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Muscle injuries and how to assist healing and recovery

7/4/2022

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Have you ever wondered what happens in your body after an injury? In this article we’ll talk about tissue healing in general and look at muscle injuries, their healing and what you can do to aid the healing process in more detail. 

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Tissue Healing

Tissues are muscles, ligaments, menisci, discs and fascia. These heal through three main phases: inflammation, proliferation and remodelling. These phases overlap somewhat and can happen simultaneously.

Inflammation
Inflammation occurs directly after the injury and usually lasts up to five days. The signs of inflammation are swelling, heat, redness, pain and loss of function. 

Treatment in this phase is directed towards relieving pain, preventing further injury, increasing blood flow as well as maintaining muscle tone and pain free range of motion. 

Proliferation (scar tissue formation)
Depending on the tissue that has been injured this phase can last anywhere between 48 hours to over six weeks. In this phase the immune cells that have arrived at the site of the injury during inflammation, start removing the debris and form scar tissue that tentatively connects the different sides of the injured tissue together. At this stage this connective tissue “bridge” is not very strong against tension because the new connective tissue fibres that are created haven’t been told what direction to take. That only happens when the tissue comes under progressive tension. If the tension is too strong, it’ll break the new tissue. Just the right amount of tension, on the other hand, will help to make the tissue stronger. That is why this phase requires a lot of patience from the patient.

Treatment in this phase is directed towards preventing early adhesions, orienting the repairing tissue along the line of tension, relieving pain, maintaining muscle tone and range of motion, reducing swelling, starting exercise to return to normal activity as soon as possible, addressing any possible psychosocial issues and preventing the transition into chronic condition.

You can support the healing with good nutrition including protein, fruits and vegetables and with some supplements. Especially vitamin C, zinc and magnesium are important. 

Remodelling 
The final phase of the healing process is the longest and can take anywhere between three months to over a year. In this phase collagen, the fibre that gives the tissue its strength, is remodelled to increase the functional capabilities of the tissue in the direction of stresses put upon it. This could take the form of stretching and moving the body part gently in the pain free range of motion. 

Osteopathic treatment in this phase is directed towards proper alignment for collagen, increasing the elasticity of scar tissue, reducing fibrotic adhesions, relieving muscle spasms, increasing strength and range of motion, normalising joint and muscle activity addressing any possible psychosocial issues and preventing the transition into chronic condition.

PRICED vs METH
Most of us have heard of the (P)RICED protocol to be used in acute injuries, but not many are familiar with the METH protocol. Right after the injury has occurred, the first aid is to do the PRICED protocol.
Protect - take care not to re-injure the damaged tissue
Relative rest - taking it easy, not putting pressure on the injured tissues, this is only for the first 1-2 days (sometimes also substituted with OL for optimal loading)
Ice - indicated if there’s a concern for compartment syndrome, excessive swelling and helps to relieve  the initial pain, only use for 1-2 days after the injury at the most
Elevation - elevate the injured limb to prevent swelling
Doctor - see a musculoskeletal practitioner, such as a Reg Osteopath, for accurate diagnosis and care plan

Later in the healing process it’s better to use the METH protocol.
Movement - when the acute pain has decreased, begin pain free gentle movement
Exercise - progressive rehab programme to get back to previous activities and strengthen the structures
Traction - helps to ease the tension in the tissues and re-establish range of movement
Heat - to increase blood flow and help with healing

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Muscle injuries and their healing

Muscle injuries can be put in three different categories based on the severity. The first and mildest form of injury is a grade l minor muscle strain where some of the muscle fibres get stretched (<10%). Some of the symptoms include mild pain with activity, muscle guarding, mild trigger points (knots) in the muscles and mild local compensatory joint motion restrictions. There’s no bruising or loss of function but slight weakness may be noted with strong muscle contraction. Delayed onset muscle soreness (DOMS) that is common after a hard workout is classified under this category. 
Usually rest is enough to let the tissues heal. Functionally the muscle heals in about 2-7 days, and has re-established its structural strength within 4-14 days. 

