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FALLS AND FALLING OVER

FALLS AND FALLING OVER

Falls and Falling over

Falls and falling over  are very prevalent in the elderly and are a significant cause of both fractures and increased death rate, so this urgently needs attention.

As people get older, they may not require the sometimes more vigorous techniques in Osteopathic treatment, but this does not mean it may not be of some use and certainly becomes more useful when combined with Tai Chi and Vitamin D supplementation.

Tai Chi

A controlled trail found Tai Chi superior in the over 70’s both to aerobic and strength exercises and stretching in adults age over 70

A randomized controlled trial (RCT) found that in the over 70’s therapeutic tai chi is superior to both, strength, aerobic exercise and stretching, for the prevention of falls. In this particular study Tai chi was reported to be over 58% better than exercises such as stretching and 40% better than mild aerobics and strength training.

Strength Training

There is overwhelming evidence to show that lower limb strengthening exercise dramatically reduce fall rate. These should be done at least twice a week preferably three times a week.

Vitamin D

Although a recent study has suggested Vitamin D may not help bone health there are other studies showing that high levels of vitamin D leading to a reduction in falls by 37%, in older. However this study shows that in these cases only high levels of vitamin D supplementation (higher than 800 i.u. / day are helpful in this case.

In conclusion in addition to Osteopathic treatment to ensure the body works at its maximal efficiency and in a pain free fashion, certainly as we become older and unsteadier Tai Chi and Vitamin D supplementation may be a way of helping this problem.

References

  1. https://www.bmj.com/press-releases/2012/08/06/balance-and-strength-training-can-prevent-falls-older-people
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118778/
  3. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.1996.tb01433.x
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183251/

Diziness and vertigo

Vertigo

Dizziness and vertigo are quite complex manifestations of a variety of possible conditions. I will try and explain in this blog the essential guide to what helps us maintain our balance:

Essentially, there are three sources of sensory information that feed our brains.

  • Eyes showing where we are in space.
  • Vestibular system which is divided into a static and kinetic systems. The static system is reliant on the position of the head.

The kinetic system relies on the head position during movement and does this with what are called the semicircular canals of which there are three and positioned at 90 degrees to each other, acting very much like a gyroscope.

  • Proprioceptors, which are biological sensors which are found around joints and muscles.

The neck is the most important, but they are also found in the spine, limbs and extremities. The proprioceptive inputs from the neck (cervical spine) and ascend in the vestibulospinal tract.

Role of cervical spine in maintenance of balance

In this case head movements lead to movement of the proprioceptors which via neural pathways to the brainstem inform it as to the position of your neck and head. In neck trauma, osteoarthritis, neck tension there are mixed signals going up to the brain from both the cervical spine the vestibular and Ocular pathways which then can lead to feeling of dizziness.

Vertigo vs diziness

Vertigo is a symptom with a feeling of rotation that you or the world are spinning and is usually indicative of an inner ear problem. When you move your head in one direction this leads to a feeling of spinning.

Dizziness or lightheadedness is a nonspecific feeling of wooziness, unsteadiness and suggests a non-vestibular pathology.

Causes of vertigo

Vestibular causes

  • Viral labyrinthitis, Meniere’s disease, ear infection, drug induced this is when vertigo lasts more than 24 hours).
  • Benign paroxysmal positional vertigo, psychological, and neck (vertigo lasting seconds).

Central causes

Migraine, MS, tumors e.g. acoustic neuroma or stroke.

Causes of dizziness

Cardiovascular e.g. heart disease, arrythmias.

Proprioception: e.g. arthritis in the neck

Metabolic: hypothyroidism, anemia, alcohol, peripheral neuropathy.

Psychological:

What can be done to ease vertigo or dizziness?

When drugs don’t work, it is worth getting your neck assessed as this certainly may be the cause of some of your dizziness and could be involved with your vertigo.

