osteopathy bondi junction

We are commonly asked what the difference is between an Osteopath and a Physiotherapist. Our Osteopath Jerome Smith spent the last 5 years working in a clinic that employs both osteopaths and physiotherapists, so he is uniquely positioned to answer this question.

In Australia, physiotherapists specialise in rehabilitation. Rehab is a very diverse field, with physio’s working for sporting teams, and physio’s working in hospitals helping stroke victims walk again. They are probably best known for work with soft tissue injuries. For example, if you were to tear a ligament in your knee, and required surgery, a physio is the best person to see to help rehabilitate that injury. Apart from ligament tears, things like torn muscles or tendonitis type injuries are other things a standard physiotherapist would work with.

Osteopaths look at soft tissue injuries like muscle strains, tendon and ligament injuries as well. But they also work on the skeletal system – bones, joints, and general structural alignment. The reason they look at both is because of the interactions involved – muscles and tendons attach to bones, ligaments attach to either side of a joint and so their actions become inter-related, and they directly affect each other.

So it makes sense to look not just at the soft tissues, or just at the joints, but to look at them in combination. For this reason Osteopaths are described as wholistic practitioners, meaning they look at the body as a whole.

Your Osteopath may also talk to you about things like ergonomics. For example, how does your posture at work impact your back or neck. They may talk to you about nutrition, in terms of the role food plays in your general health and wellbeing, and how things like sugar might affect your inflammation levels and affect your healing rate. And they will almost certainly give you advice on mobility or strengthening exercises that might help you prevent future relapses of your injury.

To learn more about what Osteopaths do or to enquire about a booking, click this link.

WHAT ARE SHIN SPLINTS?

Shin Splints is a slightly vague term, and it gets used a lot when people have pain in the lower leg. Sometimes it’s really straightforward, but it can represent a more serious problem, so if it’s been ongoing for a little while, especially in a child, it’s important to get it checked. 

It is common in sportspeople, but can affect anyone who is on their feet a lot. It’s most often associated with running, but shin splints are also common in sports such as soccer, AFL and rugby, and in sports played on hard surfaces such as basketball, netball and tennis.

In practice, shin splints will be one of the following 3 injuries:

1. Medial Tibial Stress Syndrome

MTSS is caused by a sudden change in the amount or type of activity you are doing eg starting a new sport. This leads to the muscles of the lower leg pulling on their attachment on the tibia or ‘shin bone’. There are a number of additional factors that play role a shin splints including fitness, biomechanical efficiency in the lower limbs, footwear, playing surface, recovery, fatigue and dehydration.

Depending on the particular muscles involved, the area of discomfort can be variable (front of the shin vs. inside of the shin), however the typical pattern of pain following exercise is a common feature.

At this point it is really straightforward to treat, and we use a combination of treatment in clinic with home exercises to get the best result. If left unchecked it can progress.

Long bones such as the tibia have a thin covering called ‘periosteum’ that muscles grip onto at their site of attachment. Excessive loading of weak muscles in the lower leg will cause the periosteum to ‘peel away’ from the underlying bone and a layer of fluid will develop in the tibia as a result of a local inflammatory response. The problem here is that the fluid will weaken the bone in the affected area and the patient will be at increased risk of a stress fracture (read on).

2. Stress Fracture

A stress fracture develops over a period of time when the stress on a bone has exceeded the bone’s ability to heal at the normal rate. They are usually subtle injuries that are difficult to visualise on x-ray because they affect the micro-structure of the bone, rather than the whole structure. However, x-rays can demonstrate swelling of the periosteum, which is a clue that there could be an underlying stress fracture. In this case, MRI follow up is the best course of action in order to check for stress fracture.

Female athletes are at increased risk of developing stress fractures, because there is an established link between low bone mineral density, an irregular or absent menstrual cycle and eating disorders. We call this type of presentation the ‘Female Athlete Triad’. Working with Premier League female soccer teams taught me to maintain a high suspicion for underlying stress fractures and to help minimise the risk through early screening, preventative home exercise programs and patient education.

Stress fractures are usually painful at the time of exercise and will often prevent a person from exercising. It is important that this condition is managed correctly and appropriate imaging is obtained to provide a time scale for treatment.

3. Compartment Syndrome

Rather than affecting one small part of the bone, like a stress fracture does, CS affects a larger area. It results from overuse, inflammation or a direct impact to the connective tissue ‘compartments’ that contain the muscles and vessels of the lower leg. 

Pressure inside one or more of these compartments increases with exercise (which brings on the pain) and then reduces after exercise – this is distinct from MTSS where pain is normally felt after exercise and not during.

Increased pressure in the compartments of the lower leg can cause compression of nerves and blood vessels that supply the foot, causing pins and needles, numbness and/or weakness. This is a case for urgent medical attention as there is a risk of long-term nerve damage and infection. Don’t ignore these symptoms!

If you have shin pain, the first steps are to determine what type of shin splints you have and exclude a stress fracture or compartment syndrome. Then we must formulate a treatment plan that incorporates manual therapy to provide relief and exercise rehabilitation to prevent symptom recurrence.

Dry needling is particularly useful as we can treat muscles in the lower leg effectively without applying pressure to the affected area – this would normally be very painful for someone suffering from shin splints. We can also help you modify your exercise program and address other factors that are playing a role in your condition.

If you think you may be developing shin splints, don’t delay in booking an appointment to get the problem managed properly. Early detection and intervention will stop the problem from worsening and reduce your time away from sport, so that you can focus on your performance rather than an injury!

Harley Place Health Osteopath Jerome Smith has studied advanced dry needling, so he may recommend it for you depending on your condition. What does it actually do?

Dry needling is commonly used to address deep myofascial tension. Often it can be painful or very difficult for a practitioner to work deep enough to hit these points, so using a needle is a great way to release the underlying tension.

During a session, myofascial trigger points may be felt by both you and your practitioner. For your practitioner, it will present as a hard, focused point of tension. For you, a description a lot of people use is that they feel a ‘knot’ in a certain part of a muscle.

The indication for treatment would be reducing muscular pain and stiffness, improving range of motion or flexibility. Studies have shown varied results with respect to effectiveness, but the trend in studies is that it is effective for reducing pain and improving mobility. This is backed up anecdotally, with patients reporting a profound release when the needle hits the trigger point.

If you have any questions about dry needling email us harleyplacehealth@gmail.com or if you would like to book a session with Jerome visit our booking page.

We are very excited to welcome Jerome Smith to Harley Place Health. Jerome has extensive experience with professional sportspeople and will be a fantastic addition to our team of practitioners.