James Gillard Osteopath

A Functional medicine approach to migraines

My Dad suffered from migraine as a child. In addition to head pain he experienced changes in vision, nausea, vomiting and being unable to leave a darkened room.

Migraine is best understood as a primary disorder of the brain. About 15% of the population suffers from migraine at some stage in their lives, disproportionately affecting women (22% vs 10%) with the highest prevalence between 35-45 (1).

Fortunately my own experience with migraine is limited. I suffered an attack whilst at university. Firstly losing the clarity of the words on the page followed by a rather embarrassing public projectile vomit on the train ride home.

Migraine involves dysfunction of brain-stem pathways that normally modulate sensory input. Certain ‘triggers’ lower the threshold to activate the trigeminovascular system. This system relays signals from blood vessels in the brain to higher centres of the central nervous system. When activated, sensory nerves trigger the release of molecules that widen and cause leakage of the blood vessels. The resulting neuroinflammation is thought to contribute to the development of a migraine attack. (2)

Pain  is characterised by severe and frequent throbbing on one side of the head and may be accompanied by nausea, vomiting, or sensitivity to light, sound, and movement usually lasting between 4-72 hours (2).

Current treatment involves the avoidance of migraine triggers including stress, dietary triggers, and dehydration, in addition to the  preventative and/ or acute medications targeted at altering the biochemical imbalances that may prevent or abort a migraine attack.

Functional Medicine is a science based, whole systems approach that focuses on identifying and addressing the root cause of presenting symptoms or disease. It emphasises an evidence-based nutritional and lifestyle approach to improve the function of bodily systems to create an environment that promotes self healing.

Rather than asking “how do we treat themigraine?”, it asks “what’s causing the migraine?”

Migraines have been associated with inflammatory diseases and changeable risk factors including obesity, comorbid pain conditions, and sleep problems. However, causes of migraine vary for each individual patient and hence the best treatment and prevention is also individual.

Some potential Migraine causes:

• Metabolic imbalance
  • An imbalance of energy demands of the brain and the bodies inability to meet them may be a trigger leading to migraines (3)
• Gastrointestinal problems
  • Migraines have been associated with IBS, celiac disease and low levels of vitamin D (4)
• Mitochondrial dysfunction
  • Increase in the levels of the destructive free radicals with and a poorer antioxidant capacity to help mitigate this. (5)
• Trace minerals and Heavy metals
  • Appear to have a role in the genesis of increased production of free radicals in migraine attacks (6)
• Hormone imbalance
  • Abrupt drops in estrogen occurring just prior to mensturation and during menopause have commonly been observed to trigger migraines (7)
• Musculoskeletal
  • Dysfunction of  joints and muscles in the neck have been observed in patients with migraine (8)

By taking a thorough medical history, examination, interpreting and utilising specific functional testing, a functional medicine approach helps to narrow in on a root cause and provide specific individualised treatment and management recommendations.

Some strategies employed may be:

• Dietary changes to improve blood sugar regulation, mitochondrial function and antioxidant capacity
• Developing supportive exercise programs, sleep hygiene and stress management strategies
• Use of supplementation to improve micronutrient status, energy production and reduce inflammation

Functional medicine is complementary and works alongside your conventional medical approach. As your body heals, you can work together with your medical provider to gradually reduce your reliance on medication and pain relief.

If you would like more information on how a functional medicine approach may be able to assist your migraines please contact the clinic and schedule a free discovery call.

