• Regain joint stability and mobility using isometric strengthening and control exercises.
• Balancing muscle tone, length and strength using appropriate techniques, moving onto more functional dynamic strengthening exercises, as soon as appropriate.
• Promoting good postural and movement patterns to reduce risk of recurring injury.

• Among professional and amateur golfers, low back pain has been cited as the most common golf-related injury. It is estimated that 10-33% of LPGA and PGA touring professionals are playing whilst injured at any given time, and that half the group will develop chronic problems.
• In the modern swing, the golfer finishes in a lordotic 'reversed c' position. This 'reversed c' leads to hyper-extension of the lower back which adds increased stress on the joints and paraspinal muscles of the lumbar spine.
• Increased loads to the lumbar spine during the golf swing, as well as the large forces generated by these muscles, predispose the golfer to muscular strains, spondylosis (degenerative spine condition) and associated risk of herniated discs.

• The middle of the upper back or thoracic spine can make or break the golf swing. A flexible and supple T-spine will allow for smooth swing mechanics while restrictions will inevitably lead to poor performance and/or injury.
• The ribs need to be able to expand, contract and rotate. This allows the diaphragm to move freely. Rotation can be restricted if the muscles between the ribs (the intercostal muscles) are tight. You may have felt something similar to a sharp, stabbing pain in your ribs after a day of hitting balls.
• This could be your intercostal muscles telling you that they have worked too hard. This is particularly important when associated with general arthritic spinal conditions.

• As well as having similar spinal restrictions, this area is one of the most important for golf.
• Good stable mechanics for the golfer's eye-to-ball connection is fundamental in allowing the whole body swing to work correctly.

• Three small bones make up the coccyx.
• These bones are usually loosely fused together, and the coccyx becomes more flexible in pregnant women to allow them to give birth more easily.

• Many different factors can cause pain and damage to the coccyx, such as childbirth or falling on the base of the spine. Coccydinia can also be caused by poor posture, or by a repeated activity or motion such as cycling or rowing.
• Aches and pains in the lower part of the back can also result in coccydynia (known as secondary coccydynia).

The treatment of older people requires as special approach as older individuals have needs stemming from ageing physiology, the psychological impact of ageing together with age related diseases.

• Therefore the care of older people is multidisciplinary and holistic with David. All driven by the goals of health maintenance, and optimum function.

• David’s Osteopathic Medicine is ideally suited to the pursuit of these goals as diet and nutrition together with exercise will be used alongside gentle hands on treatment, targeting stiff and painful joints in the neck, spine and other joints such as the shoulders and hips.

• As you get older you may suffer more from aches and pains, and of course degenerative conditions such as osteo-arthritis also become more common. However, osteopathy can do much to help maintain mobility and quality of life.
  
• Some of the conditions that occur with age cannot be completely reversed. An arthritic joint, for instance, cannot be fully restored to its original condition, but osteopathic treatment can help in maintaining range of movement and minimising pain. The benefits of keeping up exercise in old age are now well documented and David can provide advice on the most suitable exercises. He can also help compile exercise programmes and can also give advise on how to modify lifestyle to reduce injury risks, and on the types of aids and equipment available to older patients.
  
• Many older patients worry about the safety of manual therapy, and whether the treatment may be too forceful for them. Osteopaths, however, have a wide range of gentle and non-invasive techniques available to them, and David is careful to choose techniques that are safe for older patients.

Spinal manipulation is effective for low back pain (BEAM trial, 2004)
Government guidelines recommend osteopathy for persistent low back pain (NICE, 2009)
Osteopathy is possibly effective for infantile colic (Hayden 2006)

Using gentle techniques David can treat immediately after a plaster cast is removed, within a few days of arthroscopy and a few weeks following joint replacement.
Osteopathy delivers a supportive role which is available throughout the life time of all people, as required. Any person with changing needs and circumstances, will be provided with reviews, to enable these to be assessed. Regular assessment & goal planning are tools by which David involves each patient in their own treatment plan.
The following areas are where David can provide osteopathic input & support:

• Following complications, such as pressure sores, fractures, surgery, contractures, operations etc.

