Health Blog

Fibromyalgia: definition, causes and treatment

  1. Fibromyalgia: definition, causes, prevention and treatment

Fibromyalgia is a widespread pain disease that is characterised by 11/18 tender points (9 pairs). These tender points are in the neck, shoulder, chest, elbow, the lower back, the hip and the inside of the knee.

There are psychological deficits associated with fibromyalgia. These includes fatigue, depression and sleep problems.

There are also some physical symptoms:

-nausea
-irritable bowel
-numbness
-dizziness

Causes

The cause of fibromyalgia is thought to be because of the brain interpreting stress and pain signals abnormally. It may be due to the effect of the pain signals on the central nervous system and the secondary changes it makes to the brain.

Stress Hormones

Abnormalities in the hypothalamic pituitary adrenal (HPA) axis can cause fibromyalgia. The HPA axis is responsible for the stress response (fight or flight), depression and sleep.
Lower levels of norepinephrine and cortisol are seen in people with fibromyalgia and this is linked to inappropriate stress responses to:

– Infections
– Accidents
– Stress
– Hormonal disorders such as Cushings
– Medications

Central sensitisation

Some research suggests that in people with fibromyalgia, the brain interprets pain differently to non – fibromyalgic people. Overactivity of the pain processing areas of the CNS have been seen in people with fibromyalgia, as well as high levels of substance P which is associated with a high level of pain awareness.

Treatment

Food such as eggs, cheese, pineapple, tofu, turkey, nuts and seeds and salmon can boost serotonin levels. Sun, exercise, probiotics and a positive mental attitude can also increase serotonin.

CBT (cognitive behavioural therapy)

Cognitive behavioural therapy is is a form of treatment for being with mental health issues such as depression and anxiety. It focusses on changing dysfunctional, habitual, subconscious thought processes into healthier ones in order to effect behaviour positively.
In fibromyalgia, behaviour and what action is taken (I.e exercising) is crucial to recovery. Altering maladaptive thought processes which stop people from exercising, may relieve fibromyalgia.

Psychotherapy

Emotional trauma is a potentially a cause of fibromyalgia, therefore psychotherapy may be beneficial in dealing with unresolved conflicts in the psyche. It may also act as a preventative treatment.

Massage, Physical therapy, Yoga and Pilates

As physical injuries can trigger fibromyalgia, physical therapy from an osteopath, chiropractor, physiotherapist or sports masseuse may be of great benefit in preventing fibromyalgia from occurring. Yoga and Pilates taught by a recommended instructor may also act as a preventative.

 

Spondylolisthesis – definition, causes and treatment

Spondylolisthesis is a condition where a vertebra moves forward on top of the vertebra below. It’s possible at any level but L5-S1 is the most common. In some cases it can lead to spinal nerve or cord compression. This can cause back pain, numbness and weakness in both legs and in severe cases, loss of bowel and bladder control.

Sometimes there are no symptoms until many years after the slippage.

Symptoms

  • Back, buttock or neck pain that gets worse when you bend over or twist
  • Tightness in legs
  • Numbness and/or weakness in legs
  • Difficulty walking
  • Pain down the legs
  • Loss of bowel or bladder control in rare cases

What is the cause?

  • Stress fracture or defect in the spinal joints . The defect can be congenital, caused by an accident or injury. A stress fracture caused by overuse (certain sports) or the joint damaged by infection or arthritis.

There are different grading systems to diagnose spondylolisthesis.

1. Grade I is a slip of up to 25%.
2. Grade II is between 26%-50%.
3. Grade III is between 51%-75%.
4. Grade IV is between 76%-100%.
5. Grade V, occurs when the vertebra has completely fallen off the next vertebra.

Treatment

  • Rest
  • Core strengthening and activation
  • Improve flexibility in the spine and lengthen and strengthen  the hamstrings.
  • Contrast hydrotherapy to reduce inflammation
  • Back brace

Prognosis is generally good for people with spondylolisthesis. If you are experiencing any back or leg pain, please go to see a back specialist.

http://www.webmd.com/back-pain/tc/spondylolisthesis-topic-overview
http://www.medicinenet.com/script/main/mobileart.asp?articlekey=101597#what_are_spondylolisthesis_symptoms

Prostate cancer

Prostate cancer: causes, symptoms, and treatment

Prostate cancer is the second biggest killer in a America for men after non metastatic skin cancer. It’s often symptomless in the early stages. Later symptoms can cause urinary symptoms. It usually affects men over 65. It usually can be treated and most people do not die from it.

