Medical Acupuncture Archives | Holve Healthcare

Case of Knee pain caused by Hip Pathology

29th September 2019

Knee Pain

Sep 29, 2019 | Acupuncture, Osteopathy | 0 comments

In this blog I am highlighting an interesting case history of knee pain, caused by a hip problem.

I have written on cartilage tears for knee pain before. I want to write about some interesting cases whose outcome may come as some surprise.

Knee Pain
I want to write about an interesting case of knee pain caused by a hip problem. What you initially suspect is not always what it seems.

This case of knee pain concerns a 56 years old man who complained of right sided knee pain, over an eighteen month period. He had previously seen his GP, Physiotherapists, and another Osteopath.

Eventually he saw an Orthopaedic surgeon who found a tear in his cartilage.

No arthritis was found and the tear was deemed to be the cause of his pain. He was advised to undergo arthroscopic surgery. The outcome was that he still had exactly the same amount of knee pain after this surgery.

Treatment had not relieved any of his symptoms of pain and restriction, and he had difficulty walking any distance, and he walked with a walking stick.

Knee Examination
On recommendation he consulted me and the remarkable things was that his knee had a normal amount of movement and could flex and extend his knee normally.

I then examined his hip joint which was painful and restricted on rotation. This immediately suggested the possible start of hip Osteoarthritis.

I then proceeded to treat his hip with Osteopathic manipulative treatment to try and increase the movement, and lessen the pain in this area suspecting that this area might indeed be the cause of his pain.

within a few weeks all his symptoms had gone, and was able to walk without pain.

Case of knee pain caused by hip problem
This was a more unusual case in which his hip joint was actually referring pain into his hip.

This can happen as inflammation around the hip can be a cause of knee pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336883/

This is a good example of why it is important for an Osteopath o look around the body for tissue that may refer pain to other parts of the body.

It is always wise to have your body checked to make sure there are no patterns emerging that may lead to your body not working as it should.

If you have any niggles that just aren’t going away give a call on

to get your body working efficiently again!

Does Paracetamol Help Back Pain?

23rd September 2019

Should I take paracetamol for my back pain?

Paracetamol for back pain? Recently or in 2014 there was a paper in the lancet which suggested paracetamol was of almost no effect in the treatment of back pain. (The Lancet 2014; 384(9954): 1586-1596). https://www.sciencedirect.com/journal/the-lancet/vol/384/issue/9954

Sifting through the evidence though it seems paracetamol may still have a place.

Paracetamol for low back pain has been an over the counter medication that has been used over years to help reduce low back pain. Studies have suggested that paracetamol is of little or no benefit to low back. These studies have not had many subjects in them to reach any definitive conclusion.

Recently studies have been done which was much larger where low back pain subjects were given ad hoc paracetamol for acute flare ups and some were given regular paracetamol.

The results showed that neither regular nor as required paracetamol improved recovery time as compared to a placebo. There was additionally no effect on function, disability or pain and as a result there was no symptom change in sleeping or quality of life. There was also no increase in recovery time.

However, looking more carefully at the results although paracetamol does not alter the recovery from back pain it is still “mildly useful” in helping pain on a short term basis including on an “as needed basis”.

I advise patients in pain to try and see if it helps as the great thing with paracetamol is that unlike anti-inflammatories, it does not cause heartburn or aggravate the stomach.

The more noteworthy aspect is that manipulation and or Acupuncture are both superior to just paracetamol and in many cases not only reduces pain quicker but also curtails a low back event enabling a patient to get back to normal activities quicker, and as a result not having to take any medication!

If you do suffer back pain give a call and help will be there to get you off your Paracetamol.

4164572666 a92b373962 m paracetamol — paracetamol

Common foot conditions: Part 1

17th March 2019

Over the coming weeks I will be going through common foot conditions that many people suffer sometime in their lives. Today’s includes the common foot conditions of Morton’s Neuroma and Bunion…

Morton’s Neuroma

This is a condition that manifests itself as sharp burning pain which radiates into the toes, usually between the third and fourth toes. It is due to hypertrophy (enlargement) of a digital nerve which becomes entrapped and undergoes compressive forces against the deep transverse ligament which traverses the forefoot.

This condition can be reasonably easily diagnosed by pressing on the foot which elicits a click (Mulder’s Click), and of course the unique symptoms this condition presents

Investigations

This can be done by ultrasound or MRI scanning, ultrasound, where the overgrown nerve can be visualized, in a clinic situation positive Mulder’s Click. The latter is easily undertaken in an osteopathic setting where the forefoot is drawn together to see if a click can be elicited.

Treatment

Should someone attend with this problem, there are a variety of ways in treating this: Acupuncture, Osteopathic manipulative treatment, orthoses can be of help. However, if these don’t work then steroidal injections can help reduce symptoms and then surgery can be used to remove the fibroconnective tissue.

Ref: https://search.proquest.com/openview/4475cbba9889e577396015907e8dad14/1?pq-origsite=gscholar&cbl=39729

Hallux Valgus (Bunion)

This is where people have a bump on the big toe, with some deviation to the side. There is usually pain associated on the inside of the toe and because of pressure symptoms

Orthoses do not help this condition, and the only suitable treatment for this condition is surgery. However, Acupuncture can help reduce pain and may well enable the person to continue normal movement

Ref: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007809.pub2/abstract

Falls and falling over

16th December 2018

Falls are very prevalent in the elderly and are a significant cause of both fractures and increased death rate, so this urgently needs attention.

As people get older, they may not require the sometimes more vigorous techniques in Osteopathic treatment, but this does not mean it may not be of some use and certainly becomes more useful when combined with Tai Chi and vitamin D supplementation.

