Knee pain in the middle to late decades of life is a common complaint amongst patients presenting to osteopathic clinics across the globe. Osteoarthritis (OA) is a common cause of knee pain in this age group of people. Research suggests approximately 654 million people aged 40 years and over were living with knee OA in 2020 around the world. This comes at an incredible cost to healthcare services worldwide, with figures in the billions of dollars!
What is osteoarthritis?
Osteoarthritis is just one of a number of forms of arthritis… Essentially a disease which affects the joints in our body. OA is the most common form of arthritis, with Rheumatoid Arthritis (RA) being the second most common form. This blog will focus on OA, a potentially debilitating disease that most commonly affects the weight-bearing joints of the body (i.e. the knees, hips and lumbar spine), but can affect any joint in the body where the joint surfaces are covered in cartilage.
The characteristics of OA include loss of the cartilage that covers the ends of bones that come together to form joints. The underlying and surrounding bone, as well as other joint structures (including joint capsules and other tissues) are also susceptible to degenerative changes that ultimately lead to poor functioning of a joint. The process usually occurs over a long period of time, often starting early in life (interestingly with little to no symptoms at all) and progressing into the latter years. The severity of the disease varies from person to person with some people only experiencing mild symptoms throughout their life. Other people experience more severe symptoms and may require joint replacement surgery as a last port of call to ensure they can continue to live their life as pain-free as possible.
Osteoarthritis of the knee can affect either of the two main joint components of the knee… The joint between the ends of the thighbone and the shin-bone (called the tibiofemoral joint), and the joint between the thigh-bone and the knee-cap (called the patella-femoral joint).
There are certain factors associated with higher rates of knee OA. These include:
- Age: Rates of knee OA increase in the elderly
- Obesity: Rates of knee OA increase with higher levels of obesity
- Gender: Females slightly out-do the males with this one, being approximately 1.5 times more likely to develop it
- Trauma: A trauma to the knee can increase your likelihood of developing knee OA
- Smoking: Smoking is associated with higher rates of knee OA
Signs and symptoms
The signs and symptoms of knee OA include:
- Reduced range of motion
- Difficulty performing functional movements including squatting and kneeling
Pain associated with tibiofemoral OA commonly affects the inside region of the knee first, where the two bones meet at the joint line. Patella-femoral related pain is often felt deep behind the kneecap. Pain will vary from one person to another, and the severity of pain does not necessarily relate to the severity of degeneration. Although if you speak to a person who is about to have a joint replacement surgery (i.e. their joint has degenerated to the point of needing a surgical intervention to keep the person functioning well), they will likely tell you that the pain is extremely debilitating.
Pain and stiffness are regularly felt first thing in the morning and late at night. OA tends to respond well to movement of the joints, and so people often find their pain and stiffness improves once they are up and moving, for it to return once their day has finished and they are relaxing at night.
So, you’ve been diagnosed with knee OA. What to do? Call your osteo… Ta-dah!!!! Given we are experts in how the human body moves (we study human biomechanics at uni), we’re good at picking up how the body should and shouldn’t move. There are no magic pills for treating OA of the knee, and no practitioner can claim to treat the disease itself, as there is unfortunately no cure for OA. It is a progressive, degenerative disease, but there are ways of stunting the progression of this condition if the risk factors leading to its presence are attacked head on.
Poor movement resulting from daily postural repetitive strain, or an old injury that wasn’t treated to resolution is a big factor in the maintenance and development of OA in the knee. Poor movement or dysfunction occurring in the low back, hip or ankle can all lead to excessive load being placed through the knee joints, which can exacerbate the disease process. This is where we come in. We can watch you move during an assessment and work out what is causing the excessive loads through the knee and put a plan in place to improve range of motion and flexibility, strengthen muscles and return you to (hopefully) pain-free daily activities. We will use a combination of soft tissue manipulation, joint mobilization and progressive exercise programs to restore life to your body. Returning to efficient movement patterns after years of neglect, poor movement and a de-conditioned body part will take time, but with determination from both you and your practitioner, it can happen.
As previously mentioned, some cases of knee OA can end up requiring surgical intervention to replace either part of or the whole joint. The good news is, if you do have to go through this process, we have your back (well… in this case, your knee) and can help you through rehab and recovery. Many people who have a knee replacement return to full daily activities and live a long and pain-free life.
