Research has shown that patients with PTSD using mind-body therapies reported positive effects on their PTSD symptoms, including therapeutic effects on stress responses; reductions in anxiety, depression, and anger; an increase in pain tolerance; improved self-esteem; and an enhanced ability to relax and to cope with stressful situations (9). 
 
Mind-body therapies such as osteopathic treatment of the muscles, ligaments and peripheral nervous system work by stimulation of somatic, visceral, and/or chemosensory receptors, influencing central neural processing and mental processes via ascending pathways from the periphery to the cerebral cortex, resulting in increased heart rate variability and reduced expression of cytokines (10). This effectively reduces the symptoms of PTSD which cause distress to the individual.
 

References:

(1) Effectiveness of an osteopathic treatment on the autonomic nervous system: a systematic review of the literature
(2) Berthoud HR, Neuhuber WL. Functional and chemical anatomy of the afferent vagal system. Auton Neurosci. 2000;85(1-3):1-17. [CrossRef] [PubMed]
 
(3) Campbell SM. Winkelmann R. Walkowski S. Osteopathic Manipulative Treatment
Novel Application to Dermatological Disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486778/
 
(4) Collard K. Preliminary prediction models for autonomic nervous system response to a cranial osteopathic technique https://unitec.researchbank.ac.nz/bitstream/handle/10652/1387/Kim%20Collard%20MOst.pdf;jsessionid=9EED965260A4FFEAFEF818BF863166E6?sequence=1
 
(5) Dowling DJ, Scariati PD. General Physiologic Considerations. In: DiGiovanna EL, Schiowitz S, Dowling DJ, eds. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005:38-52.
 
(6) Van der Kolk BA. Clinical implications of neuroscience research in PTSD. Ann N Y Acad Sci. 2006;1071(1):277-293. doi: 10.1196/annals.1364.022 [CrossRef]
 
(7) Foreman RD, Qin C, Jou CJ. Spinothalamic system and viscerosomatic motor reflexes: functional organization of cardiac and somatic input. In: King HH, Jänig W, Patterson MM, eds. The Science and Clinical Application of Manual Therapy. Edinburgh, Scotland: Churchill Livingstone Elsevier; 2011:11-127.
 
(8) Klarer M, Arnold M, Günther L, Winter C, Langhans W, Meyer U. Gut vagal afferents differentially modulate innate anxiety and learned fear. J Neurosci. 2014;34(21):7067-7076. doi: 10.1523/JNEUROSCI.0252-14.2014 [CrossRef] [PubMed]
 
(9) Kim SH, Schneider SM, Kravitz L, Mermier C, Burge MR. Mind-body practices for posttraumatic stress disorder. J Investig Med. 2013;61(5):827-834. doi: 10.2310/JIM.0b013e3182906862 [CrossRef] [PubMed]
 
(10) Taylor AG, Goehler LE, Galper DI, Innes KE, Bourguignon C. Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research. Explore (NY. ). 2010;6(1):29-41. doi: 10.1016/j.explore.2009.10.004 [CrossRef] [PubMed]
 
​

​Melanie Young
B.A., BSc.(Clin Sc.) B.Osteo Sc. MONZ
Reg Osteopath
​Director City Osteopaths
Wellington
​New Zealand

​Phone 04 4991439

http://www.cityosteopaths.co.nz

​What is temporomandibular joint dysfunction?​
The jaw is also known as the temporomandibular joint (TMJ). The joint is formed by the mandible (the main bone that we consider to be the jaw) and the temporal bones on either side (these form part of your skull). TMJ dysfunction is a term used to describe pain felt in and around the jaw.
​The masseter (one of the main muscles that controls the movement of the TMJ) is the strongest muscle in the body, relative to its size. There’s no wonder why tension held here can have a huge impact on other areas of the body too. Although some people will feel pain directly in or around the jaw, you may not necessarily be aware of the tension that you are holding there. However, tension or dysfunction of the TMJ can contribute towards neck pain and headaches. 

What can cause TMJ dysfunction?
During times of stress and anxiety, it’s common to clench or grind our teeth. This can often happen subconsciously, particularly at night when we’re sleeping, which is known as nocturnal bruxism. This could mean that you wake with headaches, neck pain or pain directly in the jaw. Sometimes, we can be more aware of this going on during the day. We may notice that our breathing has become shallow, we are holding tension in our shoulders and we are clenching our teeth, which will cause tension through our jaw.
Tension or dysfunction of the TMJ can also occur following direct trauma or dental work. Having to hold our jaw open for a period of time can create strain of a key ligament that helps to support the joint. TMJ dysfunction can also be caused by having an under or overbite ,and also if there is derangement of the articular disc which cushions between the two bony surfaces that form the joint.