If you suffer from BPPV (benign paroxysmal positional vertigo), this can be caused by calcium crystals being deposited in one of your semicircular canal. Some exercises can be shown whereby these crystals are shifted to bring relief to this type of vertigo.

Both acupuncture and neck treatment may well be useful in at least mitigating these symptoms, as these can relieve neurological inputs to the brain and thereby reduce symptoms.

Tension headaches and migraines. What can be done?

Headache

Recurrent headaches such as tension type headaches and migraines lead to considerable impairment and days off work. It is often wondered what relation the neck has in relation to this most debilitating of conditions.

Neck pain often accompanies headaches and to be very technical this is a sign of an interaction between small nerves from the cervical spine and trigeminal nerve in what is called the trgeminocervical nucleus. This is located just outside the upper three neck (cervical) spinal segments, which means that any problems originating from cervical structures. Therefore pain originating from neck structures supplies by the upper neck nerves are perceived in areas supplied by the trigeminal nerve such as the front of the head, and the orbit

The spinal nucleus of the trigeminal nerve extends caudally to the outer lamina of the dorsal horn of the upper three to four cervical spinal segments. This is known as the trigeminocervical nucleus, which receives afferents from the trigeminal nerve and the upper three cervical spinal nerves. Convergence between these afferents’ accounts for the cervical-trigeminal pain referral. Therefore, pain originating from cervical structures supplied by the upper cervical spinal nerves could be perceived in areas innervated by the trigeminal nerves such as the orbit and the frontotemporoparietal region.

The main difference diagnostically between tension type of headaches from the migraine type is that ranges of neck flexion, extension and rotation are usually less in patients with tension type head than migraines, additionally there is a degree of neck tenderness with patients of tension headaches.

This helps in deciding what treatment protocols can be used to relieve your headaches.

Firstly, by palpating your neck we can identify trigger points, and use manipulative treatment to help restore mobility to your neck, additionally Acupuncture can be used to help reduce pain and muscle spasm often associated with headaches.

Physical treatment can be as effective as surgery in cartilage tears of the knee

Knee Pain

Meniscal tears commonly called cartilage tears often present themselves to me. In a broad sense they can be labelled obstructive and non-obstructive meaning that in obstructive ones the tears themselves fold over and get in the way of the joint and cause locking, with a patient often not being able to fully extend the knee. This is much commoner in earlier life up to the age of 35 and is commonly referred to as a bucket handle tear.

In middle age and older non-obstructive tears are relatively more common and occurs when the meniscus frays around the edges and splits.

Obstructive tears are more likely to require surgery to clean them out, so no bits of the meniscus get in the way of the joint as this causes joint damage and the symptoms of locking or giving way.

A recent study has shown where patients with degenerative tears were assigned to a structured program of physical therapy this was just as effective as arthroscopic surgery and without risk of surgical side effects. Findings are consisted that non-obstructive tears should not be the first treatment course in middle age or over older patients.

So what sort of treatment is best to manage meniscal / cartilage tears? The degenerative tears are more likely to be manage with a combination of Osteopathy and or Acupuncture which can in turn both help pain and return joint function to normal faster than if left alone and would certainly help reduce the need for surgery.

Can Tennis elbow pain be improved?

 

 

 

 

 

 

 

 

Tennis elbow refers to pain experienced on the outer side of the elbow and affects tendons that extend the wrist and can present between acute, onset and chronic.

What are the causes? 

It is caused by anything causing a twisting motion of the wrist and elbow such as games of tennis, but also such hum drum activities as carrying loads, window washing and even waving too much!

People with this condition often experience pain, sometimes weakness and many can have symptoms referring all the way to the wrist.

It is easily diagnosed as there may be pin point tenderness over the side of the elbow, and often muscular contraction can be felt along the crease of the elbow and sometime down the forearm sometimes reaching all the way to the wrist.

Will acupuncture or osteopathy help tennis elbow?

Medical acupuncture, trigger point therapy and osteopathy for tennis elbow are all effective treatments for this troubling condition.