References

1. https://headacheaustralia.org.au/wp-content/uploads/2018/08/MigraineFactSheet.pdf
2. Spekker, E., Tanaka, M., Szabó, Á., & Vécsei, L. (2022). Neurogenic Inflammation: The Participant in Migraine and Recent Advancements in Translational Research. Biomedicines, 10(1), 76.
3. Gross, E. C., Lisicki, M., Fischer, D., Sándor, P. S., & Schoenen, J. (2019). The metabolic face of migraine—from pathophysiology to treatment. Nature Reviews Neurology, 15(11), 627-643.
4. Cámara-Lemarroy, C. R., Rodriguez-Gutierrez, R., Monreal-Robles, R., & Marfil-Rivera, A. (2016). Gastrointestinal disorders associated with migraine: a comprehensive review. World journal of gastroenterology, 22(36), 8149.
5. Nattagh-Eshtivani, E., Sani, M. A., Dahri, M., Ghalichi, F., Ghavami, A., Arjang, P., & Tarighat-Esfanjani, A. (2018). The role of nutrients in the pathogenesis and treatment of migraine headaches. Biomedicine & Pharmacotherapy, 102, 317-325.
6. Gonullu, H., Gonullu, E., Karadas, S., Arslan, M., Kalemci, O., Aycan, A., … & Demir, H. (2015). The levels of trace elements and heavy metals in patients with acute migraine headache. J Pak Med Assoc, 65(7), 694-7.
7. Reddy, N., Desai, M. N., Schoenbrunner, A., Schneeberger, S., & Janis, J. E. (2021). The complex relationship between estrogen and migraines: a scoping review. Systematic Reviews, 10(1), 1-13.
8. Castien, R., & De Hertogh, W. (2019). A neuroscience perspective of physical treatment of headache and neck pain. Frontiers in neurology, 10, 276

With motherhood fast approaching, there are a lot of new and exciting changes happening during pregnancy, but sciatica shouldn’t be one of them.

Frequently pregnant patients come in complaining about sciatic pain pointing accusingly at their low back. Whilst we know that roughly 1 in 2 pregnant women will suffer from back pain during their pregnancy (1), sciatica isn’t back pain. Sciatica actually refers to an irritation of the sciatic nerve, which is a large round nerve, about the size of your middle finger. It begins at the spine and runs down the back of the leg supplying most of the tissues in this area. If you have a compression of this nerve, you know about it! There maybe sharp shooting pain down the back of the leg, muscle weakness or pins and needles.

Why sciatica during pregnancy?

Pregnancy is a fine example of the bodies adaptability. The body changes in order to accommodate the growing fetus and as the baby grows, a bigger belly means more weight is distributed to the front. So you don’t topple over, the curve in your lower back increases. Clever huh? This can narrow the space for nerve roots which make up the sciatic nerve to become irritated leading to sciatic pain.

Pregnant women are unsteady on their feet. In fact 27% of women will fall at least once during their pregnancy (3). It’s no surprise really. The hormones released during the latter stages of pregnancy cause a softening of the ligaments around the hips and pelvis. The change in shape of the pelvis also causes the hips to rotate out which conveniently also widens the base of support and stability. Unfortunately it also shortens the piriformis muscle. This becomes a problem because the sciatic nerve runs underneath this muscle and is vulnerable to being a bit squished.

Can osteopathy help with sciatic pain during pregnancy?

Osteopathic treatment can help to support the normal physiologic changes during pregnancy (4). Treatment directed to the low back and hip can help relieve tension in these areas and create more space for the sciatic nerve to run unimpeded. Osteopaths can use  gentle technique to balance the tension around these changing ligaments and help to reduce the protective muscle spasm in these areas.

We know that staying mobile during pregnancy is really beneficial (5), but it also helps in recovering from sciatic pain. So there may also be some exercise or lifestyle factors your osteopath may advise you on to complement the treatment.

Sciatica doesn’t have to be a part of pregnancy. Make an appointment with an osteopath to see how they can help you!

References

1. Pregnancy related back pain
2. Alterations during pregnancy gait
3. High incidence of falls during pregnancy 
4. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy
5. Benefits of exercise in pregnancy

Mention the word posture and it’s as if those around you shift uncomfortably in their chairs. Perhaps the knee jerk reaction is a result of our childhood being filled with the ‘sit up straight’ and ‘don’t slouch’ mantras overemphasised by our mums and dads. It appears that posture is often blamed for our aches and pains. But is poor posture responsible for pain? Does perfect posture actually exist?

Our bodies adapt to the different forces acting on us caused by gravity and the way we move during the day. As conservation of energy is of paramount importance for the body, adjustments are made to make the frequent movements or postures we assume more energy efficient. A forward curve of the spine increases to accommodate a habitual downward gaze toward a mobile device, while hip flexor tension increases from the long periods of time we spend sitting. These changes the body makes don’t occur instantaneously and the act of adopting these postures isn’t the problem, but rather the the duration of time spent in them can impact our health.