How will I know if I have dysfunction of my jaw?
Structures in the body are intrinsically connected. The muscles and ligaments that attach to the jaw, also attach to bones in your face, head and neck. Therefore, pain or dysfunction originating in the TMJ could be felt in the jaw itself but could also be felt in the face, neck or base of the head. As well as pain, you may notice clicking or clunking in the jaw as you open and close it. If one side of your jaw is tight, compensatory patterns can occur and the two sides of the jaw can become slightly out of sync which contributes towards the clicking and clunking that you hear and feel. You may also feel a restriction of movement and not be able to open your jaw fully.

How can Osteopathy help?
​We can examine the movement that is occurring at the TMJ by asking you to do some simple opening and closing movements whilst we palpate the joint which is located just in front of your ear lobe. We can also palpate for tension in the muscles and ligaments that control the movement of your jaw. If there is dysfunction of the joint or tightness in the soft tissue structures, we can gently but directly treat these.
We can also work on other structures in the neck and head where the muscles of the jaw attach. The techniques that we use are often external, however we’re able to do intraoral techniques with your consent. Our patients often really enjoy treatment of the TMJ as it is common to feel the benefits immediately afterwards. They often feel that they can open their jaw further and feel less tense through the jaw, face and neck. 

What can I do at home to help?

Relaxation methods
Given that pain in the jaw is often caused by clenching or grinding the teeth due to stress or anxiety, managing this stress and anxiety can help to prevent us from holding tension in the body subconsciously. Diaphragmatic breathing is key, as effective breathing will physiologically help to calm the nervous system. Check out City Osteopath’s blog post by Becky on how to breathe effectively. Otherwise, relaxation can look different for everyone, whether it be meditation, yoga, listening to music, reading a book or heading out for a walk, the most important thing is for you to take the time to unwind.

Set a reminder to be conscious of tension that you may be holding
Write a note to yourself and have it near your screen or set a reminder on your phone to remind you to think about your posture, and tension that you could be holding. We often end up leaning over our computers, shallow breathing and holding tension in our shoulders, neck and jaw. It is important to make ourselves aware of this, so every 30 minutes, take a moment to sit back, relax your shoulders, take some deep breaths into your lower rib cage and allow your jaw to soften.

Apply heat
The application of heat will encourage blood flow to the area to promote healing, reduce muscle tension and therefore help to reduce pain. Be careful that the heat pack isn’t too hot and keep it on for just 10 minutes at a time. You can repeat this every 2-3 hours throughout the day.

Self-massage
To locate the masseter muscle, contact the space just below your cheekbones and about two fingers width in from your ear lobes. A good way to test if you are in the right spot is to gently clench your jaw and you will feel your masseter contract into your hands. (Try not to clench to test this too often; once you’re in the right spot you don’t need to keep clenching to check). You can use two or three fingers to apply gentle pressure to the muscle and use circular motions for one to two minutes on each side to increase blood flow and reduce muscle tension.
 
There are many other exercises that we can explain to you in further detail. It is best for a practitioner to examine and advise you directly to provide personal advice specifically for you.

We are now offering online consultations so please feel free to contact us for further advice.  
 
 
http://www.advances.umed.wroc.pl/pdf/2012/21/5/681.pdf?_ga=2.173678890.882744632.1585797841-837875174.1585797841
​

​Rhianna Smith 
DO M.Ost. Reg. Osteopath, MONZ 
www.cityosteopaths.co.nz
​Phone 04 4991439

Whenever I mention breathing to my clients, the reply is usually along the lines of “Breathing? Don’t we all know how to do that already?”
​
Of course, we all breathe, but how we breathe is the interesting part. Do you breathe with your ribcage moving outwards, to the sides and back? Or do you breathe by moving your ribcage upwards, using your neck and shoulder muscles to raise it?  

​During inspiration, when we breath in, our ribcage must expand to make space for the lungs to inflate. This happens due to the muscular action of the diaphragm and the intercostal muscles (the muscles between our ribs). The intercostals pull the ribs up and outwards while the diaphragm flattens and pushes the lower ribs out to the sides. Both actions create space in the ribcage for lung expansion.  
​
The diaphragm is dome shaped and its vertical fibres attach to the lower ribs. When it’s contracted it flattens and these fibres push the lower ribs outwards as they shorten (1). This movement is known as lateral excursion. You can imagine it like an umbrella opening.  