In grade II muscle injuries some of the muscle fibres are torn, so there’s a partial tear in the muscle. Common signs of this are moderate to severe pain, guarding the affected site, loss of function, bruising and swelling, decreased mobility, limping and muscle weakness. There is usually significant pain when the muscle is stretched. Sometimes the tear can be even palpable. In these cases it’s recommended to see your doctor and get diagnostic imaging (usually ultrasound) to evaluate the extent of the damage and need for surgery. If the tears are not treated properly, partial tears can progress into full thickness tears with repeated trauma and usage. Functionally partial tears heal in 1-10 weeks, structurally they are sound in a few months. 

In full thickness tears (grade III) there’s severe pain at the time of the injury but very little pain afterwards. Other symptoms include severe bruising and loss of function as well as guarding the affected muscle. Usually tears are visible under the skin. In these cases surgery is most often needed and a return to full function might not happen and there’s often long term issues.. Functional healing time for these types of injuries is usually somewhere between 10 weeks to 6 months but structural strength takes longer, usually over a year. 

For the grade ll and lll, you need to see a healthcare professional to help you take care of your injuries. Osteopaths can help with evaluating the extent of the injury and give advice on how to take care of it including the right exercises and when. Osteopaths help to make sure that everything else is functioning optimally in your body so that it can concentrate on healing the injury and minimise the discomfort from compensations. Osteopathic treatment helps to increase blood flow which helps to promote healing and ease the pain. Osteopaths can also make a referral for ultrasound if a  muscle tear is suspected. 

What you can do at home
In the first few days after the injury apply PRICED or METH protocols (see above). Avoid aggravating activities and rest, and take painkillers if needed to ease the pain. Nutritionally eating more protein and making sure you’re getting enough zinc, magnesium, manganese and calcium, as well as staying well hydrated is going to help give your body all the building blocks and optimal environment to repair the muscle tissue. Be sure to take it easy and avoid reinjuring the tissue which could lead to prolonged healing and even chronic issues. 
Applying heat will improve blood flow and aid the healing process.. At this stage you can go see your osteopath for gentle treatment to improve your range of motion and to reduce stiffness and pain. When you can tolerate it, the osteopath will guide you to gently move  the affected site in pain free ranges of motion to avoid stiffness and contracture.

In the remodelling phase of healing your osteopath will give you exercises to improve your proprioception and balance and to start working on building back the strength in the injured tissues. As the healing progresses, the exercises will get more strenuous and more challenging, and if you’re an active person, more activity specific, to help you gain the level of confidence and strength needed to do the things you love doing. 

It is good to remember that muscle strains heal in three overlapping phases and the duration of the healing process depends on injury’s severity and on the general health, activity, nutrition and age of the individual. Lack of patience in the rehabilitation process and too early return to full activities increases the likelihood of reinjury and the development of chronic pain. Recurring injuries result in increased scar tissue formation and loss of function. So in the long run it pays to have patience in the beginning, that way it’ll take less time and your body will heal better overall. 

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Venla Kärki Reg Osteopath, MONZ
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Cycling Injuries, Cycling Optimally and how Osteopathic Manual Treatment can help you

3/27/2022

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Hi Wellingtonians! Reg Osteopath Diego Polo here, if you’ve had a moment to read my profile on the City Osteopaths’ website, you will see that I’m from Rio, Brazil and that I moved to live in Wellington very recently!