What treatment is available?

Tennis elbow is thankfully reasonably straightforward to treat. The main aim of the treatment by Laurens Holve is to reduce any muscular spasm that may be present very much as in the blog on sports injuries. In the old days the conventional approach involved deep soft tissue treatment by a Physio, and if this didn’t work, steroid injection, which would in many cases reduce pain in the short term.

As time has moved on, a new approach has been to spin a small amount of the patients’ blood to enhance certain compounds in it and inject it back into the part of the tendon that has been causing problems – which has shown promising results.

Long-term studies suggest, however, that many of these treatments do not give any more long-term benefit than anything else.

How effective is treatment in both acute and chronic tennis elbow? 

After having treated many elbows over my lifetime I find that a combination of both acupuncture, trigger point treatment and sometimes manipulative treatment gives much more significant both short and long-term results.

Often with treatment patients feel an immediate difference and can soon resort to normal activities.

Golfers elbow, though not as common as tennis elbow, is very similar. The treatment approach is therefore very similar as well.

Should you have any elbow trouble, call Laurens Holve in our Highgate clinic in North London on 020 7692 1818 or e-mail lholve@camdenpractice.co.uk to take the first steps towards managing your tennis elbow, and benefit from a combined treatment approach of osteopathy, acupuncture and trigger point therapy.

 

 

 

Falls and falling over

Skeleton Falling

Falls are very prevalent in the elderly and are a significant cause of both fractures and increased death rate, so this urgently needs attention.

As people get older they may not require the sometimes more vigorous techniques in Osteopathic treatment, but this does not mean it may of some use and certainly becomes more useful when combined with Tai Chi and Vitamin D supplementation.

Tai Chi

A controlled trail found Tai Chi superior in the over 70’s both to aerobic and strength exercises and stretching in adults age over 70

A randomized controlled trial (RCT) found that in the over 70’s therapeutic tai chi is superior to both, strength, aerobic exercise and stretching, for the prevention of falls. In this particular study Tai chi was reported to be over 58% better than exercises such as stretching and 40% better than mild aerobics and strength training.

Vitamin D

Although a recent study has suggested Vitamin D may not help bone health there are other studies showing that high levels of vitamin D leading to a reduction in falls by 37%, in older. However, this study shows that in these cases only high levels of vitamin D supplementation (higher than 800 i.u. / day are helpful in this case).

In conclusion in addition to Osteopathic treatment to ensure the body works at its maximal efficiency and in a pain-free way, certainly as we become older and more unsteady, Tai Chi and Vitamin D supplementation may be a way of helping this problem.

The approach we take to treating sporting injuries

It’s very common for people to get injured participating in sporting activities. For example, if you’re planning to run a marathon without proper training and stretching you’re almost bound to injure yourself. People who are not very active and take on a huge amount of strenuous activity run a similar risk. Even sporting professionals who live and breathe physical work can get injured, although they tend to be more protected because of the fitness and training that is such a large part of their lifestyle. The sporting injuries we treat more commonly are the result of people not preparing their bodies for the stress and strain they are inflicting on them.

Injuries in sporting activities

Your local osteopath in action!

At Holve Healthcare, our approach to sporting injuries is unique to every client. However, there is a rule of thumb that I recommend to anyone when the signs of an injury appear: PRICE. Protection. Rest. Ice. Compression. Elevation. Nevertheless, if an injury is serious, such as a broken bone, you should probably go to A&E. In other, less serious cases on the shoulder, knee, ankle or hip, our combined treatment of osteopathy and acupuncture can work a treat.

Pain relief, controlling inflammation and speeding up the repair of damaged tissue are the main goals we aim to achieve when using our combined treatments. To bring down the inflammation and improve movement we use stimulate the nerves in tissues by using acupuncture, only where swelling and pain are not an issue.

Kneading the injured area, varying pressure on particular trigger points, including the joints themselves are what out osteopathic treatments are about. Occasionally, when we perform more forceful movements joints have the tendency of making a popping sound as they move over each other. Despite what it sounds like, this process is normal and quite painless.

