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Welcome to Stonehenge Osteopath

Published on by Caroline Whitehorn

What qualifies me to treat?

I have been working as an osteopath in my local area, since qualifying in 2007. I have been in Amesbury since 2016, treating the population and Shrewton prior to that. More recently I have worked in the NHS alongside my private work. This has given me the opportunity to learn and work a great deal more on rehabilitation of a multitude of conditions including post operative care for musculoskeletal operations such as knee, hip or shoulder replacements.

I am registered with the General Osteopathic Council which is a legal requirement to be able to call myself an osteopath. As a registered osteopath I have a proven level of training and safety. The GOSC is the osteopathic equivalent of the General Medical Council.  They only approve courses that meet their standards. These are four year degrees, which ensure I am safe to treat people whether they are referred by their GP or a family friend.  We have an act of parliament to keep us in order!

I am also a member of the Institute Of Osteopathy (also known as the British Osteopathic Association).

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Feet

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I love feet! Not in some weird way. Feet are often an ignored part of our self care. We run, workout, do pilates or play tennis. Keeping our body fit and our heart in tip top shape, but we often don’t think about our feet. Our feet have 26 bones, 33 joints and 29 muscles in the foot (well, some start outside the foot and finish in the foot). They need working and moving like the rest of our body. So how much do you move your feet joints and muscles?

If you are wearing stiff or firm soled shoes then the joints in the foot aren’t doing a great deal and therefore the muscles aren’t being used optimally. Do you ever walk around your home bare foot?

All the little muscles and joints need to move!

Often, pain in the foot can be from lack of movement through these muscles and joints over months or years, through foot wear or training changes or activity changes. Things like plantar fasciitis develop due to lack of flexibility through the foot and it’s arches. Tight calf muscles can be a part of it, as this can restrict the flexibility of the foot. This is a very common condition which can cause an awful lot of discomfort and affect normal daily activities or exercise.

Ideally, you should be able to walk around your home bare foot, without pain (if you get pain it may be you need to get an assessment and rehab advice). Also, have a go at moving each toe individually, can you spread your toes to create space between them?

Can you raise all your toes and lower each one individually to the floor?

Can you bend and create movement through your foot?

These are all signs of good and strong foot health. You can work on these and make your feet stronger. You can start with these things:

Scrunching your toes against the floor.

‘piano’ playing with your toes.

Moving your big toe away from the second toe.

Heel raises- both feet and single foot

Use your hand to wiggle your foot in different directions.

Hip pain?

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Hip pain can be worrying, especially if you are thinking it is your joint and you are in your 50s or 60s or older. Often people assume they have arthritis in the hip. They come to me worrying about whether I am going to say they need to see the GP and then a consultant because their hip is worn down. Sometimes, it is true, this can be the case. wear and tear or degenerative change does happen over time and after the age of 25 we are all slowly deteriorating! Great news! Aging is normal.

However, often people come to me and describe they have hip pain. On further investigation I realise they are not talking about the hip joint. Commonly, hip joint pain shows itself in the groin, the pain is in the crease at the top of the thigh. I see people with worries about needing a hip replacement but what they are describing is lateral hip pain, pain on the outer side of the hip area.

How people describe the symptoms is part of the picture and the onset. A diagnosis is never one thing alone.

Women are more likely to suffer this when they are around the peri-menopause or menopause years. But they are by no means the only ones. Lateral hip pain can affect younger active people or older men.

What is it then if it isn’t my joint?

If after assessment your joint is cleared. There are several different tissues on the outer thigh that can be causing this, there are little fluid filled sacks called bursas, they can become inflamed and irritated, tendons can become irritated too. Also, the gluteal muscle can have a tear. These can happen individually or a few together. They cause pain on walking, going upstairs, standing.

What causes it?

It can be a change in activity, either an increase or decrease in activity. Have you had a recent lifestyle change or weight loss or gain? Have you taken up a new activity and increased the amount you do, or have you previously been quite active, stopped for a while and then tried to start again?

Irritatingly, you could be trying to become fitter or improve your activity levels only to come to a halt due to pain!

What to do about it?

First thing is to try to reduce the irritability of it. This can be by using ice over the area, or anti inflammatories if they are ok for you (speak to a pharmacist or GP if you are unsure or you are on other medication which may conflict with it). Trying to reduce the activities for a time that irritate it. For example, If that is after a certain distance of walking, reduce your walking. Pace activities that require you being on your feet. Or if you have an exercise regime reduce it to a level where you weren’t getting the pain.

There are exercises which can help alleviate the pain. These need to be suitable for where you are after diagnosis and progressed appropriately. That’s the good news. The bad news is it can take several weeks or even a few months to get to where you want to be, especially if you leave it ages to get it looked at.

Understanding Hormonal Fluctuations in Women’s Fitness

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Last week, I attended a women’s health conference. There were speakers from different elements of women’s health such as endometriosis, specialist menopause doctors and lifestyle coaches. It was great to get the most up to date information about these issues.

