Coming in all shapes and sizes, the foot is one of the most vital structures that we possess. A study in 2015 discovered that the average British person takes 6322 steps a day. That’s an incredible amount of stress going through the foot and this is just in one day, so during an average week, we can expect to take somewhere in the region of 44,400 steps!
The foot is a hugely complex structure made up of 26 bones, 33 joints and over a hundred muscles, tendons and ligaments. Being the foundation for stability and movement it is essential to keep our feet as supple and as well supported as possible. During Osteopathic practice, it is often the case that pain experienced in the lower back and in the hips is the result of foot condition or dysfunction.
But what can we do to keep our feet healthy and functioning optimally? With the feet being the furthest structure from the vital organs they can be the first to experience a lack of oxygenated blood especially during winter when we are less active. To keep them stimulated, practice massaging the sole (plantar fascia) of the foot to activate the muscles and keep the blood moving back up the body.
With the weather improving and getting warmer, take time to walk out on the lawn in your bare feet. Again this can stimulate blood flow to the area and allows the muscles to fire and keep the foot mobile. If you have any problems walking barefoot then please consult your doctor before doing so.
With all the different shoes out there all claiming to be the right one for you, it can be difficult to know which way to turn. Getting your feet assessed by an Osteopath can be a great start to improving the health of your feet, alternatively a qualified podiatrist can help with more severe foot types, which may need a particular type of specialised shoe. If you need any guidance with this then please get in touch with us here at the Exeter Osteopaths, we will be delighted to help you in any way we can.
Mark Twain once said that golf was a good walk spoiled. Now I am not known to argue with literary geniuses, but on this occasion I feel that the bearded wonder may have got this one, well, wrong. I have had many a fine evening wondering the hallowed turfs of England’s green and pleasant land and apart from the odd time when I have scuffed the ball into the pond I have never considered it wasted.
Perhaps like many others, you were entranced by the recent British Open going into Monday and there being a three way tie at St Andrews Old Course. Perhaps you have become inspired by the professionals and either want to don the plus fours again or take up the sport.
If so, then there are a few things you need to consider. In Golf, it is one sport where in order to achieve the perfect shot, all the components of the swing need to be in harmony. For this, we need strong, flexible feet, stable and moveable hips and a responsive and adaptable thoracic spine (the bit in the middle).
Most of the drive and power in golf come from the hips, so having good strong buttock muscles are essential. In order to do this, squats and lunges are a good start. The feet need to be strong too because a) you are going to be doing a lot of walking and b) a lot of movement and stability is required in them to keep the swing in check. If your feet are inflexible you will start to recruit muscles from higher up the chain and this will reduce your impact when striking the ball.
The rotation in golf starts in the thoracic spine and this is the really key area. If this part of the spine is inflexible, then the lumbar spine (the lower part) begins to do too much rotation and this is where problems start to happen. The low back should really just be the channel between the hips and the thorax, just passing the information between each other. The moment it stops being the messenger is when we begin to injure ourselves.
So how can we prevent this. First have a try of these exercises below:
Golf is meant to be fun and is a great way of exercising and keeping fit. Allied to all of the exercises above, always make sure that you warm up for 10 minutes at least before you play. Go for a walk, swing the club in the opposite direction to normal and get the blood pumping by running on the spot. You may get some strange looks, but then you won’t be the one nursing a sore back at the end of the round! Good luck!
For many of us a ski holiday is the perfect way to get away in the winter and do some physical exercise. The only problem is, due to the short days and cold nights, most of us have actually cut down on our level of exercise during the winter.
Start early – Get yourself to the gym, pilates, aerobics at least 1 month before your holiday and work on your core abdominal muscles and leg strength.
It’s a balancing act – Balance is the single most important factor in skiing. Use a wobble board to improve balance and build up ankle muscles. For a thorough ankle work-out, rocking heel to toe is good for snowboarders and left to right is best for skiers.