Knee pain? What are you waiting for? Call us today on (416) 546-4887 or book online to schedule your appointment.
1. Cui, A. et al. 2020. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 100587. 29-30. Available from: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2820%2930331-X
- Arthritis Australia. 2016. Counting the cost. [Online]. Available from: https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/Final-Counting-the-Costs_Part1_MAY2016.pdf. [Accessed 09 February 2021]
- Centres for Disease Control and Prevention. 2020. Cost statistics: The cost of arthritis in US adults. [Online]. Available from: https://www.cdc.gov/arthritis/data_statistics/cost.htm. [Accessed 09 February 2021]
How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Many sprains occur in the sporting world, but there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!
What is a ligament sprain?
Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorised into the following grades:
- Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
- Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
- Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.
Why is a sprain of the outside of the ankle so common?
The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.
One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:
- Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
- Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
- Being taller and heavier in weight
- Having wider feet
Signs and symptoms
Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):
- Pain (possibly preceded by an audible click or pop) over and around the affected ligament
- Limping on the affected side when walking
- Reduced movement of the affected ankle
- Instability of the ankle joint (i.e. excessive movement) if severe enough
After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).
Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.
The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.
When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.
If you have sprained your ankle and need some help, look no further, our team can help you get back and running. Our osteopaths can help with treatment and rehab, whilst our chiropodist can help out with alignment corrections and shoe recommendations. Call us today on (416) 546-4887 or book online at beachealth.janeapp.com to book your appointment and begin treatment immediately.
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf
We hope you’ve had an enjoyable Christmas and sent 2020 off with the bang it deserved. We’re kicking things off with a blog about neck pain relating to small joints in our neck known as facet joints. Are you waking up to 2021 with a pain in your neck? You might have had one too many sleeps in the armchair over the festive period. And maybe the exercise dropped off a bit as focus changed to family get-togethers and binging in front of the TV after an exhausting year. Never fear, we’ve got your back (oops… we mean neck!)
What are facet joints?
Facet joints are small joints in the neck, formed between bony parts of two adjacent vertebrae. With a few exceptions, you can find a pair of facet joints at each level of the spine: one on the left, one on the right. These joints, along with the disc connection between vertebrae, are responsible for allowing and restricting movements of the spine, depending on what region of the spine you are looking at. For example, the facet joints in the neck are orientated to allow a relatively wide range of motion in all planes of movement… Flexion and extension, rotation, and side-bending (lateral flexion). When we look over our shoulder to check our blind spot in the car, we are mainly using movement in our neck to get there.
If you move to the low back region of the spinal column, the facet joints are orientated in a slightly different way, allowing plenty of flexion and extension, but minimal rotation. This allows us to bend our bodies forwards and backwards easily.
What is a facet lock?
This condition is pretty self-explanatory from its name. A facet lock is a facet joint that is ‘locked’ or severely restricted in movement. This type of joint is what we call a synovial joint. This means it’s a joint that is held together by a joint capsule and is filled with a lubricating fluid, known as synovial fluid. A facet joint tends to lock when it has been overloaded with excessive forces acting upon it. This tends to occur over time and results in a ‘straw that breaks the camel’s back’ moment. It can also happen following a quick jerking movement of the neck, where a sudden large force is placed upon the joints and it is too much for them to bear. The tissue around the joints, including the overlying muscles which drive the movement stiffen and may go into spasm, and you are left with a neck that is extremely painful to move.
More often than not, we are moving poorly above and/or below the joint, leaving it struggling to hold everything together and keep movement going. The body is good at compensating for poor movement up to a point, and then failure is inevitable, unless we intervene.
Signs and symptoms
The signs and symptoms of a facet lock in the neck include:
- Neck pain
- Restricted neck movement
- Restricted mid-back and shoulder movement
- Headache (this is more likely if neck movement is not restored following injury)
- Inability to perform daily tasks such as checking your blind spot whilst driving (we strongly suggest if you cannot turn your neck, to NOT get behind the wheel of a vehicle) and looking/reaching up to a kitchen cupboard
After the initial onset of pain, you will progressively lose movement in your neck over the next few hours. The following few days will be painful while your body deals with the acute inflammation occurring in and around the joint. Slowly but surely, you will begin to notice movement becoming easier and pain reducing.
