Think you’re too busy to exercise? Think again.

Exercise, running, sports injury, stress, osteopathy, Cheltenham.

So, so, SO many patients tell me they have no time to exercise.  Some are telling the truth, a child in hospital, a family to support, a baby, two babies, a mental boss, setting up a new business, mortgage, doom.

I’m no fool, I get it, there really isn’t time.  When I worked in fashion, there was a girl in our department who would do her 14/15 hour day (fashion norm) and no matter what, go training at the end of it.

 Sat at a bar drinking away my stress with a colleague one evening, I remarked that she was nuts and eventually she’d break.  My colleague turned to me and said, “No.  We will.”

My colleague was absolutely right.  That same girl still works at Condenast and is successful.  I on the other hand had a break down, retrained as an osteopath and moved to Gloucestershire #cliché.

You cannot, not have time to exercise.

Before I go in to the science, I will state the obvious.  If your body fails you, and believe me it will if you are in a seated position feeling stressed about things most of your life, then you are no good to anyone.  It’s like the aeroplane safety video, “put your own oxygen mask on before fitting others”. 

How exercise makes you a better, stronger, happier, faster, more beautiful business person/ parent/ builder/ plumber/ director/ Doctor/ cattery owner etc

1.   More oxygen reaching more muscle tissues

No biggy right?  You don’t care about muscles you just want to get through the day…….if only it weren’t for that pain in your neck/back/hip.  Well, obviously there can be any number of reasons for things to go wrong in the body but I estimate 75% of patents I see have postural related pains and strains because they are suffering something called mild ischemia in their muscle tissues. 

Ever been for a massage and told, “Oooo, those knots in ‘yer shoulders are dreadful!”  Let me walk you through those painful knots and you will see how simple it is to avoid them.

Each muscle in your body is covered in something called fascia, effectively a pair of stockings over every muscle to separate it from the next.  Then in between the muscle and the fascia is a fluid called hyaluronan.  Crucially, this fluid allows sliding between muscle and fascia and it needs oxygen to keep it slippy. 

Now, if you’ve been bunched up at a desk, tensing stressed shoulders for example it’s like clenching your fist.  In fact, clench your fist now and see what happens….is it white yet?  Yes, that’s because you are restricting blood flow and therefore oxygen. After a while it’ll hurt and you will release your fist.  However, when stressed and immobile we can’t release tension so easily and those muscles became starved of oxygen and send messages to the brain of, ‘pain’ your body wants you to do something about it i.e. move so more oxygen can reach your shoulder and back muscles.  But you don’t because there is a deadline.  Oxygen starvation continues and that slippy fluid turns to PVA glue and ‘knots’ begin to form.

Manual therapy gives temporary relief because by pressing the painful area then releasing it forces a rush of blood back in to that area flooding the starved muscle with nutrients and oxygen.

Exactly the same thing would happen if you went for a run/yoga/gym/desk stretch in your lunch break.

How much more effective would your work be all afternoon if you weren’t in pain… Still no time for exercise?

2.   Hormones

Men, I know you’re thinking you’ll skip over this one because you don’t suffer such afflictions? Wrong.

By now most of us know about cortisol, adrenaline and noradrenaline.  They are hormones.  We all have them.  We need them, but not in the quantities found kicking about in most peoples systems. 

This ties in nicely with my last rant about oxygen levels.  If we aren’t moving and lot’s of lovely oxygen isn’t reaching tissues then the body becomes physically stressed.  The pain signals flying from your aching shoulders to your brain aren’t just chatting pain, it’s telling the brain something’s wrong.  Eventually, the brain will turn to your adrenals for help.

The adrenal glands perch on top of your kidneys and in times of danger when a predator is trying to eat you, or your boss/ husband/ wife/ teenager/ accountant are bugging they will kick out the three magic hormones, cortisol, adrenaline, noradrenaline. 

This basically enables you to run away faster and more efficiently because digestion stops, blood is shunted away from your extremities (hands and feet- in case one of the predators bite it off, helps you stop bleeding out) higher blood sugar and glucose production occurs for more energy to get away. Sodium and potassium are released to help regulate your body’s pH after this scary event. 

Very good.  You escaped the predator….but not your husband/ wife/ boss/ accountant or teenager who are all still very much a part of your life.  So your body carries on kicking out the magic three and long term effects ensue.  To name a few

·      Weight gain.  Particularly around the middle which is visceral fat and has been linked to increase risk of certain cancers.

·      Increase blood pressure.  Leading to stroke/ heart attack/ aneurism etc

·      Increased cholesterol leading to stroke/ heart attack/ aneurism/ embolism.

·      Decreased immunity.  So you’re more likely to be sick all the time and miss work/ not be around for your family.

