This page is provided to give an indication of common musculoskeletal problems and injuries in different areas of the body. It provides an indication of some of the problems that Osteopathy can treat. For more information on any of these musculoskeletal problems please contact us.
There are a reported 100
different types of headaches, most of them are secondary to other causes. The two most common primary headaches are
migraine and tension headache. Medications used to treat various headaches try to intervene in the biochemical
chain that results in the symptoms.
are many theories regarding the causes of migraine, but a common thought suggests
it is caused by a cycle of vasoconstriction (narrowing) then vasodilation
(widening) of the blood vessels of the head. Other theories include the existence of blood shunting vessels that
divert arterial blood directly to the veins without ever reaching the head, and
also a slowly moving wave of neural activity traversing the cortex of the
brain, causing the aura. These theories
are only speculation and migraine sufferers may have their own theory for the
causing or relieving factors.
- Severe throbbing head pain usually felt unilaterally and near or over one eye.
- Some experience about 30 minutes prior to an attack focal neurological symptoms (aura) which is more common a in a 'classic' migraine.
- About 1 in 5 have feelings of depression, irritability, restlessness or nausea.
- About 1 in 5 see jagged, or shimmering lights, or lose vision in a specific area (scotoma).
- Hypersensitivity to light, sound or smell is common.
- Migraines can lasts from hours to days.
are a variety of different triggers, but the main ones which have been
- Dietary – such as cheese, red wine
- Emotional – such as stress, depression
- Physical – such as fatigue, over-exertion
- Systemic – such as oestrogen cycles
- External stimuli – such as flashing lights
Soft tissue manipulation can
help improve blood flow to the area. Massaging the temples (the side of the forehead) or the parietal (top of
the head) can also help abort or ease an attack. Some forms of migraine are caused or
aggravated by restrictions to the vertebrae in the neck.
A subnucleus of the
trigeminal nerve is found at C2/3 in the neck. Irritation at this level causes the trigeminal
nerve to release vasoactive substances which causes the vasoconstriction /
vasodilation cycle stimulating and causing a migraine. Dysfunction of the upper cervical vertebrae
can be treated by articulation or manipulation of the neck. Postural and mobility exercises together with
avoiding migraine triggers are also helpful in management. Lymph drainage techniques may also aid in
relieving any congestion in the head.
- Begins morning or early afternoon, it gets progressively worse
- Pain is felt over the eyes, at the back of the head, or as a band around the head, it sometimes refers to the neck and shoulders
- Pain is usually bilateral, constant; a 'tight' feeling may be experienced, and never throbbing in nature
- Lasts from 15 minutes to one week
tension is believed to restrict blood flow, there also appears to be a
reduction in pain suppression. Stress
and depression may also contribute to the cause.
at the back of the head may be due to compression of the second cervical nerve. This is often attributed to poor posture with
the head held forward of the shoulders and then being held in extension. It is more common if a person has an
increased kyphosis (an increased curve of the upper spine) which will give a
rounded shoulder appearance and cause poor posture in the neck.
tissue treatment to the neck can improve blood flow by releasing tight
muscles. Articulation or manipulation to
the occipito-atlantal joint can improve posture and help prevent compression to
the second cervical nerve, making osteopathic treatment an effective treatment
for headache of a cervicogenic nature.
of the occipito-atlantal joint
of the cervical spine
Joint (TMJ) Dysfunction / Jaw Pain
TMJ (or jaw) is the most frequently used joint in the body, opening and closing
to eat, talk and breathe. The joint
moves by a combination of a hinge opening, and a forward sliding action. Inside the joint is a disc, if the joint is
dysfunctional the muscles opening the TMJ can pull the disc forward causing the
mandible to ride over the joint, creating a click. Typically the jaw will not open in a straight
line, but will follow a C or S shaped path to the dysfunctional side. This can be felt by placing both index
fingers anterior to the ear canal and opening the jaw slowly, this action
should be symmetrical, of one side moves first or protrudes more a dysfunction
may be present. This is often
asymptomatic in a lot of people.
