH FOR MY SHOULDER PAIN?

Everyone’s pain is different and everyone has different goals they aspire to achieve. We strive to treat the person, not just the injury. Whether your goals are to run marathons, muck around with the kids or enjoy your time in retirement, we take them very seriously (whilst always having a laugh in the treatment room at the same time!). These goals help us form the basis of our individualised management plan to ensure that together we are able to get you back doing the things that you love.

IF YOU’D LIKE TO KNOW MORE ABOUT SHOULDER PAIN, READ SOME OF OUR GREAT BLOGS BELOW:

https://www.pakenhamosteopathy.com.au/shoulder-pain-injury-treatment/

https://www.pakenhamosteopathy.com.au/shoulder-pain-pakenham/

https://www.pakenhamosteopathy.com.au/shoulder-joint-can-move/

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HOW CAN OSTEOPATHY HELP MY POSTURE PAIN?

Our society is becoming more and more sedentary everyday. Whether it’s the morning and evening commutes, working at a desk, watching TV or playing on our endless list of electronic devices, we spend far too long sitting down. Depending on how you sit, certain muscles and joints can become tight and stiff over time, creating muscular imbalance which may lead to pain and discomfort. Common areas for this to occur are the upper and lower back and the neck.

When we’re sitting at a desk, reading a book or looking at our phones we’re naturally drawn to whatever it is we’re paying attention to; we want to be closer to the screen or book so that we can take in as much information as we can. When this happens, the muscles at the front of the neck and in your mid-back ‘go to sleep’ as they’re not being used, causing them to weaken over time. The opposite happens at the back of your neck and chest – these muscles are overused and become tight in response.

Upper crossed syndrome

The lower back can undergo similar changes. As you can see below, the gluteal and abdominal muscles can become weak and the muscles at the front of the hip and lower back become tight.

lower crossed syndrome

You might think that these tighter, overused muscles are the ones that need to be stretched, massaged and manipulated and you’d probably be right. However, the weaker muscles still need some attention and need to be strengthened. Often if all areas aren’t addressed, then the chances of having a flare up or recurrence of your pain are increased. This is why your osteopath at Pakenham Osteopathy will give you exercises to do at home or in the gym and it’s often the reason that appointments extend beyond just resolving your pain; we want you to be stronger and healthier than you were before you even started to experience pain.

What Can Osteopathy Do For You?

Qualifications & Training

Osteopaths have 5 years of University training under their belt where they learn to master the difficult task of assessing, diagnosing, treating and managing musculoskeletal injury.

Thorough History & Assessment

An initial consultation with our osteopaths are 60 minutes long to ensure your story is heard. Every person’s pain is different, so our osteopaths take the time to understand your history and the circumstances surrounding your pain. Our questioning is thorough, ensuring we can tailor an efficient assessment to pinpoint the cause of your pain and develop an individualised management plan based on your goals.

Hands On Treatment Approach

Soft tissue massage & stretching
Joint mobilisation
Joint manipulation
Rigid and kinesio taping
Dry needling
Shockwave therapy

Individualised Treatment Plan

Here at Pakenham Osteopathy, we strongly believe that your understanding of your condition or pain plays an important part in your recovery. That is why we take the time to explain your pain and provide you with a written management plan outlining your diagnosis, why it has occurred, expected recovery time and anything else that is required to reach your goals.

Holistic Approach

how to stop sciatica For many people, postural pain can become a recurring annoyance and can affect more than just your work. We believe in long term success and therefore adopt an holistic approach to your injury by not only treating your pain, but also addressing the root cause of your problem. This will reduce the likelihood of pain returning in the future so that you can live a healthy and active life moving forward.

SO WHY SHOULD I SEE AN OSTEOPATH FOR MY POSTURAL PAIN?