Tai Chi

A controlled trial found Tai Chi to be superior in the over 70’s, both for aerobic and strength exercises and stretching.

A randomised controlled trial (RCT) found that in the over 70’s therapeutic Tai Chi is superior to both, strength, aerobic exercise and stretching, for the prevention of falls. In this particular study Tai Chi was reported to be over 58% better than exercises such as stretching and 40% better than mild aerobics and strength training.

Strength training

There is overwhelming evidence to show that lower limb strengthening exercise dramatically reduce fall rate. These should be done at least twice a week preferably three times a week.

Vitamin D

Although a recent study has suggested Vitamin D may not help bone health there are other studies showing that high levels of vitamin D leading to a reduction in falls by 37%, in older. However, this study shows that in these cases only high levels of vitamin D supplementation (higher than 800 i.u. / day are helpful in this case).

In conclusion, in addition to Osteopathic treatment to ensure the body works at its maximal efficiency and in a pain free fashion, certainly as we become older and unsteadier, Tai Chi and Vitamin D supplementation may be a way of helping this problem.

References

Diziness and vertigo

5th November 2018

Dizziness and vertigo are quite complex manifestations of a variety of possible conditions. I will try and explain in this blog the essential guide to what helps us maintain our balance:

Essentially, there are three sources of sensory information that feed our brains.

Eyes showing where we are in space.
Vestibular system which is divided into a static and kinetic systems. The static system is reliant on the position of the head.

The kinetic system relies on the head position during movement and does this with what are called the semicircular canals of which there are three and positioned at 90 degrees to each other, acting very much like a gyroscope.

Proprioceptors, which are biological sensors which are found around joints and muscles.

The neck is the most important, but they are also found in the spine, limbs and extremities. The proprioceptive inputs from the neck (cervical spine) and ascend in the vestibulospinal tract.

Role of cervical spine in maintenance of balance

In this case head movements lead to movement of the proprioceptors which via neural pathways to the brainstem inform it as to the position of your neck and head. In neck trauma, osteoarthritis, neck tension there are mixed signals going up to the brain from both the cervical spine the vestibular and Ocular pathways which then can lead to feeling of dizziness.

Vertigo vs diziness

Vertigo is a symptom with a feeling of rotation that you or the world are spinning and is usually indicative of an inner ear problem. When you move your head in one direction this leads to a feeling of spinning.

Dizziness or lightheadedness is a nonspecific feeling of wooziness, unsteadiness and suggests a non-vestibular pathology.

Causes of vertigo

Vestibular causes

Viral labyrinthitis, Meniere’s disease, ear infection, drug induced this is when vertigo lasts more than 24 hours).
Benign paroxysmal positional vertigo, psychological, and neck (vertigo lasting seconds).

Central causes

Migraine, MS, tumors e.g. acoustic neuroma or stroke.

Causes of dizziness

Cardiovascular e.g. heart disease, arrythmias.
Proprioception: e.g. arthritis in the neck
Metabolic: hypothyroidism, anemia, alcohol, peripheral neuropathy.

What can be done to ease vertigo or dizziness?

When drugs don’t work, it is worth getting your neck assessed as this certainly may be the cause of some of your dizziness and could be involved with your vertigo.

If you suffer from BPPV (benign paroxysmal positional vertigo), this can be caused by calcium crystals being deposited in one of your semicircular canal. Some exercises can be shown whereby these crystals are shifted to bring relief to this type of vertigo.

Both acupuncture and neck treatment may well be useful in at least mitigating these symptoms, as these can relieve neurological inputs to the brain and thereby reduce symptoms.

Your organs can refer pain around your body

14th August 2018

Types of pain

There are two types of pain in the body one called somatic pain which comes from the skin, muscles and soft tissues.

Visceral pain

Visceral pain comes from the internal organs and can be experienced as feeling dull and vague and is experienced by 40% of population.

Organs are not as well supplied by sensory nerves, so their pain usually comes from a reduction in blood supply (e.g. the heart in a heart attack or angina), or distension (e.g. the bowel or gall bladder as in irritable bowel or gallstones), or compression (as when a tumor compresses against an organ).

In Visceral pain people often experience a sense of unwellness including profuse sweating, nausea, bowel disturbance, changes in heart rate, temperature or blood pressure.

Very often visceral pain can radiate to other parts of the body for example in a heart attack symptoms may be sweating, nausea, vomiting, palpitations and anxiety with pain radiating down the left arm, the stomach, back, neck and jaw. In a silent heart attack pain in the chest may be absent.

Kidneys have a typical presentation of loin to groin pain, Lung and diaphragm to neck and shoulders, liver and gallbladder to and around the right shoulder blade, both stomach and pancreas to upper stomach area.

Somatic pain

This is generally seen as a musculoskeletal pain, it has a more defined area as nerves supply the bones, joints and muscles and as a result tends to be more intense.

The receptors picking up these pain impulses are called nociceptors and are sensitive to swelling, temperature and vibration and gives a pain sensation as for example bruising yourself when falling over.

Deep somatic pain usually arises from joints, tendons and muscles, whereas superficial somatic pain arises from the skin and mucous membranes.

Somatic pain can become chronic as for example in low back and neck pain (not caused by nerve damage), fibromyalgia, tension headaches and arthritis.

Help is at hand

Somatic pain can all be generally helped with Osteopathy and Acupuncture, both effective in reducing the pain from both muscles, tendons and the deeper joints.

For many kinds of visceral pain help is at hand to help reduce pain particularly in more benign conditions such as irritable bowel. However, it is always important to seek further treatment to seek advice in treating the affected viscera.