Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Pelvic girdle pain is a set of very commonly occurring symptoms in pregnancy and includes the conditions of sacroiliac joint dysfunction, sacroiliac joint instability, pubic symphysis dysfunction and diastasis symphysis pubis.

These conditions are all linked as they have a very similar set of symptoms but with differing intensities and primary source of pain. They can also occur together because the anatomy of the pelvis is like a ‘bowl’ with all of the bones connected in a circle. If one of the joints is affected or dysfunctional, the other joints are also likely to be affected and cannot function normally. For simplicity, the conditions are named according to where the majority of the pain is being experienced. In most cases, there will also be symptoms occurring at the other pelvic joints simultaneously.

Anatomy of the pelvis

The sacroiliac joints lie below the dimples in your low back. Each joint is between the Innominate bone (A) and the Sacrum (B). These joints are involved in movements of the low back and hips such as walking, moving between sitting and standing, climbing stairs, etc. The pubic symphysis is the joint (E) at the front of the pelvis between the two innominates (A) at the pubic ramus (D). This joint rotates and compresses, especially during the gait/walking cycle.

A: Innominate Bone
B: Sacrum
C: Acetabulum (‘cup’ of the hip joint)
D: Pubic Ramus
E: Pubic Symphysis or joint
F: Ischial Tuberosity or ‘sit’ bone

Sacroiliac Joint Dysfunction

Pain is primarily experienced at the sacroiliac joints and tends to be a deep ache with a sharp grabbing sensation with certain movements such as standing up from a seated position.
This condition tends to be a result of muscle imbalance within the pelvis due to tightness or weakness, which effects the joint’s ability to move freely and symmetrically. Sacroiliac joint dysfunction can occur in any person and is not specific to pregnancy.

Sacroiliac Joint Instability

Pain is primarily experienced in the sacroiliac joints but to a much greater intensity than with sacroiliac joint dysfunction. This is a condition largely associated with pregnancy and can become very debilitating, especially in the final few months, with a small percentage of women requiring a wheelchair or crutches to move around. For pregnant ladies this condition occurs due to the increased levels of relaxin, estrogen and progesterone hormones which act to soften the pelvic ligaments to enable birth. In some women, especially those with prior history of lower back pain, the ligament softening occurs more than normal and results in the sacroiliac joint not being stable enough.

Pubic Symphysis Dysfunction

Pain is primarily experienced at the pubic symphysis joint at the front of the pelvis with the joint widening (<9mm). Pain may also be experienced in the sacroiliac joints, gluteal muscles and the inner thigh muscles. This condition occurs due to muscular imbalance from weakness or tightness that prevents symmetrical and normal movement/functioning of the pelvic joints. This condition can occur in any person and is not specific to pregnancy.

Diastasis Symphysis Pubis

Pain is primarily experienced at the pubic symphysis joint at the front of the pelvis with the joint widening (>9mm). Pain and disability is much greater than with pubic symphysis dysfunction. As well as muscluar soreness, many women also experience a clicking or clunking sensation in the pelvis. For pregnant ladies this condition occurs due to the increased levels of relaxin, estrogen and progesterone hormones which act to soften the pelvic ligaments to enable birth. Some women however seem to be affected more by these hormones and the joint widening is greater than normal.

What can be done about these conditions?

If you, or someone you know, is suffering any of the above conditions or symptoms you/they may benefit from seeing a registered Osteopath like Dr. David Howard. Even if the conditions and/or symptoms cannot necessarily be ‘fixed’, they can be managed throughout the pregnancy – osteopathic treatment can reduce the intensity/severity of any pain being experienced. If you’re still unsure as to whether osteopathic treatment would be of benefit to you, please feel free to call the clinic – 9379 3888 – or send through your questions/queries via the Contact Us page.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

With the turning over of a new year, you may have decided to lose some kilos and get fit. So you join the gym, take on a personal trainer or start jogging. In the first week all goes well, you get up early, sweat, run, jump and lift. Just as you start to think that this year will finally be the year that you stick to your resolution, it all goes pear-shaped and your body lets you down. Any number of things could happen… your knees start to hurt, your achilles tendon is sore, the soft tissues on the sole of your feet start to burn or you throw your back ‘out’. This results in you stopping the exercise and all of that great momentum you had is gone. So what has happened??