Despite my poorly drawn stick figures, the image above depicts that the further away structures are from the midline, the more load placed on the spine by gravity. We are told is to sit more like the image on the right. However the issue with even the most ergonomic postures is that whilst the loads going through the spine are reduced in these positions, the loads are still going through the same spinal structures, sometimes for 6-8 hours a day.

A patient of mine who had back pain when sitting at work pulled a few strings and got himself a standing desk. When he returned for his next visit, he no longer had back pain, but he could hardly walk because of the pain in his legs. Should we assume a more ergonomic posture? Probably, but the body isn’t really interested in minute adjustments that make you more comfortable and move less. It’s far more important to  look at how you may work more dynamically, in various postures to help disperse the load placed on the spine by gravity throughout the day.

The principle is essentially the same for those with active jobs. If you perform a repetitive movement, is there a way you can perform it differently? Split stance, squat? Even breaking up tasks during the day so that the movement requirements are varied and the risk of muscle fatigue and injury are reduced.

If you want to heed mums warning about slouching and back pain, stop worrying about trying to sit a little straighter and just get out of the chair. If you still struggling with pain or just need some direction, click here to make an appointment to see an osteopath today.

References

1. Daily Mail UK
2. Movement nutrition
3. The department of health

As an osteopath I deal with movement everyday. I also see how a reduction of movement leads to a body struggling with pain, dysfunction and illness.

Our bodies are designed to move, even down to a cellular level.  The movement of blood, lymph, neurotransmitters, cartilage, bone and immune cells all help to maintain health. The way our bodies function is a result of how we have moved throughout our entire lives. This is because our cells adapt to forces we create by the way we sit, stand and move throughout the day as well as forces caused by trauma and injury.

Exercise is an important part of any healthy lifestyle. But exercise is different to movement. Lifting weights, riding a bike or trying to get a kick on the weekend require different movements to those required for function. We know that periods of heart pumping, sweat inducing exercise isn’t enough to offset sedentary activities throughout the rest of the day. Combine this with other poor lifestyle choices and the result is a population with an increasing number of people suffering from chronic pain, stiffness and ill-health. Being able to walk 25km, carry heavy loads, hold your own body weight or transitioning swiftly from floor to standing may not give you the same endorphin boost, but it does require movements which are essential for our biology.

Society has evolved to create a greater divide between the way we move and the way we were designed to move. We have adapted to changes in technology, transport and ergonomics, which have made those tasks requiring varied movements, effortless or obsolete.

So why bother? Shouldn’t we embrace the ease in which technology provides us?

The problem is, that although our environment and the way we use our bodies has changed since we were hunter gathers, the fundamental biology has not, nor have the movement requirements for health. As our cells adapt to our new sedentary ways and the capacity for varied movement diminishes, it is no wonder our tissues fail when we are required to load them outside their usual capabilities. Its a regular occurrence to have patient presenting with pain following moving house, a sunny days gardening or a new job.

With an ageing population and the rate of chronic disease and disability on the rise, we at Holistic Osteopathy think it’s time we got people moving again. That’s why we are introducing ‘Love to Move’ sessions, which involve a combination of our traditional osteopathic treatments as well as a unique movement based assessment of your whole body. From here we work on re-training your muscles, joints and nervous system to move more efficiently.

We have found this approach to be suitable for general sports rehabilitation, chronic pain sufferers, post birth pelvic issues or those who would just want to move with more freedom.

What are you waiting for? Click here to book!

How far do you walk each day?

If you are an average Australian it’s about 3.2km (1). Doesn’t sound like a lot does it?

The introduction of trains, cars and planes has made the issue of distance negligible. We can be halfway around the world or visit family 100’s of km away in a single day. It has also made our innate form of transport appear time consuming and inefficient. I’m talking about walking of course. Walking is to “move along by putting one foot in front of the other, allowing each foot to touch the ground before lifting the next” (2) and it would take an awfully long time to visit uncle John in Albury by foot.

So whats so important about walking anyway?

• It strengthens the heart and lungs, increasing overall fitness.
• Improves muscular endurance and strength
• Helps to improve circulation, particularly in the legs
• It is weight bearing and vitally important for bone density
• Low impact and less stressful for joints
• Can assist in weight loss
• Mental health benefits

How much should I be walking?