Get it checked – Most skiers find turning one way easier than the other. Poor technique might not be the problem – muscle weakness and joint alignment could be. Visit one of our osteopaths to sort out any misalignments and improve performance.
Work those legs – You need to target the thigh muscles (quadriceps) so squat and stand up repetitively whilst making tea, brushing your teeth or in the adverts on TV. As you get more advanced do your squats on a bed or wobble board to improve your coordination and stability. One legged squats are next.
Challenge! – Think you’re an expert skier and well coordinated? I will believe you if you can do a one legged squats on your bed, with both eyes shut for more than one minute without falling over! – TRY IT!
Target the calves – Due to being on a heel or toe edge on your board, your key muscles are on the front and back of the calf. To train them walk up and down the corridor on your tip toes and then return only on your heels (ie lifting your toes off the floor). You’ll look strange but it really works.
Sit down, stand up – As you spend a lot of time sitting in the snow and getting up, your arms get a good work out and in particular your triceps muscles. Practise by placing your back to a table, resting your hand on the edge and dipping the body down and then pressing up.
ON THE SLOPES
Hot and Cold – Warm up before strenuous skiing. Start off gently rather than heading first for the black runs and round the day off with a stretch. Take plenty of breaks – Overexertion will ruin your holiday – moderate the length of skiing time and listen to your body. Pain is a warning sign, don’t ignore it.
Liquid lunch – Drink plenty of water and isotonic drinks to avoid dehydration and stay clear of alcohol, tea and coffee. Drink plenty with breakfast.
Put the boot in – No matter how many lessons, skiers won’t improve without the right boots and this is where most skiers put their first foot wrong. Skiers often choose on comfort alone – don’t make this mistake. Get a moulded footbed (called Orthotics) from the ski shop first as this improves fit, comfort and ski control. Opt for a shop with a wide range of boots so you are spoilt for choice.
(Freeride in Meribel, Precision Ski in Val d’Isere/Les Arcs, Footworks in chamonix)
Carry on – Always be careful when carrying skis/boards. Leave them standing upright so you don’t have to bend to pick them up. Carry them over your shoulder, swapping shoulders regularly.
Ice is nice – With an acute injury, use ice rather than heat.
Tread carefully – A great deal of people are injured by slipping on ice at the ski resort, not just on the slopes. Wear shoes with a deep treaded sole and use strap-on studs for ski boots to help keep you upright. (see – yaktrax at www.ellisbrigham.com )
Get Protected- Buy a helmet and wrist guards before you have a fall.
WHEN YOU GET HOME
Should you be unfortunate enough to be injured during your holiday, all our osteopaths are experienced in treating sports injuries and post operative rehabilitation so don’t put off getting treatment on your return.
Jenny has recently completed a gruelling ascent of Alpe D’Huez in France. Here she gives some top advice on how best to prepare for yourself for injury free cycling.
For all the fair weather cyclists (and tough it out winter lot!) who are upping their mileage in the summer, here are some stretching basics to keep you going both on and off the bike.
When stretching there are right and wrong ways and to do it, but here are the simple rules:
Only stretch when you are warm, so this could be prior to a workout (but only after you have warmed up for 10 minutes), or post workout when you are still warm from the workout.
Timing and length of holds are important too. If you are stretching before the workout only hold for 5-10 seconds, do both sides twice
If you are stretching post workout, then you will still be warm and the stretches can be held up to 10-20 seconds, do both sides twice.
If you really want to work on your flexibility, stretches are best done in the evening, after a nice warm shower or bath, and should be held a long time, 30-60 seconds, and do both sides three times.
If you are naturally very flexible/hyper-mobile, stretch very little and for short duration, or not at all. There is a upper limit of how much flexibility you want as this leads to instability and potential injury to joints.
This is not an exhaustive list but these some of the major groups to focus on; Just click to follow the links to the video demonstrations.
There are many common injury presentations found in walkers. Particularly in those who are occasional walkers. Those of us who believe ourselves to be fit and healthy, can run for half an hour or complete many exercise classes often find many new body parts that begin to ache very quickly.