TMJ Dysfunction can be caused by:-
- Stress and teeth-grinding
- Chewing gum
- Trauma to the jaw
- Loss of teeth, causing an uneven bite
of TMJ dysfunction:-
- Clicking or popping when opening the mouth
- Jaw pain
- Neck pain
treatment can involve soft tissue manipulation, stretching and articulation of
the jaw to help balance the muscles of mastication and improve jaw function. Advice and home exercises can also be
prescribed to help restore and maintain proper function.
neck is complex and pain can easily be caused by dysfunction of the muscles or
vertebrae in the neck. Poor posture
often causes the neck muscles to fatigue if overworked, which in turn cause a
build up of by-products from constant contraction which can be painful. Vertebrae can also become restricted, limiting
the movement of the neck in one or more planes. Dysfunction of the neck can cause headaches, and can also refer pain
into the arm, forearm and fingers.
nerves supplying the arm originate in the neck, and follow a complex path
between the vertebrae, through the muscles of the neck, under the clavicle (collar
bone) and muscles of the chest into the arm. The nerves can become compressed at many of
these sites en-route causing the referred pain into the arm and is commonly
referred to as a 'trapped nerve' or 'nerve impingement.'
treatment involves articulation, mobilisation and soft tissue manipulation to
restore mobility to the neck, relax the muscles and help flush the area of
toxins. Lymph drainage will also help to
improved congestion. Posture and
mobility exercises can help prevent the condition returning over time.
are many injuries and conditions of the shoulder that are frequently treated
with osteopathy, including:-
Frozen shoulder (adhesive capsulitis) - Typically lasts for approximately 18 months, although soft tissue manipulation and articulation can aid in maintaining and regaining mobility.
Rotator-cuff tears, also referred to as the SITS muscles - Provided the tear is not complete, soft tissue manipulation, strengthening and proprioceptive exercises can improve function in the joint.
Biceps tendonitis - Inflammation of the long head of the biceps as it runs through the bicipital groove of the humerus.
Bursitis - Small synovial fluid sacs becoming inflamed through overuse or trauma.
most commonly strained muscles are - Deltoid, biceps and the rotator cuff
muscles (supraspinatus, infraspinatus, teres minor and subscapularis).
Sterno-clavicular Joint Dysfunction
clavicle (collar bone) articulates with the sternum at the front of the chest, and
the acromion process of the scapula at the other end. Dysfunction in one of these joints often
causes dysfunction at the other end. The
acromio-clavicular joint is especially vulnerable as the joint is only
supported by ligaments and can be easily strained by lifting heavy objects or
by repetitive strain. The sterno-clavicular
joint dysfunction can be caused from a seat-belt restraint in a road traffic accident,
where the clavicle is restrained by the seat-belt against the inertia of the
body. Both joints can also be aggravated
by poor posture, as the upper back curves forward and the shoulders rotate
inwards which compresses the joints.
and sterno-clavicular joint dysfunction can be improved by articulation and
mobilisation of the joints, and correcting postural imbalances in the thoracic
spine. Stretching the pectoral muscles
also helps open up the chest and allows the shoulders to be seated in a more neutral
of the muscles of the arm can be strained or overused. The biceps muscle is easily strained or even
torn. As its name suggests, it has two
heads, the long and short head. The long
head runs though the bicipital groove and through the capsule of the shoulder
joint. This tendon can easily become
inflamed through trauma or overuse, and is easily mistaken for shoulder
pain. Drainage techniques can help
reduce the inflammation, and tension can be reduced in the biceps to encourage
blood flow and improve healing.