Many injuries will heal over time with a bit of help from mother nature if left alone, but our services work very well in speeding up the healing process so that you can go back to living your best life.

Want to talk to us about an injury you may have obtained? Or even if you want to know more about sport injury therapy, please don’t hesitate to call us at The Camden Practice or at The York clinic in Woking.

Exercise For Health and Mobility

A Little Bit of Exercise

Exercising for fitness and health
As many of you have read in the press, there is now overwhelming evidence that exercise – both aerobic and strength training – can both stave off the time your mortal coil hits the ground and as importantly, help you enter your twilight years in better health both physically and mentally.
The other big plus is that exercise also keeps joints working and health way into old age. Its not so much what you do, it’s more that you do it.
In summary exercise helps us by:
1. Making us feel happier
Exercise has been shown to improve mood and decrease feelings of depression, anxiety and stress
It produces changes in the parts of the brain that regulate stress and anxiety. It can also increase brain sensitivity for the hormones serotonin and norepinephrine, which relieve feelings of depression. it also boosts the production of endorphins, which also help you relax and reduce pain perception.

2. Helping us with weight loss
Exercise is crucial to supporting a fast metabolism and burning more calories per day. It also helps us maintain muscle mass and lose weight.

3. Helping our muscles and bones
Exercise plays a vital role in building and maintaining strong muscles and bones.
Physical activity like weight lifting can stimulate muscle building when paired with adequate protein intake.
This is because exercise helps release hormones that promote the ability of our muscles to absorb amino acids. This helps them grow and reduces their breakdown.
As people age, they tend to lose muscle mass and function, which can lead to injuries and disabilities. Practicing regular physical activity is essential to reducing muscle loss and maintaining strength as we age.
Exercise helps reduce the onset of osteoporosis – an important condition to avoid in later life.

4. Helping increase our energy levels
Exercise can be a real energy booster for healthy people, as well as those suffering from various medical conditions. it can help reduce symptoms of chronic fatigue syndrome, however you need to exercise through your fatigue.

5. It Reducing risk of chronic disease
Lack of regular physical activity is a primary cause of chronic disease.
Regular exercise has been shown to improve insulin sensitivity, cardiovascular fitness and body composition – while decreasing blood pressure and blood fat levels by boosting good fats and reducing cholesterol levels.
In contrast, a lack of regular exercise — even in the short term — can lead to significant increases in belly fat, which increases the risk of type 2 diabetes, heart disease and early death.
6. Assisting our brain health and memory
Exercise can improve brain function and protect memory and thinking skills.
To begin with, it increases your heart rate, which promotes the flow of blood and oxygen to your brain.
It can also stimulate the production of hormones that can enhance the growth of brain cells.
Regular physical activity is especially important in older adults since aging — combined with oxidative stress and inflammation — promotes changes in brain structure and function.
Exercise has been shown to cause the hippocampus, a part of the brain that’s vital for memory and learning, to grow. This serves to increase mental function in older adults.
8. Helping with relaxation and the quality of our sleep
9. Helping reduce pain
Chronic pain can be debilitating, but exercise can help reduce it.
The main cause of joint deterioration is not excessive exercise – it is inactivity.
In fact, for many years, the recommendation for treating chronic pain was rest and inactivity. However, recent studies show that exercise helps relieve chronic pain, such as fibromyalgia, chronic low back pain.
Exercise has favorable effects on the pain that’s associated with various conditions. It can also increase pain tolerance.
So let’s exercise!
Many reasons can be found for why exercise can’t be done – too cold too wet, too boring, and above all “I haven’t got the time”.
So how can we fit in an exercise routine into a busy schedule?
I suggest there are four main rules to follow to ensure you get the full benefit of exercise
1. Keep it short – no more than 30 minutes
2. Keep it interesting – so you don’t get bored
3. Keep it regular – least twice a week.
4. Don’t buy a gym membership unless you really want to – most things can be done at home and for free!
HIIT (High Intensity Interval Training)
This system is unique in keeping it short and keeping it intense. Just 20 minutes of using this system gives you more benefit and makes you fitter quicker than an hour plod or endless swimming up and down a pool. It is also very easy to implement and can start at any level of fitness.
First pick an activity e.g. walking, running, swimming, cycling, cross trainer. If you’re starting from a very low fitness level start with doing 10 minutes, then go up in time up to around 20 minutes if you are already fit.
Firstly, warm up for say 5 minutes by jogging on the spot or its equivalent, and don’t forget you can start these exercises by just using walking.
Then start your exercise, for the first time try doing 20 seconds – fast followed by a 40 – 60 second break.