Your body needs time to adapt to changing levels of exercise. If you go from being sedentary to active or from low to high intensity, your body may not be able to compensate fast enough. Your muscles get tight, sore and over-loaded and your tendons get inflamed and painful. This lack of adaptation can lead to injuries like muscle tears, torn ligaments and tendonitis. It is vital to start exercise and to increase intensity slowly/gradually!

So what can you do?

*Have a check up with your GP. Your physician will inform you if you have any medical conditions (or are on medications) that will impact your ability to safely exercise. You may need to start extra slowly or avoid certain things.

*Check the ‘health’ of your running/exercise shoes. Many lower limb sporting-related issues start because of unsupportive or inappropriate footwear. It is recommended that runners are replaced every 6-12 months (or every 1000km’s). Even though they may look fine on the outside, it is the supportive aspects of the shoe that wear out the quickest.

*Don’t train too hard. You can achieve great results with medium intensity training. In fact, fat burning occurs more effectively at a moderate intensity rather than by going ‘flat out’.

*Make sure that your technique is correct with weights and other strengthening exercises. Get a personal trainer to check your technique if possible. Take it slowly, it is better to do less and do it correctly than do more and get injured.

*Give your muscles at least 48hrs recovery between workouts, otherwise they may start to break down/falter. A day off between working on a particular muscle group ensures that any micro damage has been able to heal and that the muscle has becomes stronger before challenging it again.

*Stretch – regularly! It is important to stretch after (and preferably before) any exercise to keep your muscles supple and functioning at full capacity.

*Walk before you run. (e.g. For the first week, walk 2 minutes, run 1 minute. The next week 1 minute each. The third week run 2 minutes and walk one. Etc…)

*Remember to do a warm up and a cool down. As it suggests, a warm up warms your muscles and tendons up so that they are supple, loose and ready to exercise. After exercise while your muscles are still warm is the best time to stretch.

So remember, to stop injury preventing you from reaching your weight loss and fitness goals, start and progress slowly! For further and more specific/individualised advice book an appointment with Dr. David Howard today.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

As most people spend about the same time sleeping as they do sitting at a desk, your sleeping posture is just as important  as your sitting posture. Research has indicated that 41% of people sleep in the foetal position. This posture, however, isn’t optimal in maintaining correct spinal alignment.

The best spinal alignment when sleeping is the same as when sitting, but obviously lying down – click onto this previous article for more detail. The triple C-curve of your spine is maintained and there is no excess pressure on any part of the spine. I know bad habits are hard to change but try going to sleep correctly and hopefully your sleeping body eventually gets the picture. We will start from the top…

*Neck straight with your chin away from your chest
*Good supportive pillow filling the gap between your head and shoulders - click onto this previous article for more detail
*Arms in front of you or hugging a pillow
*Maintain the curve in your low back or lumbar spine by having your knees below the level of your hips
*Both knees should be together so that the back is nice and straight. (Many people, especially women with larger hips will find this uncomfortable or impossible. Placing a pillow between your knees will remedy this).

Your bed may be the culprit…

Goldilocks wasn’t wrong… your bed shouldn’t be too hard or too soft, it should be just right. A bed that is too soft will not support your spine enough and a hard bed will not allow your pointy/bony bits to sink into the bed to enable correct spinal alignment.

A bed lasts 7-8 years before the internals start to fail – How old is yours?

Your bed should be at least 15 centimetres longer than you are

If you sleep with a partner, don’t settle for anything smaller than a queen size bed. The average sleeper turns 40-60 times a night – if there is not enough space, you will keep waking each other up.

Buy the best bed that you can afford - there seems to be a strong correlation between cost and quality.

If your current bed is too hard and not very old, consider buying a pillow top in latex or memory foam to save buying a whole new bed.

Some tips for sleeping posture when pregnant

Silk, or other shiny PJ’s, will allow you to slide when turning rather than having to lift your whole body weight

Invest in a pregnancy pillow. There are full length ones or those just for under the belly – and they really do make a difference!

If you are suffering from hip region pain at night or when you get up, your bed may be too hard with your change in weight distribution. Regular egg carton foam underlay can drastically improve your symptoms.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Although we all love the idea of having a 6 pack and a flat stomach, doing lots of stomach crunches isn’t the key to strengthening the mid section – focusing on the core is! Not only does having a strong core act like a corset tightening the midsection, it is also vital in preventing lower back pain and injury. Strong core muscles are your own internal back brace when lifting or going about your everyday activities. This type of exercise also trains you to be more conscious of your posture which further helps in preventing injury.