​I would like to share two things with you that have really caught my attention in a positive way around here. The first one is the high percentage of people in Wellington, who regularly exercise. I would say that 90% of the clients I’ve already seen in our clinic, practice one or more types of sports and/or physical activities. For someone who has been working with professional and amateur athletes all my working life, that’s really amazing! Particularly because, alongside quality of sleep and nutrition, physical activity is essential to keeping us healthy and increasing our quality of life. The second one is the large number of cyclists there are in the city. I thought I was coming to the land of Rugby?! 
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    In recent decades, a lot of research has been done with cycling athletes - both professional and amateur, to investigate questions related to competitiveness, performance and physiological responses of this sport. Another facet of the research focuses on the well-being and health status of these athletes. 
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Much is now known about the injuries of the lower limbs that are common to cyclists and the presence of discomfort and risk of injury caused by pressure on the perineum/pelvic floor and genital area. Additionally, the risk of injuries of the spine, especially on the lower back and neck regions, are very common. The position on a road bike requires long periods of time in an unfavourable posture, with an aggressive flexion of the trunk and hips and extension of the cervical spine and head, in order to reduce drag forces and favour aerodynamics. The posture adopted by the cyclist will also be influenced by the length of the bicycle frame, the seat height, and the rise of the stem, as well as the height and width of the handlebars.
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As a cyclist, you may have experienced one or more of the most common injuries of this sport. Some of these are:

1. Falls: Falls are probably the most common cause of injuries for cyclists. Falls can cause different types of injuries, from skin bruises, clavicle and wrist fractures, muscle strains and problems that can bring more serious disorders, such as concussion.

2. Knee Injuries: Different types of injuries can affect the cyclist's knee, causing pain in different regions of the joint. They are: patellar tendinopathies, pes anserinus tendinopathies, patellofemoral pain syndrome, caused by excessive use, shortening and/or imbalance of the different quadriceps muscle portions, which can lead to patellar chondropathies and in particular, Iliotibial Tract Syndrome, which often requires extra treatment, especially if the athlete continues to compete.

3. Hip and Groin pain: Pain in the hip and groin region can cause marked discomfort and significantly decrease an athletes' performance.

4. Low back pain: As already mentioned, the cyclist's posture in extreme lumbar and hip flexion will commonly generate pain in the lumbar region, either by a flexion strain on the intervertebral discs, or by an overload of the extensor musculature of the lumbar region, which can reduce the stability in the region, leading to possible muscle injuries and overload in other regions, such as the hips and pelvis. A sign of concern is when pain spreads through the lower limbs, such as radiation, numbness and muscle weakness. This can occur due to problems arising from the lumbar region itself or due to excessive tension in some muscles, which can compress peripheral nerves of the lower limbs.

5. Perineal pain: The perineal region, or pelvic floor, is a set of muscles located in the lowest portion of the pelvis, between the anus and the genital region, which has several important functions and carries several vital structures, such as nerves, arteries and veins. Prolonged posture in the sitting position on the saddle can favour the compression of these structures, leading to changes in sensitivity, such as numbness and tingling, in addition to pain itself. Paresthesia can extend to the scrotum and penis, in men, and labia majora in women. The type of saddle and bike adjustment have a considerable influence on the emergence of these symptoms.
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6. Neck pain: As already mentioned, the cervical spine is always positioned in hyperextension during pedalling, especially the upper cervical spine. This positioning excessively strains the neck and shoulder muscles. The most affected muscles are the suboccipital muscles, which have a very important proprioceptive function, as they always act by making micro-adjustments in the positioning of the head so that we can keep our gaze horizontal. These muscles are among the most innervated in the body and they developed exponentially at the end of man's evolutionary process, when we adopted the bipedal posture and needed to keep our gaze horizontal to master the environment around us. For this reason, the cyclist's cervical posture can cause not only neck pain, but also headaches at the base of the skull and in the back of the eyes and forehead region.

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7. Wrist pain and tingling in the hands: Occurs mainly when the cyclist keeps his hands on the handlebars for a very long time. In addition to overloading the various joints of the wrist and hand, there may be neurological compression, especially of the ulnar nerve, which can cause tingling, numbness and weakness in the fourth and fifth fingers of the hand. Rough terrain also exacerbates this condition, affecting mainly the median nerve and generating carpal tunnel syndrome. In this case, it is the first 4 fingers of the hand, including the thumb, that will present these neurological signs.

