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.
stretching. including muscle energy techniques (METs)
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.
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).
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.
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
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.
Stretching and exercise are super useful for managing many conditions and sciatica is no exception. Here are some examples of stretches for Sciatica. Everyone is different though, so I recommend you seek professional guidance if you are in pain.
Stretch your Back, Reduce Back Pain – Child’s Pose-Child's pose is a yoga stretch which is often really useful when you have back pain. It works in a similar way to knee hugs - try both and see which you prefer. 1. Start in a kneeling position. 2. Stretch forwards and down, allowing your forehead to rest on the floor with your arms outstretched Read More
Stretch – Improve your Posture in 30 Seconds-This gentle and easy stretch can be performed any time and is great for stopping slouching. 1. Stand with your feet shoulder width apart. 2. Put your hands on your hips. 3. Carefully lean backwards and hold for 10 seconds. 4. Perform 3 times, once a day. – Keep breathing normally Read More
Stretch – Glutes Stretch you can do at your Desk-You can perform this stretch any time you are sitting down - perfect if you work in an office environment. It stretches the muscles around your hip and can help ease low back pain. 1. Sit upright and place your right leg over your left thigh. 2. Gently lean forwards until you can feel Read More
Stretch – Knee Hugs for your Low Back-This is one of my favourite stretches. It is very easy to do, very gentle and effective for many types of back pain. 1. Lay flat with your knees straight. 2. Bend both knees and draw them up towards your chest. 3. Clasp your hands round the top of your shin, just below your knees. Read More
3. I really rate the Cat Cow exercise and I know many of my low back pain clients enjoy it.
4. Seven ways to prevent weak bones. “Weight-bearing exercise (walking, running) helps to keep bones strong. Ideally, you need a mix of “feet on the ground” activity and muscle resistance such as weights, press-ups and swimming.”
I have really enjoyed this month. The longer days and sunnier weather are so lovely.
I started off the month with a trip to Paris. We stayed in a lovely airbnb in Belleville and spent most of the weekend just walking around in the sunshine. It was brilliant! I also enjoyed my first ever steak tartare.
On May Day bank holiday I went on a lovely walk along Regent’s Canal and tried several pubs along the way.
A quick visit to COPA exhibition was informative. No free pens this year but I did manage to get some free food, and I won a bottle of Champagne from MRIPlus. On the same day I attended a really fascinating lecture about epilepsy at Royal Institute.
Other than that I have been enjoying productive days in clinic, evenings at the allotment and a bit of sewing time. I am determined to get to the bottom of my fabric stash!
We are still working on taking card payments at Ashlins which hopefully will be in place fairly soon. How has your month been?
Sciatica seems to be a well known but poorly understood condition.
It generally refers to pain in the buttock and back of the leg, but can also include back pain, tingling, shooting pain, numbness and muscle tension.
Sciatica is a result of irritation to the sciatic nerve. The sciatic nerve is the longest and largest nerve in the human body; about the width of a pencil in places and stretches from the low back down to the tip of your toes.
Your sciatic nerve supplies your skin, muscles and joints in the back and side of your leg, so these structures are affected when the nerve is irritated. This is what causes tingling and numbness (sensory fibres supplying your skin) and muscle tension (motor fibres supplying your hamstrings and calf).
So what causes sciatica? The two most common causes are a problem with the intervertebral discs in your low back and tension in the piriformis muscle in your buttock.
Your discs act as cushions between your vertebrae (bones in your spine).
If they become damaged or irritated (sometimes referred to as a slipped disc) they can cause low back pain and sciatica. This may be because they start squeezing on part of the sciatic nerve, or because inflammation in the low back is irritating the nerves.
Either way, the sciatic nerve can become very sensitive and start to cause painful symptoms.
There is a muscle deep in the buttock called piriformis. In many people the sciatic nerve emerges through or underneath this muscle before continuing its journey down your leg. If piriformis becomes too short and tense it can squeeze the sciatic nerve and eventually lead to sciatica.
There are various potential causes of disc problems and piriformis syndrome which are too long to go into here!
Those are just the 2 main causes of sciatica. There are other causes, some of which are quite serious conditions such as tumours or infections around the spine. Thankfully they are pretty rare but it is sensible to seek professional attention if you have back pain or sciatica.