Repeat these 10 times. This can be increased both in longer ‘fast times’ e.g. up to two minutes, whilst as you become fitter reducing the break interval or indeed keeping the activity going but at a much-reduced intensity.You can also increase the number of repetitions.

With this method, all your exercise needs can be covered in less than 20 minutes. And because of the increased intensity and variation, you are less likely to get bored.

Let me know how you get on, and if you have any questions, you can always email me:
lholve@camdenpractice.co.uk.

Shoulder Pain

by Laurens Holve | Mar 13, 2018 | Osteopathy | 0 comments

 

 

 

 

 

 

 

 

 

 

Shoulder pain is the third most common reason for musculoskeletal consultation.

At some point most of us will have had a bout of shoulder pain, with what seems like a small pull which instead of disappearing in a few days seems to continue and often gets worse, preventing us from using our shoulders, and in some  cases preventing sleeping due to night time pain.

What causes it and what can be done?

To give a complete overview of shoulder problems, let alone treatment protocols, requires a book to be written, which in this article I don’t plan to do.  Instead I will give a brief overview of the more common shoulder ailments, their cause, why shoulders nearly always take longer than other joints to get better and treatments that can help.

In future editions I may well go deeper into some of these conditions to give some insight into what causes them and what can be done to help you recover.

The main symptoms that bring patients to me is either inability to lift their shoulder due to restriction often accompanied by pain.

The more common conditions people bring for treatment usually fall into one of the categories below:

  1. Frozen Shoulder
  2. Impingement Syndrome: (difficulty in lifting shoulder beyond 90 degrees)
  3. Rotator Cuff failure/ tear

FROZEN SHOULDER

This is a condition whereby a shoulder becomes very painful and stiff to move. It just seems to occur without any history of injury.  There are a few conditions associated with it:

  • Diabetes
  • Parkinson’s
  • Hyperthyroidism

In other words the shoulder joint is not involved in this condition, it is more a stiffening and inflammatory process that occurs in the capsule that surrounds the joint.  X Rays appear normal. It is characterized, by three main phases:

  1. Freezing stage. Any movement of your shoulder causes pain, and your shoulder’s range of motion starts to become limited.
  2. Frozen stage. Pain may begin to diminish during this stage.
  3. Thawing stage. The range of motion in your shoulder begins to improve.

Without intervention, your shoulder will pass through each of the stages at its own pace, taking anywhere between 18 months and several years in total.

Acupuncture and some form of physical treatment are helpful in all three phases and in some cases can help the freezing stage jump to the thawing stage more rapidly.

Adjunctive treatment such as painkillers can be used in conjunction with the above treatment, and improvement should start being felt after two or three sessions.

IMPINGEMENT AND ROTATOR CUFF TENDINOPATHY

I shall cover these together as they are interrelated.

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

Your arm is kept in your shoulder socket by your rotator cuff. These muscles and tendons form a covering around the head of your upper arm bone and attach it to your shoulder blade. Tendons don’t have a good blood supply and because of this and their constant work of trying to ensure shoulder stability explain why shoulder always take some time to improve.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.

This condition is noticed when it is difficult raising your arm above 90 degrees.

