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Shin splints is a term that, in essence, simply refers to lower leg pain. It is a common injury amongst runners, especially long distance runners, but it can manifest in anyone whose prime activity involves running or jumping.

Typically, shin splints are divided into three separate conditions.

Anterior compartment syndrome (ACS) – this is pain felt on the front of the shin. When we exercise our working muscles need an increased amount of blood to provide the oxygen they need, as this blood supply increases so does the size of the muscle. A thin but tough layer of tissue called fascia that keeps the muscles separate and contained surrounds muscles. As the working muscle expands, the fascia must stretch to accommodate, however in the case of ACS the fascia does not expand sufficiently, causing an increased pressure in the muscle and pain.

Medial Tibial Stress Syndrome (MTSS) – typically felt on the inside of the shin, directly on the side of the bone, this condition is caused by stress between the outer layer of the shin bone and tendon attachments. Typically seen in runners with ‘flat feet’ where the constant rolling inwards of the feet pulls on the shin bone via the tendons causing an irritation and inflammation of the bone.

Stress Fractures – constant repetitive impact gradually leads to a weakening of the bones and small hairline fractures appear causing a great deal of pain. This does not only occur in the shin but is also seen in the heel and up into the neck of the thigh bone.

What are the causes of shin splints?

• Poor running biomechanics – when you run what does your foot do? We don’t often give this much thought… we just run! There’s a lot that should happen in the split second your foot is in contact with the ground.
• Using the wrong shoes – for sports or activities that involve repetitive impact, make sure your shoes are giving you the support and protection you need.
• Muscle imbalances, restricted joint movement, especially around the foot and ankle.
• Sudden changes to your training – what type and level of training are you doing? Have you progressed gradually to this level? Sudden increases or a sudden change of surface you are training on will over-stress your lower limb.

How can I prevent shin splints?

• Warm up properly before every training session.
• Spend plenty of time stretching at the end of your session, especially your calf and shin muscles.
• Try to avoid excessive running on roads. Stick to grass, tracks or cross-country.
• Ensure your shoes are giving your foot the support it needs. For runners, make sure you have shoes specifically fitted to your running style and be aware of when to retire them, generally between 500-700 miles.
• Keep well hydrated.
• Spend time training in other sports to vary the training effect, especially sports which involve lateral, side-to-side, movements.

The most important point to consider with these injuries is to listen to the messages from your body. If you feel any new ‘niggles’, aches and pains, especially in the lower leg, don’t ignore them. These are overuse injuries and the body needs rest to help them recover. It is a common trait of the long distance runner to ignore these signs for fear that resting will affect future goals, but think about the big picture, eventually, if left unchecked these pains may develop into a debilitating condition that may prevent any running for several months.

Bridge to Health are offering running assessments for anyone who is concerned with their training and the risks of developing injury, followed by any relevant treatment and rehabilitative exercises. Please contact the clinic for more information.

We often have patients come to us for a Deep Tissue Sports Massages to relieve tension, work-out aches and for simple relief of stress. This is a great treatment to work into knotted muscles, and stimulate blood flow. Although we provide such treatment as a specific service, we are always looking at the body through osteopathic eyes and we often find that although the massage will achieve the desired result, the effect is not always as long lasting as it might be with a more holistic approach to treatment.

Sports massage is extremely effective for patients involved in… you guessed it… Sports! By treating the working muscles before training or competing, performance can be enhanced, and massage post event will speed recovery. But you don’t have to be a high level athlete to reap the rewards.

We often use these massage techniques as an integral component of broader osteopathic treatment. It must be added that the reason some patients like this kind of treatment is that it is quite simply an enjoyable and relaxing treatment in its own right.

The Bridge to Health Osteopathic Healthcare clinic is located in Uxbridge town centre, 4 minutes walk from Uxbridge station on the Picadilly and Metropolitan underground lines (so we are just a hop from Hillingdon, Ickenham and Ruislip). Nearest car park is Cedars, off the roundabout on Oxford Road.

We spend a lot of time working with patients who have developed an injury or poor health through the stresses imposed by their occupation. There are many factors that must be considered to give a complete treatment plan.

How did the initial injury happen?
e.g. A lifting injury, picked up a large sack, forgot to bend knees and felt a twinge in the back

How are office ergonomics?
Lot’s of travel, but often need to fit into small spaces with cluttered floors… (which are occasionally on fire.)

