Osteoarthritis in winter

Many people who suffer with arthritis report their symptoms to be worse in winter. Why is that? We had Briony do some research into why this might be the case. 

Arthritis is a common condition, affecting 48.9%of people over the age of 75 worldwide(1). There are multiple types of arthritis, with osteoarthritis and rheumatoid arthritis being the two most common, accounting for 57% and 13.9% of arthritic cases respectively(1). For the purpose of this article, we will be focusing on osteoarthritis. Osteoarthritis can also commonly be referred to as “wear and tear” or “age related degeneration”.

There is a general consensus amongst medical professionals that arthritic patients report their pain to be worse in winter(1-3). Despite this anecdotal evidence, there is minimal and conflicting research as to how and why this happens(2). Multiple theories exist on how winter influences arthritis, though there is little consistent data to support one theory over another.

The most researched theory is cold temperatures and its effects on arthritic joints(1-3). The thinking is that cold temperatures can cause thickening to the fluid inside joints (synovial fluid) which leads to increased stiffness and pain(1-3). This thickening of fluid is yet to be proven, though consistent evidence supports that for every 10 degree celsius drop in atmospheric temperature, arthritis patients will report their pain to be more intense and have a greater impact on day-to-day activities(2). Barometric/atmospheric pressure can also increase the stiffness of joints by increasing the internal pressure of the arthritic joint(2,3) resulting in more intense and frequent pain(3). 

Another avenue of research into winter's effects on arthritis, has nothing to do with temperature or the atmosphere at all, but to do with human psychology and behaviour in winter(2). We have all heard of, and maybe some of us dealt with, the “winter blues”. But have you considered how this may be impacting your pain? Long periods of cloudy or rainy weather has been proven to negatively impact people’s moods/mental health(2). The lower someone’s mood, the more likely they are to focus on bodily pain(2), with people in a depressed state experiencing their pain at higher intensity without any physical change to the health of their tissues(2). 

Physical activity, including resistance training, is one of our biggest tools for reducing arthritic pain(4). Unfortunately, this too can be impacted by winter weather: “it's raining outside so I won’t walk the dog”, or “I won’t go out in the garden, it’s too cold”. This overall decrease in physical activity due to weather changes, increases sedentary habits, furthering stiffness and pain to arthritic joints(2). It is therefore important to notice this change in activity and adjust our habits to continue keeping physically active in a different way to which we wound in the warmer months. 

So with the weather possibly making our joints stiffer, lowering our moods and decreasing our physical activity: what is there to be done? Move house to a warmer, drier climate? There are simpler, closer to home options available to help manage arthritis in winter:

• Keeping the affected area of the body warm

• This can be achieved with the use of heat packs/hot water bottles, taking warm baths/showers, wearing weather appropriate clothing as well as support garments such as arthritic socks/gloves.

• Continuing to engage in physical activity 

• Indoor activities are a great option: indoor swimming pools, gyms, home based exercise equipment such as stationary bikes or treadmills.

• Engaging in resistance training to help support affected joints and keep soft tissues healthy.

• Continuing to cycle through active and sedentary tasks throughout the day at 30-60 minute intervals.

• Looking after your mental health

• There are many more aspects to maintaining your mental health, which we will not list here for the sake of keeping this article brief. If you are in need of crisis support, please call Lifeline on 13 11 14. 

• Manual therapy

• Manual therapists, such as osteopaths, utilise techniques that can help decrease pain and stiffness in arthritic joints. We aim to increase the range and quality of motion to help decrease pain and reduce the impact arthritis has on day-to-day activities.

If you have further questions regarding arthritis and what you can do to help minimise its impact on your life, book an appointment with one of our osteopaths to discuss your options. You can book an appointment by calling us on 03 5982 2600 or booking online via our website. 

References:

1. Australian Bureau of Statistics 2022, Arthritis, ABS, viewed 22 July 2024, <https://www.abs.gov.au/statistics/health/health-conditions-and-risks/arthritis/latest-release>.