We recommend coming to see us sooner rather than later. When inflammation is fresh and everything is really restricted, it is sometimes difficult to reach a 100% accurate diagnosis on the first session. But after careful questioning and consideration of your medical history, the majority of the time we can come to a solid working diagnosis. If we cannot, and we feel something else is going on, we may refer you on for a second opinion, or for imaging. Nine times out of ten, with a simple facet lock there aren’t any serious signs and symptoms which will make us question our course of action… it usually just bloomin’ hurts and is difficult to move your head. In those cases, we can get to work immediately.
A locked, compressed and inflamed facet joint usually responds pretty well to some gentle traction of the neck. Traction techniques gently separate the joint surfaces, allowing for movement of fluid and for everything to calm down nicely. If you are super locked up and restricted, traction and very gentle neck mobilisations may be all we’re able to do in the early stages. We’ll cast an eye over the areas above and below the injury site to see what’s going on there, and treat those accordingly. Restoring movement in a non-painful area away from the injury site is commonly what’s needed to help calm everything down quick-smart. All being well, when you get up off the table after your first treatment, your pain will have reduced and your movement will have improved. Over the next few sessions, we will capitalise on this and aim to restore full function to your neck within 8-10 sessions, across a period of 8-12 weeks. These time periods are rough estimates and always depend on whether you do your homework with exercise, living well and avoiding potentially aggravating activities for a short time.
Injuries like these are usually the result of many years of poor movement. We encourage you to look long-term with your treatment goals. Injuries that take years to build up will not be undone in a few weeks. Yes, we will get your pain down and your movement up, but to get truly strong and mobile takes months to fully achieve. Our aim will be to get you to that point where the injury is not likely to return once treatment stops and you return to normal daily living.
Neck pain? Call us today on 416-546-4887 to book an appointment.
Do I need orthotics? What kind?
Many people come to the clinic complaining of foot pain from conditions such as bunions, hammertoes, a pinched nerve (neuroma), or heel pain (plantar fasciitis). I perform a thorough evaluation and examination, and together we review the origin, mechanics, and treatment plan for the specific problem.The patient usually asks if they need and orthotic and, if so, which type would be best.
I recommend a foot orthotic if muscles, tendons, ligaments, joints, or bones are not in an optimal functional position and are causing pain, discomfit, and fatigue. Foot orthotics can be made from different materials, and may be rigid, semirigid, semi flexible, or accommodative, depending o your diagnosis ad specific needs.
Different types of orthotics
There are few types of foot orthotics: over-the-counter/off-the-shelf (OTC) orthotics; “kiosk-generated” orthotics; and professional custom orthotics. OTC orthotics are widely available and can be chosen based on shoe size and problem. Kiosk orthotics are based on the scan of your feet. A particular style or size of orthotics is recommended for you based on a foot scan and the type of foot problem you are experiencing.
For custom prescription orthotics, a health professional performs a thorough health history, including an assessment of your height, weight, level of activity, and any medical conditions. A diagnosis and determination of the best materials and level of rigidity/flexibility of the orthotics is made, followed by casting mold of your feet. This mold is then used to create an orthotic specifically for you. The difference between OTC/ kiosk and custom made orthotics may be likened to the difference between over-the-counter and prescription reading glasses.
Which type of orthotic is right for you?
A person of average weight, height, and foot type and with a generic problem such as heel pain, usually does well with OTC or kiosk orthotic. They are less expensive, however you may have to replace them more often. Someone with a specific need, or a problem such as severely flat foot, may benefit from custom prescription orthotics. These also last longer.
Another important fact is that your foot specialist will be able to educate you about proper footwear. You may be surprised to learn that many people have not had their feet professionally measured in years. As we age our foot length and width changes, and sizing may not be consistent between brands.
In my experience, certain groups of people benefit from an examination performed by foot specialist, and prescription for custom orthotics. These may include people with diabetes who have lost a feeling in their feet, people with poor circulation, and people with severe foot deformities caused by different foot misalignments and medical conditions.
Are you in or approaching your latter years and are wondering what you can do to ensure your bones stay strong through the next period of your life? As we age it is common to begin feeling the effects of years of ‘life’ on your body. Diseases like osteoarthritis (i.e. degeneration of joints) and osteoporosis (i.e. weakening of bones) are more common in the elderly population. But just because the figures show this, it doesn’t mean these diseases will affect your ability to lead a full and active life.
The good news is, there is plenty you can do now to reduce the risk of bone-related problems down the line. Read ahead for a few exercises you can perform regularly to keep you and your bones in tip-top shape!