Any dietary factors?
Excessive consumption of brandy and mince pies (nice case of raised cholesterol and liver cirrhosis)… thought about veg but always end up giving it to the reindeer.

Is stress a factor?
You try delivering gifts to every child in the world in one night and tell me how you feel!

If you have been helping Santa and are also suffering from similar aches and pains contact myself or Mathieu to book an appointment at the clinic on Uxbridge High Street (inside Fitness First).

While we will endeavour to keep the clinic open throughout the holiday season for anyone who has hurt themselves by lifting their over plumped turkey out of the oven(!), we will obviously be closing for a few days.

The clinic will be closed from Wednesday 24th to Friday 26th December, and also on Thursday 1st January 2009.

We will be available on the morning of the 31st for any urgent osteopathic appointments as well.

Have a fantastic Christmas break and good fortune in 2009, with best wishes from the osteopathic team at Bridge to Health.

Let me start this entry by clarifying that it is not meant as a guilt trip, and is no diatribe against your choices over the Christmas period…

“you must forego all pleasures and only eat sprouts for your Christmas dinner!” -

I’m no hypocrite, Christmas is an important time for celebration and reflection where we should get together with family and friends, take stock of the year gone and look onwards to the New Year and its new challenges. However we should note that during this time our health usually takes quite a hit and as always, prevention is better than cure. Some planning around this time should prevent the worst effects.

Start at full power

If our health is going to take a hit, it’s better to start at full strength so right now take extra vigilance in your lifestyle choices. Fend away potential illness by the most effective way we know, a healthy immune system.

• Boost your immune system with a good balanced diet, ensuring plenty of fresh ingredients, at this time of year we have a wide array of fantastic, earthy vegetables full of vitamins and minerals such as squash, parsnips, and the wide variety of greens which are in season now.
• Supplementing your diet can also help this but not as a replacement for good nutrition. There are several powerful immune boosters such as echinacea, propolis and the most effective, vitamin C.
• If you do feel you are ‘coming down’ with an illness, my personal cure is always fresh chilli and garlic (and plenty of it), although probably not before the Christmas party or you might clear a wide space on the dance floor…

During party season

If I suggest you drink less at the Christmas party, are you going to listen? If not, then at least minimise the damage you cause (both to your body and your reputation at the office).

• You need to maintain good hydration, so if you know you’re going out that evening drink plenty of fluids throughout the day and most definitely at the end of the night before bed.
• Make sure you eat a full meal before you start drinking and try to stick to one type of drink.
• The following day, get back to extra good habits, good food, plenty of fluids and some light exercise.

Into the New Year

By now we’ve drunk too much, eaten our body weight in mince pies and the body feels like it’s running on crude oil, not high-octane performance fuel. Most people have started a new year with a pang of regret about the previous couple of weeks, but that can’t be changed by then, so how do we get the body back up to full steam, and fast?

The body needs to flush out all the toxins you’ve been kindly storing and the lymphatic system will be working overtime.

• Some light exercise such as walking will provide the muscular pumping needed to clear the waste, preferably in the good fresh air, rather than up and down the Uxbridge high street, and this can also be effectively boosted by treatment aimed at stimulating your lymphatics and clearing the waste – see our January special health offer!

Back to diet, whatever you goals are for your dietary intake now is a good time to critically evaluate and improve your nutritional habits. “You are what you eat” so in order to maintain a healthy weight, a strong immune system and an active lifestyle, you must give the body the nutrients it needs and deserves. Improve your habits now!

As I said before, this is no lecture, I will be enjoying a healthy dollop of brandy butter on my Christmas pud! To be frank, this period of rest and indulgence is incredibly important and does bring with it some valuable benefits to health, but be aware of your body’s needs throughout and you will be able to start the New Year at full speed.

When you book to see an osteopath, do you know what to expect?

Modern osteopathic training is continually evolving in response to research and development, however as the osteopath develops their skills and practice, their style of treatment will evolve to a more personalised approach influenced by the different approaches to patient care found amongst the osteopathic community.