Experts suggest “30 mins of walking every or most days of the week” (4). This translates to roughly to 2-2.5km, well within the Australian average. But is the distance in and of itself enough?

Rewind to a time when walking was the only form of transport and it is estimated that our hunter gather ancestors walked an average of 4.5km per day (3). Granted we have had a couple of thousand years of evolution since then, but the fundamental physiology and bodily structure is still the same. This way of life satisfied the bodies desire for movement and equally as important as the walking distance, was the way in which they walked. The distances were varied depending on conditions and survival needs but it was combined with different speeds, slopes and on various types of terrain. Walking in this way requires a diverse range of movement through various joints and causes muscles to work in different ways, which is vital for function.

So perhaps the obstacle for the modern day walkers isnt walking distance, but walking in an environment which is flat, artificial and highly predictable; in shoes which don’t allow normal foot and ankle mechanics. There are few opportunities to vary our joint movement and loading by walking on uneven surfaces and slopes, or to utilise naturally stabilising muscles in the foot. Our feet have become accustomed to the cushioning and support that shoes often provide and would not thank us to kindly for completely removing it and putting them through a rigorous workout.

Here are some more foot friendly ways to gradually introduce new loads into your feet:

• Enjoy some time without shoes in the garden, beach or even the house.
• Seek advice on whether a transition to minimalist/ barefoot footwear might be appropriate
• Use a ball to help mobilise joints of your foot.

Our environment has changed the way we move. The walking variability our body craves may not be always available to us but we can still walk more day to day for huge health benefits. Try these:

• Take public transport
• Park the car a short distance away if you’re driving
• Suggest a walking meeting or coffee break
• Walk with a friends or family
• Take pets for a walk
• Organise hiking holiday
• Join a walking club

Hippocrates said ‘walking is man’s best medicine’ and there is a growing body of evidence to suggest he may be right. Studies conclude that walking can be a successful tool in helping to manage chronic disease and functional disability (5), something that modern society has in spades. It is an ‘ideal  gentle start-up for the sedentary, inactive and immobile elderly’ (5) so lets not wait until we get sick to begin walking. It’s easy to start, just put one foot in front of the other.

References

1. Care Australia
2. Cambridge Dictionary
3. Nutritious Movement
4. Why a walking workout is good for your body
5. Walking to health
6. Better health

Last week I was treating a patient of mine, who it appeared had seen just about everyone to help her with her pain. Unfortunately this isn’t the first case of it’s kind that I’ve seen, in fact many patients with persistent pain have this all too familiar narrative. As the inevitable silence descended down upon the room during treatment, I began to ponder why would a patient need to see so many different practitioners to deal with a problem…. and so I asked.

“I don’t know who I’m supposed to see” she said. The response, while apparently simple, did get me thinking. Who would I see if I needed some help with pain? How would I go about finding the correct practitioner for my complaint?

Choice is good when it comes to healthcare, but the saturation of promised pain solutions we have access to can become slightly overwhelming. With the addition of Dr. Google, endless online content and the constant social media discourse, we are now inundated with an infinite pool of cure all exercise videos for back pain, recipes for chronic gut conditions and know-it-all bloggers telling us what’s best; it’s no wonder there is a little confusion! To help navigate your way through the internet health maze, here are some important things to consider:

1. What kind of modality would you like?

Natural products, herbs and nutritional products – the most popular of complementary therapies. These include herbal or botanical medicines, certain vitamins, minerals, dietary supplements and probiotics.

‘Hands on’ therapies or body work – based on touch or manipulation of soft tissue, muscles and joints. Includes massage and Bowen therapy. Osteopathy and chiropractic are often spoken of as complementary therapies, but in Australia, these therapies are classed as allied health treatments.

Mind-body therapies – aim to influence physical functioning and promote health using the mind, thoughts and feelings. Work on interactions among the brain, mind, body and behaviour. Includes acupuncture, meditation, yoga, tai chi, deep breathing, guided imagery and support groups.

Energy-based therapies – based on manipulation of ‘energy fields’ in the body. Includes reiki, kinesiology, magnet and light therapies

Movement therapies – such as Feldenkrais method, Alexander technique, pilates, Rolfing and Trager integration.