What is possibly most useful to my sphere of interest is the advice regarding exercise and the effect on the menopause or perimenopausal woman. It is interesting in the subtle changes that can happen where the same work out you have done for years or the same activity such as running or cycling may not cut it, when it come to weight management and maintaining fitness. Of interest to me is the effect on tendons the rollercoaster ride of hormones has.

This rapid moment by moment change in hormones explains why one day a peri/menopausal woman feels fine and the next feels awful or achy or low in mood. Our hormones don’t plummet in a linear decline over a gradual period of time, neither do they drop off a cliff in one fell swoop. No they, drop and rise and plateau and drop again. This could be over a few months or few days then even out.

I think this is worth understanding when it comes to the ability to maintain regular physical activity and healthy balanced eating habits. If you can imagine, feeling great one day so you go and work out or have the run or bike ride, have a lovely balanced meal then the next day your oestrogen has dropped. You feel basically p***ed off at the world. Who wants to exercise in that frame of mind? Will you choose the lovely nutrient filled buddha bowl for lunch or the carb and starch loaded bread roll and chocolate bar?

Then to add to the fun, we chuck in the loss of resilience of tendons. So your now erratic training or exercise sessions are inconsistent and not gradually loading the tendons, because you had 4 days off then a day exercising then another few days off. The impact of this putting you at increased risk of injury is now increasing.

This is often where I meet women, Is they have a tendon issue and wallowing around in the weeds trying to work out what went wrong and how they can resolve it. I will talk with them a lot about consistency and how tendons love predictability. They don’t enjoy or respond well to sudden loading or persistent inactivity. This is where shoulder (rotator cuff issues) pain can start or achilles or lateral hip pain. Together we work out how to manage the pain, modify activities and progress to return to previous activity levels.

Remember tendons don’t like surprises!

From booking to the appointment

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As a health care practitioner I have certain legal obligations required by our regulatory body the GOSC (General Osteopathic Council) where we need to complete a medical history and full assessment before I can give a diagnosis. What does this mean to you as a patient?

When you book your first initial appointment, if you have never seen me before or not in the last 2 years, I allow an hour (£65) to do the history and assessment, asking you medical and lifestyle questions as well as why you have come in to see me. This helps me give a clear diagnosis and recommend appropriate treatment.

After this, I look at how you move, your posture and what movements aggravate the pain. Some of this may be you moving your self and some of it maybe me moving something for you (we call this passive movement). These can tell me about what your soft tissues and joints are doing and which maybe more involved.

I also use something called palpation, which is essentially touch. I am looking with my hands. Using touch to sense the quality of the tissue and tightness and see what feels tender or painful. On occasion, I may feel that you actually need to see your GP for further investigation and I may not be the right place for you.

When all this has been completed and I explain what I is happening, then if it is suitable to treat you then I use a mix of soft tissue massage and articulation of your joints to reduce tension and stretch muscles and relive pain. Telling you as I go what I am doing and why.

I also advise on rehab exercises and lifestyle advice relating to work environment, posture or daily activities and exercise training. Everything that you discuss with me in your session is entirely confidential, your expectation of confidentiality with me is the same as that of your medical doctor.

If it is necessary for you to have follow up appointments these take 30-40mins (£55). I always discuss what your aims are and what you are looking for in terms of treatment and your expectations of appointments. Generally people benefit from between 2-6 appointments for acute issues that have come on within the last 3 months. These are usually reviewed as we go and I would never suggest a course of block booked appointments because everyone is different and not everyone requires the same number of appointments even for the same issue.

Prices correct for July 2024

Menopause, tendons and exercise

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Why do my hips/shoulder/heel hurt?

‘I am 48 yrs old, I am working really hard to get myself in shape and have managed to hurt my achilles!’

When moving into the peri-menopause from about the age of 45 years old oestrogon levels begin to drop. What the hell has that got to do with why my achilles/hip or shoulder hurt? You may ask. Well, our tendons are made of lovely strips of collagen running in similar direction. Collagen loves oestrogen. Oestrogen prevents the loss of collagen. This means oestrogen helps the resilience of our tendons.

Why is any of this relevant to someone who is doing the right thing, by trying to get fit or stay in shape? If you are entering the peri-menopause and the gradual decline of oestrogen is happening you could even be doing the workout or exercises you have always done and begin to notice these key areas begin to hurt: putting your feet to the floor in the morning gives pain over the achilles, pain over the outer hip or raising an arm becomes uncomfortable.

This is because the decline in oestrogen changes the body’s ability to recover and repair after exercise. When I am talking this through with patients I take time to explain that it is important to pay attention to how the body feels in the 24 hour period following activity. It is important to listen to your body, to understand the new way your body is functioning. When they have been for their run, is it uncomfortable putting the feet to the floor the next morning, does the outer hip begin to get uncomfortable?

This is an indication that extra time to recover is necessary, maybe a longer break between that particular activity and repeating it.

3 ways you can reduce the irritation:

Cross train – introduce a different activity to maintain momentum- maybe take a swim or cycle take the jump or run out of one of the workouts

Resistance training – progressive and consistent loading of the tendon appropriate to the individual (this has so many other benefits for the body too!)

Rest a bit more frequently between the jumping or running activities.