Weight-bearing and resistance are key
It is widely accepted that to increase bone health, we need to stress the bones of the skeleton. The best way to do this is through weight-bearing exercises (i.e. exercises performed in an upright position with our legs impacting the ground). Resistance-type exercises are also beneficial in protecting the skeleton against the effects of ageing. ‘Resistance’’ implies an exercise that is performed against a force acting on the body. A simple example would be to compare walking through your house to walking through strong head-on winds. The wind pushing against the body is the resistance aspect.
When we exercise, forces acting on our muscles help to build strength. The forces placed upon the skeleton through the muscles help to activate special bone-building cells within the bones, and these help to maintain or build strength in the bones depending on the intensity of the exercise. In order to increase bone strength, we need to regularly push our bodies beyond the intensity of simple everyday tasks, like walking.
Age is a factor
Now, if you’re worried, we’re going to suggest a new gym membership and intense weight lifting program, then rest easy. There are lots of things to consider, and age (as well as medical history) is a big factor when it comes to prescribing exercise. Someone who is 80 will need a different exercise regime compared to someone who is 55 when it comes to targeting bone health.
Exercises to try
The following are simple weight-bearing exercises you could have a go at doing:
- Walking or jogging uphill
- Hiking across the countryside
- Stair climbing or step-ups
- A friendly game of tennis, badminton or squash
- Aerobics or dancing
You can add resistance to your exercise program by:
- Lifting weights (always start light so as to not overload the body)
- Exercising using cables or resistance bands (again, use light resistance to begin with)
Everyone has different requirements, so we suggest giving us a call on (416) 546-4887 or email me at email@example.com so we can create an individual a program that is perfect for you.
- Hong, AR. and Kim, SW. 2018. Effects of resistance exercise on bone health. Endocrinology and metabolism. 33 (4). 435-444. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279907/
- Benedetti, MG. et al. 2018. The effectiveness of physical exercise on bone density in osteoporotic patients. BioMed research international. 2018, 4840531, 10 pages. Available from: https://www.hindawi.com/journals/bmri/2018/4840531/cta/
- Osteoporosis Australia. 2013. Exercise – consumer guide. [Online]. Available from: https://www.osteoporosis.org.au/sites/default/files/files/Exercise%20Fact%20Sheet%202nd%20Edition.pdf. [Accessed 06 Jun 2020]
It has been, and continues to be, uncertain times for many of us as the virus pandemic continues to sweep across the globe. Lockdown has meant many of us have had to batten down the hatches and re-discover what it means to be ‘at home’. We ask you the question “how is your body being affected?” Let us take you on a scan of the body, focus on some potentially problematic areas, and give you some advice to avoid any long-term issues.
Head and neck
First stop is the very top! For all of you that normally head out to the office every day, the pandemic might mean you’ve had to start working from home. Not having your usual desk set up can place a great deal of stress on the neck region. Are you now working on a laptop instead of a desktop computer? Are you sitting on the sofa instead of an adjustable chair? Close your eyes for 30 seconds and hone your thoughts in to your neck. Move it around… How does it feel? Is it tight, restricted or does your head feel heavier than usual? It could be that your new ‘desk’ set up’ is causing some strain in places it doesn’t usually. Think about the effect of having your head looking down at a laptop for 8 hours a day compared to straight up at a monitor set to the ideal height… Your poor muscles must be feeling the strain too. We recommend trying to recreate your office space as close as possible to the real thing. If you don’t have a desk at home, a dining table may be more suitable than sitting on a sofa or armchair. You also need to ensure you are moving your neck and shoulders more regularly to avoid them being in a strained position for too long. Take a break every 30 minutes and move into a different position.
Our spine sits at the core of the body, and we need good function throughout to ensure our limbs can also function with minimal effort and maximum efficiency. Are you used to an active job and now you find yourself homeschooling the children, or trying to break the day up with a bit of reading, gaming, TV or doing a crossword? Life is suddenly much more sedentary for most of us, so it’s important to avoid getting stiff. Sitting with poor spinal posture for extended periods, day after day can wreak havoc. Our spines curve ‘out in the mid-back and ‘in ’ in the lower back. If we don’t look after those curves carefully by protecting our posture from excessive strains, then we leave ourselves open to sore backs and poor functioning limbs as a result. We recommend avoiding long periods of sitting or lying down. Save it for bedtime! Try some standing spinal twists or bends (gently, of course), go for a walk around the garden, or do a session of yoga, Pilates or simple stretching through the day to mobilize your spine. If you have kids, get them to do it with you. They will enjoy a break from their school work, no doubt.