8. Shoulder pain: Can occur due to prolonged posture of the arms in internal rotation and flexion, which favours an impaction of the shoulder joint, which may facilitate the emergence of impingement syndrome, bursitis and tendinopathies arising from it.

9. Plantar Fasciitis: Although more common in runners, some cyclists also suffer from plantar fasciitis, characterised by pain and stiffness in the sole of the foot. This is mainly due to the use of inappropriate cycling shoes and excessive tension in the muscles of the sole of the foot and calf.
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As we know, cycling has developed considerably in recent decades and there are several modalities, such as road biking, track biking, mountain biking, trail biking, cross biking and BMX, etc. The emergence of these pathologies may be associated with the type of modality you practise, but despite the variations in posture on the bike and the specific mechanism of each modality’s practice, all the above injuries can arise in any modality, as the principles of each one are very similar and have the main element in common, which is the bicycle!

Now, if you like to ride, you've most likely heard of, or used a Bike Fitting service. Simply put, the service offers careful adjustment of the bicycle for a specific cyclist, respecting all their physical characteristics to obtain greater comfort, performance and efficiency while pedalling. Having a Bike Fitting helps prevent injuries and facilitates an athlete's post-training and post-competition recovery. Currently, with the help of various software and computerised evaluations, the quality of Bike Fitting has grown exponentially and it is a good investment for those who are always riding.
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But what about the role of Osteopathy in all this?
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If you are a bike lover and want to keep riding with the best possible quality of life and performance, then what is important - if not even more important, than taking care of your bike, is taking care of your instrument to ride - your body! Think of it like this, before you make the investment in a Bike Fitting, where the bike will be all adjusted to your body with the help of technology, you ideally will have already had checked the muscle imbalances, the alignment of your joints and your body's ability to adapt to the effort required to cycle first. That is exactly how Osteopathy can help you.

Osteopathy is a science that aims to evaluate changes in mobility and in the quality of the tissues of your body, to help you find your balance and your best state of health, guaranteeing greater comfort, performance and quality of life, preventing injuries and facilitating the recovery from these, keeping you active and healthy to perform your pedalling. Osteopathic Manipulative Treatment (OMT) achieves this by improving the mobility of joints and other body tissues, balancing muscle and ligament tensions, improving vascularization and oxygenation of your muscles and different tissues, increasing your body balance and coordination, ensuring a better relationship between your Central Nervous System (CNS) and your locomotor apparatus, among other multiple benefits that will keep your body in the best possible state of health and preparedness to reap the best results of a Bike Fitting for you and your bike.

I strongly recommend that anyone who regularly likes to have a Bike Fitting done with their bike, should come for one or two treatment sessions first, at around ten and then three days before doing their Bike Fitting. That will really take your Bike Fitting to another level. If you are not worried about performance and just want to stay active and healthy, come to see your osteopath regularly, once every two to three weeks or even once a month. This will be incredibly beneficial for your health. Remember that prevention is the best treatment. 
See you at City Osteopaths, let’s work together!

