“Getting old’s not for wimps” Trouble opening jars or getting out of chairs..

How often have I heard that from a senior as he or she slowly manoevers onto  the treatment table!  Older people often complain of pain stopping them from doing simple things, and often these are in several areas: hands, hips, the outsides of the thighs, shoulders…  The widespread symptoms can be confusing & demoralizing.  Advice to take it easier, or stop doing something altogether can be frustrating to someone who wants to stay active.


The solution is..?

Strength training. This can start off without weight bearing (e.g. squeezing rubber balls to improve grip strength, or lying on the floor to do hip and leg exercises) and then move to the pool or cross trainer.  

There will still be some discomfort with strength training, & results won’t be immediate, but as long as the regime is gradual rather than boot-camp style, the soreness will just be what everyone normally experiences when they’ve had a good workout.


Put aside the arthritis for a moment

You can take it for granted they’re going to have some arthritis because that’s just the cost of living – literally!! But arthritis is often symptomless, & avoiding exercise  for fear of wearing out the joints or being sore more isn’t going to help. Quite the opposite, in fact.

This is because a significant portion of soreness in the elderly is often from tendons. These come under more tension from tight muscles. Imagine knotting a rubber band in the middle, like a tight muscle, and the effect that has on the length and on how much you can stretch it. The essential fact is that as we lose muscle bulk with age, a weakened muscle tires and tightens more easily.

So if Gran has lost some muscle strength, then she may notice  that she’s developed a pain doing something she’s always done without any problem before.


P.S. Just to be clear,  I’m not talking about a joint where the cartilage is badly damaged or worn out, or it’s bone on bone.   That’s surgical territory & is beyond the help of exercise or manual therapy.

Posted in Adults, Arthritis, Older People

Have you got a bit of the Cinderella in you?

How many of these boxes do you tick?

– Are you female (you’d have to be if we’re talking about Cinderella) – Do your shoulders ache even when you’re not at work? – Did your shoulder pain just appear for no obvious reason? – Do you do desk work most of the day? – Does massage only give you temporary relief? – Does stretching not seem to help much either?  

If you’re that person then science has been showing quite a lot of interest in your problem in recent years and has even given birth to a hypothesis –that Cinderella muscle fibres are the cause of your woes.

A muscle is made out of lots of individual fibres, as you know when you pick a bunch of them out of your teeth when eating steak!  Ordinarily, muscle fibres start being used in order of size. The smallest fire first when you’re doing really light work (like typing) and the big boys are only called on when stronger contractions are needed, for example to lift or move something.

Mother Nature is not stupid, of course, so She designed the small fibres for long days at work. They’re built for endurance rather than strength. That’s why they’re found in the muscles that control our posture all the time you’re out of bed.  The Cinderella Hypothesis suggests that some small fibres get used so much that they never have enough time to recover and become dysfunctional as a result.  Cinderella because first up to work, but last to stop.  


When things go wrong

Research has shown Read more ›

Posted in Adults, Arm, Shoulder and Neck

Nerves (part 2) – the recovery process

Last time  I said that nerves often recover from compression or bruising.  Incidentally, I didn’t mention that stretching can damage a nerve.  That’s because I was only talking about things that pressed on nerves.  A bad break or dislocation can do this kind of harm.  Pulling on a newborns arm during an awkward delivery is another well known injury. Moving on though, I thought I’d go into a bit more detail about the process of recovery, which involves making the distinction between two sorts of nerves.  


Sensory nerves

These convey sensation  recover more quickly than motor nerves, which tell a muscle to contract. It can be many months for either to fully recover. Notice the word can! A lot will recover in just a few weeks or months. It all depends on the severity of the injury.  These are the ones that might give you the numbness or pins and needles when affected.  


Nerves re-grow slowly!

– just millimeters per month – and as long as the myelin sheath covering them is still intact. In the simplest terms this sheath is like an insulator which prevents electrical signals going along the nerve from flying around in a disorderly fashion. If that sheath isn’t whole then Read more ›

Posted in Adults

Nerve Irritation 101

It’s sometimes difficult to judge how much  people who aren’t osteopaths or physios know or don’t know about the body.   So I thought it might be useful to do a couple of posts on nerve pain just in case.  Maybe next time I’ll go into a few typical nerve problems.  But if you haven’t already seen it you might be interested in my last post where I talked about a patient who came to me with a profoundly weak right arm.  