The Muscles

The function of the core muscles is to stabilise movement of the lumbar spine and pelvis before and during any movement. There are two types of muscle fibres in the body – fast and slow twitch fibres. Fast twitch fibres can be found in muscles like the biceps whose function predominantly involves short, fast and strong contractions (i.e. when lifting something).  Slow twitch fibres are your postural muscles like those of the core, whose function is to contract softly yet over a long period of time. The exercises therefore to strengthen the core are slow and controlled and initially require a lot of concentration to do correctly.

The key muscles of the core are the Transversus Abdominus, Multifidus, Internal Oblique and the pelvic floor. When all of these muscles contract together, they produce pressure within the abdomen which stabilises the lumbar spine. This core ‘protective system’ is very intelligent – as you think of performing a movement, the muscles contract ready for when you do the movement.

Since these muscles have a postural and stabilising function, they need to be strengthened when your spine and pelvis is in the correct alignment. These muscles don’t need great strength but instead need endurance. The key to training the core is doing it regularly, carefully and correctly.

The basic contraction

*Lie on your back with knees bent
*Your lower back should be neither arched nor flattened against the floor, but aligned normally with a small gap between the floor and your back. This is ‘neutral’ spine.
*Breath in deeply and relax all your stomach muscles
*Breath out and, as you do so, draw your abdomen below your belly button back towards your spine (i.e. like you are trying to zip up tight jeans)
*Breath in and out normally whilst holding this contraction for about 10 seconds
*Repeat 5-10 times
*It is vital that this is done correctly in order to get the most benefit.

Some points to keep in mind

*Visualise the deep abdominal muscles as a corset that wraps around the abdomen
*Place one hand above the belly button and one below
*Only the bottom hand should be feeling the abdominals tightening
*You shouldn’t be feeling much of a contraction in the 6 pack muscles (above the belly button)
*You should be able to breathe relatively normally during the ‘hold’ phase of the contraction. If not, you may be trying to contract the muscles too hard
*Don’t hold your breath
*Don’t brace too hard, you are aiming for endurance not strength
*Don’t bear down (i.e. as if you are going to the toilet). You should feel a lifting of your pelvic floor, not downward pressure.

Taking it up a notch

Now it’s time to further challenge the core. With these next exercises start with the basic contraction, then:
*Slide one leg along the ground and return to starting position
*Let one knee drop out to the side then return to starting position
*Lift one foot, then the other, off the ground with the knee joints at 90 degrees
*With both feet planted, slowly raise the hips off the floor and move your pelvis towards the ceiling

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

These 1st aid tips can be applied to any soft tissue injury, such as hamstring strains, pulled calf muscles, shoulder strains, corked thighs and sprained ankles.

First 48 hours

The first action to take as soon as possible after the injury has occurred is RICER – Rest, Ice, Compression, Elevation, Referral. This should continue for at least 48 hours after the injury as occurred. RICER helps to reduce bleeding, swelling and pain in the soft tissues. It therefore makes the recovery and healing process much faster.

Rest: Keep the body part as still as possible. This prevents further damage and slows down the bleeding in the soft tissues.

Ice: Ice is very important in reducing bleeding, swelling and pain. Never apply ice directly to the skin as it can burn. Wrap the ice source in a damp towel. Ice can mean anything from a bag of peas, a cold pack or ice cubes, whatever you have access to is fine just as long as it is very cold. Apply the ice for 20 mins, roughly every 2 hours, for the first 48 hours. Avoid pain always and use discomfort as a guide as not everyone will be able to put up with icing for a long period of time. If you are sensitive to the cold, it is better to do 3-5 mins every hour than none at all.

Compression: Reduces swelling and bleeding and also provides support to the area, reducing further injury. Use a firm elastic compression bandage  over the injured area as well as above and below. Routinely check to make sure there is good blood flow into your finger tips and/or toe tips.

Elevation: Raise the injured area above the height of the heart as frequently as possible. This reduces blood flow to the injured area so decreases bleeding and swelling.

Referral: Visit an osteopath to ensure correct diagnosis and treatment. A scan may be warranted to confirm the extent of the injury.