·      Poor sleep.

·      Atrophy of the hipposcampus….that means, literally, the part of your brain that is your memory, dies off.

Actually there’s loads more but I imagine this list has already stressed you out and that is counter productive to what I’m trying to do here.

You cannot necessary leave your stressful job, you can’t abandon your family and we all have to pay tax.  So most of the time, the things that stress us out are permanent fixtures and you have to work out coping mechanisms.

Like exercise.

When we exercise you release endorphins which are feel good neurotransmitters.  Endorphins curb appetite, make us feel fab, help boost libido, enhance immune response and combat the effects of stress hormones.  Fact.

4.  Vascular health

I’ll be quick on this subject.

Exercise = Increase heart rate = increase cardiac output ----à

Increased cardiac and vascular health.

Also known as Starlings Law.

This is because the heart is working harder (it gets more muscly, it is after all, a muscle, sort of) and more oxygen is reaching more tissues.

Overall you are less likely to be ill and/or die from heart disease or cardio vascular related problems.

5.  Weight

Lets do this one in plain English again.

Calories in vs Calories out = your weight.

Yes, I’m fairly certain we are all familiar with that one.  The main thing to bear in mind is more than fitting nicely into your bikini/ speedos.  Remember what I mentioned above about visceral fat?

Being heavy, or having an above average BMI for everybody means increase joint wear and tear.  So if you are over weight and do nothing you can be sure that arthritis will be an issue for you one day. 

6. Achievement

I could go on and on about how not exercising can ravage your body and mind.  However, I know, the thing that motivates people most on this subject is feeling good about yourself because your trying to do something about a situation you thought you couldn’t control

 Wine, drugs, sugar/ comfort food, TV, Instagram .…all things we use to help us ease stress.  We justify their use, we deserve it, and it’s only a little pleasure.  Fine, do it, but none of it does ease stress or improve your health.

 ‘Anything worth having is worth working for’,

 ‘Strive and you shall achieve!’

‘ Sweat is fat crying’

(I couldn’t resist that last one, ridiculous) So many motivational quotes.  When exercise becomes a part of your life it becomes like eating meal, you just do it because you feel that your body is lacking in vital sustenance without it.

You need endorphins and the other benefits of exercise I’ve listed just like you need calories.  Without it, your body will fail.

Infant Torticollis Part II- WHAT IS INFANT TORTICOLLIS?

Torticollis as I touched on in last weeks blog comes in different forms.  Congentital torticollis, when you baby is born with a twisted neck and the reason may be due to his/her position in utero or a congenital deformation of the bones in the spine or a neurological problem. Congenital torticollis ought to be reviewed by a paediatrician who may chose to send a baby for x-ray or ultrasound scans to rule out any pathological or genetic reason for the torticollis.

Then there is congenital muscular torticollis (CMT) this is develops after the child's birth (usually 2-4 weeks) and involves your baby's head tilting to one side and there chin pointing to the opposite shoulder.

Many practitioners like to subdivide.  This can vary but a straight forward guide increasing in severity is:

●Postural – Your baby prefers to have their head in a certain position but can happily move their head in all directions when stimulated by a toy or food etc It is also possible for you to turn your baby's head in both directions.  This may be due to a flat patch on the back on the baby's head from lying in one position too long or as a result of natural birth pressures through the child's cranium.

●Muscular – This is when there is tightness in a muscle called sternocleidomastoid (see diagram) your baby cannot move their head fully round in one direction, even if you are gently aiding them.  Again this could be as a result of birth strain or assisted birth e.g forceps

●Sternocleidomastoid mass  – This is when there is a thickening in the belly of the sternocleidomastoid (SCM) muscle.  There is limited range of movement in your baby's neck when they try to move themselves and when they are gently aided.  The mass could be due to a tumour but if detected your GP will have referred on for investigation.  More likely the mass is due to a rupture (or tear) in the belly of the SCM.  The tear could have occurred if the baby's shoulders were stuck and the head and neck wedged against opposing forces during birth, or from forceps/ventouse delivery.

If there is a rupture of the SCM osteopathic treatment and daily exercises for your baby are very important.  There muscle looses it's elasticity because of scar tissue from the tear.  Next week I will go through the excersises you can do at home with your baby and describe what osteopaths do to help aid the recovery of an SCM injury in CMT.

How stress affects your body

Just a quick Monday morning post about how real stress is.  I found this wonderful TEDed video over the weekend that clearly explains what the physical effects of stress on the body are capable of.  Many of my patients feel guilty about their stress levels and that all the physical pain they feel could be, 'in their head'.  Knowledge is power and having a deeper understanding of the long term effects of stress might just make you reconsider ignoring those life choices you might just be putting off....