What is the prostate?

The prostate is a male exocrine gland that lies in front of the rectum and below the bladder which produces seminal fluids. Exocrine means that the fluids it produces leave the body. It is approximately the size of a walnut. The urethra, the tube that carries urine and semen out of the body, goes through the prostate.

Urine control

The prostate has muscle fibres which control the release and flow of urine.

Prostate specific antigen (PSA)

The cells in the the prostate produce a protein called protein specific antigen. The PSA helps keep semen in its fluid state. Some PSA leaves into the blood stream. When blood tests who PSA to be high, that can indicate prostate cancer.

Benign prostatic hyperplasia (BPH)

In some older men, the prostate enlarges and presses on the urethra making it difficult to pass urine. This condition isn’t cancer but must be treated.

Disease progression

In most cases, prostate cancer is slow and men die of old age without ever knowing they had it.

Doctors say that prostate cancer starts with tiny changes in the prostate cells – prostatic intraepithelial neoplasia (PIN).

Doctors also say that 50 per cent of nearly all men have PIN but the levels vary from high to low. If a man has a high grade PIN then he should be monitored closely as it may develop into prostate cancer.

Classification

It is important to know what stage prostate cancer is at. This helps with the decision on what therapies to use and the prognosis. This is best done with TNM (tumours/nodes/metastases). This determines if the tumour has spread, if lymph nodes are involved and the size of the tumour. It is integral to differentiate between tumours that are in the prostate and those that are elsewhere. T1 and T2 cancers are in the prostate, T3 and T4 are elsewhere.

Computer tomography (CT) scans and find out whether the cancer has spread to the pelvis and bones scans will check for spreading to the bones. Endorectal coil magnetic resonance will look at the seminal vesicles.

The Gleason score

A pathologist will look at the prostate tissue biopsy under a microscope and grade the tumour from 2-10. A high Gleason score indicates a higher grade of abnormal prostate tissue.

Signs and symptoms

During the early stages of prostate cancer there are usually no symptoms. At this stage, men can often find out they have it from a routine blood test.

When there are symptoms, they are usually the following:

  • The patient urinates more often
  • The patient urinates at night more often
  • He may find it hard to start urinating
  • He may find it difficult to keep urinating once he’s started
  • Painful urination
  • Blood in the urine
  • Pain when ejaculating (rare)
  • Difficulty getting and maintaining an erection

If the cancer is advanced he may experience the following:

  • Bone pain in the pelvis back or ribs if the cancer has spread to the bone
  • The proximal part of the femur can be painful
  • Leg weakness if the cancer has spread to the spine and compressed on the spinal cord
  • Urinary and/or fecal incontinence (if the cancer has spread to the spine and compressed the spinal cord)

Causes

The cause of prostate cancer remains undetermined. They’re are many factors that could play a part in causing it including: age, genetics, race, lifestyle and diet.
Studies show that if an identical twin gets prostate cancer then the other twin has a much higher chance of getting it.

Race

A US study showed that Afro-Caribbean men have more chance of getting and dying from prostate cancer.

Recent research has showed two faulty genes to be causative in prostate cancer (BRCA 1 and BRCA 2). They are also important risk factors in breast and ovarian cancer. Some experts are saying that if BRCA 2 is found it’s best to start treatment straight away as it can be a very aggressive form of cancer.

Diet

A Mediterranean diet with lots of vegetables may reduce the chance of getting prostate cancer. Some research has indicated that selenium, green tea and soy could prevent prostate cancer.

A study published in a cancer journal suggests that vitamin D deficiency can cause aggressive prostate cancer. As well as a diet high in red meat.

A pilot study has shown that an intensively healthy diet and exercise regime with stretching, yoga and support groups can prevent prostate cancer because it can alter the way genes behave.

Obesity and anti inflammatory medication has also been linked with increased prostate cancer risk. Where as statins have been showed to potentially lower the risk.