Anyone who works in a seated position knows what effect this can have on the hips. Having your hips in a ‘flexed’ or in a seated position for long periods of time can leave your hip flexor muscles tight and short. This decreases your ability to open the body out into a fully straight position, reducing flow of fluids through the central part of your body and leaving the back chain of muscles in a lengthened state, which can eventually result in the weakening of the chain. We recommend lots of upright exercises for this one. Counteract the time spent seated working or binge watching a TV series with some standing-based exercise. Jumps, skipping, walking, running or bridging is a nice way to open those hips and get the blood flowing. Our underlying message through all of this is to move, move, move! You are a movement machine, so regularly start the ignition and go for a spin. Look after yourselves and please get in touch today on 416-546-4887 if you need help keeping your pandemic posture in check!
The ankle is made up of 3 bones: The Tibia (the shin bone), Fibula (runs on the outside of the shin bone) and Talus (connects our foot to the shin bone). The bony bumps found on the inside and outside of the foot are called the medial and lateral malleolus.
The way the ankle is designed, its primary movement is dorsi and plantar flexion (up and down), while it is subtalar joint which produces eversion and inversion movements (turning foot in and out).
The ankle has a number of ligaments which holds the bones together and allow the ankle and foot to move. The two main sets of ligaments which originate from the malleolus are the Medial and Lateral Ligaments.
The Medial Ligament, or the Deltoid ligament is a strong, flat and triangular band which consist of four ligaments and fans out from the medial malleolus to the talus, calcaneus and navicular bones. The primary action of this ligament is to resist over-eversion of the foot or rolling the foot inwards. This particular type of rolling motion which may cause an ankle sprain is rare and is normally associated with a fibula fracture known as a Pott’s fracture.
The lateral Ligament has 3 parts to it, which we separate into 3 different names. The Anterior talofibular, Posterior talofibular and Calcaneofibular ligaments. They all originate from the lateral malleolus and attach onto other bones of the foot. These ligaments all resist over-inversion of the foot. This type of ankle sprain is the most common.
So how do we treat a sprained ankle?
As osteopaths, we have a number of special test that we can do to make sure that we are able to identify the exact ligament that is involved and rule out a fracture. If we are unable to rule out a fracture we may advise an x-ray to identify a break and possibly a cast if needed.
If no break is suspected, the first goal of treatment is to assist in getting the swelling down while keeping as much range of motion throughout the foot and ankle bones. Rehabilitation is extremely important with a ankle sprain and vital for getting the person back to their sport or daily task. We would start off with some advice which would include rest, ice, compression and elevation (RICE). Then followed by basic ankle and foot range of motion exercises such as the ABC’s (which is just moving the foot to the letters of the alphabet).
Once the person’s pain and swelling has decreased and their range of motion is better, we can start to add in some harder exercises like balance exercises, theraband ankle work and increasing their range of motion exercises. The very last step is to make the persons rehab a little more sport specific to them, such as hopping, jumping and changing directions. Whether it is basketball, running or just getting back to playing with the kids.
Written By: Brendan Ashman
The carpal tunnel is a narrow passageway in the wrist, which opens into the hand. It is enclosed by the bones of the wrist (underneath) and the transverse carpal ligament (across the top).
Many structures pass through the carpal tunnel, including:
The median nerve, which gives feeling to the thumb, forefinger, middle finger and half of the ring finger. The muscles of the thumb are also innervated by the median nerve. A person with advanced carpal tunnel syndrome may find weakness in thumb movements and difficulty grasping objects.
Many tendons also pass through the carpal tunnel – the long flexor tendons from the forearm run through the carpal tunnel into the hand. These tendons are covered by a smooth membrane called the tenosynovium and allow hand movement.
Signs and symptoms
The symptoms of carpal tunnel syndrome include:
- Pins and needles
- Pain, particularly at night
- Darting pains from the wrist
- Radiated or referred pain into the arm and shoulder
- Weakness of the hand
- The little finger and half of the ring finger are unaffected.