• Changing circumstances, hospital move, change in carer, stage of life, change in environment etc.

• Gait Training

• Maintenance programs and exercise regimes.

• The bursa is what cushions the tendon and thereby helps prevent friction between the tendon and the bone. 
• Unfortunately, constant rubbing of the tendon over the bone with high amounts of repetitive arm, shoulder, hip, knee and ankle motion can lead to enough friction of the bursa itself to cause the inflammation and irritation of the bursa called bursitis.    

• The treatment goals are to reduce inflammation in the joint, restore proper posture and movement, and bring the body back to its healthy state, preventing the bursitis from occurring again.
• David as an Osteopath is skilled in assessing the possible causes of the injury. An appropriate treatment and management plan will be designed to address the cause and help recovery. Specific exercises will be prescribed to speed the recovery process and prevent it coming back.

• The most common tendon areas that become inflamed are the elbow, shoulder, hip, knee, ankle, and heel.  Of course, bursitis can will vary with each person, as it strikes the areas you use and irritate the most.

• Symptoms can vary from an achy pain and stiffness to the local area of the joint, to a burning that surrounds the whole joint around the inflamed bursa. With this condition, the pain is usually worse during and after activity, and the bursa and surrounding joint area can become stiffer the following day.

• How Tendonitis Occurs
• Tendonitis is usually seen after excessive repetitive movement with which the tendon gradually becomes tighter until the fibers begin to tear.  

• For example, a person who plays tennis may overuse the muscles of the elbow through hitting the ball repetitively and cause tendonitis to the area.
• Tendonitis is also regularly treated in carpet fitters, builders, plumbers athletes, runners, footballers and those who perform regular activities like house work.

• Symptoms can vary from an achy pain and stiffness to the local area of the tendon, to a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day.
• The pain is frequently more apparent at night time.

• De Quervain's tendonitis occurs when the tendons around the base of the thumb are irritated or constricted.
• The word "tendinitis" refers to a swelling of the tendons.
• Thickening of the tendons can cause pain and tenderness along the thumb side of the wrist.
• This is particularly noticeable when forming a fist, grasping or gripping things, or when turning the wrist.

Sports/Remedial - Massage

Sports and Remedial Massage or Deep Tissue Massage is a deep treatment that loosens up tight muscles, breaks up adhesions in muscle fibres, and generally focuses on restoring and/or maintaining the full functionality of your muscles. It can help your muscles perform better and prevent injury. Muscle injuries will often heal more effectively with the help of sports massage.

What is Sports - Massage

Special form of massage developed to help athletes reach their peak perfomance, to assist in their recovery afterwards and to facilitate the healing processes after injuries as well as prevention from injuries. It utilises techniques similar to Swedish, Therapeutic and Trigger Point Massage being suitable for all individuals with injury and is adapted to their current problem. David uses his experience as an Osteopath to deliver comprehensive treatments.
There are four types
Training - Massage
To prepare the body for peak performance. It is vigorous and deep to the body's tissues and should be done at least a day before the competition.

Preparation (Pre Training) - Massage
Just before event. It is fast, light and pleasant inducing stimulation of the muscles.

Break Massage
During event to accelerate changes of fluid in muscles thus restoring and rebalancing their energy.

Anti-fatigue (Post Training) - Massage

After event to drain wastes away and restore a proper level of oxygen in the muscles and promote relaxation. Again it works vigorously and deeply into the tissues of the body.

• Make your computer back-friendly Sitting badly in front of a computer for hours on end
  • is storing up trouble.
• The body can tolerate being in one position for only a short period of
  • time before you feel the need to adjust.
• Positioning monitor, keyboard and mouse correctly
  • can help to ensure good computer posture and the proper chair is essential.
• Repetition – performing the same movement over and over again – can also lead to muscle fatigue or
  • injury, especially if your body is badly positioned.

• Neck pain
• Upper Back pain
• Shoulder pain
• Headaches
• Thoracic outlet syndrome
• Carpal tunnel syndrome
• Stress...

