All posts by Daniel Gerber

About Daniel Gerber

Daniel Gerber is an osteopath in Glasgow, Scotland.

Rocktaping the Hoka Highland Fling Race

Running the 2015 Hoka Highland Fling? Annoying niggle or pain? I’ll  Rocktape it for free on (although a little donation to charity would be appreciated) on Friday the 24th of April the day before the race.

Reason why I’m offering free taping

The 2015 Hoka Highland Fling is in 2 days (at time of writing this). Yesterday, I had a patient in who was entered in the fling, suddenly grow worried that a little training niggle was going to cause them to DNF or potentially if the worry increased DNS. In the time available I can’t treat and a get you to complete a rehab routine, but with Rocktape I may be able to help you get through the Fling.

I treat runners nearly everyday that I’m in clinic and I know how much time and training effort goes into preparation for an ultra, so I want you be the best you can be. I want you to run. So It’s my turn to give back, I’m taping for free, and rocktape.uk have given the tape as any proceeds given will go straight to charity (hospices in Glasgow and Leeds)

If you do have any problems I will be running the taping as a drop in session. either drop in and wait, or put your name on the list and come back. I’ve already had a few people arrange to get Rocktaped and meet with a few other people traveling to Glasgow for the fling. So we could end up being the early social centre for the fling!

This is obviously an old post now, but the feel for the need to tape can apply to any race..If you have any worries make an appointment.

If you need taping this may be good to read so you’re get the best results. Prepare for taping

 

5 Rules for Rocktaping

What you need to do before applying Rocktape

I described Rocktape as both duct tape like, and as adhesive tape that we sometime put on your skin. Just like any other kinesiology tapes there area a few rules to follow to  help it stick and last longer. So here’s a quick list to help you with your taping.

fell runner with rocktape kinesiology tape on knee
Runner with Rocktape on Knee
  1. Make sure the area is clean: naturally occurring grease and oils in the skin can stop Rocktape sticking
  2. No lotions or creams: Just as naturally occurring oils can stop adhesion, so can moisturisers, sunblocks and midge repellants. Tip apply after tape, but try and keep off, as some may dissolve adhesive
  3. Dry area for application: leave applying for a few minutes if just out of the shower or bath, just to allow the area to dry properly. Sweat can also stop kinesiotapes from sticking. Both of these can cause a problem if out running and you want to apply. Sometimes it feels like it’s either wet from sweat, or the rain, sometimes both (been there done it!). Tip see if you can find a wall/tree/hedge to give you just a little lee to protect from elements.
  4. Shave area?: You don’t have to shave the area, but when you have to peel the rocktape off it doesn’t hurt as much (you can thank me later for that!) I don’t like the area shaved smooth as hair could be described as part of a sensory organ, so it may help the tape work better. Stubble is a good compromise.
  5. Can you do it: Make sure everything you need is easily reachable before you start applying. All the pieces of tape, scissors if you haven’t pre-cut (although I still sometimes find I need to shorten it mid application) and instructions if you’re not sure what you’re doing.

This sounds very arduous, but in reality it’s quite easy to do. If you need to be taped for an event, I will try to make sure that you can apply to yourself before you leave.

High Hamstring Tendinopathy

High Hamstring Tendinopathy

It’s also known as proximal hamstring tendinopathy or high hamstring tendinitis and refers to inflammation of the common origin (ischial tuberosity) of the hamstring muscles. The origin is where the muscle attaches to the bone.
Having a quick internet search there seem to be 3 main causes or reasons associated with the onset

  1. Over use. This seems to be the most commonly written about on the internet. Specifically in relation to middle or long distance runners
  2. After back pain. This seems to be due to the pain irritating the sciatic nerve, The cause of the sciatica nerve irritation doesn’t appear to be indicated
  3. Traumatic or sudden onset. Possibly due to a slip or slide and sudden contraction of the biceps femoris pulling and irritating the tendon and where it attaches to the bone. There also seems to be where the fibrosis or sticking of the sciatic nerve to the muscle occurs.

Other causes are given below, but I think these are better thought of as maintaining factors.

  • Adhesions between the sciatic nerve and one of the  hamstring muscles.
  • The fascia covering the hamstrings is scared and bound to other structures and as a result may inhibit sciatic nerve function, and also shorten range of motion.
  • Gluteal weakness can cause overuse of the hamstring muscles. This can cause shortening and tightness in the hamstrings and potentially lead to high hamstring tendonopathy.