So, here goes.

If a disc (or anything) presses on a nerve hard enough, you’ll find changes in the muscles that are linked to that nerve because everything the muscle feels or does has to be via a nerve.  Sometimes these changes are only in sensation – the person gets pins and needles, tingling or numbness.  Other times the change affects power.  And eventually this can lead to muscle wasting, where the affected muscle looks less developed than on the other side.

If all that sounds a bit grim, the good news is that in most cases recovery is possible unless the nerve is totally severed or there’s some actual nerve disease.


Things that can press on nerves:

  • A bulging disc
  • Fluid pressure.  For example, inflammation that builds up in a confined space and which can’t drain out of the area easily.  Incidentally, nerves can be irritated just by the chemical ingredients in the inflammatory fluid without any compression being present
  • Bone.  As we age we often get bits of bone forming (sometimes called spurs), irregularly in and around joints.  They sometimes form in the tunnels for the nerves as they leave the spine, which reduces the space for them and occasionally actually pinch them
  • Broken bone, as a piece moves out of position
  • Scar tissue.  For example, from an operation.  Scar tissue is relatively inelastic and can form around a nerve in a tight knit that ‘strangles’ it.
  • A tight muscles when the nerve travels through it.  The effect is much the same as with scar tissue, but easier to treat and stretch
  • Scarier (but much rarer) stuff, like tumors or cysts that grow in the area and take up limited space and push on adjacent structures  like nerves

Read more ›

Posted in Adults

Floppy arm comes back to life!

Here’s a rather unusual case I had recently. A man came to me having fallen on his front & sliding along the turf during a hockey game, leaving him with profound weakness in his right arm.  Now our clinic Eftpos machine is kept on a shelf above waist height & it was so bad he could hardly raise his arm high enough to swipe the machine!  He could only do it by hitching his shoulder up.

What was so unusual was the fact that he had very little pain.  In fact he only had some in his lower right neck some 2 days after the fall, when he woke with neck pain, but none in the arm.  Interestingly, he’d had a similar episode some years ago which gave him grief for over 3 weeks.  So it seems that there was probably a weakened structure there waiting to re surface.  


So what happened?

Read more ›

Posted in Adults

“It feels like a trapped nerve…” (But is it?)

Folk often say this to me when they feel a sharp pain with small movements in the neck and lower back.  But sharp pains are common and come from other problems too.

Let’s start with facet joint irritation.  Each joint in your spine has two surfaces (facets) that slide and glide around on each other as you move.  If this are irritated, say from whiplash by being slammed against each other too hard they will give a sharp pain. Even sharper perhaps is when part of the capsule lining the joint gets caught between these surfaces.   That’ll also give you spasm and make it next to impossible to turn your head one way.  It’ll probably also make you hold your head to one side to help open up the joint and relieve the pinch on the capsule. Joint problems in the low back often also irritate the soft tissues around the upper buttock area and poking your finger in the area can feel sharp.  


True nerve pain

Read more ›

Posted in Adults

“I must have slept funny” – Morning neck pain

If you wake to neck pain in the morning

Just as the day is a dawning

Your neck will lock tight

You’ll look quite a sight

From something that struck with no warning  


“I must’ve slept funny…” 

I hear this a lot as an explanation for a pain that appears for no obvious reason when waking.  It seems strange, doesn’t it, that something can go wrong with just your normal bed and pillow? But maybe this is just a convenient scapegoat.  After all, as humans we always want to be able to blame something.  And if you wake to a pain that wasn’t there before, it’s natural to suspect the last thing you were doing before the pain – sleeping! 

I hear this so often that I think there must be some truth in sudden movements first thing before the neck is warmed up and ‘ready’ for action.  But it’snot necessarily correct just because the sleeping came before the pain.  So did a lot of other things – like brushing your teeth, but you wouldn’t think to blame that, would you?

Read more ›

Posted in Adults, Arm, Shoulder and Neck

Older people need to exercise smarter!

Most of us steaming slowly but inevitably into middle age and beyond will have noticed how niggles and pains seem to come about randomly and for little or no apparent reason.  Worse still is how they appear to hang around for much longer than before or that seems reasonable!  