IF YOU’D LIKE TO KNOW MORE ABOUT POSTURAL PAIN, READ SOME OF OUR GREAT BLOGS BELOW:

https://www.pakenhamosteopathy.com.au/posture-and-ergonomics/

https://www.pakenhamosteopathy.com.au/workers-urged-to-stand-up-for-their-health/

https://www.pakenhamosteopathy.com.au/back-pain-pakenham/

https://www.pakenhamosteopathy.com.au/avoiding-neck-pain-back-pain-at-your-desk/

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Carpal Tunnel Syndrome

Most of us have heard about or know someone who has suffered from carpal tunnel syndrome (CTS), but what is it? What causes it? And what can you do about it?

The Anatomy of the Carpal Tunnel

The carpal tunnel is an important structure found at the front of the wrist, just below your palm. It is formed by the bones of the wrist (carpal bones) and a thick band of connective tissue known as the flexor retinaculum.

The tunnel houses the tendons of the muscles that allow you to flex your wrist and fingers. The median Nerve, which supplies some of the muscles in the forearm and hand, also runs through the tunnel. Compression of this nerve in the carpal tunnel leads to a collection of signs and symptoms that are known as carpal tunnel syndrome.

What causes CTS?

Often CTS develops idiopathically, meaning it occurs spontaneously without a known cause. It can also be caused by the thickening of ligaments and tendons, bony spurring of the carpal bones and inflammation within or near the carpal tunnel.

There are a few things that can increase your risk of developing carpal tunnel syndrome, such as:

Conditions that affect the nervous system (e.g. diabetes)
Rheumatoid arthritis
Obesity
Occupations that require repetitive wrist movements, especially wrist flexion

Your osteopath will work with you to identify any underlying risk factors that you may have and manage them accordingly.

What are the signs and symptoms?

The main symptoms are pain, numbness and tingling in the thumb and first three fingers. This pain can radiate further up the forearm and can often wake you up at night. If left untreated, CTS may cause weakness and atrophy (muscle wasting) of the muscles of the thumb. This may cause you to drop things and struggle to button up shirts or jackets.

What can I do about it? And what can an osteopath do for me?

Your osteopath here at Pakenham Osteopathy will take a detailed history and conduct a thorough examination to formulate a diagnosis. We will tailor a management plan to your specific goals and needs, so that you have a clear understanding of exactly what is needed to get you out of pain and back to full health.

Inside the treatment room, your osteopath may use techniques such as soft tissue massage and stretching, articulation, mobilisation, manipulation and dry needling, as well as provide you with some advice about your posture at work. A home based exercise program may also be prescribed to target areas that may be contributing to your CTS.

What about bracing?

In some instances, braces can provide some relief of overnight discomfort. There are plenty of options out there and it can be hard to know which one is right for you, so your osteopath at Pakenham Osteopathy will discuss this with you.

I want to know more!

If you have any further questions, don’t hesitate to get in touch via email at darren@pakenhamosteopathy.com.au or call the clinic on 5941 4157.

LET US DISCUSS, THE MEN-IS-CUS

Before I get stuck into the nitty gritty of one of the most common knee injuries, I want to talk about where my fascination with a little piece of cartilage began.

Growing up as a Miami Heat fan I loved Dwyane Wade and the way he approached basketball on and off the court. For those of you who don’t know, Wade’s career was arguably cut short by ongoing knee issues stemming from an injury he suffered in his college career – a meniscus tear. The decision was made to remove the meniscus in his left knee completely. By his own admission, that’s likely where his ongoing troubles began (1). These days, complete removal of the meniscus (meniscectomy) is uncommon – but more on that later….

WHAT is a meniscus?

A meniscus is a C-shaped piece of cartilage that sits in both of your knees on top of your tibia. You have two in each knee and they act as shock absorbers, providing cushioning and stability when you run, walk and jump.

As you can see in the image below, the outer part of the menisci (the ‘red zone’) receive a reasonably good blood supply but the further we go inside the knee (the ‘white zone’), the poorer this supply gets. This can play a significant role in the management of meniscus injuries, as we’ll discuss later.