Infant Torticollis Part I- WHEN WILL MY BABY BE BETTER!?

Torticollis is one of the most frequently occurring asymmetries of infancy and unlike plagiocephaly (flat spot on your baby's head) seems to really worry parents.  So, I hope  this blog will straighten some of the confusion out of torticollis (that was an osteopathic joke there)

Broken down torticollis means "tortus" twisted and "collum" neck.  Occasionally you will hear it referred to as wry neck.

There are two types: 

• Congentital Torticollis; baby born with a twisted neck.
• Congenital Muscular Torticollis  (CMT) baby born straight and ends up wonky.

Now, for this article I have gone to the Gods of cranial osteopathy and also to a Paediatrician, I shall tell you why.  

Most mothers come to me worried that their baby's head is so twisted the only possible solution can be surgery, and I suppose to a mother, they would expect me, an osteopath to disagree with them.  By speaking to a Paediatric registrar as well as osteopaths I have collected a balanced point of view on the course of treatment advised that will improve if not completely resolve your baby's wonky head.

When should I take my baby to the doctor for Torticollis?

There are no NICE (National Institute of Clinical Excellence) guidelines on when exactly you should take your baby to a GP for torticollis.  In  a paper written by Charles G Macias, MD, MPH et al (All the letters mean he's a Doctor) on Infant torticollis it recommends intervention at 3 months of age or older if there is no improvement before that time.  However, if you are concerned you can take your baby to a GP or paediatric osteopath at any point as they should be able to asses whether it is CMT or Congential Torticollis and more importantly spot if there are any nerve palsy's (nerves exiting the brian and spine being affected by abnormalities in the spine) or eye issues as a result or the torticollis.  Occasionally there can be a sternocleidomastoid (neck muscle) tumour/cyst causing the torticolllis.

The above has probably freaked you out, but the study also mentioned that out of 1086 infants with torticollis 90% who were treated by a manual therapist and stretches taught to parents at home improved their head tilt and did not need surgery.  

Well how long will it be until my baby is no longer wonky?!

Good question.  Depending on what you read the answer will be different and of course, depending on who you speak to and the severity of your child's torticollis.   Referring to Charles G Macias, MD, MPH et al again, the majority of CMT resolve after 4-5 months of manual therapy and home stretching.  The study showed that the earlier treatment started the faster the recovery.  

Paediatric osteopaths Giles Cleghorn (DO MSc (Ost) MSCC) and Eva Moeckel (DO MRO MSCC) subdivide CMT in to functional torticollis which is where the wonky head is caused because of muscle spasm or contracture and Torticollis caused by muscular tear.  This is significant as functional torticollis can be treated effectively over a 3-4 month period but muscle tear can take significantly longer.  If your baby tore a muscle during birth for example, it can result in a haematoma (bleeding in the muscle belly) and scarring, this reduces elasticity in the muscle.  Treatment success can not be guaranteed in this case but will reduce the severity of the twist in the neck.

So the above is a bit of a politicians answer, but there really is no way of saying, "Yes, that will be 4 treatments over a 4 week period."  but hopefully you have a better idea of the factors involved in your baby's recovery. 

These two questions are the most frequently asked and it is why I have begun with them.  Next I shall explain as clearly as I can, what exactly torticollis is....with a picture and minimal confusing wording!

Most important of all I will demonstrate the vital home stretching you need to practise with you baby to help speed up recovery.

My blood pressure? It's fine, I think....

The past few weeks I have had many patients who had no idea their blood pressure was high.  None of them smoke, drink heavily, nor were they over weight.  The only common denominator was stress.  Even more tragically a young patient was struck by a stroke out of the blue.  There was absolutely nothing about his lifestyle that could have caused it.  These events have prompted me to write about the importance of keeping an eye on blood pressure and knowing the signs.  One day you might save a loved one or even yourself by knowing them.  

High blood pressure is medically known as hypertension.  It rarely has noticeable symptoms.  Understanding risk factors can help as well as taking your blood pressure often (NHS guidelines are at least every 5 years)  if it's something that's on your mind then you can always ask your osteopath or physiotherapist to check it if you dont have time to go to a nurse or doctor (you should always have time to do this but it's a line I hear from many of my patients!) better still buy a blood pressure monitor!  

The main risk factors to be aware of are: 

* Being overweight

* Someone in your family has a history of high blood pressure. 

* Smoking

* Constant high levels of stress and anxiety. 

* Lack of excercise (you should do something that gets you out breath for at least 20 mins a day!) 

* Drinking too much alcohol

* Drinking too many caffeinated drinks such as coffee or energy drinks. 

* You are aged 65 or over

* You have a high salt diet.  