When you visit your osteopath, the initial consultation is an information gathering session. We are looking at your posture, how you move, and your description of the condition in order to build a picture in our minds of what might be happening. The next point of diagnosis will come from laying hands on the body and moving joints passively to gather information from the affected areas. Once armed with a diagnosis, treatment goals are to restore good function to the body, but the approach can vary between osteopaths.

There are several distinct styles of osteopathic treatment and whilst some osteopaths will draw on several, others will focus essentially on one form only.

What are the different styles?

Structural Osteopathy
This is the most common approach to osteopathic treatment and is the foundation upon which modern training is based. It is where the osteopath will use manual techniques to affect the musculoskeletal system: joints are moved, muscles are stretched and in so doing the treatment effect can reach into the body and help the nervous system, blood supply or organ function.

Classical Osteopathy
Although this style involves a structural approach it is based on more traditional principles.

Osteopathy was founded in the US in 1874 by Andrew Taylor Still and then further developed by John Martin Littlejohn who also introduced osteopathy to England in 1911. They developed a system which mobilises the body in a specific manner, such that it generates an impact on the underlying physiology.

The first osteopaths were primarily healers who were concerned with treating ’systemic illness’ such as typhoid and diphtheria, rather than the modern day osteopath who is most well known for treating back pain and sports injuries. Classical osteopathy is based on a specific routine known as the ‘body adjustment’ where the entire body is involved, and more specific treatment can be directed as appropriate. Unfortunately, this form of osteopathy is not so well understood today, and there are only a few osteopaths who use this approach exclusively.

Cranial Osteopathy
This is a more subtle approach which involves a gentle ‘hold’ of the patient to interact with more subtle energies and the body’s fluid dynamics.

Tiny physiological movements in the bones in the head and face are vital for health, and cranial osteopathy can focus on any obstructions to these microscopic movements that may have been caused by trauma or injury. Last month Mathieu explained more about this style of osteopath in his post what can a cranial osteopath treat.

Visceral Osteopathy
This approach looks at the relationship between the physical structure of the body and the organs, such as the digestive tract or respiratory system. Through the stresses imposed by poor posture, diet or lifestyle pressures, the organs can build areas of tension which can then lead to referred ‘viscero-somatic’ pain.

One example of this is the intense groin pain created by an acute kidney infection. In this case treatment over the area of pain may be ineffective whereas direct manipulation of the kidney may stimulate the healing response needed to relieve the pain.

Visceral treatment can aid movement of the digestive tract and good function of abdominal organs as well as the lungs.

Summary
Good osteopathic treatment is based on the principle that structure governs function, and vice-versa. Unlike other forms of manual therapy, all osteopaths will tend to have a “whole body”, integrated approach to assessment and treatment.

An osteopath will draw on a variety of techniques to make a change to the body in a bid to restore good function or structure. The way they interpret their findings and seek to make this change varies depending on their training, experience and technique preference of the osteopath, however, the principles that govern the reaction of the body to treatment and the healing process overall remain common to all osteopaths.

There is a saying“if I had a pound for every time I was asked …” This is one question that many patients ask at some point during their course of treatment, and I look forward to referring them to our blog for answers from now on!

I will try to answer this without bias but please note that I am an osteopath and therefore cannot be truly objective. It is worth noting that as an aspiring health practitioner, I did consider all three, but chose osteopathy from some specific reasons that are still valid in my eyes today.

Osteopathy

is a holistic form of manual therapy, which deals with a wide range of acute, chronic and systemic disorders of the body, both musculoskeletal and visceral.

Osteopathy uses in-depth physiological and clinical knowledge, coupled with keen observation and palpatory skills. The osteopath will combine a detailed health case history with a thorough physical evaluation to diagnose the patient’s condition and treat it. The patient’s diet, work and leisure practices all inform this process.

The osteopath doesn’t treat a painful back, stomach or knee, but a body as a whole unit that is suffering an injury, and must be treated in an integrated manner to return to good balance and function: can an injured knee be treated conclusively without addressing the biomechanics of the ankle, hip, pelvis and back? The osteopath’s aim is not merely symptomatic relief, but addressing the underlying causes of the current presentation to prevent any re-occurrence.

Osteopathic treatment combines joint mobilisation – and occasionally manipulation – with work on muscles and ligament tension, as well as gentle work on visceral structures when required.

As naturopathic osteopaths, our specific bias is not merely to achieve better functional alignment of our patients’ bodies, but also to impart dietary, exercise and lifestyle advice that more generally enhance their long-term health.