So why is this?  Well, three things spring to mind: Firstly, there’s the decline in muscle mass and quality as we age.  Unless we make a special effort – and it does take more effort just to keep what you’ve got as grow older – our muscles tend to diminish in size.  This means they tire & come under strain more readily.

Another thing is that  the quality of the muscle fibres changes.  They become less elastic and aren’t capable of generating the same force as younger muscle fibres.  They also need longer recovery time, not only between intense physical activity, but also to injury.  That twisted ankle that you shrug off after a couple of weeks in your twenties is going to hang around for a lot longer in your fifties.  So you’ll need to learn to be patient!

The third thing is that ‘white-stuff ‘ injuries become more common as you age.  White stuff refers to the glistening cartilage and muscle tendons you see when you’re boning a chicken or leg of lamb.  The injuries to these increase because on the cellular level there are changes that happen which make the tendon less elastic and less strong – and less able to recover from repetitive strains.

So you may be doing something which doesn’t seem to require that much effort & which you’ve done loads of times before, but the fact of doing it repeatedly leads to a niggle appearing from nowhere.  


What does all this mean for the over forties?

First, we need to work on maintaining our strength as we age, or improving it if you’ve been inactive for a long time.  Just going for your daily walk is not going to cut it in terms of improving strength in other parts of the body not used much in walking.  But just be careful to increase the intensity of your exercise regime slowly to give those muscles and tendons extra time to adapt.  

Second, and very importantly, vary the exercise to avoid too much repetitive strain on those tendons.  Try to avoid just returning to the same exercises week after week.  Try rotation.  Two that are often affected are the achilles tendon  and the tendons around the outside of the elbow involved in wrist movements.  The shoulder is another commonly affected area.  

Third, since recovery slows with age, allow more time for recovery and rest for muscles that have been worked hard or strained.

And finally, warming up & easing into physical activity gradually rather than jumping in may help to prepare less elastic muscles for activity and avoid cramp or pulled muscles.  Warming down and stretching just after should help too instead of just coming to a sudden halt before going to shower.

Posted in Adults, Older People

Back Pain – “Could it be my kidney?”

It’s only natural  in the search for a self diagnosis that we point the finger at any organ in the painful area.  So if it’s at the front of the chest you think heart, and just the worry might be enough to give you palpitations!

I’ll just say right up front that I’ve only seen relatively few people with back pain which didn’t come from a joint, nerve or muscles.  And that’s a good thing as it has meant that treatment and recovery was a relatively simple matter. But cases of kidney related back pain are out there.  


What you’d be looking for with kidney issues

Basically, if any of your internal organs is playing up and in trouble you’re going to have noticed other symptoms associated with the function & purpose of that organ.  With the kidney we’re talking about issues with peeing.  For example, changes in how often you go, discoloured or cloudy urine or pain peeing.

Read more ›

Posted in Adults, Back and Hip

The best exercise for Achilles tendinosis?

Well, l I’ve got a question mark there in the title of this subject for three good reasons. The first is that the research and reports about this are not conclusive – how often is health related research cast-iron??  The second is that no one exercise is good for all sufferers of tendon related issues.  What works for one person, will be ineffective for someone else!  And the third is that your Achilles pain may not actually be from the tendon itself.  Other structures near the heel could be to blame, so you need a correct diagnosis to begin with.

Having said that, if you’ve had a nagging Achilles tendon problem for weeks (and probably months), which is worse when running or jumping, there’s a good chance you’ve got Achilles tendinosis.  Chances are that you’ve already seen someone about it if it’s that bad, in which case you might already know what’s to come…  


What is tendinosis?

Basically, a condition in which the fibres of the tendon become rather disorganized and less able to cope with the huge forces through it when your calf muscles are being used.  So further aggravation of the tendon is more likely, and for reasons that are still not quite understood, the repair process seems to get disrupted so that it takes forever to come right in some people.

An Achilles problem Read more ›

Posted in Adults

4 easy exercises for a stiff upper back

Gyms, running or walking are great for working out our lower bodies, legs or specific muscles,  but our upper backs often get forgotten or are under challenged.  It’s an important area, not least because of its connection to  healthy neck and rib movements. So why not try these exercises in between all that sitting or whilst you watch t.v?  