2. Wang, Lin et al. “Associations between weather conditions and osteoarthritis pain: a systematic review and meta-analysis.” Annals of medicine vol. 55,1 (2023): 2196439. doi:10.1080/07853890.2023.2196439

3. https://www.arthritis.org/health-wellness/healthy-living/managing-pain/understanding-pain/best-climate-for-arthritis

4. Turner, Meredith N et al. “The Role of Resistance Training Dosing on Pain and Physical Function in Individuals With Knee Osteoarthritis: A Systematic Review.” Sports health vol. 12,2 (2020): 200-206. doi:10.1177/1941738119887183

How and when do I use a massage gun?

Have you noticed an increase in the use and advertising of massage guns? We certainly have! Have you got a massage gun laying around, still in its box from Christmas? Or just seen an ad for one on Instagram? We had Harley look into their benefits and how to use them most effectively.

What do massage guns do to muscles? 

Harley’s research found there have been many studies addressing the use of vibration based tools and therapies (Lee et al., 2018). The use of a vibration based therapeutic device causes a tonic vibration reflex within the body. A tonic vibration reflex is when a muscle is subjected to vibration type stimulus, the vibration activates receptors within the muscles fibres, as well as, skin and tendons, causing this muscle to contract. This contraction causes increased blood flow, activation of the muscle fibres and increases range of motion of the associated joint/s. One study found that when compared with foam rolling and self-myofascial release (a type of self massage), the massage gun was superior.

When should I use a massage gun?

The simple answer is before and after exercise, with the research indicating that benefits experienced came with the use of the massage gun for five minutes on a muscle. If used for five minutes as part of a warm up, before exercise, a massage gun can increase the range of motion of a joint without losing performance(Konrad et al., 2020). When using a massage gun device immediately after exercise, research indicates a reduction in delayed muscle soreness (DOMS; which is the broad muscular pain one can experience immediately after, and in the days following exercise).

Here are Harley’s suggestions on when and how to use a massage gun:

• Use a massage tool as part of warm up, cool down and/or rehabilitation program

• Use for 5 minutes at a time on each muscle group

• Avoid bony body parts

• Avoid overuse

Harley concluded that a self massage device that is vibration based should be utilised within a warm-up routine and rehabilitation programs. This is due to the positive effects on range of motion and muscular soreness, concurrently having no negative impact on muscle activation, strength or power. It also doesn’t necessarily have to be one of these trendy new massage guns, as there are many vibrating massage tools out there now. As long as you follow the above suggestions, you have added another great tool to your warm ups, cool downs and rehabilitation programs.

References

Martin, J., 2021. A critical evaluation of percussion muscle gun therapy as a rehabilitation tool focusing on lower limb mobility. A literature review. [ebook] Winchester: Department of Health and Wellbeing. University of Winchester. Available at: <https://scholar.google.com.au/> [Accessed 12 July 2022].

Lee, C., Chu, I., Lyu, B., Chang, W. and Chang, N., 2018. Comparison of vibration rolling, nonvibration rolling, and static stretching as a warm-up exercise on flexibility, joint proprioception, muscle strength, and balance in young adults. Journal of Sports Sciences, 36(22), pp.2575-2582.

Konrad, A., Glashüttner, C., Maren Reiner, M., Bernsteiner, D. and Tilp, M., 2020. The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles’ Range of Motion and Performance. Journal of Sports Science and Medicine, 19(4), pp.690–694.

Low Back Pain

Degeneration, wear and tear, disc bulges/irritations/herniations, joint sprains, arthritis, chronic pain...etc. What does it all mean?

As Osteopaths, a large portion of the patients we treat have low back pain. As you will begin to understand as you read on, many of these patients' pain is based on management and not a “cure”, others may be acute injuries that resolve. Patients often ask if their pain is ‘normal’. Research is predominantly showing that pain is not ‘normal’, though it is common. To show just how common it is, back pain affects between 60% and 80% of people throughout their lifetime. (Physiopedia). (1)

Lower back pain is defined as pain in the tissues inclusive of, and surrounding the lumbar spine (the lower 5 vertebrae of the spine before the pelvis begins). This pain can present in many different ways and areas of the back: it can present as a sharp or dull pain, hot and burning, tingling and everything in between. The pain can be localised, it can spread, radiate or refer. The quality, location and pain experience patients suffer with is dependent on the specific tissue (or tissues) that is injured/irritated (2, 3).