Sciatica is easily confused with other conditions. Issues with the low back, sacroiliac joints (in the pelvis), hip and knee can cause similar symptoms. I always take a thorough case history and examination so I can work out what I think is causing the problem. Then an appropriate treatment plan can be formulated, or I can refer to another therapist or your GP if necessary.
I hope you’ve had an enjoyable month and have some fun plans for the bank holiday weekend. I’ve rounded up my favourite health and wellbeing articles from this month, so make yourself a cup of tea and get up to date with the latest news.
“If you take up exercise later in life, as a treatment for joint or hip pain, you should expect a small, temporary increase in pain. But if you proceed sensibly, you will be rewarded with pain relief similar to that of a non-steroidal anti-inflammatory drug, such as ibuprofen, and twice that of a non-prescription painkiller, such as paracetamol.”
Aside from taking a break from blogging I have been enjoying spring! I had a nice walk to Wanstead Park to see the bluebells.
In February I became the proud tenant of an allotment. I’ve enjoyed clearing the weeds and have started planting a few crops. Currently I am over run with thistles but hoping to dig them up and plant more goodies soon.
My allotment, and a gigantic pile of horse manure
I’m also taking part in Walthamstow Beer this year. The hop lives in our garden where we can keep a close eye on it. We have named it Roger and he is growing very quickly so far.
Roger the Hop
I have been on a few trips this year including California for a family wedding, Cornwall for my Grandad’s birthday, and Nice for a bit of a jolly with Mr Sarah. Did you know that ravioli was invented in Nice? And Nice only became part of France in the 1860s? I had no idea.
I’ve also been doing quite a bit of sewing and am pleased to say my skills have improved since last year 😁. I’ve made quite a few tops and skirts and have a long list of patterns to work through. That’s all on hold for the moment while I finish sewing my Guide badges on to my camp blanket.
At Ashlins we have been working hard on GDPR. We’re also making big strides towards taking card payments, which is very exciting!
It’s International Osteopathic Healthcare Week this week and to mark the occasion I’m busting 3 big osteopathy myths and explaining how osteopathy can improve your health.
Osteopaths only treats backs
Osteopathy is well known for helping people with back pain but it’s definitely not all we do!
Osteopaths are able to help with a wide range of problems including many muscle and joint issues.
I frequently treat neck pain, shoulder pain such as rotator cuff tendinitis and frozen shoulder, arm and wrist pain such as tennis elbow and RSI, hip pain, sciatica and many more.
Osteopaths typically train for 4 years and have detailed knowledge of anatomy, physiology and pathology meaning we understand and can manage a variety of conditions. We will also refer you to another practitioner if we think it’s what you need.
Osteopathy is about clicking and cracking joints
This is absolutely not true! Cracking joints (known as HVT or HVLAT) is a useful technique but just one of many used by osteopaths.
Utilising only one technique is a pretty limited approach to treatment. It works for some people but is not likely to lead to longer term improvement and isn’t suitable for everyone. For some individuals HVTs are contraindicated. I prefer to use a range of techniques which I mix and match to get the best results for you.
I use a variety of techniques including:
Soft tissue technique
Muscle energy technique
Strain Counter Strain
Gentle joint mobilisation
Stronger joint mobilisation
Each technique can be applied in lots of different ways in each area of the body, so osteopathic treatment can actually be very varied and tailored to your needs. It’s much more than a few clicks and cracks.
Osteopathy is only about muscles and joints (musculoskeletal system)
It’s true that osteopathy is primarily focused on the musculoskeletal system. It is well suited to aiding problems with muscles and joints.
It’s important to consider the musculoskeletal system in the context of your general health and wellbeing. For example, your low back pain may recover faster if you have a balanced diet, active lifestyle and sufficient sleep.
So your osteopath will also be interested in your diet, exercise and activity levels, stress and overall wellbeing. This allows for a more tailored, detailed treatment plan which should help you get better quicker.
Most of us have some room for improvement when it comes to our health. Your osteopath will be able to advise you on how you can make positive changes and can direct you to other practitioners and resources for more detailed guidance.