It’s always nice to get positive feedback from a happy patient. I’ve treated Isobel a few times now and am really happy with how it’s going:

I found Richard on Twitter while looking for local sports massage therapists in Nottingham, having recently moved to the area for University study. On our first meeting it was clear that he was a highly knowledgeable and ambitious therapist who was passionate about his work and about helping people to find optimum comfort and performance. He has been treating me regularly ever since and I feel the enormous benefit of his work every time! As an elite level High Jumper, I place a lot of strain on my muscles and joints so I’m very grateful to have Richard on my side to help me find perfect form for big events. I would highly recommend him to anyone who wants an intelligent, professional and highly effective treatment experience.
Isobel Pooley, International High Jump Athlete – Great Britain

Keep your eyes and ears open as you’ll be hearing a lot more from Isobel as she progresses through her athletic career.

It seems there’s a lot of confusion with the general public about what an osteopath actually does. To add to this, I’ve noticed that the term ‘physio’ seems to be used to describe a whole range of therapies, treatments and techniques including sports massage, stretching and even personal training. So, when somebody says that they ‘need to see a physio’, exactly who should they see?

Osteopaths are primary care practitioners, meaning that you don’t need to visit your GP first to be referred. We’re not constrained by how many treatments we can give or how long we can spend with you, it’s down to our own discretion. I always spend at least an hour with new patients, to thoroughly talk through the pain, injury or discomfort and then use my extensive knowledge of anatomy and physiology to make a diagnosis.

Treatment is likely to include a mixture of hands-on massage and mobilisation, some manipulation techniques (cracking!) if appropriate, kinesiotaping if you have an acute injury and some specific exercise advice. What we won’t do is just give you a photocopied exercise sheet or plug you in to an ultrasound machine and then send you on your way – everything that we do is tailored to you specifically. Follow-up appointments will be discussed and planned to make sure that you’re happy with the care that you’re being given and each treatment based on your own progression.

So, is that what you expect from a ‘physio’? Perhaps next time you hear somebody at home, work or in the gym say that they ‘need a physio’, maybe they actually need an osteopath…

I’m very pleased to report that local lad and long-term client Dan Hardy has won his latest UFC fight against the durable Amir Sadollah by unanimous decision at the Capital FM Arena on Saturday night. It was a great performance from Dan featuring super-crisp stand-up work and some strong takedowns.

I first started treating Dan back in 2007 and have worked with him numerous times since.

With all of the training I do, my body is always tired and beaten up. Rich is the first person I go to when I need my body working to its full potential. I have had several sessions with Rich and always make sure I see him before a fight. I can’t recommend him highly enough.

Well done Dan, look forward to your next fight.

I’ve been using kinesiotape/RockTape for nearly a year now and I’ve always felt that CrossFit was particularly well-suited to the benefits that the tape offer, from improving muscle mobility to tissue recovery to posture correction, so I was extremely pleased to treat a CrossFit-ter recently for a shoulder issue.

After a full assessment and treatment of an early case of should impingement, we did some taping. As the pain was worst on overhead presses, the aim was to reduce compression through the upper fibres of trapezius and levator scapula, whilst improving the fascial movement in the upper limb. Results were great:

It worked really well. Especially on Friday it felt it’s supporting the right posture and pulling my shoulders back. It also sticked really well still after working out and showering, only the endings came off a bit.

This week has been rather momentous…

Firstly I’m extremely proud to announce that our little boy turned one year old on Monday and we celebrated with a three-day party, setting a rather dangerous precedent for the future! We all had a great time though and having the opportunity to celebrate with friends and family was fantastic. He’s growing up to be quite the young gentleman!

In other news, I’m now an osteopath! Found out on Tuesday that I’ve passed all my exams and coursework and am officially graduated from Oxford Brookes University with a First Class BSc(Hons) in Osteopathy!! Just waiting for my registration from GOsC to come through and then I can start practicing.