Treatment for prostate cancer

For early stage prostate cancer:

If the cancer is minimal and localised, the following treatments are suitable:

  • watchful waiting – PSA levels are monitored – Prostatectomy (the prostate is removed)
  • Brachytherapy – radioactive seeds are implanted into the prostate
  • Different types of Radiotherapy
    – More aggressive prostate cancer may need a combination of radiotherapy and hormone therapy.

Summary

Prostate cancer is usually treatable and steps can be taken to lower the risk of developing it. This includes taking a genetic test (BRCA), dietary, psychological and exercise interventions.

http://www.medicalnewstoday.com/articles/150086.php?page=3

Disc bulges: symptoms, causes and treatment

A disc bulge is a spinal injury. It is also known as a protruded/slipped disc. When the bulge is significant enough to cause the gel-like fluid in the centre of the disc to come out – this is called a herniation.

It can occur anywhere in the cervical spine (the neck), the thoracic spine (mid back) or the lumbar spine (lower back).

What is a disc?

The spinal discs are rings in between the vertebra which act as shock absorbers.

The outer area of the disc consists of fibrocartilagenous fibres (the annulus) which surround a gel like glycoprotein centre (the nucleus).

Disc injuries include:

  • strains
  • internal derangements
  • mild to moderate bulges
  • complete rupture and herniation of the nucleus through the annular wall.
  • If the annulus is injured, the nucleus can press or irritate the exiting spinal nerve through the weakened annular wall. This can cause:
  • pain
  • pins and needles
  • cramping in the legs, feet, arms and hands

The cause of bulges can come under 3 headings:

Repetitive Microtrauma

This is when the discs are put under repeated pressure. The best example of this is through posture. The way you sit, stand and walk can effect the outer fibres of the annulus, causing them to overstretch and become weak. Osteopathic postural correction can help prevent bulges and aid healing of an existing bulge. Research shows that changing your posture very 15 minutes is more effective than having  perfect posture constantly.

Sudden load

A sudden load when catching something heavy or heavy lifting with poor posture, can cause the annulus to rupture. It is important to lift in a safe way while maintaining your core stability.

A road traffic accident can also cause the annulus to rupture by a sudden unexpected force.

Genetics

You can be genetically predisposed to disc injuries. Higher amounts of elastin in the fibrocartilagenous component of the annulus are thought to make it more susceptible to tearing. This can be passed down in our genes.

Environmental factors that are known to have an effect are excessive abdominal fat, poor core strength, poor buttock and leg strength and occupation (one which requires heaving lifting or pulling).

Symptoms

  • Pain in the back legs or feet which is aggravated by sitting, sneezing, coughing, straining, bending forwards or lifting.
  • Pins and needles
  • numbness or weakness in the legs are suspected by more serious injuries.
  • Bowel and bladder problems (diarrhoea or incontinence)  are caused by severe nerve compression. Immediate medical attention is needed in this case.

Diagnosis

An osteopath, chiropractor or physiotherapist will diagnose your back condition based on your:

  • symptoms
  • signs
  • special tests results
  • general movement test
  • MRI or CT scan (X rays will not show a disc bulge) They do however show degenerative disc disease and disc narrowing.

Treatment

Good news – the annulus can heal. Treatment with an osteopath, chiropractor or physiotherapist aims at encouraging you fluid back into the disc which will allow fibres of the annulus to knit back together.

A back brace or support belt may be given to you to help keep your spine in the best position to allow healing. This will help scar tissue form the correct structure. This may take 6 weeks, so avoiding aggravating postures, exercises and positions is important.

Ice therapy will reduce inflammation.

When the pain has subsided, your therapist will turn the focus on realigning structures by doing certain techniques such as stretching, soft tissue massage, joint mobilisations and adjustments. They should try and find the root cause of the problem.

Core stability is crucial in prevention of disc bulges. Contact a recommended Pilates instructor. A god osteopath should be able to provide you with core stability exercises.

Please contact me if you have any questions.

 

Foot pain – causes and treatment

It can be so debilitating when you’ve got foot pain. This article will explain the possible causes and treatment of foot/feet conditions.