References
Di Alencar, Thiago Ayala M.; Matias, Karinna F. S.; Bini, Rodrigo R.; Carpes, Felipe Pivetta (2011). Revisão etiológica da lombalgia em ciclistas. Revista Brasileira de Ciências do Esporte (Impresso), 33(2), 507–528.
Salai, M.; Brosh, T.; Blankstein, A.; Oran, A.; Chechik, A. (1999). Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. British Journal of Sports Medicine, 33(6), 398–400. 
K. de Vey Mestdagh (1998). Personal perspective: in search of an optimum cycling posture. , 29(5), 325–334.
Dannenberg, A. L.; Needle, S.; Mullady, D.; Kolodner, K. B. (1996). Predictors of Injury Among 1638 Riders in a Recreational Long-Distance Bicycle Tour: Cycle Across Maryland. The American Journal of Sports Medicine, 24(6), 747–753.
Weiss, B. D. (1985). Nontraumatic injuries in amateur long distance bicyclists. The American Journal of Sports Medicine, 13(3), 187–192.
C. A. Wilber, C. 1. Holland, R. E. Madison and 5. F. Loy, An Epidemiological Analysis of Overuse Injuries Among Recreational Cyclists. Int. J. Sports Med., Vol. 16, No. 3, pp. 201 -206, 1995
Asplund, Chad; Webb, Charles; Barkdull, Thad  (2005). Neck and Back Pain in Bicycling. Current Sports Medicine Reports, 4(5), 271–274.        
Alencar, T., & Matias, K. (2018). BIKE FIT E SUA IMPORTÂNCIA NO CICLISMO. Movimenta (ISSN 1984-4298), 2(2), 59-64. 
Educational Council on Osteopathic Principles. Glossary of Osteopathic Terminology. Washington, DC: American Association of Osteopathy Colleges: 2001.
Denslow JS. Pathologic evidence for the osteopathic lesion: The Known, unknown and controversial. En: Beal MC, ed. Selected Papers of John Stedman Denslow, DO. Indianápolis, IN: American Academy of Osteopathy; 1993: 154-160.
Korr I. The neural basis of the osteopathic lesion. En: Peterson B, ed. The Collected Papers of Irvin M. Korr. Colorado Springs, CO: American Academy of Osteopathy, 1979: 120-127.

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Diego Polo DO, Reg.Osteopath, MONZ

Click here for Diego's Bio

Phone 044991439 to talk to our front desk team
​Book online www.cityosteopaths.co.nz

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Osteopathy in Sport for Peak Athletic Performance