AVOID: Heat of any type as this increases the bleeding and swelling (i.e. heat lamps, heat creams, heat packs, saunas, spas) / Massage / Alcohol.

After 48 hours

Get weight bearing and moving within pain limits to prevent formation of inflexible scar tissue which can result in the area being weak and reinjured easily. Very light exercise, movement and mobility gets blood into the injured tissues and with it the nutrients needed to continue healing.

Avoid any activity that causes pain.

Osteopathic treatment (including soft tissue massage, mobilistaion and stretching) to physically loosen up the involved soft tissues, and to remove any of the biomechanical factors that may has caused the injury and may impair full healing.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Most of us, hopefully, spend at least 8 hours a night with our head on a pillow. This can become a big problem if your pillow is not supporting your neck correctly.

The spine in your neck curves in order to evenly distribute the weight of your head when upright. Whatever position you prefer to sleep in, it is important to keep your spine as close as possible to its correct alignment - which is how it is when upright. This means that the natural curve is maintained and the shoulders aren’t squashed.

Symptoms of a bad pillow

If your neck is not supported correctly when sleeping, an array of symptoms can develop such as:

Neck pain
Headaches
Migraines
Shoulder pain
Numbness and tingling in the hands (due to the nerves and blood vessels being squashed)
Upper back pain
Lower back pain
Neck stiffness in the morning
Restlessness/tossing/turning at night (which will negatively affect your immune system) 

What happens when your pillow is not right…

Too High

Your neck will be bent away from the bed, stretching the muscles and taking the spine out of alignment.

Too Low

Your neck will sag towards the bed putting a strain on the spine and neck muscles. If you are a side sleeper it will squash your shoulder, and also make you more likely to roll your leg forwards which puts your lower back in poor alignment.

No Contours

If your pillow has no contours it is harder for the natural curves of the spine to be maintained. A supportive pillow with contours fills the neck arches and therefore maintains the correct curves. It can also take pressure off your shoulder if you sleep on your side.

Is your pillow ok?

Here are some questions to ask yourself about the pillow you are currently using:

Is it more than 2 years old?
When you lie on your side do you feel pressure on your shoulder?
Do your sleep with your arm or hands under your pillow?
Do you try to support your neck with your hands when sleeping?
Are you constantly fluffing up your pillow?
Do you try to bunch your pillow into your neck for more support?
Do you toss and turn?
Do you have any of the symptoms mentioned above such as neck pain and headaches?
Do you wake up in the morning with a stiff neck?

If you have answered YES to 2 or more of the questions you need a new pillow as you are probably not getting the neck support that you need!

How to get it right…

How do you sleep?

If you are a back sleeper, the pillow needs a contour to mould to the back of your head and neck. It will be lower than those who sleep on their sides.

If you are a side sleeper the width of your shoulders determines how high the pillow needs to be.  The broader you are the higher the pillow needs to be as the gap between the side of your head and your shoulder is greater. There also needs to be a contour to maintain the correct alignment of the spine as there is a difference in height between the side of your head and your neck.

Avoid sleeping on your stomach. If you’re finding the habit hard to break, you will need either no pillow or a very thin pillow as a higher pillow will turn your neck further to the side and produce more strain.

How hard is your bed?

With a soft bed you need a lower pillow as your shoulder sinks into the bed. Therefore you need a higher pillow with a firmer bed.

How much do you weigh?

Your weight also effects which pillow is correct for you as it effects how far you sink into the bed.  The heavier you are, the lower the pillow needs to be.

Get someone to check you out

A great way to check if your pillow is the correct height is to get someone to look at you lying on it! If you are a side sleeper, from behind your neck should look straight - not bent up or down. If you are a back sleeper then your neck should look like it does when you are upright with your chin a good distance from your chest. If you’d like me to check your pillow/sleep positioning, feel free to bring your pillow in with you to your next osteopathic consultation.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

With technology being a big part of our lives these days many people spend long periods of time at a desk or in front of a computer, whether it be at work or at home. Poor desk set up and poor sitting posture are huge contributing factors to the many and varied symptoms of a large percentage of my patients.