Pain can be referred into
the arm from the neck or from impingement of the brachial plexus. The nerves from the neck create a network
(plexus) above and behind the clavicle (collar bone). They travel together with the artery and vein
supplying the arm. The path runs through
muscles in the neck, under the clavicle, over the first rib and underneath
pectoralis minor. This nerve and blood
supply can be trapped at any point. This
is made more likely by poor posture, with the shoulders rotating forwards and inwards. The referred pain can be at any point in the
arm, even down into the fingers. Articulation, mobilisation and manipulation of the neck, shoulder and
clavicle can all help restore proper function.
muscular dysfunctions at the elbow are medial and lateral epicondylitis (tennis
and golfers elbow). Both are caused by
muscles tractioning their insertions and causing inflammation, with the wrist
extensors causing tennis elbow and the wrist flexors causing golfers elbow. Both dysfunctions are readily treated by soft
tissue manipulation. Ligament sprains at
the elbow are less common as the joint is a hinge joint with little accessory
of the bursa at the elbow is also relatively common, and can be caused by
continually resting on the elbow.
of the head of the radius in the radial groove of the ulna can cause symptoms
similar to tennis elbow, or may contribute to the problem. This can be improved by articulation or
manipulation of the radial head.
Wrist and Hand Pain
Carpal tunnel syndrome is a
common problem at the wrist, with the median nerve becoming trapped under the
flexor retinaculum when it becomes inflamed. This condition is common in keyboard users, and sufferers often wake at night
with pain in the hand that they shake off. This can be improved by drainage techniques and stretching of the flexor
retinaculum, helping to avoid surgery of the wrist. The median nerve can also become entrapped
between the two heads of pronator teres which also responds well to osteopathic
Displacement of the carpal
bones can also cause pain in the wrist. These bones move in a helicospiral motion to provide the intricate
movements of the wrist and hand. They
are usually displaced towards the back of the hand and restricting the sliding
motions of the joints of the hand. This
may contribute to other problems such as tennis elbow, as the body tries to
compensate. Articulation and manipulation
can help restore the position of the carpals and the function of the wrist.
Ribs are attached to the
vertebrae at the back and to the sternum at the front. The ribs provide the movement required for
breathing and provide attachment for muscles of the back, shoulder girdle, neck
and the abdominals whilst also protecting some vital organs in the lower
section of the rib cage. The joints at
the back are complex with most ribs having three articulations with the
vertebrae. This renders them liable to
dysfunction, often getting fixed during inspiration, in their elevated
position. This can then irritate the
intercostal nerve which follows the course of the rib.
Rib dysfunctions usually
present in the following ways:-
- Pain in the back, slightly to one side
- Pain in the back and front, feeling like a skewer
- Discomfort when deep breathing, coughing or sneezing
often find they have very tender 'knots' between the shoulder blades - these
are usually rib dysfunctions and massage to them will make them sore. They are an extremely common problem that an
Osteopath will see every day. They can
be treated very effectively by manipulation and articulation of the ribs and
also the thoracic spine.
Low Back Pain
lumbar spine is a complex load bearing area also providing the neural supply to
the legs and many internal organs. It is
greatly affected by posture and biomechanical dysfunction, and can cause
debilitating pain. Back pain is very
common and may be due to a variety of tissues:
- Muscle Strain
- Ligament sprain
- Facet joint irritation
- Nerve irritation
- Disc herniation
- Sacroiliac dysfunction
tissues may not necessarily be the cause of the problem, but can be an
irritating factor. A pelvic torsion is a
very common cause of back pain, as it causes an artificial leg length inequality. The base of the spine is then no longer level
and to compensate the spine has to curve sideways, resulting in the muscles on
one side being stretched and on the other side being shortened. This causes muscle strain and can reduce
movement of the vertebrae of the spine causing facet joint inflammation and
pain. Massaging the muscles of the back
will only result in symptomatic relief and the pain will return. Correction of the pelvis is required, and
this can be done by articulation or manipulation. This allows the base of the spine to become
level and allows the spine to return to the neutral position.