HOW does a meniscus tear happen?

In the younger population, meniscus injuries typically occur during sports that require sharp directional changes and twisting movements such as basketball, netball, cricket and football.

This can be the same for the older population, however degenerative injuries are more common in this demographic due to gradual fraying of the meniscus as we get older.

WHAT are the signs and symptoms of a meniscus tear?

There can be great variation in how a meniscus tear presents and they can often be completely symptom free. In fact, a systematic review on 5,397 asymptomatic knees conducted in 2018 (2) found that 19% of people aged over 40 had a meniscus tear upon imaging (4% in individuals under 40).

The most common signs and symptoms of meniscus injuries are:

Pain in the knee, especially when twisting or changing direction
Swelling (usually minor due to the poor blood supply)
A sense of instability
‘Locking’ of the knee
Inability to fully extend the knee
Clicking/grinding in the knee

HOW long will I be out of action for?

There is great variation in the healing time frames for meniscus injuries.

Tears in the ‘red zone’ tend to heal more rapidly as they have a reasonable supply of blood and nutrients, where as tears in the ‘white zone’ can be more difficult to manage and can take longer to fully recover.

Healing times are also heavily dependant on what type of injury or tear is present, how significant it is, how impaired your activities of daily living have become and whether or not surgery is warranted. Typically, recovery can take anywhere between 4-12 weeks.

WHAT can I do about it?

If you suspect you might have a meniscus injury, basic first aid principles (such as rest, ice, compression and elevation) may help with the pain and swelling in the short term. Conservative management (i.e. manual therapy, activity modification and exercise rehabilitation) is usually trialled first. If this is unsuccessful, other options can be explored such as surgical repair of the meniscus.

The osteopaths at Pakenham Osteopathy have a thorough understanding of the knee and will be able to assess you and develop a management plan based on your specific needs.

BUT I still ‘kneed’ to ask more questions?!

Don’t hesitate to get fire through some questions via email at darren@pakenhamosteopathy.com.au or call the clinic on 5941 4157.

References:

1. https://www.espn.com.au/nba/truehoop/miamiheat/story/_/id/9760169/dwyane-wade-miami-heat-regrets-having-meniscus-removed-college

2. Culvenor, A. G., Øiestad, B. E., Hart, H. F., Stefanik, J. J., Guermazi, A., & Crossley, K. M. (2018). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med, bjsports-2018.

Stress!!! And How to Deal With it Better…

It’s something all of us have or will experience in our lifetime. Don’t get me wrong, we need a degree of stress in our lives; it protects us. Think of coming face-to-face with a lion or a tiger. What would happen if we didn’t have a stress or ‘fight or flight’ response? The trouble is, it’s not often that we find ourselves in a 1 on 1 with a lion during our regular 9-5. Often we find ourselves stressing about minor, insignificant events. Whether it be the weather, traffic, work or even our favourite sports team underperforming (I’m looking at you, Melbourne). All of this mounts up.

So why is an osteopath rambling about stress? Well we know that stress affects more than just our minds. It affects our body in many ways and the hormones involved may be associated with chronic pain (1). So it makes sense that if we can minimise our stress levels, we can live healthier and happier lives.

So how do I do this?

There are plenty of ways to tackle stress and below are just a few that we can all easily implement into our daily routine. It’s important to remember that, as with any injury or gym program, change takes time and it can occur at different rates for everyone. The same applies with reducing your stress levels.

Drink water & enjoy a balanced diet

This one speaks for itself. It’s important to eat a healthy diet, but it’s also important to enjoy the food you’re eating. Restricting yourself too much can lead to undue stress and binge eating later down the track.

As for drinking water, the average adult water consumption is estimated to be around 1-1.5L per day which may sound like a reasonable amount, but not when you consider that the average adult loses at least 2.5-3L throughout a regular day.