The snake wriggle

Sit with feet flat on the floor, preferably on something with a bit of spring like a mattress or sofa, cross your arms & hold onto your shoulders. Now try to produce a continuous & rhythmic side to side motion through your upper back – so it does a snake-like movement.  The bounce in the sofa or mattress will help produce some recoil & spring that helps with the movement. As a variation, try taking in and holding a deep breath whilst doing this.


Freestyle no-arms “air swimming”  (like air guitar!)

sidebending Sit like before, but this time imagine doing the free style swimming movement with your shoulders. This is similar to the snake wiggle above, but it adds an extra dimension of rotation with each shoulder describing circles in a forwards-backwards direction.            







Painting  overhead circles with straight arms

Read more ›

Posted in Adults, Back and Hip

A slouched upper back can reduce your neck & shoulder movements.

If you’re one of those whose upper back slumps & sags forward and down, try this little experiment.

Sit in your normal slumped position, & turn your head as far as it will go to one side.  Notice how it feels.  Stop right there – don’t move your neck.

Now lift your chest a little & try to make your neck longer – without tipping your chin up.  Notice how your head will turn a bit more without that same level of discomfort.

I’ve had patients complaining of low neck pain turning their heads to reverse the car, and this one simple adjustment to posture is sometimes almost all that’s needed to eliminate or greatly reduce the pinching feeling.

In the next blog:  some ways to improve your shoulder and thoracic mobility

So what about shoulder mobility?  What’s the connection with a slouched upper back?  Well the problem is related more to upper backs that are both curved forward (‘kyphotic’, to use the technical term) AND stiff.

Shoulder flexion – i.e. moving your arms forwards and straight up all the way above your body is only possible if the upper back also bends back slightly for the last part of the arm raise.

So if your back is too stiff that’s going to be harder to do. You’ll feel a tightness at the front of your shoulders as they struggle to do all the movement without your back’s help, or you’ll ‘cheat’ by arching your lower back more – not the best if you suffer from low back pain too!

But hey, what’s the problem?  After all, unless you’re a basketball or netball player, how many of us actually need to raise our arms straight up high on a daily basis?

Actually, over the long term the effects can be more insidious and give a pinching pain just raising our arms up to lift, put on a jacket or brush teeth and hair.  That’s called impingement syndrome and is another story in itself…

Posted in Adults, Arm, Shoulder and Neck

Moles & melanomas – know your ugly ducklings and your a b c…

Okay, perhaps you’ve been to a skin clinic for a check up, but for some of us it could be months or years before we remember to book in a follow up.  So in the meantime why not get into the habit of checking yourself?


THINK A – B – C – D & E!

A  is for asymmetry, or a shape that isn’t round.

B is for border.  Watch out for… one that is notched, uneven or a bit indistinct.

You can see both A & B in this rather large & evil looking one.  But many will start out smaller.

Read more ›

Posted in Adults

Think you might have a disc problem?

Hi everyone – however many that may be…

Suddenly I seem to be seeing a lot of people with disc injuries, ranging from relatively mild to one particularly bad case that will probably end up needing surgery.  Luckily most don’t and they get better, though progress can be slow because of its properties and position jammed in between your spine.  You can’t exactly take it out and give it a rest!

If you can identify with any of these symptoms, you might also have a disc problem, but before you get depressed, remember that many are mild and most get better!

Tingling, pain or numbness running down the arm, the outside back of the leg, or in the toes; central low back pain worse with long periods of sitting or standing; a long period of discomfort (more than an hour) in the morning on waking; leaning to one side to avoid pain; pain coughing, sneezing or bending over.


If any of that sounds like you, then you may find some of these tips helpful

  • Get treatment!  Now, okay, I would say that, wouldn’t I?  But not without good reason.  Treatment can help because you need as much movement and flexibility in othe parts of the spine so that as little stress and pressure goes on the part with the damage.  Yes, I know a lot of physical problems do get better by themselves…. eventually.  But  eventually can be a longtime.  The “She’ll be right” attitude is admirable, but why chance a needless extension of pain?
  • Don’t allow anyone to manipulate (i.e. ‘click’) your spine where the damaged disc is.  I’ve heard of cases where that’s been done because the over confident therapist thought they could ‘put it back in.”  Yeah, right!   What happened in these cases was that the disc injury was worsened and pushed along the scale from mild to severe!  Manipulation is okay (and I use it in these cases), but only as long as it’s for other parts of the spine.  Good technique is also essential.
  • Avoid sitting for long periods.  Get up and move around from time to time.