• Decrease your lumbar lordosis (decrease extension of low back) which feels good because you stretch some muscles but in fact you over stretch for 8 hrs a day your ligaments , capsules and discs of your low back.
• Increase of thoracic kyphosis (flexion of mid back). This leads to a poor relaxed posture which compromise greatly the function of your diaphragm. In fact your diaphragm cannot contract properly because it sits on your abdominal organs. This obliges you to breathe with your upper chest and use breathing accessories muscles.
• Bring your head back, as the you might have a bit of wear and tear in his neck this neck extension is precipitating some neck pain and headaches.
• Only the wrists or first third of the forearm is resting on the desk. By doing so you need to carry the weight of your arms and forearms. And well known muscles for their tendency to give neck and shoulder pain !
• Tendency to use the mouse moving all the arm and shoulder. The shoulder is not made to do some precise movements but wide ones. if you try to do precise movement with your shoulder you need to contract all the muscles of the shoulder! Mouse Syndrome.

• Sit right back on your chair, not your back but your buttocks. Now lean forward and insert the grandma cushion down your low back. Now straighten up. How do you feel? if you have the good size cushion you should feel being straight without any effort. The cushion should be situated at the upper part of your low back, if this make sense. Don't try to force your shoulders to touch the back of the chair. Just sit straight.
• Now come closer to your desk, a bit more, a bit more. Be close enough from the desk to have 2 inches between your stomach and the desk.
• Your feet should be flat on the flour with a nice 90 degree angle at your knees. Add a foot rest if your legs are too short.
• Now rest your two forearms on the desk, your keyboard should be at least 25 to 30 cm away from the edge of the desk. Adjust the height of your chair to feel your shoulder relaxed and your arms/forearms resting comfortably on the desk. You should be pretty comfortable in this posture and should feel your shoulder much more relax than earlier. In fact you don't carry the weight of your arms anymore, but the desk does it for you !
• The mouse is situated at the same level than your keyboard. Have your mouse sensitive enough so that you can run through the screen only using your wrist.
• The screen should be standing at least 45cm away from the edge of the desk. I would recommend a 17 or 19 inches flat screen.

• Each time you breathe in avoid to breathe with your chest but pushing out your abdomen.
• When you breathe out pull in your stomach and contract your abdominal muscles and pelvic muscles firmly, and when you breathe in just relax them.
• Doing this will promote a good breathing, a better digestion, a firmer abdo belt, decrease your stress and being more focus on your work !

• Usually, by the time people go to see an Osteopath they are already in pain, which is the body’s natural alarm bell to say that all is not well.
• The aches and pain experienced are often a sign that muscles are pulling the body out of proper or comfortable alignment. Certain areas become tight and stiff while others may have weakened. This will put strain on the spine and joints. Over time, it can lead to inflammation and even wear and tear, which then maintains the aches.
• An assessment can be very beneficial if you have been suffering from back or joint pain for a while, have recently had a baby or are about to take up or change an exercise regime.
• As a consequence of the assessment, your Osteopath will not only be able to treat the current discomfort/pain through gentle manipulative treatment, but also be in a position to note how your body will respond to exercise. That is, which areas may need stretching or strengthening, and which form of exercise may be the most suitable to cause your body least strain and most gain.
• Everyone has a different body, different routine and slightly different cause of back pain.
• Healthy fitness is about optimising your body’s ability and potential without causing excessive stress or strain. Everyone will have different needs and a different level of ability.
• An Osteopathic assessment with David and he will be able to assist you professionally.

• Due to health and safety directives, employers are faced with ever increasing demands for professional and thorough work place assessments.
• It is common for HR departments to have trained staff who perform these assessments.
• Although there is an understanding of what is required, essentially every employee is different and therefore the same rules cannot be applied to every person.

• Repetitive strain injury: Generally this is described as symptoms of the neck, arm and wrist. However please see article of RSI for a more detailed explanation.
• Eye strain: This is often a result of VDU work and is a particular problem for workers who concentrate on the screen for long periods.
• Symptoms can range from sore eyes or head aches to visual disturbances.
• Badly positioned screens and poor lighting are contributors to this.