Whole (alternative) medical systems – such as ayurvedic, traditional Chinese medicine (TCM), naturopathy and homeopathy.

(Courtesy of Better Health)

2. What are your expectations and goals of treatment?

• Reduced risk of disease
• Feeling more relaxed
• Supporting health
• A cure
• Assistance with managing the condition
• Pain relief
• Reduced risk of complication

3. Speak to your friends and family

Most of us will have people close to us who have seen a particular practitioner for some ailment or another. This is a great way to get insight into a particular modality, practitioner or treatment style. Don’t just take their advice as gospel, ask them what the practitioner helped them with and why they liked them.

4. Ask a health professional you trust

1 in 5 Australians suffer from chronic pain and often consult their GP as first point of call (2). GP recommendations are worthwhile investigating as they can have some good insight into local practitioners, with whom other patients may have attained good results. However, also be wary, as there is minimal information provided in GP training about some health services and hence there may be other more appropriate options available. If you are already seeing a health professional for a complaint, ask if they know of anyone who might be of assistance. They may actually be able to help you or let you know someone who can.

5. Do your research

Most clinics will have practitioner bios available on the website and I suggest you sift through this information in order to get an idea of who you are dealing with . Look if they have an interest in working with particular complaints and what kind of approach or management style they have. Given that  you are going to be working with this practitioner, it’s important you actually like them. Do they have similar interests to you? Do they have similar beliefs about health?

Next, ring up and ask to speak to the practitioner directly, if they can’t, insist they call you back. This gives you a great opportunity to have an initial interaction with the practitioner. Give them a brief idea of what’s going on and then ask them the following;

• Do they have any experience working with complaints similar to yours?
• How might they address such a complaint?
• Is there any evidence for effective treatment of these issues for their chosen modality?

6. Give it a go

Once you have made a well thought out selection, temper your expectations.Your chronic pain will not disappear in one visit. Give the therapy and your body a chance to do it’s work. Four visits should be enough to give you an idea if it is worth pursuing.

Here are some things to ask your practitioner regarding your complaint to give you an idea if they are on the right track;

• What is the problem?
• How long will it take to get better?
• How is your treatment going to help this?
• What is my role in the recovery?

Whilst it may seem like a little time investment, making an educated decision may save you a lot more than just time and money in the longer term!

References

1. Better Health
2. NSW government health

Another year of the AFL season is underway. For those teams with a poor start to the year, reality has hit hard, while those who’ve had early season success remain optimistic about a finals campaign and dare to dream of premiership glory.

I sit at a cafe, perusing an article dissecting Geelong’s poor team defence. The early ‘keep a lid on it’ disposition has rapidly changed, having lost the last three games. The smell of freshly cut wood and the mesmerising dance of the fire provide a feeling of comfort. A South of Johnson long black warms me from the inside out, against the chill of a gentle Melbourne breeze announcing footy is well and truly here. A Hawthorn footballer sits across from me, deeply engrossed in a novel, mind far from the disappointing start to their 2017 campaign.

Amidst the chilled indie rock playing through the overhead, I contemplate what a life after football looks like for these players. The AFL is a business. Clubs strive to attract members and bolster ticket sales to increase revenue. Players are assets, pawns whose health is sacrificed in the pursuit of greatness. A win at all cost mentality ensues, one that pushes the boundaries of physiology and medicine for an edge that thrusts them ahead of the pack. But at what cost? The impact of continually pushing the body each week bears it’s ugly scars later in life. “76 per cent of past players experienced serious injuries in elite football and of those who reported serious injuries, 64 per cent are still affected in daily life and 60 per cent require ongoing treatment” (1). The result of years of continual trauma, the underbelly that we as supporters, don’t see.

The game is now a free flowing, continuous and entertaining spectacle. With such speed, although the contests are perhaps less frequent, the force of collisions and load through soft tissues are such that injuries are an unsurprising by-product. For these athletes, this is their job, with the injuries passed off as an occupational hazard. “Injury rates at the elite level are on the decline, indicating better treatment and preventative management for players” (2), but rehab is a lonely place. Daily physiotherapy means structured exercises programs performed with mind-numbing repetition and laser focus, in order to meet the deadlines for next weeks match selection.