Research suggests that lower back degenerative conditions are common. For example: if a group of people that are 50-59 years of age and suffer no lower back pain were to undergo diagnostic imaging, we would find up to approximately 80% of them would have some form of a lower back degenerative back condition. (4). Furthermore, for a group of people within 20-29 years of age with no lower back pain to undergo the same diagnostic imaging, up to 37% of them will have some form of a lower back degenerative back condition. (4).

Factors that can be associated with low back pain include: age, gender, weight, occupation, hobbies, posture, physical activity and inactivity, diet, poor hamstring flexibility and lack of glute muscle group activation.

Can an Osteopath help my low back pain? 

In your consultation with your Osteopath we will use orthopaedic testing to identify what the source of pain is and what tissues are involved. We will then discuss your diagnosis, explaining what may have led to this pain and what this pain may mean for you moving forward.

From there, provided it is safe to do so, we will perform manual therapy techniques on the tissues involved and those surrounding. Techniques such as: soft tissue massage, joint articulation, proprioceptive neuromuscular facilitation stretching and in some cases myofascial dry needling. 

If we find it relative and beneficial to your case we can prescribe exercises or an exercise program with the aim of helping you to manage your condition.

Below are some of the more common diagnoses when it comes to low back pain.

Facet sprains: much like any joint sprain this injury occurs when you take a joint of the lower back beyond it’s normal range of motion, therefore stretching or spraining the ligaments surrounding that joint. (5)

Degenerative disc disease: the use of the word “disease” can be misleading as this is not a disease in the colloquial sense of the word, it is normal age related degeneration. It is categorised as degenerative disc disease when one or more discs decrease in height. (6)

Degenerative joint disease: also known as Osteoarthritis, the term ‘wear and tear’ is also commonly used to describe this condition. Degenerative joint disease is the slow breakdown of the vertebrae of the lumbar spine. (7)

Disc dissection: this refers to the dehydration of the fluid within the discs, this occurs as we age. (8)

Spondylolythesis: refers to one vertebrae “slipping” or moving forwards on the vertebrae below. (9)

If you have any further questions or would like to discuss further with any of our Osteopaths please call the clinic on 03 5982 2600 or book an appointment online.

1 - Low Back Pain in Australian Adults. Prevalence and Associated Disability

https://www.sciencedirect.com/science/article/abs/pii/S0161475404000351

2 - Back Problems

https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/what-are-back-problems

3 - Low Back Pain

https://www.physio-pedia.com/Low_Back_Pain

4 - Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations

http://www.ajnr.org/content/36/4/811.short

5 - Facet Joints

https://www.physio-pedia.com/Facet_Joints

6 - Degenerative Disc Disease

https://www.medicalnewstoday.com/articles/266630

7 - Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3606549/

8 - Disc Dessication

https://www.healthline.com/health/disc-desiccation#:~:text=Disc%20desiccation%20is%20one%20of,or%20slowly%20lose%20their%20fluid.

9 - Spondylolythesis

https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis#:~:text=Spondylolisthesis%20is%20a%20spinal%20condition,treatment%20can%20relieve%20your%20symptoms.

Headaches and Migraines. Can Osteopathy help my headache?

June, 2023 is migraine and headache awareness month, (King, 2023), so at BBB we thought we would explore and discuss headaches, migraines and how we as Osteopathic practitioners aim to help. (Migraine Headache Awareness Month)

A headache is defined by The Mayo Clinic as “pain in any region of the head”. Headaches may occur on “one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a vice-like quality.” (Mayo Clinic., 2020). In 2013 a team of researchers explored more than 20 different types of headaches (Zarshenas et al., 2013). As Osteopaths, the most common types of headaches we see in private practice are: cervicogenic headaches (caused by neck tension and/or injury), tension type headaches and migraines (with and without aura).