• If workstations are not set up correctly for the individual employee, they are at risk of pain and discomfort.
• Often ensuring that regular breaks are taken to walk around can be all that is needed.
• The lack of fluid movement through body tissues (i.e. sitting in one place for a long time) can have huge impact on the working structures of the body.
• For more information regarding back pain, please refer to the article on back pain.

• So if you feel that by the end of your working day you are experiencing aches and pains it may well be due to your working environment.
• It is advisable to seek professional advice as soon as possible to ensure it does not develop further.

• The femur, which is the large bone in your thigh, attaches by ligaments and a capsule to your tibia.
• Just below and on the outside of the leg, next to the tibia is the fibula, which runs parallel to the tibia.
• The patella or what we call the knee cap, rides on the knee joint as the knee bends.

• The main muscles of the knee which pass over the knee joint are the quadriceps and hamstrings.
• However, it is the ligaments which are the vital component of the knee joint, as they bind the joint together.
• This is why ligament tears can be serious and often require repair.

• A road traffic accident is certainly a shocking and disturbing experience. Even minor whiplash injuries can be extremely painful and as a result it is human nature to think that some long-term damage has been done.
• However, permanent damage is often rare and in most circumstances damage does not extend to the bones, discs or nerves.
• Many people only develop pain a few days after the accident, which can be attributed to the trauma that the ligaments and muscles have been subjected to.
• It is extremely important, however that if you have a violent accident and you are suffering from intense pain, you should go to Accident and Emergency, to ensure that there is no serious damage.
• This is particularly important if you have been unconscious, have experienced visual disturbances, pins and needles, numbness or weakness, or indeed had any difficulty walking. X-rays and MRI scans can detect any serious spinal injuries.
• Although the pain can subside after a few days, it is the damage to the muscles and ligaments that an osteopath can help with.
• Osteopaths such as David, have the knowledge and skill to assess your neck and also will investigate how the rest of your body has coped with this recent trauma. David will be able to advise you on the appropriate course of action to take and help your body cope with the recent stresses it has suffered.

• The specific approach to osteopathic treatment is dictated by the diagnosis at presentation, following a thorough examination and detailed history of each individual patient.

• Not every pain felt in the shoulder region is actually caused by a problem in the shoulder joint. When the problem is in the shoulder joint the pain is often felt over the front of the shoulder or in the upper part of the arm. It can appear to spread down the arm to the elbow (known as referred pain). If the pain spreads further, or if there is tingling or pins and needles, the pain probably comes from a problem in the neck.

• Each shoulder problem has its own pattern. Most conditions cause pain with use and movement, and it is worth noting which movements give most pain because this will be a good indication of where the problem lies. Most shoulder problems do not give much pain when the shoulder is at rest, other than at night, which can be a particularly difficult time. Some people cannot lie on the affected side and find it better to be propped up in bed.
• The causes of frozen shoulder are not fully understood. The process involves thickening and contracture of the capsule surrounding the shoulder joint.
• Frozen shoulder occurs much more commonly in individuals with diabetes, affecting 10 percent to 20 percent of these individuals. Other medical problems associated with increased risk of frozen shoulder include: hypothyroidism, hyperthyroidism, Parkinson's disease, and cardiac disease or surgery.
• Frozen shoulder can develop after a shoulder is immobilized for a period of time. Attempts to prevent frozen shoulder include early motion of the shoulder after it has been injured.
• Osteopathy is also frequently recommended for patients with adhesive capsulitis, (frozen Shoulder). The treatment program for these patients initially focuses on regaining a range of motion and, once this is achieved, improving strength. Multiple controlled clinical trials have documented the effectiveness of conservative physical treatment for patients with adhesive capsulitis in improving range of motion. Vigorous and repetitive exercises are contraindicated for patients’ with shoulder problems.
• Symptoms
• Pain due to frozen shoulder is usually dull or aching. It can be worsened with attempted motion. The pain is usually located over the outer shoulder area and sometimes the upper arm.
• The hallmark of the disorder is restricted motion or stiffness in the shoulder. The affected individual cannot move the shoulder normally. Motion is also limited when someone else attempts to move the shoulder for the patient.
• Some physicians have described the normal course of a frozen shoulder as having three stages:
• Stage one: In the "freezing" stage, the patient develops a slow onset of pain. As the pain worsens, the shoulder loses motion. This stage may last from six weeks to nine months.
• Stage two: The "frozen" stage is marked by a slow improvement in pain, but the stiffness remains. This stage generally lasts four months to nine months.
• Stage three: The final stage is the "thawing," during which shoulder motion slowly returns toward normal. This generally lasts five months to 26 months.