Any risk factor that causes a reduction in the amount of space inside the carpal tunnel can cause carpal tunnel syndrome. If left unchecked, the median nerve is squashed against the transverse carpal ligament until the nerve cannot function properly. Numbness and pain are the result. It can affect one or both hands. Many factors can increase your risk of developing carpal tunnel syndrome. These include:
- Anatomic factors: A wrist fracture or dislocation that alters the space within the carpal tunnel can create pressure on the median nerve. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller than in men and there’s less room for error. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
- Nerve-damaging conditions: Some chronic illnesses, such as diabetes and alcoholism, increase your risk of nerve damage, including damage to your median nerve.
- Inflammatory conditions: Illnesses that are characterized by inflammation, such as rheumatoid arthritis or an infection, can affect the tendons in your wrist, exerting pressure on your median nerve.
- Alterations in the balance of body fluids: Certain conditions — such as pregnancy, menopause, obesity, thyroid disorders and kidney failure, among others — can affect the level of fluids in your body. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after the pregnancy is over.
- Workplace factors: It’s possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve, or worsen existing nerve damage. There is little evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.
Early diagnosis and treatment are important to avoid permanent damage to the median nerve. An Osteopath will perform a physical examination of the hands, arms, shoulders, and neck which can help determine if your complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger is tested for sensation, and the muscles at the base of the hand are examined for strength and signs of muscle wasting.
Occasionally it is necessary to confirm the diagnosis by use of electrodiagnostic tests:
- Nerve conduction study: electrodes are placed on the hand and wrist to measure the speed with which nerves transmit impulses.
- Electromyography: electrical activity can be viewed on a screen to determine the severity of damage to the median nerve.
- Ultrasound imaging: may show impaired movement of the median nerve.
Initial treatment of carpal tunnel syndrome generally involved resting the affected hand and wrist for at least two weeks – avoiding all activities that might aggravate the symptoms. If there is inflammation, applying a cool pack can help to reduce swelling.
Osteopathic management consists of ensuring optimal hand, wrist, elbow, shoulder and neck biomechanics with techniques such as joint articulations, manipulations, and soft tissue therapies. Identifying and removing the aggravating or underlying causative factor is important for a long term resolution.
Stretching and strengthening exercises are often helpful once the severity of the initial symptoms have reduced. Yoga has also been shown to reduce pain and improve grip strength among some patients with carpal tunnel syndrome.
Medication: Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other on-prescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics may help to decrease swelling. Corticosteroids* can be injected directly into the wrist or taken by mouth to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.
*Corticosterioids should not be taken without a doctor’s prescription.
Occasionally carpal tunnel symptoms do not resolve with conservative treatment alone. Carpal tunnel release is one of the most common surgical procedures and is generally considered if symptoms last for 6 months. Surgery involves severing the band of tissue across the wrist (transverse carpal ligament) to reduce pressure on the median nerve.
Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. After surgery, an Osteopath will assist to restore wrist strength and mobility.
Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.
If you are suffering from any type of hand or wrist pain, contact us for an appointment.
As an Osteopath, one of the common conditions that we see is Osteoarthritis or OA. OA is the most common type of arthritis which affects nearly five million Canadians or 1 in 6 people. So what is Osteoarthritis? OA is described as a progressive disease of the whole joint that leads to breakdown of joint cartilage and the underlying bone. And used to be described as degeneration or “wear-and-tear”, but recent studies have described it as a result of the body’s failed attempt to repair damaged joint tissues, as the body lays down more bone to protect itself.
So who gets OA? Osteoarthritis does not discriminate against race or sex, however according to the World Health Organization, Women are more likely to get osteoarthritis than men at a 2:1 ratio. This is most likely due to hormonal and bio-mechanical differences.
There are a number of risk factors than may influence and increase the risk of a person’s chance of developing osteoarthritis beginning with; Age, sex, family history, excess weight, previous joint injuries, some occupations, Joint misalignment/deformities, muscle weakness and a sedentary lifestyle.
What are the signs and symptoms of OA?
The most common presenting complaint is pain, which generally gets progressively worse over months to years. The joint pain or joint stiffness may may last up to 30 minutes or until the joints warm up and is typically worse in the morning or after long periods of inactivity. The most common places of pain are typically weight bearing joint such as the knees, hips and spine, although OA can occur at any joint in the body. OA symptoms may also disrupt your sleeping patterns, which can make your symptoms feel worse, and alter your mood.
How is Osteoarthritis Diagnosed?