Basic foot anatomy

The foot consists of the following bones: the fibula, tibia, talus, calcaneus (heel), navicular, cuboid, three cuneiforms, 5 metatarsals and 3 phalanges on each of the little toes and two on the big toe. The foot has tendons, muscles and ligaments that allow us to run, jump and dance. The Achilles’ tendon attaches the calf muscle to the calcaneus. It is named after the Greek hero “Achilles” who was said to have been dipped into holy water by his mother in order to protect him but as she held him at the heel, the Achilles remained the only area of vulnerability as it did not come into contact with the water. This tendon is the thickest in the body and allows for jumping and standing on tip toes.

Conditions organised by areas of pain

Heel pain

This could be a condition called plantar fasciitis. This is inflammation of the long ligament that connects your heel to your toes. The pain is often felt in one foot or both feet first thing in the morning and is painful with the first few steps.

Treatment

– Often good arch support can help or even prevent this condition. Seek advice from a recommended and qualified osteopath or physical therapist.

– Leg and foot stretches can help alleviate the condition

– Rolling a golf or tennis ball, on the sole of the foot

– Rest

Heel spurs

Heel spurs are another cause of foot pain and they often go hand in hand with plantar fasciitis. Pain is usually felt in the heel. The spurs are abnormal bony growths on the heel of the foot which can occur when you overuse your feet (excessive walking and running). You can also get them from abnormal foot wear or running/walking posture. People with high or flat arches may be more likely to suffer from heel spurs. Many people have heel spurs but don’t feel any foot pain.

Treatment

– Wear a heel pad
– Rest your foot
– Wear insoles or arch supports
– Wear good trainers that have a cushioned shock-absorbing sole.

Stone bruise

This is an impact injury to the fat pad of the heel usually caused by a jumping injury.

Treatment
– Rest
– Ice
– Cushioned shoes

Mortons neuroma

This is the thickening of neural tissue in between the third and fourth toes and can cause pain, numbness and tingling over the ball of the foot.

Treatment

– Wear an insole which reduces the pressure around the nerves
– Minimise time spent wearing heels or shoes with narrowed toe space
– Physical therapy from an osteopath, chiropractor or physiotherapist.

Sesamoiditis

Near the big toe, there are two bones connected by tendons called sesamoid bones. If the tendons become inflamed this results in pain around the big toe which is called sesamoiditis. This is a form of tendonitis which is common among ballet dancers and runners.

– Wear flat, cushioned shoes
– Rest
– Ice
– Wear a foot pad under the big toe
– Tape the big toe to immobilise the joint and allow healing

Gout

This is a form of arthritis which commonly effects the big toe causing excruciating pain, swelling, discolouration (purple toe).

Treatment
– avoid food that make gout worse such as fish, meat, poultry, high purine veg, alcohol. An osteopath will be able to discuss this in more detail.
– rest
– ice
– medication

Bunions

A bunion is a bulge at the side of the big toe. It is usually caused by ill fitting shoes or shoes which do not have enough toe space. Ageing is a risk factor. Try switching to more comfortable shoes, and wear shoe inserts too (see a recommended orthotic specialist). Remember prevention is better than cure so wear wide, comfortable shoes to avoid bunions. See a podiatrist for further advice.

Hammer toes usually occur in the second third and fourth toes, when the middle of the toe bends and creates a hammer like appearance. It can come from a muscular imbalance and also from wearing ill fitting shoes.

Treatment

– exercises to stretch and strengthen toe muscles
– wear shoes with a wide berth at the toe end

Claw toe

This is a condition where the toes are unable to straighten. It is usually the result of alcoholism or diabetes and the consequential nerve damage which causes weakening of the joints, ligaments and muscles.

Treatment

– wear better fitting shoes
– do stretches for your feet and legs
– seek treatment for alcoholism and diabetes
– try orthotics

Ingrown toe nails

This is when the skin of the toe or toes grow over the nail. It can be painful and lead to infections.

Treatment

-soak the feet in warm water 4 times a day.
-apply gauze between the skin and the nail once a day
– see your doctor if the above does not help

Turf toe

This is when you feel pain at the base of the big toe. It’s an overuse injury usually caused by a strain. The typical symptoms are pain, swelling and restriction at the base of the big toe. A differential diagnosis may be sesamoiditis or a sesamoid fracture.