More about what is ‘holistic’ osteopathy and a description of osteopathy here.

Chiropractic

The origins of Chiropractic are close to osteopathy, as the first chiropractor was a student of the founder of osteopathy. Indeed, in some instances, one would be hard-pressed to distinguish between the treatment provided by a good chiropractor and osteopath. However, a large proportion of chiropractors focus treatment on manipulation of spinal segments to normalise spinal position and effect underlying nerve roots.

Treatment plans are often based on regular manipulation for a set number of sessions in order to wholly correct a disorder. Chiropractors also often use imaging to aid diagnosis such as x-ray. These x-rays will often be conducted in the clinic as part of the course of treatment.

Physiotherapy

is the most commonly known form of ‘manual therapy’ due to its prevalence within the NHS.

Physiotherapists specialise in the rehabilitation of acute and chronic joint injury, often using a variety of prescribed exercises that the patient carries out when away from the treatment couch. Physios also use machines such as ultrasound or TENS machines to facilitate change in an injured area.

NHS Physiotherapists tend not to have diagnostic input, the diagnosis and treatment request tending to emanate from an orthopaedic surgeon, consultant rheumatologist etc.  As a result, treatment will also tend to be more specific than integrative.

Inevitably, this brief snapshot doesn’t do justice to the development of three different forms of manual therapy with their unique methods and philosophy. It merely attempts to highlight some of the key differences in clinical practice that you can expect from each – although as suggested above, the practice of some physios and chiropractors is sufficiently all encompassing as to be well aligned with osteopathic practice.

Sadly too, some osteopaths also stray into being too specific in their form of treatment, and come to rely too heavily on joint manipulation.

The word holistic is one that is widely used amongst many forms of therapy and is frequently misused, as well as misunderstood. All too often, when we use this word as osteopaths, we come across a sceptical look from patients as they conjure images of some type of faith healer, chanting prayers whilst surrounded by clouds of incense! This isn’t quite what we are referring to.

Holism is a core osteopathic principle, centred on the notion that “the body is a unit”. Therefore, our approach to health takes the view that the cause of pain in one particular area may not originate from that specific location, its roots may not even stem from a physical origin. Health is multi-factorial (i.e. health is affected by many factors) and it is the role of the osteopath to remember this when dealing with each individual patient.

This diagram below represents some of the factors that contribute to health. It is a simple view of something which is infinitely more complicated.

To take a truly holistic view, these areas can be further broken down. When patients come to see us with shoulder pain, they often get confused as to why we start assessing their pelvis or foot mechanics, but it isn’t possible to get a full understanding of how the shoulder is affected without taking a step back to take a look at the ‘whole’’ of the person, including their health history, posture, gait, and so on.

In the same manner that osteopathy is ‘holistic’ in examining a patient, it is equally holistic in the forms of treatment that it employs to help steer its patients’ health back onto the right path. “Holistic treatment” involves physical therapy, combined with exercise, lifestyle changes (shoes, bags, seated ergonomics, learning how to lean over and carry etc.), dietary advice, or simply acting as a counsellor to the patient to ease health concerns.

Marcus and I are ‘holistic’ osteopaths, our practice is called Bridge to Health, and we are based in Uxbridge, West London.

The need for regular exercise is well publicised, government recommendations set weekly requirements at a minimum of three, thirty minute sessions. These guidelines are designed to maintain a basic level of health, but not to improve your level of fitness.

What are some key goals for exercise?

• Cardiovascular strength
• Respiratory function
• Lymphatic flow/waste removal
• Muscular strength
• Bone strength
• Flexibility
• Posture
• Joint function and health
• Stress reduction
• Weight control

Not to mention the number of possible personal reasons and goals that an individual might have that motivates them to exercise, this could continue into a very long list.

As our lifestyles have evolved, so too has the way we use our bodies. In the past most people were active throughout the day so the notion of ‘exercise’ was redundant. As time has progressed and the majority of workers have moved into the office, the need for conscious exercise to promote good health has increased, thereby prompting the increasing popularity of gyms and health clubs. One of the problems here is the type of routines that gym goers perform. As an example, after a day behind the desk, people rush down to the gym in time for their 45 minute spinning class and ‘blast’ away at full pelt, then straight home for a nice evening in front of the television. The problem here is the contrast from nothing to full power and back again in a short space of time. Although this has benefits for cardiovascular health and is preferable to no exercise, this approach puts a lot of stress on the body and can lead to an increased risk of injury or illness.  Our bodies are better designed for ongoing exercise – e.g.  roaming the plains all day hunting woolly mammoth! Fortunately the world has moved on from here.