Headaches fall into one of two categories, primary or secondary headaches. Primary headaches are not a result of any underlying medical condition, these include: migraine (with and without aura), tension type headaches and trigeminal autonomic cephalalgias. Secondary headaches occur in relation to a specific medical condition or disorder that may be known to cause headache pain, the most common being headache associated with trauma or injury to the head and/or neck, referred to as a cervicogenic headache. The most common types of primary headache are migraine type headaches and tension headaches (Fernández-de-las-Peñas et al., 2020).

You may find yourself asking what is the difference between a headache and a migraine? The diagnostic criteria for each type of headache or migraine may deserve a detailed blog of its own. In short, many of us are going about our lives with what we consider to be a headache, however the symptoms meet the diagnostic criteria of a migraine. Researchers suggest that when it comes to migraine headaches, the frequency is significantly higher, being two to three times higher in neurologists when compared to non-neurologists. This is thought to be due to the under-reporting and under-recognition of a migraine by those non-neurologists (Wei Z et al.). In short the average person is under-reporting migraines due to the fact that we are generally less aware of the symptoms that make up a migraine.

Research indicates that headache pain is the fifth most common primary complaint when it comes to peoples’ health and seeking medical help. Approximately 96% of people will experience headache pain in their life, with a higher prevalence in females (Zarshenas et al., 2013). Manual therapy is the most common non-pharmacological treatment requested by patients that experience tension type, migraine and cervicogenic headaches. Non-pharmacological therapies are included on most international guidelines for management of tension type and migraine headache pain. However, it is worth acknowledging that not all treatments have the same effects on each patient or headache type. Management of a headache is most beneficial when it is multimodal: non-pharmacological, self management, possible use of pharmacological interventions and, most importantly, addressing the main causative factor/s (Fernández-de-las-Peñas et al., 2020).

As Osteopaths we will primarily treat and help manage the musculoskeletal components and factors that can influence a headache, including posture and trigger points. All the while endeavouring to find and correct the main causative factor/s (Blumenfeld & Siavoshi, 2018).

It has been proven that therapeutic exercises are effective at decreasing the intensity, frequency and duration of headache pain. Manual therapy including a combination of mobilisation techniques (especially to the tissue of the neck), stretching and soft tissue massage have similar effects to pharmacological interventions (pain killers) when it comes to managing headache pain (PMC).

When receiving Osteopathic treatment for headache pain, you can expect to receive a combination of various manual therapy techniques, and be prescribed exercises that can help you to self manage your headache pain. Whilst we know there are many factors that contribute to headache pain, we aim to help you manage the musculoskeletal components, meanwhile addressing and managing the other factors through ergonomic and lifestyle advice. In future blogs we will explore and explain some of the other factors that can contribute to headache pain.

Written By Harley Pascoe. Edited By Briony Chase.

References:

Headache (2020) Mayo Clinic. Available at: https://www.mayoclinic.org/symptoms/headache/basics/definition/sym-20050800 (Accessed: 21 May 2023). 

Fernández-de-las-Peñas, C. et al. (2020) Clinical reasoning behind non-pharmacological interventions for the management of headaches: A narrative literature review, MDPI. Available at: https://www.mdpi.com/1660-4601/17/11/4126 (Accessed: 21 May 2023). 

King, C. (2023) Migraine & Headache Awareness Month, MHAM. Available at: https://www.migraineheadacheawarenessmonth.org/ (Accessed: 21 May 2023). 

Wei Z, Y., Blizzard, L. and Taylor, B.V. (no date) What is the actual prevalence of migraine? - wiley online library. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/brb3.950 (Accessed: 21 May 2023). 

Zarshenas, M.M. et al. (2013) Types of headache and those remedies in traditional Persian medicine, Pharmacognosy reviews. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731875/ (Accessed: 21 May 2023). 

Blumenfeld, A. and Siavoshi, S. (2018) The challenges of cervicogenic headache - current pain and headache reports, SpringerLink. Available at: https://link.springer.com/article/10.1007/s11916-018-0699-z (Accessed: 21 May 2023). 