Treatment
-rest
-ice
-elevation
-immobilisation with a boot or by taping or strapping
-crutches so no excess weight is put on the toe

It can take 2-3 weeks for the pain to go. After this, therapy with an osteopath or another physical therapist is recommended to regain the strength and movement of the toe and foot.

Fracture

A fracture can occur anywhere in the foot. If you have any pain when standing or walking, or if you’ve had an accident, it may be best to get an x ray. Small breaks may only require rest and ice.

Hallux rigidus

This is an arthritic condition which causes stiffness in the base of the big toe, making it difficult to walk run, jump or squat. Usually there’s a problem with upward movement of the big toe. It can get be alleviated with stretching and exercises.

Treatment

-shoe inserts to improve the alignment in your feet
-lifestyle changes
-different types of shoes

Diabetic neuropathy

The feet may be affected in diabetes. Symptoms can include:

– loss of sensitivity to pain and temperature in the feet.
– tingling burning or prickly feeling in the feet
– sharp pain or cramps
– extreme sensitivity to even light touch

All of these symptoms are usually worse at night.

If you have diabetes, a foot examination should be carried out each year.

In summary, always seek help from a GP and osteopath/podiatrist of you are experiencing any pain in your feet. A prompt diagnosis should be made and subsequent treatment.

If you have any questions on the above please contact me. I’ll be happy to help.

http://www.webmd.com/pain-management/guide/foot-pain-causes-and-treatments

http://www.mayoclinic.org/symptoms/foot-pain/basics/causes/sym-20050792

http://www.webmd.com/pain-management/picture-of-the-feet

http://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments

The Pelvic Floor: anatomy and dysfunction

The pelvic floor: anatomy and dysfunction

Did you know pelvic floor dysfunctions can refer to the lower back or pelvis and cause pain there?

Pelvic floor (PF) muscles function to support pelvic floor organs, assist in urinary and fecal continence, aid in sexual performance (orgasm), stabilize connecting joints, and act as a venous and lymphatic pump for the pelvis.

Anatomy

Bony Pelvis

The pelvic floor consists of three muscle layers:

1. Superficial perineal layer: innervated by the pudendal nerve – nerve roots S2-S4
* Ischiocavernosus
* Bulbocarvernosus
* Superficial transverse perineal
* External anal sphincter (EAS)

2. Deep urogenital diaphragm layer: innervated by pudendal nerve-nerve roots?

* Compressor urethera
* Uretrovaginal sphincter
* Deep transverse perineal

3. Pelvic diaphragm: innervated by sacral nerve roots S3-S5

* Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus
* Coccygeus/ischiococcygeus
* Piriformis
* Obturator internus

Trigger Points in the muscles of the PF may refer pain in the distribution of the pudendal nerve. The pudendal nerve’s distribution is sensation from the skin of the anus, perineum and both male and female external genitalia. It also supplies motor power to muscles of the pelvic floor including the external urethral and anal sphincters.

* Bulbocavernosus and Ischiocavernosus refer pain to the perineum and adjoining urogenital structures
* EAS (external anal sphincter) refers pain to posterior pelvic floor
* Levator ani and coccygeus refer pain to sacrococcygeal area
* Levator ani refers pain to vagina
* Obturator internus refers pain to vagina and anococcygeal area

Pelvic floor disorders

PF problems occur when it becomes weak or damaged and is not strong enough to hold the pelvic organs.

Symptoms of pelvic floor weakness:

Incontinence (urinal or faecal)

Prolapse of pelvic contents (uterus, bladder or bowel) into the vagina or vaginal canal or anus causing a protrusion.

Increased urgency to urinate

Painful urination

Urinary retention

Constipation

Discomfort or uncomfortable pressure in the vagina or rectum

Muscle spasms in the pelvis, genitals or buttock region

Who should you see if you have any symptoms?

You can go and see your doctor who should refer you to a radiologist (to help diagnose your condition through imaging and scans) urologist, urogynecologist or gastroenterologist.

From there you may be referred to by a physical therapist such as an osteopath, physiotherapist or chiropractor who should be trained to provide you with exercises to retrain the pelvic floor.

Please contact me for further information.