back pain symptoms can be improved with dramatic results in just one treatment,
but not all back pain responds in this manner - it depends on the tissues
causing the symptoms. An acute facet
joint irritation can respond very well to an initial treatment, whereas a
ligament sprain in the back will take far longer to heal, as it has a poor
of the lumbar spine and sacro-iliac joint
hip is a very strong joint due to the depth of the cup and strong ligamentous
attachments, reducing the risk of injury. The joint is, however, a major weight-bearing joint and is a common site
for osteoarthritis. Pain in the hip can
be referred from the lumbar spine or the sacroiliac joint. The hip itself can also refer pain to the
back or even to the knee. Pain and
inflammation to the hip can be relieved by osteopathic treatment. In cases such as arthritis where there is
permanent damage to the joint surfaces, osteopathy can help retain as much
mobility as is possible and reduce the strain on the joint by ensuring that
other joints such as the ankle and knee are functioning optimally.
are many powerful muscles around the hip that can cause pain due to strain,
overuse, or from other biomechanical dysfunction. The psoas muscle contains the lumbar nerve
plexus and this can become very painful if hypertonic. The sciatic nerve runs under, over or even
through the piriformis muscle, this can cause pain down the back of the leg. The iliotibial band, a large ligamentous
structure, runs over the greater trochanter and can become very contracted and
painful. In addition, it may cause
inflammation of the bursa (a synovial fluid filled sac) over the greater
trochanter. Osteopathic treatment is
very effective in treating the musculature of the hip, as there are a broad
range of techniques that can be applied to muscles that are inaccessible to
other manual techniques.
at the front of the thigh is commonly caused by straining the quadriceps,
although the upper lumbar spine may also refer here. The femoral nerve can also become entrapped
as it leaves the pelvis. Unbalanced
quadriceps can cause an uneven pull on the patella (knee cap) and cause a
burning pain at the front of the knee. The quadriceps are easily treated through the soft tissue manipulation and
muscle energy techniques of osteopathy.
in the posterior thigh can be referred from the lumbar spine, or from
compression of the sciatic nerve, most commonly from a tight piriformis. The hamstrings can also be easily strained
from overuse, or shortened due to long periods of sitting. Pelvic dysfunction can also cause a change in
tension on the hamstrings as the origin of the muscle is changed. Again osteopathic treatment is effective in
treating the soft tissues of the thigh.
Lateral and Medial Thigh
on the outside of the thigh is very often due to a tight iliotibial band. This is a long ligamentous structure running
all the way down the side of the thigh. If it becomes contracted, it can become very painful and also alter knee
mechanics, as it attaches to the knee and sends fibres to the patella. The muscles of the inner thigh are the
adductors, and these pull the leg towards the midline of the body. Groin strain is an injury of the adductors,
where they insert on the pelvis. The
adductors and iliotibial band can be treated through soft tissue manipulation
and stretching exercises. The soft
tissue changes may be secondary to alterations in biomechanical
dysfunction. Osteopaths are experts in
integrating their knowledge of biomechanics into how the patient's symptoms
have occurred. This ensures that, where
possible, the root cause of the problem is addressed rather than just
knee is a very complex joint, with many pain sensitive structures. It is notoriously difficult to examine and
identify the cause of the symptoms. The
joint has to cope with many minor accessory movements to allow for adaptation
and shock absorption during gait. The
compromise for this is stability.
knee has four main ligaments, the medial and lateral collateral ligaments, and
the anterior and posterior cruciate ligaments. The most commonly sprained ligament is the
medial collateral ligament on the inside of the knee, as this takes the force
of an impact from the outside of the knee. This ligament also has fibres attached to the medial meniscus. The cruciate ligaments are inside the joint
capsule and when completely torn require surgical repair. Strength and proprioceptive training after a
ligament injury helps re-educate the knee to reduce any instability.
menisci are more commonly know as the 'cartilage' of the knee. They help cushion the joint and provide a
larger surface area for the femur to articulate with. The medial meniscus is the most frequently
torn, and the lack of blood supply makes it more difficult to heal. Tears cause more problems if they fold over or
if material becomes loose in the joint causing locking. Tears can eventually be worn away, or if
presenting an everyday problem surgery can be considered.
are fluid filled sacs that reduce friction between different surfaces in the
body - usually between muscles or muscle and bone. Around the knee there are at least fourteen
bursae, and any one of them can become inflamed from hypertonic muscles, trauma
or even infection. Inflamed bursae can
mimic many other conditions of the knee, and can be relieved by drainage
techniques and reducing the tonicity of the muscles around them.
