020 8520 5268 | Ashlins Natural Health, 181 Hoe Street, E17 3AP sarah@saraholiverosteopathy.com

Now accepting card payments!

That’s right!  At Ashlins we are taking big steps into the 21st century and have just got a card machine.

Card Payments now accepted

You can now pay for your appointments with me by debit or credit card, so no need to rush to the cash machine anymore.


Card payments aren’t available for all therapists yet but we hope to roll it out in the Autumn.

What are knots and what can I do about them?

Knots in muscle are also known as myofascial trigger points (MFTPs), trigger points and tender points.  Their name, cause and identification can be contentious but they are a very common phenomenon and frequently contribute to muscular pain.

Knots usually have these characteristics:

  • Feel lumpy,hard or gristly in a taut band of muscle.
  • May be sore or tender to touch.
  • On pressing a knot it may cause pain to radiate outwards or produce pain in another location.
  • Knots can appear in groups with a primary trigger point surrounded by secondary points.
  • They may align with acupuncture points.
  • Skin over a trigger point may be slightly warmer than the surrounding area.

Trigger Points in levator scapulae. Taken from The Concise Book of Trigger Points by Simeon Niel-Asher


Trigger points are usually described as a hypersensitive  group of muscle fibres.   They may develop following stress or strain to muscle e.g. overuse, sustained poor posture, emotional stress.   It seems likely that poor diet contributes to the formation of trigger points.

There are lots of treatment options for knots.  Their efficacy varies from person to person and also depends on the location and severity of the knot.  Usually it’s best to use a combination of techniques.  It’s difficult to get rid of knots entirely but you can definitely minimise them and reduce pain levels.

Useful techniques include:

  • massage techniques
  • self massage using foam rollers, massage balls, tennis balls and other devices.
  • stretching. including muscle energy techniques (METs)
  • dry needling,
  • posture improvement
  • exercise
  • stress reduction

It is possible to treat trigger points at home but you should see a qualified therapist or your GP to confirm the diagnosis.  There are more serious conditions which can appear similar to trigger points but require medical treatment.



What are discs and what are slipped discs?

Intervertebral discs sit between the bones in your spine (vertebrae) and act as shock absorbers.  They also contribute to the flexibility of your spine.

Spinal Anatomy taken from Functional Anatomy of the Spine Middleditch & Oliver


Discs sit in the anterior (front) part of your spine so you can’t feel them through your skin.  When you touch your spine you are feeling the Spinous Processes, which are the pointy bits of each vertebra shown on the picture above.


There are a few components of the disc which are useful to understand. At the top and bottom of each disc is the vertebral end plate, which grows into the adjacent bone and helps provide nutrition to the disc.

Anatomy of intervertebral discs taken from Functional Anatomy of the Spine by Middleditch & Oliver


If you take a horizontal slice through a disc you can see outer rings.  This is called the annulus fibrosus.  The centre of the disc is made of a thick gel called the nucleus pulposus.   This structure allows your discs to stretch and move.

The outer part of your discs are supported by several of your spinal ligaments, which join bone to bone and also grow into the annulus fibrosus.


What’s a slipped disc?

Your discs don’t actually slip anywhere, they are held firmly in your spine so they cannot come out of place.   They can become injured, irritated or change shape which may lead to pain.  Interestingly MRI studies have shown that many people have disc ‘injuries’ with no pain or stiffness!


We think that several different things can happen to your discs.

Firstly the outer annulus can become torn.  This may lead to inflammation and then to pain and muscle guarding.

Secondly the disc may change shape and bulge outwards.  This can happen anywhere around the edge of the disc but is most common towards the back and side.  A disc bulge can be very small or more substantial.  They can also change depending on your position.

If a disc bulge is close to a nerve root it may irritate the nerve or squeeze it.  This can cause pain, pins and needles or numbness along the path of the nerve.  A famous example of this is sciatica.


Disc injuries are very common. Most people make a full recovery with conservative care such as exercise, stretching and manual therapy (including osteopathy).



Weekend Reads June 2018 – Pigeon Pose & eating Popcorn with Chopsticks

It’s the last day of June so it’s time for your monthly round up of health news.



The pigeon pose isn’t suitable for everyone, but if you’re fairly flexible it is a satisfying way to stretch your hips.

2. Apparently popcorn tastes better when you eat it with chopsticks.

If you are not enjoying your favourite things as much as you used to, new research suggests a way to break through the boredom: Try the same old things in new ways. Researchers found that people found new enjoyment in popcorn, videos — even water — when they consumed them in unconventional ways.


3.  How to eat like a chef for £20 a week!


4. This quirky video from the BBC explains how to strengthen your pelvic floor.


5. Seven ways to strengthen your core


What I’ve Been Up To

June is one of my favourite months!

It includes our wedding anniversary and my birthday, which are made even better by a nice holiday.  We spent 9 days in Italy enjoying the sights of Pompeii and the taste of pizza and Aperol Spritz.  We had 2 lovely AirBnBs (Naples, Ischia).  You can get £25 off you first stay with my link: www.airbnb.co.uk/c/soliver8

View of Procida


Castel Aragonese in Ischia

I discovered the self guided walks published by City of London and spent a nice evening following one of the tree trails.


We’ve continued to work hard at the allotment.  I was very excited to harvest some broad beans, new potatoes, lettuce and radishes and am hoping for lots more produce over the summer!


This weekend we’ll be making the most of the sunshine with a BBQ.  What do you have planned?

How do you diagnose Sciatica?

Reaching a diagnosis is a bit like being a detective and collecting as many ‘clues’ as possible.

We start by looking at your symptoms.  Sciatica usually presents with pain shooting down the back of your thigh and calf.  You may also have pins and needles or numbness in your leg or foot.   You may find it difficult to straighten your leg and prefer to bend your knee.  It may also be very painful weight bearing on that leg.

Sciatica may also cause pain in your low back or buttock.

Then we move on to a physical examination.  Sufferers of sciatica often have altered posture due to pain (we call this antalgic posture).  You may avoid weight bearing on the painful side and you may lean to one side.

Flexibility of your low back, hips and knees may be reduced due to pain and muscle guarding, so you might find it difficult to bend.  Often there will be restriction and soreness around the low back or buttock.

I usually perform some tests to your low back where I gently compress your spine.  This can be quite uncomfortable if you have sciatica caused by a bulging disc.

I also use the Straight Leg Raise (SLR) test.  This is very simple – you lay down on your back and I lift up your leg while keeping your knee straight.  This stretches the sciatic nerve.  Normally this is not painful but if the nerve is irritated for some reason, SLR will probably cause pain or pins and needles.

Sometimes I will also test your reflexes and perception of touch.

Sciatica has several potential causes including disc herniation and piriformis syndrome.  There are also many other conditions which may mimic sciatica in some way.  So I also examine your hip joints, sacro-iliac joints, knees and many of the muscles in your low back, buttock and legs.

I do not routinely suggest further investigation such as MRI, although they may be useful in some cases.


Once we have worked out what’s causing the problem I can focus your treatment on the most relevant areas.