Symptoms

High Hamstring Tendinopathy gives you pain in the lower buttock on the part of the pelvic bone you should be sitting on. The pain in the buttock has been described as very sharp or like a tooth ache all the time. There doesn’t seem to be any inflammation in the ischial tuberosity although it’s painful to pressure, most notably sitting. When I had this I wasn’t able to sit comfortably for about 6 months. The pain I had when driving was almost unbearable.

Contraction of the hamstring muscles causes pain in the buttock as does a hamstring stretch . Standing does not cause pain buttock although a slight pull maybe noticed in back of the knee on the outside. Tightness may also be noticed  in the upper hamstrings.

Management

  • 1st stop running/exercising if this is the cause.
  • Next, deal with any active inflammation. Ice around the insertion and tendon. Heat in the muscle belly feels good and may help release any tightness in the muscle itself.
  • In the early stages do not stretch the hamstring muscles, as this will pull on the tendon and further irritate it. I found rollering ineffective.
  • Get it examined so it can be diagnosed and treated as quickly as possible as this may shorten the duration of the condition.

Treatment

Treatment by an osteopath is always based on the needs of each individual patient, because of that it is hard to give a definitive treatment guide.

To manage the potential link between low back pain and sciatica nerve, treatments I have  in the past have included soft tissue techniques to the Iliolumbar Ligament, Lumbar Erector Spinae, and Multifidus. Sometimes manipulation on the lumbar spine may be necessary although articulation can be used instead. Also soft tissue to the gluteal area and the deep hip rotators (piriformis and it’s relationship with the sciatic nerve deserve extra attention), but taking care to avoid the ischial tuberosity and the proximal part of the hamstrings.

When treating the hamstring a variety of soft tissue/massage techniques are used. The techniques chosen depend on the goals for that particular stage of treatment. I normally take care to not stress or tension the upper hamstring tendon until the later stages of treatment.

Conclusion

High hamstring Tendinopathy is a debilitating condition that can affect many aspect of your life. Simple things that we take for granted such as sitting down and eating a meal to leisure activities like running can become excruciating. I don’t want that to happen to you.

Not only have I treated high hamstring tendinopathy, I’ve  suffering from it as well. I understand the frustration that it can give, so aim to get you back to your normal activities as quickly as possible. I have the experience to diagnosis, treat and also advise on a rehabilitation program to try and stop it reoccurring.

Please note. I can’t give a diagnosis online, If you live or work in the Glasgow area it may be an idea to book an appointment.  Click to book an appointment now.

Diagnosing ME/CFS – further research

Research into the diagnosis of Myalgic Encephalomyelitis

A diagnosis of ME/CFS is usually made by exclusion. If you have been diagnosed with ME or CFS you know what this means. If you haven’t or you’re waiting for a ME diagnosis it can be extremely frustrating. This piece of research is important because it could potentially be key to getting The Perrin Technique and it’s “instant” diagnosis through the NHS

An earlier very small scale study was performed by Professor Basant Puri using part of the diagnostic procedure developed Raymond Perrin. This earlier showed very promising results. Dr Perrin is trying to take this research further.

Over the coming weeks I aim to break the outline for this planned research down into small easily understandable chunks. Below is Dr Perrins summary account of the research.

SUMMARY OF NEW RESEARCH PROJECT 2013

Examining the accuracy of a physical diagnostic technique For Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

                       

The novel manual system of diagnosis being examined was developed in 1989 by the principal investigator Raymond Perrin. The diagnostic procedure used in this technique focuses on certain physical findings, namely specific tender points in the chest and abdomen, the presence of palpable varicose lymphatic vessels in the chest, restricted and posturally dysfunctional thoracic spine and a disturbed cranial rhythmic impulse (CRI).

Illness behaviour can be defined as relatively distinct but subtle behavior, posture, mannerism and/or responses which may happen in patients with long term health problem. If the presence of physical signs were demonstrated  to be significant in CFS/ME  then this will demonstrate that one can tell that somebody has CFS/ME not only by  observing obvious illness behaviour.

Following the first oral hearing on Tuesday 18th April 2006 of the Gibson Enquiry at the House of Commons, it was generally concluded by those present that an earlier diagnosis would usually lead to a better prognosis when treating CFS/ME.  The published report from the Gibson enquiry of Nov 2006, described The Perrin Technique as “a useful and empirical method which although unorthodox should not be dismissed as unscientific and that it required further research”. The most recent survey carried out at The University of Bristol in September 2011 claimed that CFS/ME affects up to 2.6 per cent of adults in Britain. A quicker diagnosis would thus reduce the huge financial burden placed on the health service by reducing the need of some of the specialist services used and the pathological tests carried out at present.