Most of us know this and most of us could admit that we do fall into at least one of the above categories.... Even me! Yet we do nothing because we are young, or feel fine, or think it is the kind of thing that won't happen to you.   

Listen to this programme By Robert McCrum on BBC Radio 4 then read that list again.  Perhaps I shan't have that glass of wine tonight after all.... 

http://www.bbc.co.uk/programmes/b0540b3p

Paracetamol does not help back pain.

This morning the results of a study on the effects of paracetamol on lower back pain were finally released.  It is of no surprise to me it has been found to be ineffective.  Even if a pain killer does help your pain, it isn't solving the cause of your lower back pain.  After years of nagging my patients it was so good to hear a GP on BBC news talk about the benefits of treatments like Osteopathy and the importance of excercise to help cure and avoid back problems.  

So to all my patients I have been nagging to get excerising and take up stretching and strengthening classes like yoga and pilates.... You've heard it from the Doctors too now! 

Now is the perfect time to check out @ellaandfleurhotyoga or contact me about any worries and questions you may have about what to do next for your specific case of back pain if pain killers won't help

E: Olivia@o-osteopathy.com

Or click to read this BBC review: 

Paracetamol ‘no good for back pain'

Ella and Fleur hot yoga

For all my patients I've been nagging to go to yoga classes!  Please check out this wonderful yoga centre in the heart of Cheltenham.  Hot yoga benefits you in many ways but particularly those who suffer muscular injuries. The warm environment helps prevent muscle strain because you don't start your practise with contracted cold muscles!  And the warm and friendly teachers  won't make you feel like an idiot if you've never practised yoga before and/or can't touch you toes! 

For more information on classes go to their website: 

http://www.ellaandfleurhotyoga.co.uk/

Paediatrics course

Day 1 of the paediatrics course with Sutherland Cranial College getting back to basics with embryology and "normal labour" it's incredible looking through the forces that are imposed on mother and baby.  Studying this in detail helps us understand why your baby might feel unsettled and uncomfortable after birth! 

Osgood-Schlatter Disease

It has come to my attention that information on how to manage Osgood-Schlatters disease and what it actually is, has not been documented particularly well online.  For the most part, people seem to have forgotten it is teenagers that suffer with this condition but nothing has been written in a way that teenagers can easily understand, or relate to....so I shall endeavour to rectify this!

First of all.  Lets bullet point this.

• Osgood-Schlatters is not a disease.  But it sounds so serious it might persuade a P.E. teacher to let you off playing netball/rugby in the rain!  Osgood and Schlatter were the blokes who 'discovered' the condition.
• Osgood-Schlatters is common, especially in teenage boys.  This is simply because the main problem is that the Quadriceps muscles grow and become more powerful than the bone it is anchored to which is still growing and if you like, slightly soft.  Has anyone reading this has ever had a puppy or young horse and been told not to over exercise it too young?  Well the same applies to you!  If muscles become more powerful than growing bones you can end up with problems (I shall draw a little picture shortly to demonstrate what I mean) girls,  broadly speaking, do not grow such large powerful muscles but I have treated young gymnasts and female runners who have the condition. 
• Can Osgood-Schlatters be cured?  Yes. But not overnight! Without treatment pain will continue until the growth plate on the tibia (shin bone) has closed up....which could be months or even years depending on your age. The official stance on treatment from the NHS is that mild cases usually settle and that rest mixed with taking inflammatory's will help.  Osgood-Schlatters will resolve faster with treatment because the faster the quads are lengthened and stretched, the faster the tension causing the pull on the tibial bone will be released.  If you do not have access to physiotherapy or osteopathy, I advise following some of the exercises I will post on this blog.  Please do not take anti-inflammatory drugs unless a medical professional advises it...even though they're available over the counter they're still powerful drugs and your livers are young and healthy and you should avoid feeding them any sort of drug if you can help it!
• Can I carry on playing the sport I love?  By far the most commonly asked question and by far the most controversial to answer!  As you can see above, the official NHS guidelines are to rest.  However,  it is worth considering how complete rest will impact on the mental health of an energetic young man/woman who perhaps is training/aiming high in their athletic field....as is often the case in the teenage patients I see.  I believe that you can continue training BUT you really ought to seek specialist advice and treatment.  Further more, stretching your quadriceps and hamstrings out every day, perhaps twice a day and ESPECIALLY before and after sport is crucial....CRUCIAL.  If you don't then you risk injury and aggravating the condition.  

O.K. thats the basic info.  Next I'll post some diagrams to demonstrate in a slightly more scientific way what I'm on about and then some lovely stretches...maybe even a video if my ex-Osgood suffering patient consents to being filmed!