3/4/2022

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A well-balanced and injury-free body is the dream of every athlete. Unfortunately, this is not always the reality. Osteopathy in sport has been used in different countries to prevent and treat injuries, giving the athletes a better quality of life, and helping them to achieve better results, no matter which kind of sport we are talking about.
There are a great number of top athletes that benefit from osteopathic treatment. In 1998, just after winning the World Cup, the former football player Zinedine Zidane said: “I owe a large part of my presence in the final match to my osteopath.” Fourteen years after that, he talked about Osteopathy again: “treating yourself naturally, with less medication and anti-inflammatories, allows you to preserve yourself after your sports career and age better". Currently, many other athletes utilise Osteopathic Manipulative Treatment (OMT), for example the Polish tennis player Jerzy Janowicz, the British olympic champion Mo Farah, and the French Real Madrid’s football player Karim Benzema.
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Therefore, it is no surprise that a team of osteopaths have been present in all Olympic Games since ‘London 2012’. That was the first time that 25 osteopathic health professionals joined the health team of the biggest sporting event in the world. There were more than 900 treatment sessions there. In ‘Rio 2016’, the number of osteopaths that joined the health team increased to 30. Consequently, the osteopathic approach has become a reality for prevention and treatment of injuries for high performance athletes.
However, amateur athletes can also benefit from osteopathic treatment to increase their health status, quality of life and improve their performance. Presenting a truly holistic approach, Osteopathy considers the body as a single unit, where all the systems are interrelated and interdependent, also considering all the other aspects that are common to every human being, like the psychological, mental, social, environmental and spiritual fields.
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Another singular feature of the osteopathic approach is its unique type of diagnosis, termed osteopathic or somatic dysfunction. These dysfunctions can facilitate the emergence of physiological adaptations in the human body, both in short and long term, that can interfere with the athlete’s performance, even without the manifestation of pain or other symptoms. By diagnosing and treating these dysfunctions pre-emptively, it is possible to avoid many future injuries and pain and also improve the practice and performance of the chosen sport. The majority of the dysfunctions of the musculoskeletal system have a traumatic cause. So, it is essential to look for  osteopathic assistance after any trauma, even if it appears to be a not so severe one. Then the professional can diagnose and treat very specifically, helping your body to find a good balance again, and prevent the loss of the ability to adapt, decreasing the likelihood of injuries and pain.
In osteopathic training, much importance is given to develop the hands on palpatory skills to a very high level. Because of that, the osteopath's unique palpatory skills ensure an enormous advantage in determining the location, extent and associated manifestations of sports injuries. 
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Historically speaking, Dr Andrew Taylor Still, the developer of Osteopathy,  in the late 1800’s presented the importance of the balance and coordination between the structure and function in the body, and the importance of the musculoskeletal system for human health. Dr Still helped many athletes of his time, when sports medicine did not yet exist. For this reason, Dr Still was also considered the forerunner of sports medicine.
Keeping in mind that what really matters is treating the root of the problem and not only the symptoms, these are some of the many benefits of Osteopathic Manipulative Treatment (OMT) for the amateur and elite athletes:
  1. Injury prevention
OMT does not treat only acute injuries, but mainly helps to prevent them from occurring. That is because the osteopath seeks the root of the problem, helping the body to find its own balance, preventing injuries becoming repetitive and constant.
  1. Avoid or reduce medication use
All treatment techniques used in the OMT are manual, that is, without the use of any type of medication. It avoids the occurrence of side effects and is especially important for top athletes who have a series of restrictions on the medications they can take.
  1. Helps to speed up the recovery
The osteopathic treatment helps athletes to achieve a faster recovery. It uses a large arsenal of techniques, each one with different purposes, working in different tissues, increasing treatment specificity. The healing process of injuries is also optimised by the global and holistic vision of the Osteopathy, that leads the practitioner to do a complete analysis of each patient, not only focusing on minimise the symptoms of the injury, but on treating the cause of it.
  1. Promotes a higher quality of life
As Osteopathy does not only seek to treat diseases or injuries, it understands that a balanced body is essential for the individual to enjoy more well-being and better quality of life.
For athletes, amateur and professional, suffering with fewer injuries and having a biomechanically balanced body is essential, as it improves their results, reduces pain and recurrent problems from sporting practice.
  1. Improves Performance
Without injuries, pain, and training with a well balanced body, athletes tend to perform in their highest level. Even without symptoms, it is recommended that athletes insert OMT in their routine, as it can treat the causes of possible future injuries that can then be avoided. Integrating Osteopathy in pre-competition period and post-competition recovery might be the turning point to increase the performance and achieve your goals as a sports person.
As you have seen, Osteopathy in the sports’ field has multiple applications and can be very beneficial for athletes. This is the reason why it gains more importance in this area each day.

References
Still Jr CE. Frontier Doctor – Medical Pioneer: The Life and Times of A. T. Still and His Family. Kirksville, MO: The Thomas Jefferson University Press; 1907 (Reprinted 1991):205-216
Educational Council on Osteopathic Principles. Glossary of Osteopathic Terminology. Washington, DC: American Association of Osteopathy Colleges: 2001.
Denslow JS. Pathologic evidence for the osteopathic lesion: The Known, unknown and controversial. En: Beal MC, ed. Selected Papers of John Stedman Denslow, DO. Indianápolis, IN: American Academy of Osteopathy; 1993: 154-160.
Korr I. The neural basis of the osteopathic lesion. En: Peterson B, ed. The Collected Papers of Irvin M. Korr. Colorado Springs, CO: American Academy of Osteopathy, 1979: 120-127.
Grant M, et al. The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study. Braz J Phys Ther. 2020.
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Diego Polo DO, Reg.Osteopath, MONZ
See you at City Osteopaths, and let’s work together!

City Osteopaths Healthcare
Level 4, 166 Featherston St

Wellington 6011
​New Zealand
Phone 04 4991439
http://www.cityosteopaths.co.nz

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Mood disorders, your diaphragm muscle of breathing and Osteopathic Manual Treatment

1/11/2022

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According to New Zealand based research by Kovanur and Roy (2015), most practising osteopaths in Aotearoa come across patients with a history of mood disorders.

As the New Zealand mental health 2020/2021 survey has shown, psychological distress in adults, and also in children, has increased from 7.5% the previous year possibly due to the pandemic and lockdowns.