The new research will evaluate a major principle behind the Perrin technique which is the presence of specific physical signs in CFS/ME patients. The research study, is a practical method to confirm or refute this main principle of the Perrin technique. Subsequently, this should inform the Perrin practitioners, CFS/ME patients and general clinicians about the role this technique may or may not play in the management of CFS/ME patients.

Aim

The aim of this study is to explore if there is validity in the use of specific physical signs as an aid to diagnosing CFS/ME

METHODS

Recruitment

100 participants will take part in the study which will consist of CFS/ME patients and healthy controls.

Groupings

Group 1 will be around 50 volunteers who have been selected consecutively by the research assistant from a larger group who have been diagnosed by consultant in the NHS and confirmed as suffering from CFS/ME using an informal interview screening tool based on the NICE guidelines.

Group 2 will be around 50 healthy controls again selected consecutively from a larger group of volunteers by the research assistant and who have been matched for age and gender with the patient group  and confirmed as not suffering from CFS/ME using an informal interview screening tool based on the NICE guidelines.

 

Health professionals involved the study

The examination of the participant using the Perrin Technique will be carried out by a trained chartered physiotherapist with a few years experience in this specific manual technique working with CFS/ME patients and the other a registered osteopath who has been recently trained in the manual technique specifically for this study with little or no prior experience of CFS/ME patients. Training of the osteopath in question should only take around two weeks working in The Perrin Clinic under the guidance of Dr Perrin. When the osteopath is having his/her training, he/she will only stay in the treatment room for Dr Perrin to demonstrate the physical signs and then leave to let Dr Perrin carry on with his consultation. This will be done to minimise the osteopath’s ability to use anything other than the Perrin signs to reach their final conclusions during the study. The third clinician involved in examining the participant will be a physician who will be selected due to a reasonable knowledge of CFS/ME and have had experience working in an NHS clinic for CFS/ME. They will not have had any experience regarding the physical aspects of the Perrin technique.

Examination of Participants

The participant will see all three practitioners on the same day. This will take place no later than 1 month of being accepted onto the study.

The examination of the participant by both the physiotherapist and osteopath will follow the same  protocol as developed by Dr Perrin.The NHS physician will examine the participant using a standard clinical neurological and rheumatological examination.

 

The basic method of this project is represented in the flow chart below:

RECRUITMENT

Recruitment and Research of ME/CFS research

RESEARCH COMPLETED AND RESULTS PUBLISHED

 

Timetable

 

January 2013                                                           Recruitment of research assistant,

NHS physician and osteopath.

 

May 2013                                                                 Begin recruitment of volunteers and proceed with

diagnostic instruments.

 

December 2013                                                      Complete recruitment of volunteers and diagnosis.

 

January 2014 – April 2014                                   Analysis and documentation of results.

 

May 2014 +                                                            Publish results and dissemination of findings through

relevant conferences and patient groups.

 

 Costs

The costs of this research project have been calculated as being no more than £60,000 for the year and are being fully funded by the FORME Trust,  Charity No 104 5005.

 

 

10 Causes Of Buttock Pain

We’ve probably all had buttock pain at some time, from a numb bum because you’ve been sitting too long, to the  sharp shooting pain of sciatica. Buttock related pain or hip pain as some people describe it because they feel it around the big hip or pelvic bone can range from mild to severe. In some cases, it can significantly affect a person’s quality of life and their ability to perform activities of daily living. Pain in the buttock area can be caused by buttock structures, or it can be referred  from other areas of the body, such as the lower back or thigh muscles.

Sciatica:

This is not a diagnosis, it’s really a description of pain in the distribution of the sciatic nerve. The sciatic nerve is the longest nerve in your body. It starts in your low back, then runs from the back of your pelvis, through your buttocks, and all the way down both legs, ultimately parts of it end at your feet. When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back into your buttock and can travel down your leg to your calf.   Sciatic pain can range from being mild to very painful.

Sacroiliac Joint:

This is sometimes shortened to  SI joint, S/I joint or occasionally SIJ. This is the joint between the triangular sacral bone at the base of the spine and the iliac or pelvic bone. Pain here can be caused by too much or too little movement. Some  people term these as Sacroiliac joint dysfunction. Certain types of Arthritis can also cause inflammation and pain at this joint. Weight changes and ligamentous laxity during pregnancy can also lead to pain at this joint.