Patella (knee cap)
back surface of the patella is V-shaped and is designed to slide up and down a
V-shaped groove in the femur. The
quadriceps attach to it via the patella ligament, because of the angle of the
knee, three of these muscles pull the patella slightly inwards and only one
pulls it slightly outwards. If these
muscles are imbalanced, or the Q-angle of the knee is increased, this causes
wear and inflammation to the back of the knee cap resulting in a burning pain
behind the knee. It often comes on after
walking or running for some distance, or from being seated for long periods. This condition is readily treated by
addressing the tonicity of the muscles involved and giving strengthening
exercises to the quadriceps pulling the patella inwards. The problem may also be caused by hip or foot
dysfunction affecting the Q-angle of the knee.
Superior Tibio-fibular Joint
joint is a small joint very close to the knee that may mimic knee pain or
affect the functioning of the knee. This
may be due to a dysfunction of the foot causing restriction of the fibula. This can be very easily treated by
articulation and manipulation, addressing any foot dysfunction and treating any
resultant muscular dysfunction.
of the knee
Lower Leg Pain
main two muscles of the calf are the soleus and gastrocnemius, and can cause
tremendous pain when strained. They have
to deal with tremendous loads as bodyweight is amplified during walking,
running and jumping. Occasionally the Achilles
tendon can rupture with an audible crack requiring surgical repair. Stretching and deep soft tissue treatment can
help treat strained calf muscles and Achilles tendonitis.
Foot and Ankle Pain
anterior talo-fibular ligament is the most commonly sprained ligament in the
body, usually when rolling over on the outside of the foot. This ligament contains many nerve endings
(which is why it is so painful), that informs the brain of the position of the
ankle in space. Damage to the ligaments
disrupts this mechanism, which is why repeated ankle sprains are common. Treatment to the ankle helps re-educate the
brain of the position of the ankle to reduce further occurrence.
sprains can also pull on the fibula and cause problems at the fibula head, often
presenting as a knee problem.
on the sole of the foot can often be due to inflammation of the plantar fascia,
a ligamentous structure that helps maintains the arches of the foot. The pain is often very sharp and stabbing in
nature. This can be placed in traction pulling
at its insertion into the heel and heel spur can be a consequence.
foot is a very complex structure and dysfunction can result between any of the
bones of the foot causing restricted movement and altered gait. This can affect other parts of the body such
as the knee hip or back, as the body tries to compensate for the structural
change. Osteopathic treatment to the
foot and ankle restores the biomechanic functioning of the complex, relieving
pain and preventing dysfunction from ascending through the rest of the
of the foot and ankle – medial view
of the foot and ankle – lateral view
Thoracic / Mid and Upper Back Pain
are many muscles of the back that can be strained through overuse, sport, or
poor posture. The muscles around the
shoulder blades are particularly prone to becoming overused, especially as
posture becomes poor and the back rounds. VDU operators and drivers are at risk of muscle strain because of
continually holding out their arms out in front of them. Neuromuscular technique is particularly
effective at treating tender points in the muscles around the shoulder blade.
vertebrae in the thoracic spine are restricted in their mobility due to the
attachment of the ribs. The muscles of
the spine often become hypertensive reducing the movement of the
vertebrae. This leads to pain as the
joint surfaces are compressed, the joints become irritated and the lack of
movement stops the products of metabolism from being pumped away. The lack of mobility can in turn cause rib
dysfunction. Articulation and
manipulation to the spine can help restore the mobility and re-educate the
muscles to help prevent them clamping down.