• Arthritis refers to inflammation of a joint.
• What Type of Arthritis?
• The types of arthritis include: osteoarthritis, rheumatoid arthritis, gout, ankylosing spondylitis, scleroderma and systemic lupus erythematosus. There are two main types, osteo and rheumatoid:

• Osteoarthritis is often explained as “wear and tear” to the joint, which is true to a certain extent. But what has brought on this “wear and tear” and why only that joint? Well, it can be put down to occupation (i.e. the body being used repetitively in the same way) as well as obesity (more pressure on the joint surfaces), however, sometimes it is due to altered postural and biomechanics (movement of the body). This can be caused by a past trauma, growth patterns and even as far back as the most traumatic experience in any ones life – the birthing process. Symptoms include tenderness and stiffness, which are somewhat relieved after a period of movement. Osteoarthritis is degenerative joint condition sometimes called ‘wear and tear’ affecting the spine, hips, knees, feet, and hands.

• Rheumatoid arthritis is a more complex, it is an autoimmune condition, i.e. one in which the body’s immune system attacks the body’s own tissue. It usually affects the whole body, particularly the membranes of the joints. The joints typically affected are the hands and feet, wrists, ankles and knees. These tend to be warm, tender and swollen, and the skin over the joint will take on a ruddy purplish hue. Joint deformities occur in the hands and feet, as the disease progresses.
• David as an Osteopath is highly skilled in helping patients with the effects of conditions appropriately. As the symptoms are produced largely by the inflammation around the joint, specific movements and treatment techniques can be extremely effective. By encouraging the movement of fluid around the joints and tissues, this helps to remove the inflammatory substances. In the elderly, minimal treatment can often have profound effect in reducing the pain.

• There is no cure for arthritis however osteopathic treatment can do a great deal to reduce pain, ease swelling and improve mobility and range of joint movement.
• Management focuses on eliminating symptoms through early diagnosis and improving lifestyle to prevent further degeneration.
• Osteopathic treatment involves gentle manual osteopathic techniques on joints, muscles and ligaments. This may involve gentle stretching, mobility, and traction techniques.
• Exercises to do at home may also be prescribed to improve joint function and to reduce muscle spasm.
• Provide immediate relief from symptoms
• Reduce pain and swelling
• Promote range of joint movement
• Improve mobility
• Assist in rehabilitation after surgery such as hip replacement
• Educate on how you can improve your quality of life through diet and nutritional support, posture, and exercise.

• Not only do our muscles and joints have to cope with external influences as we age, our muscles also progressively become tighter.
• The flexibility within our joints reduce, thus decreasing the body mechanism to cope.
• Aging affects parts of the body differently and slows an active lifestyle and even hinders day-to-day activities.
• Some people develop tight hamstrings, while others have tight neck and shoulders muscles.
• If you have tight hamstrings this can affect your back and cause lower back pain, and tight neck muscles can lead to headaches and even dizziness.
• Stretching helps to balance muscle groups that might be overused during exercise or physical training or as a result of bad posture.
• When a joint has limited range of motion, muscles, tendons and ligaments are at risk to strains and sprains.
• When you stretch on a regular basis the length of your muscles and tendons is increased.
• As a result of this, muscle tension is minimised and normal range of movement is increased thus improving muscle balance and posture.
• The more flexible and pliable your muscles, the less chance you will be prone to injuries.
• Everyone can learn how to stretch and it is great for all ages and levels of flexibility.
• It’s not only great for the body but also good for the mind as it induces a sense of well-being and relaxation.
• Whether you are at work in front of the computer, just finished your exercise program or watching your favourite TV show, there is no excuse! Stretching can be done almost anywhere and at anytime and is easily incorporated as part of your daily routine.