There’s no hard and fast recommendation for water intake but the BetterHealth Channel website suggests that males should be consuming 2.6L and females 2.1L. Our team at Pakenham Osteopathy recently completed a health challenge where we were asked to drink at least 1 glass of water for every hour we spent at work and the effects were surprising! Give it a go yourself!

Exercise

Whether it’s going for a walk, jog, hitting the gym or throwing a few haymakers at a punching bag, exercise can have a dramatic effect on our overall physical and mental wellbeing.

The Australian guidelines recommend at least 60 minutes of moderate-vigorous intensity physical activity everyday for individuals aged 5-17 years. For adults aged 18-64, the guidelines suggest accumulating 150-300 minutes of moderate intensity physical activity or 75-150 minutes of vigorous intensity activity each week. More information about these guidelines can be found at: https://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines.

Mindfulness or meditation

I know what you might be thinking – I’m not asking you to sit cross legged on the top of a mountain and hum (although if you’re interested in that type of thing, go for it!). Meditation isn’t for everyone, but it can be a great option to lower your stress levels or at the very least, enjoy some time to yourself.

There are some great applications out there that can help you get started including the Smiling Mind app which is completely free and can be tailored to your specific needs – whether it be general wellbeing, eating better, sleeping better or even exercising more.

Address the big things before the little things

Prioritise the things in your life that mean the most to you and the tasks that are the most time-sensitive. If you have a big project for work coming up, avoid procrastinating and get it done! The Asana task manager application offers a simple way to keep track of all your tasks if you find the old pen and paper isn’t cutting it anymore.

Sleep

This one is a big one – so big in fact that it deserves its own blog piece, which your friendly neighbourhood osteopath Tom Gubbins kindly took care of last week!

If you have any questions or require any further information, please don’t hesitate to get in touch via email at darren@pakenhamosteopathy.com.au or call the clinic on 5941 4157.

References

Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical therapy, 94(12), 1816-1825. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/

Shoulder Pain

We rely on having a huge range of movement out of our shoulders. We reach up to hang washing out, we reach into the backseat of our cars, and some of us wrestle into bras every morning! If your shoulder is giving you pain, it can be really frustrating and can have a big impact on your life.

One of the common causes of shoulder pain can be what us health professionals call “Subacromial impingement”.

What is it?

No one likes technical terms! So let’s break it down. “Subacromial” is essentially a term that refers to a space under the very top of your shoulder blade (the acromion). It houses the tendons of a group of muscles that help to stabilise your shoulder (the rotator cuff). Located within this space is what we call a bursa. It is a tiny fluid-filled sac that plays an important role in shock absorption and reducing friction between bones.

Subacromial impingement occurs when these tendons or bursa are squeezed or ‘impinged’.

Okay, so why does it happen?

If we think of your shoulder as a ‘ball and socket’, when you lift your arm, the ball should glide downwards in the socket to prevent compression of the bursa. Occasionally, when your shoulder isn’t moving optimally, the ball doesn’t glide down which squeezes the bursa and tendons in the subacromial space, resulting in pain and inflammation.

There are a number of reasons that your shoulder might not be functioning well – injury to the tendons that occupy the space in your shoulder, muscular imbalance and tears, poor postural control and awareness and repetitive overhead movements. The good news? These are all factors that your osteopath can assist you with.

What can I do about it?

Your osteopath will work closely with you to tailor a management plan that addresses the key factors contributing to your subacromial impingement. Generally, this will include hands on treatment and exercises (like the ones demonstrated below) to decrease your pain, restore your shoulder mobility and strengthen the surrounding muscles. You may also find that your osteopath recommends exercises to address other areas such as your neck and upper back as these can also contribute.

How long will this take to heal?

Healing times for any injury can vary greatly, but complete resolution and healing can take up to 6 months. If you have any questions or just want some more information, please don’t hesitate to email me at darren@pakenhamosteopathy.com.