With that in mind there will be a few changes ahead but more on that later 😉

As I sit here wait for my osteopathy results to come through (10 days and counting!), I’m wondering where to go next in terms of learning and one thing that really interests me is nutrition. It seems like such a minefield of what we should eat, in what combinations and at what times. I’d love to know more about it all…

The myth of ‘healthy’ and ‘unhealthy’ foods seems much more important now than ever before, which is really nicely illustrated here:

Ankylosis Spondylitis (AS) is probably the most well-known seronegative spondyloarthropathy and is certainly one of the most recognisable, with its characteristic “question mark” posture and reduced mobility in the spine.

It commonly affects men more than women and begins in late teenage years or early twenties, often beginning as a dull ache or stiffness in the lower back and sacro-iliac joints, worst on waking. It is a chronically inflammatory condition and Without treatment can steadily progress up the spine, fusing vertebral segments and causing chronic postural adaptations.

In clinic, alongside thorough case history taking, we typically have two specific tests for AS. Both measure movement in the body, one focussed on the lumbar spine and the other, the rib cage. Using a standard measuring tape we can assess:

• lumbar spine flexion – should be >5cm (see video below)
• rib expansion – should be >3cm

Once diagnosed, the BASDAI index can be used to measure progression and development of the disease.

We’ve just completed 2 of our last 3 exams and there’s always one question which throws a lot of people – this year, that question was: “which nerves innervate the sole of the foot?”. We spend a lot of time thinking about the spinal nerves that innervate the foot but relatively little time considering the peripheral nerves themselves. These are just as important though, especially when assessing nerve damage from local injury or systemic disease such as diabetes.

Here’s a great diagram courtesy of Wikipedia:

One of the most common tests that I use to assess low back pain is the Straight Leg Raise, also know as the SLR or Lasegue Test. The patient lies on their back in a comfortable position and the examiner lifts the straight leg up, noting if or when it causes any symptoms into the lower back or back of the legs. These symptoms could be low back pain, muscle tightness in the legs, shooting/electric pain down the leg or a ‘pins & needles’ sensation. If pain is illicited, the leg is lowered slightly and then neck flexion and/or ankle dorsiflexion added. The leg can also be taken across the body to identify whether the sciatic nerve is implicated or it is just hamstring tightness.

As the nerve is stretched, tension first happens in the greater sciatic foramen, then over the ala of the sacrum and then the intervertebral foramen.

A device called a goniometer is used to measure the angle where the symptoms begin, which can help diagnose what the causes could be. Personally, I have an app on my iPhone which does the same job!

Interpreting the results

Shooting pain down the leg, pins & needles and/or numbness indicates involvement of neurological structures including the sciatic nerve (L4-S3) but doesn’t identify exactly where or how. Magee (1992) suggests:

• pain that increases with neck flexion and/or dorsiflexion indicates stretching of the dura mater of the spinal cord
• pain that does not increase with neck flexion indicates a lesion in the hamstring area, lumbosacral area (LSJ) or sacroliliac joint (SIJ)
• 35-70 degrees is most likely to present as nerve root stretch across posterior IV disc
• nerve root stretching finishes around 70 degrees so pain after 70 degrees is likely to be LSJ or SIJ
• 80-90 degrees of flexion is considered normal
• pain primarily in the back = central lesion
• pain in lower back and posterior leg = intermediate lesion
• posterior leg pain primarily = lateral lesion

References

Magee (1992) Orthopaedic Physical Assessment, 2^nd Ed. Philadelphia: W B Saunders Company. p267-269

“I was suffering quite a bit when I first went to see Rich. Nine months previously I had undergone a spinal de-compression operation to relieve the pain of chronic sciatica. Unfortunately, the operation failed and I was faced with a nine month wait before I could see my consultant again.

After my first session with Rich I was relatively pain free and this has remained fairly consistent until today, eight sessions on. Rich is a professional: he is methodical, logical, skilled and caring. I feel that I am in good hands.“

Thank you Joe! Joe is the author of “Poppy Dream: The Story of an English Addict” and you can learn more about his story here.