Going away for the weekend or a holiday break to discover the surrounding countryside and hills, we often take a “short” 3-4 hour stroll, using completely different sets of muscles, which may result in: upper and middle buttock pain, hip pains, low back ache, achilles tendonotis, patellar tendonitis, shin splints, plantar fasciitis, thigh and hamstring pains. Most of these injuries are preventable given correct stretching and a sensible build up plan to hill and distance walking.
Steep downhill walks can really work the fast twitchmuscles in the quadriceps, the following day this can lead to very deep aching in the front of the thighs. Steep uphill walks mean raising the toes higher often giving rise to shin pain. Going through some gentle stretches at the end of a days walking can greatly reduce the muscle soreness for the following day.
Here at the clinic we are able to offer a full check up prior to setting off walking. We are able to observe and identify potential problems before they arise and recommend corrective treatment and preventative exercises and stretching.
Remember when walking in the country the paths are invariably on slopes and inclines are usually followed by declines. These all place the foot at precarious angles to the leg putting the ligaments, joints and tendons at risk. Correct shoes are essential not only to prevent ankle sprains and support the feet, and good grip stops you falling and injuring other areas of the body so that hopefully you won’t need to call on these guys…
North Dartmoor Search and Rescue …training exercise only! No one was harmed in the making of this photo 🙂
If you feel need help with an injury or just a tune up before heading off to the hills, please call us on 01392 428141 or BOOK ONLINE with Jenny
Five things you never dreamt would cause Back Pain
Have you ever hurt your back by simply bending to tie your shoelace? Have you ever just got into the car, driven to the shops and then couldn’t get out? Have you ever wondered why your back all of a sudden goes into spasm when it was seemingly fine just minutes before?
In fact it wasn’t fine just moments before, it’s just you didn’t realise it. When your back all of a sudden gives out on you with a small movement it is a case of straw that just broke the camel’s back.
Poor posture, bad movement patterns and repetitive motions can gradually lead to degeneration in your discs and spine. It may take years and can happen so gradually you don’t notice, until that one thing that puts you over the limit of your body’s ability to compensate.
While the best way to avoid this is to have a strong, flexible body, good postural health and get treatment as needed, there are some things you can avoid that you probably never dreamed would be a problem.
Looking at your phone or tablet
We all do it, walking along reading a text or email with our chin approaching our chest. The muscles in our upper back are under huge strain from the weight of our head in this position. Soon it becomes a habit and if we are also working at a desk our posture will gradually deteriorate.
Solution: Keep your phone or tablet at least chest high when texting or typing. Lift your chin and pull your shoulders back to correct your posture.
Reading in bed
Do you read in bed with your head and shoulders propped up on a couple of pillows so your chin is almost on your chest? It’s a great way to relax at the end of the day. It’s also a great way to jam up your occiput (the bone at the base of your skull) and strain your upper back and neck. When ligaments are on stretch they undergo something called creep. Very slowly, they start to stretch. The ligaments’ job is to guide and restrict a joint. When they stretch they don’t do that job well. Your joints then move in an unnaturally large range of movement, which makes them vulnerable to strain and getting stuck in the wrong position.
Solution: If you notice a headache or neck pain coming on while you’re reading, move to a lying position, either on your back or side with your pillow tucked up under your neck to support it. Your spine should be in line.
Sleeping on your front
Some people naturally love to sleep on their stomachs. Unfortunately it’s also a great way to strain your jaw and neck and compress your facial bones. Imagine how comfortable you’d be if you laid on your back all night with your head twisted to the side and a weight balanced on one side of your face. Again, creep kicks in and you end up with rotational strains through your upper neck and back, restricted ribs and a painful jaw.
Solution: If you really can’t shake the habit, try putting clothes pegs on the front of your pyjamas so every time you turn on to your belly they wake you up and remind you to lie on your side or back.