• Occurring more often in women than men, approximately 25% of women and 8% of men suffer from one some time in their lives.

• Migraines are different from other headaches because they occur with symptoms such as nausea, vomiting, fatigue, and sensitivity to light. An episode can last hours, days, or weeks, which can leave the sufferer virtually disabled for that particular time duration.
• An attack can be induced by various triggers, including bright light, certain food items, and alcohol. They can cause depression and psychological problems, however are not often caused by psychological factors. In severe cases your G.P. may refer you to a neurologist in order to rule out other causes of headache, such as sinus inflammation or a brain mass.
• The headaches tend to start between the ages of 10 and 46 and normally have some genetic components. The genetic factors are due to skeletal imbalance problems that are passed on from generation to generation. It is these skeletal imbalance problems that are often missed and if correctly diagnosed and treated go a long way in reducing the chronic pain.

• But how do you know what is the most suitable form of exercise for your particular problem? Should you jog, swim or do Pilates? Are certain stretches useful, relevant or likely to cause more pain?
• Osteopathy is a method of treatment which assesses the body’s muscle and skeletal system as a whole. The spine, muscles and joints are looked at from a postural, mechanical and structural standpoint. That is to say, how your body functions as a whole and how it responds to movement.

• The aches and pain experienced are often a sign that muscles are pulling the body out of proper or comfortable alignment. Certain areas become tight and stiff while others may have weakened. This will put strain on the spine and joints. Over time, it can lead to inflammation and even wear and tear, which then maintains the aches.
• An assessment can be very beneficial if you have been suffering from back or joint pain for a while, have recently had a baby or are about to take up or change an exercise regime.

• As a consequence of the assessment, your Osteopath will not only be able to treat the current discomfort/pain through gentle manipulative treatment, but also be in a position to note how your body will respond to exercise. That is, which areas may need stretching or strengthening, and which form of exercise may be the most suitable to cause your body least strain and most gain.
• Sacroiliac Joint Dysfunction Symptoms
  • Typical cases of sacroiliac pain behave similarly to many other lower back pain and sciatica conditions. Pain in the back, buttocks and legs is common. Tingling, numbness,

  sciatica

  and weakness in the back, buttocks and legs are also combination neurological symptoms experienced by the majority of patients. Pain can be irritated with activity, getting up from sitting, changing position and many other factors.
  

• Sacroiliac Joint Dysfunction Diagnosis
  • David as your Osteopath is qualified and experienced in the diagnosis of this physical problem, which unfortunately occurs regularly effecting many of the other lower back tissues.
  
• Everyone has a different body, different routine and slightly different cause of back pain.
• Healthy fitness is about optimising your body’s ability and potential without causing excessive stress or strain. Everyone will have different needs and a different level of ability.

• Many people spend a lot of time in the car seat, often driving under some stress. It is therefore important to try to find one, which is comfortable and can be adjusted for height, level and rake of back, height of seat and angle and distance from the
  • steering wheel.
  
  • Adjust your seat for maximum comfort so that the hips and knees are well flexed with arm relaxed and bent to the steering wheel.
• If there is little or no support to the lumbar region, fit a cushion or one of the many manufactured supports available.
• If on a long journey, stop occasionally and walk round to relax your legs and also ease your spine.
  
  • Do not over stretch your spine.
• To avoid whiplash injury, ensure that the car head restraint is positioned correctly. It should be raised to the point where the bottom is level with the top of the ears.
  
  • “You should look for a car seat that offers good lumbar support and allows you to reach the foot pedals without feeling cramped or overstretched. When driving, maintain an upright posture, adjust the angle of your backrest so that your arms are positioned comfortably on the steering wheel, and ensure that you have a clear view of the road.
• Adjust your mirrors carefully, as making full use of them will minimise the need for you to twist around in your seat. Ideally, when travelling long distances, you should
  • stop and take a break every hour”

• Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain.
• This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.