Osteoarthritis:

Osteoarthritis is often called arthritis or OA for short. OA is really ‘just’ wear and tear of one of the body’s joints. OA in the low back, S/I joint and possibly in the hip could cause buttock pain. The pain, when spreading from an arthritic joint, is often non specific, by this I mean there may be an ache in the area. This ache can become more centered when the joint is inflamed in which case it’s the inflamation causing the pain rather than the joint. The muscles can also become involved, this is then a muscle pain rather than arthritic or joint pain.

Bursitis:

A bursa is a fatty sack. It’s purpose is to reduce friction where muscles pass across other muscles, ligaments or bones. Muscles that are overused or are too tight can rub and inflame a bursa which then causes pain. The two main bursa in the buttock area are the trocanteric bursa and the ischial bursa. One can can give you pain on sitting the other pain when laying on your side.

Coccydynia:

Sometimes written as coccyx/coccygeal pain. The coccyx is often described as the tailbone . If affected people complain of pain at the very base of the spine, just above their anus. The pain can sometimes be felt in the ligaments that help the coccyx maintain it’s position as these ligaments become strained  The sensation can vary from mild discomfort to extremely painful.

Iliolumbar ligament:

This is a really strong little ligament that holds the lumbar spine to the Ilium (part of the big “hip” bone). The iliolumbar ligament can be felt just around the dimples in the very low back.  This can get strained and stretched leading to inflammation. A common way of stretching this ligament is by sitting with your low back unsupported in a slumped position.  Pain can vary from a mild ache to a strong throb. Some sources say that a sciatic type pain can be caused by this ligament.

Piriformis muscle:

Piriformis is a small muscle that is located deep in the buttock region. The sciatic nerve  runs through this muscle. This muscle can become tense enough for it to squeeze the Sciatic nerve, producing symptoms including pain and numbness, that travel down the leg from the buttock region. When the nerve is trapped this way, it is called Piriformis Syndrome. Additionally, trigger points in the muscle may refer pain to other parts of the buttock and the hip joint region.

Trigger points:

Trigger points have been described as “a highly irritable localized spot of exquisite tenderness in a nodule in a nodule in a palpable taut band of muscle.” Another attribute of trigger points is they when the nodule is pressed or irritated it can trigger pain distant to the nodule. Trigger points in quadratus lumborum a back muscle and soleus a calf muscle can and do refer pain to the buttock.

Buttock Muscles:

The Gluteus maximus, medius and minimus are the three main buttock muscles. Gluteus maximus is biggest muscle in the body and some sources say it’s the strongest. All of these muscles may get tendon problems causing pain in the buttock. There are also a number of trigger points within these muscles that may give pain within the buttock. There are three trigger points commonly encountered in Gluteus max, another three in medius and 7 minimus.

High Hamstring Tendinopathy:

This gives you pain most noticeably when you sit and also a tight painful sensation in the hamstring. It’s also known as proximal hamstring tendonopathy or high hamstring tendonitis and refers to inflammation of the common origin (ischial tuberosity) of the hamstring muscles.This gives you pain in the lower buttock  on the part of the pelvic bone you should be sitting on. The pain in the buttock has been described as very sharp or like tooth ache all the time. More about High Hamstring Tendinopathy

Back Pain and Sciatica

Back Pain and Sciatica

Back pain and sciatica is common, but that doesn’t mean it’s normal for it to occur.

At my Glasgow osteopathy clinic I spend much of my time assessing and treating back pain due to it’s high incidence. There are many structures in the low back which may give pain to other parts of the body. The pain and stiffness can become worse if not identified and treated sooner rather than later.

Government statistics state that “Up to 70% of people will experience back pain in their life” and that “around one in three men and one in four of women in some age groups suffered for the whole year with back pain.”

Osteopathic treatment is often the most effective first line of treatment in correcting mechanical problems caused by back pain and preventing things from becoming persistent.

Back problems are often misunderstood.

Most cases of acute low back pain are classed as ‘simple low back pain’ or ‘non-specific low back pain’. Simple low back pain means that the pain is not due to any underlying disease that can be found. In some cases the cause may be a sprain or strain or maybe even spasm of a ligament or muscle.

In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small ‘facet’ joint between two vertebrae. However, the causes of the pain are impossible to prove by tests and so it may be impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain.