Crossing your legs
It’s comfortable sitting with your legs or ankles crossed, but it also puts a nice twist through your pelvis. Your upper leg tends to tip your ilium (the bone that houses your hip) back and out. It also lends itself to your piriformis muscle tightening and bringing your tailbone over to that side. Crooked tailbone equals unhappy spine.
Solution: Sit with your knees together. It’s hard work, but at least your adductors (groin muscles) will get stronger.
Missing the curb
Have you ever been looking to cross the road, missed the curb and felt yourself jolt down onto one leg? You’d be amazed at how frequently we see this injury in clinic. Often it will go unnoticed but in the days following your back gets more and more painful for no apparent reason. Osteopathic examination will usually reveal what we call an upslip of the ilium (the bone that houses the hip) of the leg you jolted down onto. The whole bone slides upwards on the sacrum (tailbone) straining the supporting ligaments and causing protective muscle spasm and pain.
Solution: This is one that is best dealt with by a professional. Osteopathic treatment is usually straightforward. Soft tissue and fascial work to relieve the muscle spasm and mobilisation/cranial work to release the upslip and rebalance any compensatory strains in the rest of the body.
In general the best way to keep your back in good shape is to stay strong and flexible. Some, but not all, do well with yoga, or pilates, a stretching regime, some resistance work and cardiovascular exercise. Whatever you do, make it fun so your back can serve you well for years to come. If you need expert advice then call us at Exeter Osteopaths today 01392 428141 or BOOK ONLINE
We are in the midst of winter, the weather is cold and we are all in hibernation mode. Therefore, joint stiffness can become more noticeable – it is the worse time of year for arthritis suffers!
To date no cure has been found for Osteo arthritis (OA) or Rheumatoid Arthritis (RA) but the symptoms can be eased. Traditional Chinese medicine is a great treatment for these conditions. One of the main reasons is that it has been proved that Acupuncture boosts the activity of your body’s natural painkillers, helping to eliminate aches and pains.
Arthritis in Chinese Medicine
Have you wondered why arthritis is worse in cold and damp weather? Well Chinese medicine has the answer. In Chinese medicine arthritis arises when the flow of Qi and Blood are blocked and prevented from passing through the body’s energy pathways. In Chinese medicine this is caused by Wind, Cold and Damp.
Wind: the pain moves from joint to joint – like the wind in the trees, it creates movement
Cold: the pain is in one joint and is intense – when we are cold, we tend to freeze to the spot
Damp: there is swelling in the joint – like a balloon full of water, it swells up
Wind and Damp settle in the joints causing an intense ache. Dampness obstructs the free flow of the channels, joints, muscles and sinews and causes swelling, ache, numbness and a feeling of heaviness of the limbs.
Dampness frequently generates Heat – when something is unable to move freely it generates friction, and the by-product of friction is heat! This Heat settles in the joints, causing redness of the joint and makes them feel hot to the touch. Which is seen in many cases of rheumatoid arthritis.
Acupuncture treatment helps to open the blockages, balance the energy and harmonise Qi and Blood. Therefore, to improve all symptoms such as pain, inflammation and lack of mobility, as well as related symptoms like insomnia, depression or anxiety.
Call us today to book with Esmee on 01392 428141 or BOOK ONLINE
It may be a surprise to read an osteopath writing about the benefits of Physiotherapy and Acupuncture but here goes.
In Sept 2016 whilst out jogging something in my right calf pulled me up abruptly. It was a familiar feeling. Having ruptured my Achilles whilst playing football 15 years previously, I knew it was serious.
I hobbled back to work slightly in denial that I could walk it off.
The days that followed involved GP appointments, sitting in A&E and fracture clinic.
I wore a state of the art boot rather than the plaster like last time. I could relax at least no surgery was needed, just Physio and rehab.
My experience of the NHS was incredible. I had three appointments and two scans within two weeks.
The reassurance and rehab from the Physio was 1st class.