According to the same research, 100% of manual therapists perceived the need to manage and support clients with mood disorders during the osteopathic treatment. Being a current topic, I decided to show the evidence from our osteopathic point of view in how to manage patients affected by mood disorders. “Mood disorders are defined as serious mental illnesses that include depression, negative thoughts, anxiety, mood swings and bipolar behaviour”.

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​Osteopathic point of view and manual treatment
The balance between health and disease will always depend on the dynamic interaction between the intrinsic components of physical, mental and emotional states. Thus, a dysfunction of one of these three components can have repercussions on the others.
The core principle of osteopathy is that “structure and function are interrelated at all levels”.

In this context, it has been studied that emotional stress can alter the functionality of the cardiovascular, respiratory and musculoskeletal structural systems, increasing blood pressure, pulse, respiratory rate and sustaining the onset of musculoskeletal disorders.

Diaphragm muscle
Mood disorders commonly affect the functionality of the respiratory system and, consequently, the structure of the respiratory diaphragm muscle. During a stressful time, it has been shown that people tend to breathe quickly and shallowly, constantly increasing the tension in the diaphragm muscle
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Osteopathic manual treatment
At City Osteopaths, we offer fascial visceral treatment to assist the diaphragm muscle and the very gentle cranial osteopathic approach via the cranial rhythmic impulse. We also further support your recovery with the addition of specific guidance in breathing exercises, to help normalise the psychosomatic and somatic states.

Musculoskeletal system
​As mentioned above, diaphragm muscle dysfunction can happen as a consequence of mood disorders; but what is the connection with the musculoskeletal system and pain? To clarify this concept it is important to mention some anatomical information.
The diaphragm muscle is the most important respiratory muscle and it separates the thoracic cavity from the abdominal cavity. There are three attachments of the diaphragm: the xiphoid process of the sternum, costal cartilages of ribs 7-12, lumbar vertebrae ligaments, arcuate ligaments, right crus that arises from L1-L3 vertebrae and left crus that arises from L1-L2 vertebrae. The muscle fibres of the diaphragm combine to form a central tendon. Its innervation is via the phrenic nerve from the cervical roots of C3-C5.  

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If the diaphragm goes into fatigue, it follows that its attachments have a structural mechanical overload causing rib cage, dorsal spine and low back pain. Moreover, it’s also a common cause of neck pain in patients with high levels of stress, due to the neurological connection of the phrenic nerve that receives excessive aberrant signals from the dysfunctional diaphragm muscle back into the neck nerve spinal roots.

Osteopathic manual treatment
At City Osteopaths, we put into practice anatomical principles to treat the body structure and vertebral column in order to improve the function of the diaphragm muscle and, consequently, helping patients affected by mood disorders to increase their quality of life. Our goal is the patient’s wellbeing and we assist this with manual therapy.
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Bibliography:
● https://www.health.govt.nz/publication/annual-update-key-results-2020-21-new-zealandhealth-survey
● Kovanur Sampath, K. and Roy, D. E. (2015) ‘Management of mood disorders by osteopaths in New Zealand: A survey of current clinical practice’, International Journal of Osteopathic Medicine, 18(3), pp. 161-170.
● Paulus, S. (2013) ‘The core principles of osteopathic philosophy, International Journal of Osteopathic Medicine, 16(1), pp.11-16.
​ ● Sagrillo, L. M. and Frigo, L. F. (2016) ‘The respiratory diaphragm in osteopathic vision: a literature review’, MTP & Rehab Journal, 14: 414, pp. 1-6
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3D Functional Hamstring Stretch by Reg Osteopath Lewis Jenner

3/24/2019

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More functional mobility, with the 3D hamstring stretch.  For most runners, the "go to" stretch for the hamstrings involves putting your foot up and reaching for your toes. The hamstrings work in 3D and rotation is where most of the power is developed.  Give this stretch a go and you'll feel a deep stretch like never before!
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