Some symptoms of poor desk posture:

Headaches
Neck pain and tightness
Shoulder tightness
A feeling that you can’t sit up straight
Pain in between the shoulder blades
Shoulder and arm pain

If left for too long, these symptoms can develop into more serious issues such as:

Rotator cuff tendonitis (inflammation of the tendons of the shoulder muscles)
Bursitis of the shoulder (inflammation of the lubricated balloons between muscles)
Numbness, tingling, weakness and pins and needles in the arm.

Correct sitting posture:

Your butt should be right up against the back of the chair, as you can’t slump in this position. Your knees should be a bit lower than the height of your hips. Your arms should be hanging at your side with your elbows at 90 degrees. The wrists should be straight. Both feet should be flat on the floor. This position may feel quite uncomfortable to begin with because your body is likely to be ‘stuck’/used to your previous poor posturing. You may need to work up to sitting properly for long periods gradually.

If you are a leg crosser, the habit will be hard to get rid of but just regularly check in with yourself and uncross them. Hopefully you can kick the habit quickly!

Correct desk setup:

Move anything from under your desk that stops you from sitting straight and facing forward (i.e. filing cabinet, rubbish bin).

Adjust your chair height so that the top of the desk is at elbow height.

You should position the items on your desk so that you are not reaching too far for anything (i.e. phone).

Correct computer setup:

Your computer screen and keyboard should be directly in front of you. The top of the computer screen should be in line with your eye level.

The mouse should be right next to the keyboard. You shouldn’t have to reach far to use it. The top of your arm should be hanging straight down from your shoulder, not slightly forwards or backwards. If your arm if not hanging straight down, you are unnecessarily using muscles in your shoulder which can cause tightness and strain.

If you are typing from a paper document, it is best to place it between the screen and the keyboard.

A wrist support can greatly take the strain off you hands and wrists.

Correct Laptop setup:

If you are often using a laptop, I strongly suggest getting a separate keyboard so that you can place the laptop on a stand to get the screen to the correct height and distance. Looking down at a laptop screen for long periods can cause many problems in the neck and shoulders.

How can I help you?

If you have been sitting at your desk for many months/years with poor posture, your body would have been compensating for this and no doubt there will be both primary (strains/sprains/disc irritation) and secondary issues (scoliosis/twist in the spine). Osteopathic ‘hands-on’ treatment can help to undo all the hours, weeks, days and years of sitting badly and help return you to good posture. I can also give you specific stretching and strengthening exercises to help you maintain your good posture.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Sitting at a desk and tapping away on a computer all day is not what our bodies are designed to do. A large number of my patients suffer from ‘complaints of the arm, neck and/or shoulder’ – also known as CANS. This is a musculoskeletal condition that is not caused by acute trauma or any systemic disease, just by poor sitting posture. Interestingly, computer workers more often experience pain in the neck and shoulders than the hands and forearms. This is unexpected as the muscles used to type and control the mouse are predominantly in the hands and forearm.

CANS causes pain across the shoulders and often up the side of the neck. In more severe cases, the patient can experience headaches, numbness, tingling, pins and needles in the arms.

The position of an office worker’s poor posture is most commonly slumped with the head positioned forward and the shoulders rolled in. This anterior, or forward, position of the neck puts a huge amount of extra stress on the muscles of the shoulders and neck causing them to become overloaded, tight and painful.

Some of the nerves and blood vessels that supply the arm exit the neck by passing through the neck muscles, under the clavicle (collar bone), under the pec (chest) muscles, through the arm pit and into the arm. The muscles that are predominantly affected by poor sitting posture are the ones that this bundle of nerves and blood vessels pass through. The pressure of the tight muscles onto the nerves causes tingling and numbness, the pressure onto blood vessels effects blood supply to the arm causing pins and needles or makes the arm “go to sleep”.

The research into this common condition informs us that there are several other factors that influence the pain experienced by patients. Things such as high stress levels, inflexible work ergonomics, and having no/limited breaks at work all increase the likelihood of experiencing the symptoms outlined above.

Interestingly, women experience CANS more often and to a greater degree then their male co-workers in exactly the same conditions. In a year, 51% of male computer workers experience CANS verses 72% of women. The research suggests that the reasons behind this discrepancy include differences between the male and female body, that women tend to work without a break for longer than men, and due to the higher likelihood of extra stress on women from running a household and taking on childcare duties in addition to their work stressors.

What can you do about it?

There are several things that you can do to prevent and manage CANS.