We also need mid-back expansion when we breath. This is the movement of the back, just under the shoulder blades, at the level of the bra-line. Known as posterior excursion, mid-back expansion ensures that the diaphragm can also work to stabilise us in the upright position (2). When we lack good movement of the diaphragm, it reduces our ability to maintain our balance (3). This leads to stiffness in other muscles in the torso, as they take up the slack, causing pain and tension in this area.  
​
If we raise our shoulders when we breathe this shows that we are in a shallow breathing pattern.  It means our ribcage is rising upwards to create space for the lungs to expand. To do this, we are pulling the ribcage upwards using accessory breathing muscles; the muscles that attach from the shoulder to the ribcage (pectoralis minor) and the muscles that attach from the neck to the ribcage (the sternocleidomastoid and the scalenes). This can lead to neck and shoulder pain and tension, and headaches.  

So, what does this mean? Essentially, it means we need to pay attention to the way we breathe. 

When we learn to breathe using lateral and posterior excursion, we improve the strength of the diaphragm and increase the ability of our ribcage to move. Improved ribcage mobility takes the pressure off the neck and shoulders, decreasing pain, tension and headaches. It allows the diaphragm to move through its full range of motion, becoming stronger and more efficient.    

When we breathe using our diaphragm, we activate the vagus nerve which leads to an increased parasympathetic nervous system response, slowing our heart rate and breathing, and calming us down.
​    
Good diaphragm breathing increases our blood oxygen levels, promoting tissue healing and repair (4)  and improving energy and cognition. Anxiety and dizziness reduce as our ability to expel carbon dioxide from the body improves. We get less aches and pains in our neck and shoulders. Our posture improves along with the stability of the spine, reducing back ache. Mobility of the ribcage and mid-back improves, increasing movement in the areas that should move, and stability in the areas that should be stable.

Shallow breathing patterns are very common during everyday stress and especially so during this time of uncertainty. Diaphragmatic breathing is fundamental to our health and wellbeing, and now more than ever we need to breathe well. 

1. Wallden, M. (2017). The diaphragm; More than an inspired design. Journal of Bodywork and Movement Therapies, 21(2), 342-349. https://doi.org/10.1016/j.jbmt.2017.03.013
2. Osar, E. (2014). Corrective exercise solutions to common hip and shoulder dysfunction. Lotus Publishing.
3. Kocjan, J., Gzik-Zroska, B., Nowakowska, K., Burkacki, M., Suchoń, S., Michnik, R., Czyżewski, D., & Adamek, M. (2018). Impact of diaphragm function parameters on balance maintenance. PloS one, 13(12), e0208697-e0208697. https://doi.org/10.1371/journal.pone.0208697
4. Duvall, S. E. (2017). Postpartum Corrective Exercise Specialist [online training programme] [Audiovisual]. Core Exercise Solutions LLC. www.coreexercisesolutions.com​

Research has shown that there is great variation in the nasal cavity and sinus pathways between individuals. Due to natural anatomical variation some of us are more prone to sinus conditions than others. Anatomical variations can influence how out sinuses drain whether it is due to narrow nasal pathways or a mechanical restriction between two or more bones. Factors contributing to disrupted drainage pathways may be congenital (since birth) or traumatic (such as a neck or head injury).

An osteopathic treatment will diagnose your unique condition and look to address the underlying anatomical cause.

Sinus infection is most often viral rather than bacterial. Symptoms of a viral sinus infection do not require antibiotics and can ease on their own. Alongside osteopathic treatment, there are a few things you can do at home to help:

• Rest and slowing down
• Drinking plenty of fluids
• Elevating your head with an extra pillow when lying down
• Steam
• Humming
• Irrigation techniques (neti pot)

Indications for a bacterial sinus infection include fever, tenderness of the face and changes in the colour of mucosa.

​Whether it's a long term thing, or fluctuating seasonal symptoms, osteopathy can help relieve your sinus symptoms by addressing the underlying cause contributing to your unique condition.