The rotator cuff is a common source of pain in the shoulder. Pain can be the result of:

Tendinitis. The rotator cuff tendons can be irritated or damaged.

Bursitis. The bursa can become inflamed and swell with more fluid causing pain.

In impingement. As you raise your arm to shoulder height, the space between the acromion (the bone at the top of your shoulder) and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.

Rotator cuff pain is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, squash, javelin and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm can also lead to this problem.

Pain may also develop as the result of a minor injury, and am afraid to say as we age tendons like the rest of us become weaker and more prone to tearing . Sometimes, it occurs with no apparent cause.

Shoulder pain symptoms

Rotator cuff pain commonly causes tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position. Frequently patients will also complain of pain radiating down their arm. People often find putting their arm behind their shoulder is very difficult and painful as the capsule in the back of the shoulder tightens.

Patients often delay treatment thinking their shoulder is just mildly strained, however once it settles in it stays, and with time slowly worsens.

Manipulative treatment is very helpful along with acupuncture to help restore normal functioning and reduce pain.  Because of the tendons low blood supply, and weakness around the area it may well take a few sessions to start establishing a reasonable response.  These treatments alone can in many cases restore normal functioning quickly and thereby reduce pain and sleepless nights.

In some cases if the inflammation around the rotator cuff is too too  severe, steroid injections can be used to help reduce swelling and pain. In rare cases if there is either a complete tear or the tendon is too weak surgery may need to performed to stitch the tendon back to help restore its mechanical integrity.

Usually though, osteopathy along with acupuncture suffice in helping patients recover from these painful conditions.

Should you have any further questions or to see whether I may be able to help either call me on 0207 6921818 or email me.

Is Acupuncture helpful for low back pain?

Acupuncture has been used over the millennia to help patients with various ailments, including low back pain.

Low back pain is a very common condition affecting millions of people and it is one of the commonest reasons for absenteeism from work.  Most, at some stage of their lives, will have suffered some form of this disabling and sometimes crippling condition. 

Patients often present with acute low back pain, hardly being able to walk, with jolts of pain cascading around their low back area. Acupuncture in these cases works very effectively, as no spinal movement is necessary and a patient can lie in a comfortable position whilst being treated. As it does for chronic back aches where most of the manipulative toolbox has been exhausted. Acupuncture comes in as another modality to use to help patients, and we have seen many successes with this treatment.

Acupuncture can help back pain by:

  • providing pain relief –  stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors, changing the processing of pain in the brain and spinal cord (Pomeranz 1987; Zhao 2008)
  • reducing inflammation – by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007;Zijlstra 2003).
  • improving muscle stiffness and joint mobility – by increasing local microcirculation (Komori 2009), which aids dispersal of swelling and bruising
  • reducing the use of medication for back complaints (Thomas 2006)
  • providing a more cost-effective treatment over a longer period of time (Radcliffe 2006;Witt 2006).
  • improving the outcome when added to conventional treatments such as rehabilitation exercises (Ammendolia 2008; Yuan 2008).

I would be the first to say we must cast a critical eye even on something that has been existence for thousands of years, as research in this area has often been somewhat ambiguous. Studies involving ‘sham acupuncture’ methodology in which dummy needles which did not penetrate the skin showed acupuncture to be less effective.  However, in further trials it has been shown that sham acupuncture also works – thus there is always some controversy surrounding this complex topic.

For those interested, there is a very good elucidation of this in this talk.

In summary the answer directly the question posed at the beginning of this article is an emphatic yes. acupuncture is a very useful tool in the fight against back ache. The beauty of acupuncture is that it can be used singly or in conjunction with osteopathy to help gain maximum results in a relatively short period of time, whilst at the same time giving the additional glow of an endorphin rush!

If you are suffering from back pain of any sort and you wonder whether acupuncture may be of benefit, give me a call on 01483 720464 or email me at lholve@yorkclinic.co.uk where I will be pleased to offer any advice.