Make sure that your desk is set up properly. Your computer screen and keyboard should be directly in front of you. The top of the computer screen should be in line with your eye level (this is why laptops with their low position are not ideal!). You should position the items on your desk so that you are not reaching too far for anything (i.e. phone).

Make sure you are sitting properly. Your butt should be right up against the back of the chair as you can’t slump in this position. Your arms should be hanging at your side with your elbows at 90 degrees. The wrists should be straight. Both feet should be flat on the floor. This position may feel quite uncomfortable to begin with because your body is likely to be ‘stuck’/used to your previous poor posturing. You may need to work up to sitting properly for long periods gradually.

Get semi-regular treatment with an osteopath! If you can’t quit your job, you need to regularly “service” your body – just like your car - to decrease your symptoms or to prevent them from developing. How often you need “servicing” depends on your body and work stressors – you may need treatment every fortnight or once every 2-3 months, everyone is different.

Stretch – regularly! There are some recommended stretches below. These can decrease the tension in the muscles. I have patients that have an alarm set on their computers to remind them to have a short break and stretch every hour, but even twice a day will do for most people.

Torso Stretch

Seated or standing, lace the fingers together and stretch them up towards the ceiling.  Stretch up as high as you can and lean back slightly over the back of your chair.  Hold for 15 seconds.

Shoulder shrugs

Seated or standing, lift the shoulders up towards the ears, squeezing them lightly. Hold for 1-2 seconds and roll them back as you relax down. Repeat for 8-10 repetitions.

Neck stretch

Sitting in your chair, reach down and lightly grip the side of the seat of the chair with the right hand and gently pull up whilst taking your left ear to the left shoulder, feeling a stretch down the right side of the neck and shoulder. Then, slightly rotate your neck so that your nose is pointing towards your left armpit.  Hold for 30 seconds and repeat on the other side.

Upper back stretch

Seated or standing, stretch the arms straight out and rotate the hands so that the palms face away from each other. Cross the arms so that the palms are pressed together, contract the abs and round the back, reaching away as you relax the head. Don’t collapse but instead imagine you’re curving up and over an imaginary ball. Hold the stretch for 30 seconds. If twisting the arms doesn’t feel good, simply lace the fingers together.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Other common names for a disc bulge are: disc prolapse, disc herniation, blown disk, slipped disc and pinched nerve.

A Doughnut…

We first need to understand a little more about the disc.  The best way to describe it is a comparison to a jam doughnut!

The disc is made up of a strong outer layer (the crusty outside), lots of water (the soft, squishy dough) with an inner core or nucleus (the jam).

Moving Disc

With a doughnut, the jam can be squeezed around depending on where you put the pressure on the bun. If you squeeze it too hard, then the jam will likely escape.

It is just the same with the disc. When you bend forwards or sit down, the pressure is placed on the front part of the disc. This has the effect of squeezing the disc core (shown in red in the picture) backwards. The more bending forward or sitting you do, the more you are encouraging the disc material to move in a backward direction.

If you decide to lift something with your back bent, then you are adding a tremendous force to your disc. Basically you are asking for trouble!

Prolapse, Herniation, Bulge… it’s all the same thing!

And so, if pressure is placed onto a part of the disc, the central core material will be squeezed to the area of least pressure (away from where it is being squashed/compressed).

If there is too much pressure on the disc or too frequent high pressure on the disc, it can bulge out into the outer wall. This is when you get a disc bulge, prolapsed disc or slipped disc! This bulge in the disc can then press on the spinal cord or nerves as they pass out from the spine. This pressure on the nerve effects its ability to function causing pain, numbness, tingling and weakness.

Symptoms

Symptoms of a prolapsed disc can vary widely. They can range from simple localised lower back pain to very intense leg pain, weakness, numbness and/or pins and needles. The leg symptoms are most commonly down the back of the thigh, the outer side of the leg and the top of the foot. You may have difficulty walking due to muscle weakness or spasm. The symptoms tend to get worse with sitting, sneezing, coughing and going to the toilet as there is extra pressure on the disc and therefore also the neural structures (nerves). Disc bulges can occur in any age group but are most common between the ages of 20-45 when the disc is most mobile and hydrated. Unlike the typical ‘movie version’ of someone lifting a heavy weight and then collapsing on the ground, the most common way that the symptoms start is actually the next day after lifting something heavy. Patients commonly wake up not being able to move and in pain.