While player support and education is better than ever, once playing days are over, only “6 per cent of players will have treatment costs covered by their club or the AFL Players Association”(1). Not only do players still struggle with pain from old battle scars, it seems some are left feeling empty, devoid of meaning and purpose without the all consuming nature of elite level sport. Their careers have been based around long term health sacrifice for peak athletic performance and hence it is post football that these players need support.

Clinical practice has given me perspective. I see the result of many years at the elite level and how an athlete’s bodies has compensated for old strains, multiple surgeries or a new found sedentary occupation. True they are pursuing something they love, but there are repercussions for neglecting overall health.

My Hawthorn companion gets up and leaves. No doubt to attend, a post mortem of the weekend, scheduled recovery or other training activity. I feel at ease, knowing he has other passions to pursue after football. I just hope for his sake, that looking after his long term health is one of them.

References

1. Lane, Samantha. “Players Pay A Lifelong Price: Study”. The Age. N.p., 2017. Web. 15 May 2017.
2. Orchard J, Seward H, Orchard J. AFL Injury Report: Season 2014 :http://s.build001.aflprod.com/staticfile/AFL%20Tenant/AFL/Files/2014-AFL-Injury-Report.pdf

Last week was Osteopathy awareness week.  It provided much needed exposure for a profession with a relatively short history in Australia, one who’s popularity continues to grow in an increasingly health conscious market.

‘Isn’t it something to do with the bones?’.

Osteopathy was initially developed as an alternate to medicine itself. Now we are talking late 1800’s where the common practise of the time was blood letting and heroic dosage. Never the less, Dr. Andrew Taylor Still, a medical doctor, became frustrated with the ineffectiveness of treatment and the often fatal side-effects that accompanied them. The son of a reverend and an avid observer of nature, he began to ponder how he could harness the natural restorative capacity of the body and let it do it’s own healing. Inspired by Rudolf Virchow’s discoveries on cellular biology, he questioned what a cell required to carry out it’s tasks effectively? Firstly it needed nutrient rich blood in order to produce energy, secondly to remove waste produced from energy production. Simple.

Dr. Still obsessed over anatomy, years of dissection, tracing blood vessels, nerves and lymphatics. He looked at points where these structures could become obstructed, where the normal tissue circulation may become disrupted from a tight muscle, abnormal ligament tension or connective tissue congestion. He found that where these hinderances existed, he was able to make mild adjustments to the musculoskeletal system thereby removing them, normalising the structure and enabling efficient function. He found that patients he treated in this way began to get better, whilst those treated with more conventional methods did not.

Fast forward 140 years, the profession itself was perhaps poorly named, ‘Osteo’ meaning ‘bone’ and ‘Pathos’ meaning ‘sufferer’. It has moved away from it’s original roots somewhat, focusing on musculoskeletal ailments. Where before a patient would present to an osteopath because they were sick, now those with headaches, low back and neck pain tend to make up a large proportion of an osteopath’s patient list. This transition is in part due to treatment being directed towards musculoskeletal structures, but mostly as a result of advancements in technology and medicine.

We are now in an era of evidence based practice. Whilst there are many papers which show the benefits of osteopathic treatment, few, if any, would fit the gold standard criteria. Funding is hard to obtain and manual therapy’s poor congruency with the current research model makes study design difficult.

The landscape of healthcare is changing. More than ever people are seeking alternate and more proactive ways to manage their health. “Around 60,000 Australians visit an Osteopath each year” (1) and as the profession continues to grow and people become aware of it’s benefits, there is greater potential for it to be used to assist the patient on their journey to wellness. My hope is a more cohesive approach that allows health practitioners to work together to manage a patient’s health. Perhaps using osteopathic treatment to improve functionality may allow a patient’s body to more effectively process their current medical treatment.

Osteopaths treat more then the bones, why not see how they can help you

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References

1. “2017 Osteopathy Awareness Week · About Osteopathy · Osteopathy Australia”. Osteopathy.org.au. N.p., 2017. Web. 27 Apr. 2017.
2. Still, A. T. The Philosophy And Mechanical Principles Of Osteopathy. Kirksville, Mo.: Osteopathic Enterprise, 1986. Print.
3. Lewis, John Robert. ‘From the Dry Bone to the Living Man’ A.T. Still. Print.