The
Forge
Clinic

In this section I will address some of the basic principles that your practitioner is trying to implement when treating you. It is impossible to cover everything and I will try to break it down into digestible (no pun intended!) slices. Much of what is written is evidence based but some comments will be my opinion and are not meant to offend. For the sake of discussion I will have to generalise and the way a professional treats you will depend on many factors including an accurate diagnosis.

So you’re a little more curious as to what it is that your practitioner is doing to you? That’s good! I think it’s important that you should take an interest in your body and your health. It’s safe to say that no matter what type of practitioner (see What Is The Difference?) you see we all have one aim, to relieve pain! How this is achieved depends on the problem and the patients overall health status and demands but some of the principles overlap.

It all seems so mystical… Despite many practitioners wrapping their profession up in cotton wool and being very mystical a lot of what we do is really very simple! Don’t get me wrong, a qualified practitioner has taken over 4 years to qualify and it requires a dedicated work ethic. But no matter what your practitioner is (Osteopath, Physio, Massage Therapist, etc) they are all looking for something called tissue change or effect. This means that the condition of the tissue, whether it be muscle, ligament, bone, etc will be altered in its physiology. This may be to soften of strengthen muscle for example or to reduce scar tissue in an old injury. The principle tissue changes we all look for is elasticity, mobility, stability and strength. No matter what your practitioner does he will have a tissue effect.

Some of the things they do can be a little sore… Many of the treatments are designed to increase inflammation. What? But my GP gave me anti inflammatories to stop the pain! This is often true and an uncontrolled amount of inflammation will lead to pain but we try to achieve a “micro inflammation” in the surrounding area of dysfunction and tissue damage. This is the way the body heals itself and we need to keep it working at an optimum rate. Many conditions that turn chronic (i.e. long term) are made more acute and taken to a state of increased inflammation to increase the healing potential of the area.

They told me to keep moving and gave me some exercises, I always thought I should rest it! At the risk of generalising, 9 times out of 10 we will advocate movement and exercise to the effected area. Here’s why. Nutrients, oxygen and mediators of inflammation are either delivered by blood to the effected tissue or, in the case of joints, by the synovial fluid within the joint. Movement (no matter who it is delivered by!) will increase this. So I should just exercise? Well yes in a way but as a practitioner we aim to put movement through the relevant tissue, for instance a joint, for you. Now, granted it is more accurate and specific than you can deliver yourself but a lot of evidence supports exercise to promote healing and control pain. For example, many patients complain about pain first thing in the morning that eases as the day goes by. This is a classic case of the inflammatory process in action. Once you get moving blood is delivered to the tissue and inflammation is dissipated and pain reduces. We are advocates of exercise at The Forge Clinic and no matter whom you see we will promote exercise to control and rehabilitate you from your pain and allow you to take control of it, an important factor psychologically and therefore in the healing process.

I have to put ice on the area of pain, I have always put heat on it. When a tissue is initially damaged there will be a degree of bleeding (if visible there will be bruising) for the first 2 hours. After this there are chemical markers that continue the inflammatory cycle. Ice has 2 effects. If you can get to the injury within the first 2 hours it should be applied to the area of damage for 40 minutes (always protect the skin when applying ice). This causes constriction of the local blood vessels hence reducing bleeding and gross swelling in the area. After the first 2 hours ice should be applied intermittently for 10 minutes on then 10 minutes off for at least 2 cycles of 10 minutes on (i.e. 30 minutes). This does several things. Firstly it still causes constriction and dilation of local blood vessels but this time it amounts to a pumping effect within the local tissues helping remove chemical waste products that cause pain and reduce healing. Secondly it slows nerve conduction down therefore reducing direct physical pain signals to the brain.

What’s that cracking sound about? This is often what Osteopaths are well known for but often the reasons we do it are misinterpreted. When you here a “crack” or a “pop” after manipulating a joint it is important that the patient understands that we are not putting anything back! Some Chiropractors in particular claim that a joint is “out of line” and that they are putting it back. This is not true. Again there is nothing mystical about the popping sound. It acts as an aid to a practitioner in assessing the ability of a joint to move. Most often if a joint moves well within its physiological range of movement you will hear a pop as the joint is manipulated. This is caused by what is called “cavitation” of the joint. Joints are the meeting points of two separate bones, held together and in place by connective tissues and ligaments. All of the joints in our bodies are surrounded by synovial fluid, a thick, clear liquid. When you stretch or bend your finger for instance to pop the knuckle, you are causing the bones of the joint to pull apart. As they do, the connective tissue capsule that surrounds the joint is stretched. By stretching this capsule, you increase its volume. And as we know from physics class, with an increase in volume comes a decrease in pressure. So as the pressure of the synovial fluid drops, gases dissolved in the fluid become less soluble, forming bubbles through a process called cavitation. When the joint is stretched far enough, the pressure in the capsule drops so low that these bubbles burst, producing the pop that we associate with “cracking” sound for.

So why do you do it? Research continues to be carried out but there are some sound (yes I know another great pun) principles. Firstly, there is temporarily an increased range of movement within the manipulated joint. Secondly, there is a reflex activity that effects the resting tone of muscle that attaches to the joint that has been manipulated allowing muscle to relax and reduce its resting tone. Thirdly, by manipulating a joint and increasing its range of movement the joint is able to lubricate itself more efficiently and therefore disperse nutrients to the joint via synovial fluid. Recently there is some evidence that nerves that pass close by a joint that is manipulated my be effected in a way that reduces pain signals, but there is yet to be more research to carried out.

What’s all this about Core Stability and Pilates? That’s just for bored housewives isn’t it? Pilates has become hugely popular over the last couple of years and there are a lot of offshoots from what was designed initially as a form of rehabilitation exercise from injury. Initial research carried out over 5 years ago demonstrated that a specific muscle in the abdominal region, namely the Transverse Abdominus (TA) was shown to be very inactive and weak in patients with chronic low back pain and the reverse true in people with healthy backs. Since that initial research much has been shown that by increasing conscious (which leads to subconscious) control of it patients are able to reduce chronic low back pain and improve overall posture. So if I do loads of sit ups then my back pain will stop? No its not that easy I am afraid. The TA is a very deep muscle that wraps itself around the flanks of your abdomen and inserts into your low back. It acts like an old Victorian Corset. To activate the muscle requires training and guidance. The exercise itself is not strenuous. The Forge Clinic rehabilitation and personal training team are highly qualified instructors in teaching core stability and work closely with the patients Physio or Osteopath to ensure the correct exercises are given.