Treatment

Treatment is usually conservative with manual therapy such as osteopathic treatment to get everything around the affected disc moving/healthy to decrease the pressure/work-load on the disc. However, in severe cases, especially those involving chronic pain (longer than 3 months) and muscle weakness, surgery may be required. Exercise such as core strengthening and swimming are of great benefit. Anti-inflammatories and ice can help control the symptoms. In general, it can take about 12-24 weeks for disc bulge symptoms to abate however there will be a weakness in the disc for the rest of the patient’s life. Regular treatment and strengthening exercises will be needed to help prevent reoccurance/flare-ups.

How do I prevent it??

*Get regular maintenance osteopathic treatment, especially if you lift often in your day to day life such as trades-people and parents of young children. Treatment will ensure that all of your joints are working properly so that one joint isn’t getting most of the load.
*Use good lifting technique. This means using your legs, not your back! Rather then bending at the hips and back to pick up your child, bend at your knees keeping your back straight!
*Tighten your core stabilising muscles whenever you lift something. If you don’t know how to do this, ask Dr. David Howard next time you have an appointment or start clinical pilates.
*Stretch - REGULARLY. My definition of ‘regularly’ is every day. It doesn’t have to be for long – simple and frequent is better than complicated and infrequent!  
*Keep your weight within the healthy range for your age and height. Being overweight puts much more strain on your joints and discs which increases the chance of a bulge.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Sciatica is a set of symptoms rather than a specific diagnosis. The symptoms are generally buttock pain and a sharp pain down the back of the thigh and sometimes into the calf.  Occasionally, when severe, there may be numbness, muscular weakness and tingling in the leg.

The sciatic nerve is the largest and longest nerve in the body. It originates from 5 smaller nerves from the spinal cord in the lumbar spine (lower back) and passes through the pelvis, buttock and into the leg.

The symptoms of sciatica are produced by pressure onto the nerve which decreases its ability to function and causes pain. There are many different causes of sciatica as there are many different parts of the body where it can become compressed.

Here I will outline a few of these causes:

Piriformis Syndrome

When the sciatic nerve passes through the pelvis, it travels through, under or over the piriformis muscle.  If this muscle gets tight, it can then compress the nerve. This is one the most common causes of sciatica and is easily treatable with osteopathic manual therapy and stretching.

Disc bulge or prolapse

This topic is also covered elsewhere on this website – click here for further detail. The spine discs are like shock absorbers between the vertebral bones. The disc can bulge and compress one of the 5 smaller nerves that make up the sciatic nerve as they exit the spine. This can be quite a serious condition causing severe pain, numbness, tingling and weakness in the legs.

Pregnancy

In the later stages of pregnancy, the uterus itself can compress the sciatic nerve causing the symptoms. Due to the change of posture and extra strain on the body, trigger points, piriformis syndrome and sacroiliac dysfunction are more likely to occur (these are described below).

Osteophytes (bone spurs)

As part of the process of arthritis, bone spurs can grow on the vertebrae.  These bone growths can press on nerves as the exit the vertebral canal, therefore causing the sciatica symptoms.

Here are some causes of Pseudo-sciatica. This is a condition that can have symptoms like sciatica but have nothing to do with the sciatic nerve at all.

Trigger points

The pain experienced is actually referred pain. This means that the pain is felt somewhere distant from its cause/origin. A trigger point occurs when a portion of the muscle becomes ischemic. This means that it hasn’t had enough blood supply. This can occur with injury or long term muscle tightness. Trigger points causing sciatic-like symptoms are most commonly found in the ‘glute’ (buttock) muscles or in the deep hip muscles.

Sacroilliac joint dysfunction

The sacroiliac joints are the two large joints at the back of the pelvis (either side). These quite commonly become inflamed or irritated and may cause referred pain in the lower back, around to the groin, or down the backs of the thighs.

So what can you do about it???

*Always sit with good posture and both your feet on the ground.
*Never sit with your wallet in your back pocket – you are just asking for piriformis syndrome!
*Lift properly. This means using your legs, not your back. The fastest way to get a disc bulge is to bend forward, twist then lift something.
*Keep your weight within the normal healthy range so you’re not putting extra pressure on your discs and pelvic joints.
*Get treatment and advice. Osteopathic treatment can assist with all causes of sciatica and pseudo-sciatica explained above.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.