A key parameter in exercise is achieving a balance between the various exercise goals.  As such, the exercise routine should incorporate as many factors in the above list as possible; all too often a routine will lean in favour of one area, neglecting others. For example a body builder may focus on muscle size and aesthetics, not giving sufficient focus to cardiovascular strength, flexibility, and muscle resilience.

So what exercises take a wide account of this list and are well-rounded enough to give complete health benefits?

One of the greatest exercises for health is an easy one to perform, although neglected by most: walking. It may not test the cardiovascular system as greatly as more intense activity, but a prolonged walk (30 minutes to an hour) every day / other day over varying terrain, and at a pace that leaves you slightly breathless, will lead to a boost in vitality by oxygenating the body, improving circulation of blood and lymphatic fluid; in the right conditions, it is also great therapy for the mind.

Swimming is another exercise which is fantastic for the cardiovascular system as well as working all the major muscle groups of the body.  It has the added benefit of not involving weight-bearing, which is very helpful if you are over-weight, recovering from an injury or suffering from lower limb osteoarthritis.

Tai chi, yoga and pilates are great for building flexibility, core body strength and control whilst also focusing on mental balance as well.  They also provide the benefits of group practice at fixed moments in the week, which may help to maintain the commitment to, and enjoyment of, exercise.

On a personal note I’d like to highlight a favourite activity of mine. Rock Climbing is passion of mine and I’d like to use it as an example of a well rounded, health-promoting activity. It provides fantastic functional strength training for the complete muscular system as well as taxing the cardiovascular system in a moderate way. However for me, it is a meditation, whilst spending time in some of the beautiful climbing locations this country has to offer, it uses the mind in a way no other exercise can. It is a constant game of puzzle solving, how do I ‘crack’ this route? As well as dealing with fears and natural reservations which are inbuilt for good reason. It may not be to everyone’s taste, but it certainly gets you out of the gym.

In short, when planning your exercise routine, think about how it will work on all aspects of your physical health, and how it may enhance your mental outlook as well; favour activity outdoors because of the obvious benefit of fresh air to body vitality (yes, even in a park in the middle of London!), and at all times, be aware of your posture when exercising to avoid unnecessary strains.

Below are extracts from our July newsletter. If you would like to sign up (it’s free) for a monthly update including:

• Up to date news and features
• Our latest Special Offers
• Relevant Health Tips
• Clinic News

Click here to sign up to the Bridge to Health Newsletter.

Looking after your health in the workplace
Here in Uxbridge, we are surrounded by many large corporations. As a result we see a lot of workplace induced injuries.

Our corporate health program aims to prevent working days lost through musculoskeletal injury. We promote this in three ways:

• Corporate discounts ranging from 10-20% off our full treatment range
• Workshop-type presentations to your workforce highlighting some important tips to prevent injuries in the workplace
• In-house treatment days in your own office

To find out more about these services and to see if your company is entitled to a discount, contact the clinic directly.

Special Offer: Full Body MOT
Our monthly special offer helps you in your quest for good health. This month, we are offering a full health check to make sure you enjoy your summer to the full, especially if you are leaving on holiday. All too often our underlying weaknesses realise themselves when we are away. This happens for a number of reasons and finding medical help abroad can be a stressful process (take it from someone who suffered a serious spinal injury less than a year ago whilst 12,000 miles from home).

This is a complete health check to ensure your body is ‘firing on all cylinders!’. Your session includes:

• Cardiovascular assessment
• Respiratory assessment
• BMI/body fat % analysis
• Spinal health check
• Joint function testing
• Postural assessment

This one hour session will then include appropriate advice on lifestyle and injury prevention tips, plus relevant osteopathic treatment to ensure your body is working well and prevent risk of future dysfunction or injury.

This month, only £45 for the session.

You can also combine this with a full nutrition assessment and personalised diet plan for £90.

Marcus & Mathieu
Bridge to Health