However progress was very slow as this kind of injury tends to be. The tendon has a very limited blood supply so every drop you can get down there is vital.
All of the limping and protective muscle tension in my leg and back were affecting this circulation and not really being addressed in my NHS appointments.
Regular help from Toby (the master manipulator) lined me up better and helped me get around. Cranial treatment from Jenny helped release shock from my shoulders. I still felt the ankle was weak.
Esmee our Acupuncturist had just started at the practice so I booked in. Four treatments later I was really feeling like my ankle was healing. I felt calmer and that my body was just working so much better.
So the point of my blog today is that there is a place for all of us. The advice from the Physio was great as they deal with this week in week out. However to get to the cause of why this happened again I needed more help. The input from Toby, Jenny and Esmee has been so important. I am not there yet as the rehab is a six month process. I’m back at the Physio next week and looking forward to more challenging balancing exercises.
If you have had an injury which has never been quite right, I would highly recommend this combined approach for faster results.
Get the Spring back in your Step! Have you got Runner’s Knee?
Get the Spring back in your Step!
Have you got Runner’s Knee?
Runners knee tends to affect runners, walkers and cyclists. It is a repetitive strain injury and it tends to effect just one knee. There are two main types of injury , Iliotibial band syndrome (ITB) and patella femoral pain syndrome (PT) (also called patella tendonitis)
In this article I will cover ITB Syndrome
Ilio tibial band syndrome –
This is a very common running injury. The ilio tibial band is a band of tough connective tissue running from the hip to the outside of the knee. It helps to stabilise and give spring to the knee joint.
Pain develops on the side of the knee, it can be ¾ down the outside of the thigh, all the way along the side of the knee or sometimes at front of the knee just below the knee cap.
The pain can be a sharp or a dull ache with a numb feeling on the outside of the leg when exercising. It is caused by the tendon rubbing against the bone on movement. In some cases there may be micro tears and thickening which would be visible on an MRI scan . X-rays will show nothing.
Other symptoms of ITB pain-
Pain behind the knee cap, outside of the thigh
Pain on bending the knee or sitting for long periods
Pain going downstairs or hills
Running causes pain
Causes of ITT-
Worn out shoes.
Running up hill or banked surfaces.
Track workouts in the same direction.
Too much running
Pelvic imbalance/ lower back pain.
Foot problems (Pes Planus).
Weak quadriceps muscles.
Misalignment of bones from previous trauma.
If the symptoms have developed within 48 hours using ice on the sore area, resting and taking anti-inflammatories will help. If the symptoms do not settle down after a week or so then osteopathy is the answer.
We will look for the cause, not just the symptoms. In most cases the lower back or the pelvis is the problem.
Commonly the patient will have some mild pain or stiffness in this area. We use gentle soft tissue and manipulative techniques to release the pelvis and soft tissue massage on the ITT and quadriceps muscles.
After a couple of sessions the runner is not only running again but, running more freely and efficiency. Patients tend to feel as if they have a spring in their step again!
This kind of treatment is also useful for walkers and older folk who feel that they are struggling to walk as far or as fast as they used to.
Call us now to book your appointment,
You could also do an ITB stretch by following this link
PATELLA FEMORAL PAIN SYNDROME-
Patellofemoral pain syndrome (PFPS), also known as runner’s knee, is the most common of all kinds of knee pain, causing pain around and under the kneecap. Almost anyone can get it, but it particularly affects runners, cyclists and hikers, and also office workers or anyone else who sits for a living.
The stress of running can cause Irritation where the knee cap (patella) rests on the thigh bone. Pain can be sharp, dull or chronic. It may sometime disappear whilst running especially on the short runs, but only for the symptoms to return after running.
What are the symptoms of patellofemoral pain?
Pain around the knee. The pain is felt at the front of the knee, around or behind the kneecap. Often, the exact site of the pain cannot be pinpointed; instead the pain is felt vaguely at the front of the knee.