Read more ›

Posted in Adults, Arm, Shoulder and Neck, Back and Hip, Sciatica

Persistent thumb pain after a fall? Get an x-ray!

Using your hands to break a fall is common enough through all age groups, and so is the pain around the point of contact of the wrist and hand against the ground.   This is known as  a foosh injury – Fall On an Outstretched Hand.

But if you or your child has pain around the base of the thumb near the wrist after the fall that is worse with use, hurts at night and doesn’t get better after a couple of days it’s very important to get it checked for a fracture.  

Whilst most fractures heal quite well by themselves, because of the way the scaphoid is plumbed up to its blood supply, a fracture here can stop the blood flow to it. Not good,  because the result is avascular necrosis – another obscure medical label which means that a part of the fractured bone is dying.  Collapse of the bone is possible as it weakens. 

You have been warned!

Posted in Adults, Children, Hand & wrist

When stretching ISN’T the answer to your aches

“I suppose I should be stretching more” – is something I often hear from patients trying to figure out why they have on-going pain. But sometimes it’s not the best thing to do. 


Here’s why:

If you’re double jointed and super ‘bendy’, your flexibility can be a real asset in putting the rest of your yoga class to shame. Or for performing well if you’re into gymnastics or cheer leading. But that same advantage also makes joints more vulnerable to injury as they can move beyond a healthy limit, and especially if that movement is uncontrolled, sudden and under load.

Normally it’s your ligaments that prevent this, but with looser ones the control they can exert on the joint kicks in too late in the range of movement. They need an ally!


So strengthen & protect!

So what you really need to do is Read more ›

Posted in Adults

What NOT to do for your tennis elbow

Drop the anti inflammatories if you’ve had your ‘tennis elbow’ for more than a month Because most chronic (i.e. long term) tendon issues are not due primarily to damage and inflammation following a tear, but to repetitive or continuous over use of the affected muscles. T

he problem here is the way the collagen fibres (the white stuff you see in tendons) change from being organised in line to being more of a jumbled tangle of fibres which are not good at being put under tension and recovering from use.

The normal healing process also seems to break down with many people experiencing on going discomfort for months and even years. What’s more, treatments which work for some don’t seem to work for everyone. Symptomatic ‘fixes’ like anti inflammatories and steroid jabs which may help in the short term, won’t get to the cause of the issue and may even delay or retard long term recovery.

But have your really got tennis elbow? Because pain on the outside of the elbow can come from other causes too. Four other causes jump to mind as I sit here typing this out, and they all require different treatment.  These include radial tunnel syndrome, a mechanical restriction of the radial head & ligament problems.

Posted in Adults, Arm, Shoulder and Neck

Scoliosis, a teenager & Simon Cowell (‘X Factor’)

Scoliosis in the young.  How to spot it (The ‘Skyline’ test)

Get your son (or daughter), to stand barefoot in front of you with his back to you.  Ask him to bend over  to touch his toes with knees straight.  Don’t worry if he can’t touch them!  Not everyone can, especially among males.  Get your eyes at the same level as the the highest point of his back.  Is it level or does the left or right side of his back look higher (closer to the ceiling), than the other?  If ‘yes’, then you’ve found one.

You should check again, but this time watching for any ‘hump’ on one side of the spine all the time he/she is actually going down rather than just at the end of the movement.  This is because it might appear more in different areas earlier or later in the bend.


Now you think you’ve found one doesn’t mean it’s time to panic!

Curvature of the spine, or scoliosis, is more common in girls, about 1 in 30 will have one. It often runs in families and is only of concern when it gets beyond a certain angle – somewhere around 30 degrees. If it’s below that your doctor will probably just monitor your child a couple of times a year to make sure it’s not increasing.

But if it gets beyond about 30 degrees there are treatment options providing that the spine has not stopped growing. These include a body brace that’s worn night and day, even during exercise. A scoliosis inevitably leads to altered lines of tension or tightness through muscles and joints as the forces around them are no longer symmetrical.  Muscles on the inside of the curve will be shortened compared to the same ones on the outside.  It also causes people to have much easier direction of  movement when it comes to twisting the spine, which is reflected through the ribs.

Read more ›

Posted in Children