There is no specific test for the diagnosis OA. A diagnosis is made based off a patients extensive medical history and physical examination findings. However, there are imaging techniques such as x-rays that can be useful in determining the progression of a patient’s OA.
However, it is important to remember, that a patient’s symptoms do not always match what is found on x-rays. For example, in a patient with early OA, your x-ray may show no evidence that reflects the patients symptoms they are experiencing. On the other hand a patient can have severe OA on a x-ray, but present with minor pain. Which is why it is important to take an individual approach to every patient.
Is there a Cure?
There is currently no cure for OA. However, it is very important to remember that there are ways to manage a patients symptoms and improve their function. A treatment approach is generally centred around a combination of stretches/ massage, physical exercises, weight management and medications, which can be a useful way to help patients control there pain levels. In extreme cases a referral to a healthcare professional specializing in orthopaedic care may be needed.
Remember if you have any other questions please don’t hesitate to ask one of your friendly osteopaths
Written by: Brendan Ashman
Tempromandibular Disorder (TMD) refers to problems that stem from issues with either the jaw, the muscles in the face surrounding the jaw or the jaw joint known as the temporomandibular joint (TMJ).
The jaw or temporomandibular joint (TMJ) acts like a sliding hinge, connecting your jaw bone to your skull. The joints are flexible, allowing the jaw to move smoothly up and down and side to side. The TMJ allows you to talk, chew and yawn. Muscles attached to and surrounding the jaw control the position and movement of the jaw. Pain can be experienced in and around the jaw from the cartilage covering the joint, it ligaments, disc or muscles. Often as a result, there is a dysfunction in movement.
TMJ disorders can occur if:
– The disk erodes or moves out of its proper alignment
– The join’s cartilage is damaged by arthritis
– The joint is damaged by a blow or other impact
Unfortunately, the cause of TMD is not black and white and symptoms could arise from problems with the TMJ and/or the muscles responsible for jaw movement. Whiplash, blunt force and any other trauma involving the neck or head can cause TMD. Also, bruxism (teeth grinding/clenching of jaw) habits can put unusual pressure on the TMJ resulting in TMD.
The TMJ has an inter-articular disc which separates the joint cavity into two and it is made of fibrocartilage allowing a certain degree of trauma and regeneration. The TMJ functions for so many of our daily activities, the most significant of which is eating which requires tremendous leverage and strength. It is the disc that is often the bane of most the TMJ pain. It is the structure most likely to be giving the clicking sound that patients hear when chewing. This occurs as a result of disc displacement. The disc can be displaced at various places along its length and this can interfere with the smooth gliding of the mandible on the articular surface of the temporal bone. The most common problem is for the disc to be displace medially as a result of the action of the masseter muscle (the main chewing muscle) straining and lengthening the lateral TMJ ligaments and allowing excessive medial movement.
Problems with any part of normal jaw function can quickly become annoying, painful and in severe cases, even prevent a person from being able to eat. TMJ disorder can occur on either one side or on both sides of the jaw. The symptoms can either be temporary or chronic. The following is a list of common symptoms of temporomandibular joint disorders:
- Audible pops or clicks with jaw movements such as speaking or chewing
- Unable to open mouth as wide as it should be able to or limited jaw movement
- Jaw gets locked/stuck in place
- Chewing is not a fluid movement, i.e. feeling of jaw catching or bumping
- Face feels weak or tired, especially after eating a meal or having prolonged conversation
- Pain in the face, jaw joint, teeth, ears, neck or shoulders
- Swelling on one or both sides of the face
- Other common symptoms include neck pain, hearing problems and ringing in the ears (tinnitus).
Osteopathic medicine is a great choice to treat temporomandibular joint disorders because a skilled osteopath can examine a patient with TMJ complaints and likely find and fix the root of the problem. Other areas, which can often be associated with TMJ disorder and treated, are the neck, shoulders and upper back.
– eating soft foods
– avoiding hard and crunchy foods (like hard rolls and raw carrots), chewy foods (like chewing gum and steak) and larger foods (like apples).
– avoid clenching
– avoid extreme movements
– wearing a night guard can help, if grinding is known to occur.
– Stretching exercises for the jaw and neck
– Strengthening exercises for the jaw
If you have jaw pain or TMJ disorder, make an appointment with one of our osteopaths or if you have any further questions please contact us (416) 546-4887