The pain comes and goes. It is typically worse when going up or down stairs or with certain sports. Also, it may be brought on by sitting still for long periods. For example, after going to the cinema or a long drive.
In many cases, patellofemoral pain syndrome is caused by vigorous physical activities that put repeated stress on the knee —such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity. This change can be in the frequency of activity—such as increasing the number of days you exercise each week. It can also be in the duration or intensity of activity—such as running longer distances.
Other factors that may contribute to patellofemoral pain include:
Use of improper sports training techniques or equipment
Changes in footwear or playing surface
Patellofemoral pain syndrome can also be caused by abnormal tracking of the kneecap in the trochlear groove. In this condition, the patella is pushed out to one side of the groove when the knee is bent. This abnormality may cause increased pressure between the back of the patella and the trochlea, irritating soft tissues. In some cases here we may see micro tears of the very distal part of the Patella tendon. X rays will show nothing of the patella tendon, but may show worn patella grooves. MRI may show thickening of the patella tendon and is not really necessary.
Factors that contribute to poor tracking of the kneecap include:
Problems with the alignment of the legs between the hips and the ankles. Problems in alignment may result in a kneecap that shifts too far toward the outside or inside of the leg, or one that rides too high in the trochlear groove—a condition called patella alta.
Muscular imbalances or weaknesses, especially in the quadriceps muscles at the front of the thigh from possible pelvic imbalance. When the knee bends and straightens, the quadriceps muscles and quadriceps tendon help to keep the kneecap within the trochlear groove. Weak or imbalanced quadriceps can cause poor tracking of the kneecap within the groove.
There may be a grating or grinding feeling or noise when the knee moves. This is called crepitus.
Sometimes there is fullness or swelling around the patella.
Pinpointing a single cause of runner’s knee is difficult. It could be a biomechanical problem—the patella may be larger on the outside than it is on the inside, it may sit too high in the femoral groove, or it may dislocate easily. Also, worn cartilage in the knee joint reduces shock absorption, high-arched feet provide less cushioning, and flat feet or knees that turn in or out excessively can pull the patella sideways.
Just the repetitive force of a normal running stride alone can be enough to provoke an attack.
As for ITT, see above. In most cases like the ITT the pelvis and the lower back is the main cause here. It causes the quadriceps muscle to shorten which then causes patella tracking malfunction. Doing strengthening exercises is not the answer here until the pelvis and lower back are straightened out first, with lots of soft tissue stretching to the quadriceps. This treatment alone can cure your knee symptoms quickly.
At the first sign of knee pain, cut back your mileage. The sooner you lessen the knee’s workload, the faster healing begins. Avoid knee-bending activities, uneven surfaces, and downward stairs and slopes until the pain subsides. As you rebuild mileage, use a smaller stride on hills. Consider orthotics if new shoes don’t fix the problem. Give Exeter Osteopaths a call on 01392 428141 or BOOK ONLINE if the pain persists, to rule out another condition, our helpful team will be more than happy to get you back on track.
Skiing is a very demanding sport and has a specification that no other has; it is usually practiced once a year and intensely (many daily hours over a week). Imagine rowing once a year for a whole week, over 5 hours a day and without any training … it might be a bit too much, won’t it? Well this is exactly what we put our bodies through when we go skiing.
So how can we prepare in order to enjoy our skiing trip fully but also and most importantly prevent injuries? Three main themes are to be considered:
Firstly general fitness, strength and endurance,
Secondly balance and proprioception (our ability to know our body’s position in space without having to look with our eyes),
And finally flexibility.
This article will focus on the first point mentioned above: general fitness, strength and endurance.
Apply this training routine three times (Monday, Wednesday and Friday) a week for 4 weeks before you go on your ski trip and you will be on fire.
Our next article will focus on point 2: balance and proprioception.
In the meantime, if you require any further help with the above or want to get an existing injury sorted before you’re on the mountains come and see a lovely member of our experienced team of skilled osteopaths.