Bibliography

• Cappello, Z. and Dublin, A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): January 2020. Anatomy, Head and Neck, Nose Paranasal Sinuses
• Lafci Fahrioglu S, Andaloro C. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Nov 14, 2018. Anatomy, Head and Neck, Sinus Function and Development.
• Gach P, Tuchtan-Torrents L, Delteil C, Adalian P, Piercecchi MD, Ebert LC, Gorincour G. Virtual reconstruction of paranasal sinuses from CT data: A feasibility study for forensic application. Diagn Interv Imaging. 2019 Mar;100(3):163-168.
• Mahmood HT, Shaikh A, Fida M. Reliability and validity of maxillary and sphenoid Sinus morphological variations in the assessment of Skeletal maturity. J Ayub Med Coll Abbottabad. 2018 Jul-Sep;30(3):360-365.
• Villarreal R, Wrobel BB, Macias-Valle LF, Davis GE, Prihoda TJ, Luong AU, McMains KC, Weitzel EK, Yao WC, Brunworth J, Clark DW, Nair S, Valdés CJ, Halderman A, Jang DW, Sivasubramaniam R, Zhang Z, Chen PG. International assessment of inter- and intrarater reliability of the International Frontal Sinus Anatomy Classification system. Int Forum Allergy Rhinol. 2019 Jan;9(1):39-45
• Weitzberg E, Lundberg J. American Journal of Respiratory and Critical Care Medicine; 2002. Humming Greatly Increases Nasal Nitric Oxide. Vol 166(2), pp.144-145

​

Although we all consider exercise to be a key component of a healthy lifestyle, regular stretching is often overlooked and is not always integrated into our exercise routine. Whether we’re exercising regularly or not, it is important to stretch for both our physical and mental health. Many people consider stretching to be time consuming and so it’s either done very briefly, or not at all. Now that we are currently in isolation, people have more time to consider their physical and mental wellbeing at home. We can use this opportunity to incorporate stretching into our daily lifestyles.
​
If we are working from home, or simply taking this time to rest and recuperate, it’s likely that tension will build up in our muscles after prolonged periods of sitting. It is important to stretch daily to help to keep this tension as minimal as possible. The great thing about stretching is that everybody can do it, regardless of flexibility or age, and you don’t need any equipment or a huge amount of time to be able to feel the benefits. 

​Benefits of stretching

Improve posture
Office workers, or anybody who is seated for long periods of time tend to build up muscle tension in the chest, back and legs, if they don’t regularly stretch. This can dramatically impact your posture because as tension builds up, your muscles will become tighter and shorter in length, causing us to develop rounded shoulders and a slouched and slumped spine. Over time, if this is left untreated, your posture can get progressively worse and can begin to cause musculoskeletal pain. Stretching regularly will help the body respond better to stresses that we put on it through prolonged positioning and will also help to prevent chronic tension from building up.

Reduce chance of injury
Muscle injuries tend to occur when they’re tight and put under strain by being stretched too far. This can happen during simple day to day activities or sometimes through exercise. A regular, consistent, gentle stretching routine will help to keep muscles more supple and flexible, thereby reducing the risk of injury.

Improve range of motion
Tight muscles will prevent your range of motion. For example, tight hamstrings may prevent us from being able to straighten our legs fully, or bend forwards to touch our toes. Regular stretching will improve the flexibility within your muscles and therefore allow an increased range of motion to occur.

Reduce pain and stiffness
A form of active recovery for sore muscles is to do regular, light stretching of the affected muscle group. Many studies have shown that regular stretching can help to decrease pain levels and reduce stiffness, for both acute soreness and also in individuals with chronic neck and lower back pain. 

Calm the mind
Although stretching can feel a bit uncomfortable at first, the more regularly you stretch, the greater the benefit will be for both your mind and body. Focus on taking deep, mindful and slower breaths when you are stretching. This can help to relax you further and help your stretching routine to be calming and enjoyable. 

How often should I stretch?
When it comes to stretching, consistency is key. By doing a few simple stretches daily, our muscles will remain supple, our flexibility and posture will improve and our chance of injury will be reduced. Keep the stretches gentle if you’re doing them throughout the day e.g. lunch time stretches. The best time to stretch more deeply is after exercise when our muscles are warmer e.g. after walking or running.
 
How long should I stretch for?
Hold each stretch for 30 seconds and try not to hold your breath whilst your stretching. Don’t ‘bounce’ in the stretch, this can cause injury. Just take the stretch to the point that you can feel tension in the muscle and hold it there. You should not experience pain when you are stretching. If you do experience pain, ease out of the stretch to find a more comfortable level of tension or contact us for further advice.
 
Keep an eye on our social media where we will soon be posting stretches that you can easily do at home. 

​Rhianna Smith 
DO M.Ost. Reg. Osteopath, MONZ 
www.cityosteopaths.co.nz
​Phone 04 4991439