PMC, E. (no date) Europe PMC. Available at: https://europepmc.org/article/med/30425380 (Accessed: 21 May 2023). 

What is a Facet Sprain?

Back injuries are extremely common in the population, with studies showing up to 80% of people will have an episode of back pain in their lifetime. Most people have heard of or know of someone who has damaged their disc, whether it’s a bulge or herniation and this can be what people think of immediately when they hurt their back. But a much more commonly seen injury is that of the facet joint sprain.

Facet joints are joints that are made up of the vertebrate of the spine. They are where each vertebrae is connected (above and below) and are connected with strong ligaments. These joints allow us to bend forwards and backwards, rotate side to side and side bend. They are extremely important to our movement and are a common area that leads to stiffness when osteoarthritis starts affecting them. Facet joints are found throughout the entirety of the spine from your neck to your pelvis, however they change shape throughout. 

Surrounding the facet joints are many muscle attachments, other ligaments and exiting nerve roots from the spinal cord. This can be why hurting these joints can be extremely painful and debilitating.

How do I sprain a facet joint?

Facet joints are more easy to sprain than what you think. Just like any other joint of the body, facet joints can be sprained with awkward positions or repetitive movements that you aren’t used to. This is caused by an overstretching of the ligaments which then results in swelling and irritation. As this can be painful with movement, the body sends a message to the surrounding muscles to grip on and support, which can lead to a lot of surrounding muscle spasm and tightness. Commonly, lower back facet sprains can be from activities such as shoveling, incorrect lifting and/or moving techniques. Whereas neck facet sprains can be from sleeping in unusual positions, associated with long periods of sitting at a desk without changing position (including holding a phone up between your shoulder and ear), or running and jarring. 

Conversely, not having enough movement through your joint can lead to irritation and soreness, which is why having good healthy movement and posture is so important for your spine. Our joints are designed to move and love movement, which is why sometimes long periods of not moving (think an overseas plane trip) can lead to stiffness through our spines.

What are the symptoms of a facet sprain?

Acute facet sprains can cause some intense pain at both the site of injury and occasionally can refer elsewhere, good examples of this are headaches resulting from a neck facet sprain, or gluteal pain from a lumbar (lower back) sprain. Acute flare ups are often caused by excessive rotation and extension, especially if there’s any added weight to the motion (think trying to do a head check while driving!). 

Chronic facet sprains can occur in multiple ways, often aggravated by prolonged static posture, whether it be sitting or standing. The pain can move around somewhat and be quite broad. Often in these situations, the body begins to develop compensatory mechanisms so you will often find surrounding levels of tightness and irritation. 

How long does it take to heal a facet joint?

As with any injuries, healing times can change depending on many factors, such as age, weight, work and ability to avoid/manage aggravating activities.

Generally, an acute sprain can take anywhere from 2-4 weeks if managed and treated correctly. During this phase the first 2-3 days are the worst as this is when the inflammatory cycle peaks. Following this you should see a decline in your pain levels and increase in range of motion. These sprains can become ongoing and chronic if you continue to aggravate the joint, this can then take 6-12 weeks, with a high occurrence of re-injuring and flare ups in the future. For this reason, it is important to be aware of your aggravating factors and try to keep them to an absolute minimum. 

What can an Osteo do?

During your appointment, an Osteopath will go through a thorough case history and orthopedic examination to determine which segment is causing the pain and discomfort. Once a diagnosis has been established, treatment will depend on the individual but can include:

• Soft tissue therapy

• Joint mobilisation (and adjustments if required)

• Stretching

• Exercise Prescription

• Dry needling

• Cupping

• Taping (rigid or rocktape)

Treatment has been found helpful to help reduce pain levels as well as reduce pain from compensation areas. Your Osteopath will also spend time going through any stretches or exercises that they recommend for your injury and rehabilitation exercises to make sure that it doesn’t become a more ongoing problem.

We hope you find this information helpful and if you think of any questions please ask us at your next appointment!

Written by Tracy Vuat (Osteopath) at our Mt Eliza Clinic - Victoria Sports & Rehabilitation Clinic