The longer you put it off, the harder it will be to get going again.

Simple does not mean that the pain is mild – the pain can range from mild to very bad. Typically, the pain is in one area of the lower back, but sometimes it spreads to the buttock or thigh. The pain is usually eased by lying down flat, and is often made worse if you move your back, cough, or sneeze. So, simple back pain is ‘mechanical’ in the sense that it varies with posture or activity.

Problems with your back can cause pain in areas you may not associate with coming from your back. Leg pain and buttock ache, groin pain or tingling in the toes can all come from the base of the spine. This is why a back strain can be mistaken for a hamstring strain.

Conversely, a problem elsewhere in the body may give you back pain. A problem with your hip or ankle, for example, may cause you to walk differently leading to a pain in your back.

Don’t be another back pain statistic.  As an osteopath I’m ideally suited to helping you.

Book an appointment with me online today.

Frequently asked questions about osteopathy

Can you run 100 metres?

45% of the UK population don’t think they can run 100 metres according to a survey from Slimmers world . With our assessment and treatment options pre-conditioning for exercise assessment or pre-hab assessment, we may be able to help you get there.

The 45% of the population breaks down to 65% of women  and 31% of men didn’t think they could 100 metres. The survey also noted that three out of four individuals  or 75 % of the population are never physically competitive active,  whilst over half, i.e. 55% are not physically active at all. Compare that to 6 out of 10 men or 59% who watch sport on TV at least once every week. This  percentage  has increase during the Olympics.

It was hoped that hosting the Olympics in London would encourage the UK to become more active and leave a legacy of exercise and health.

Why don’t people think they can run? Maybe they don’t believe they can, or have enough confidence because they’ve had an injury in the past, but with our new appointment options we may be able help you start exercising again.

We have 3 options to help you get exercising and keep you exercising.  We’ve termed them an MOT, a Service and a Repair. Go and have a look  at our sports injury treatment options and start allowing your inspiration to be your achievement.

When to have an Osteopathic Sports Massage

Sports massage and sports therapy, When is the best time to be treated by your osteopath? Is it preventative, for maintenance or just if you’re injured with an ache or pains .

 

Sports massage and sports therapy, When is the best time to be treated by your osteopath? Here we look at a couple of scenarios.

I suppose in conclusion the answer “to when is the best time in a training cycle to get sports massage treatment” is anytime. It just depends on what your looking for or what the aim is to your treatment.

Book an appointment online now

Reflection on a Life taken by CFS

Inquest implicates CFS in death

A couple of weeks ago I was upset to read of the death of Lois Owen at the age of 34 from Chronic Fatigue Syndrome (CFS), but I was able to take something away something that possibly could be seen as a slight ray of sunshine.

A report of the inquest into her death published in the Derby Telegraph illustrates that CFS far from being an excuse for lazy people to drop out. Here was a young woman who while she had CFS went to University and graduated with a first class degree (Do you have any idea how hard that is). She wrote a book and also set up her own business. Does this sound like a lazy person. I don’t think so.

Her family and  health care team took her illness seriously. Rather that CBT and GET which a great number of people with CFS have found to be ineffective, they recommended rest. While recent (poor) research doesn’t agree with rest  or pacing a lot of people in my experience find this to be the best way of managing their illness. The benefit of pacing is seen in a survey carried out by the ME association. (pages 8,9,10 make interesting reading)

The Ray of sunshine I was speaking about. Well that is bitter-sweet, but one of the causes of her death was listed as CFS. I hope that now it is further acknowledged that CFS has the potential to kill, or at least is seen as something that can contribute towards someones death.

I also hope that politicians, heath boards and health policy makers will start to take greater notice of the people with CFS and start lobbying for and finding money for research into a diagnosis and treatment for this debilitating disease.

Through twitter I’m going to pass this post  along with the inquest report to Scottish government ministers with a heath remit. Their details are below.

I’m going to start with

  • Nicola Sturgeon (@NicolaSturgeon) MSP, Deputy First Minister and Cabinet Secretary of Health and Wellbeing.
  • Michael Matheson (@MathesonMichael),MSP, Public Health Minister in the Scottish Government
  • Shona Robison (@ShonaRobison), MSP, Minister for Public Health

Why don’t you join me?

 

Please note

  1. I had reservations about publishing this, but after talking to more people with ME/CFS and hearing some of their stories I decided to.
  2. I have only referred to CFS (not ME or CFS/ME) as this is what’s in the inquest report.