There is no denying that pregnancy is one extremely daunting experience for many women (especially the first-time round, am I right?) and that is OKAY. Comparing the parenting advice from your friend Jane at lunch who has 3 kids under the age of 6, to your mother’s advice which usually revolves around “oh, I never worried about that with you” can be extremely stressful and can make you feel as though you need to pour coconut oil over your entire life to survive. However, there are many support systems in place to help you along the way for both your physical and mental health. This blog article is aimed at shedding some light onto how Osteopathy can assist you on your pregnancy journey. It is NEVER too late to see an Osteopath along your journey, whether you plan to deliver vaginally or by C-section. During pregnancy, there are many structural changes that occur, which can impact on your daily functioning. Due to biomechanical changes experienced during pregnancy, this can result on additional pressure on the spine and pelvis. This may lead to certain musculoskeletal pain and additional ailments which can impact on a woman’s wellbeing. Changes that you are likely to see
Shift in your centre of gravity
Softening of ligaments
Increase in blood volume by almost 50%
Conditions that you might experience.
Pelvic Girdle Pain
Lower Back Pain
Upper Back Pain
Swelling of the legs
Fatigue and Exhaustion (you are growing life remember!)
High or Low Blood Pressure
Who are we? I hear you say it in your mind, “Ost-E-O-path…it’s something to do with bones, isn’t it?” correct, BUT we consider all your body systems and how they impact on your wellbeing through our wholistic approach to your health.
Government registered allied health care professionals, who attend 5 years of accredited university study inclusive of clinical practice, anatomy, physiology, pathology, neuroscience and osteopathic studies.
Osteopathy is covered by most private health funds and by Medicare’s Chronic Disease Management Plans, DVA patients, State Worker’s Compensation schemes and motor accident insurers (1).
We take a thorough medical history, perform an extensive musculoskeletal examination and any other special orthopaedic or neurological testing if deemed necessary in the consultation.
Hands-on treatment approach to suit your individual wellbeing goals and alleviate pain.
We are highly skilled in supporting women throughout their pregnancies. Our role is to be supportive, aid in maternal biomechanics to help reduce pain and possible difficulties with labor.
So, how can Osteopathic treatment during pregnancy help my journey? With limited medication considered safe to take in pregnancy this leaves very few options for pain control. Osteopathic treatment in pregnancy is safe for both mothers and babies and uses non-invasive and gentle techniques that are carefully selected to minimise any risk and to assist the body to adapt to pregnancy-related changes. Pregnancy brings dramatic musculoskeletal changes that alter normal biomechanics, accompanied by ligamentous strain, increased muscle tension and decreased range of joint motion which can cause pain (2). In a recent study, the most common pregnancy related health conditions that women reported were musculoskeletal complaints including back pain at 39.5% (3). A study of 430 pregnant women found that feelings of depression, anger, anxiety and raised cortisol levels were associated with back pain and leg pain during pregnancy (6).
As Osteopaths, one of our main philosophies is that structure and function are interrelated and symbiotic. Our treatments aim to normalize the structure so that it functions as efficiently as possible. We use techniques that will assist the natural process of pregnancy and birth by aiding the body to adapt, adjust and align as the pregnancy progresses.
We use manual therapy techniques such as soft tissue massage, mobilisation of joints, myofascial stretching and joint manipulation (when deemed safe and appropriate), visceral techniques and Osteopathy in the Cranial Field. Osteopathic Manipulative Treatment (OMT) is a body-based treatment that offers a conservative, non-invasive option for relieving pregnancy-related LBP while increasing back-related function (2).
Studies suggest that Osteopathic treatment provided during the third trimester of pregnancy lessens or halts the deterioration in back-specific functioning that often characterizes the third trimester of pregnancy and thereby provides an important clinical benefit when used as a complementary therapy (4). They also indicate that providing OMT as a complement to conventional obstetrical care during the third trimester of pregnancy has beneficial outcomes (5). Benefits of Osteopathic Treatment in Pregnant Women
Decreased Duration of labor
Decreased Sacroiliac Dysfunction
Decreased Low Back Pain
Decreased Carpal Tunnel Symptoms
Decreased Use of forceps during delivery
Decreased Likelihood of having a preterm delivery
Decreased Blood Pressure
Decreased Fluid Overload
Decreased Probability of having meconium-stained amniotic fluid (8)
Download our free “Basic Pregnancy Stretches” HERE– Before commencing, remember to take this to your Osteopath, GP, Obstetrician to get clearance. How can Osteopathy help on your post-partum journey? Regardless of the type of labour and birth, women can experience a wide range of postnatal issues that can impact their function. Like pregnancy, there are limited medications deemed safe for breastfeeding. Your Osteopath may advise you to make return visits with your newborn to help prevent or manage conditions to help you meet your baby’s needs, whilst caring for your own. Conditions you may experience post-partum;
Back and neck pain due to postural challenges relating to breastfeeding.
Fatigue, anxiety or depression due to sleepless nights and the constant changes you experience as a new mum.
Incontinence and constipation due to changes in the pelvic floor and pelvic mechanics
Lifting babies, prams and capsules causing musculoskeletal strains and sprains.
Pelvic imbalance from pregnancy and labour (including C-Sections).
mosteopathy.org.au, (2017). Retrieved 12/11/2017. Osteopathy: About Us. From www.osteopathy.org.au.
Hensel, K., Buchanan, S., Brown, S., Rodriguez, M., Cruser, D. (2015). Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects-The PROMOTE study A Randomized Controlled Trial. The American Journal of Obstetrics and Gynaecology, V (212), p1-16.
Frawley, J., Sundberg, T., Steel, A., Sibbritt, D.,Broom, A., Adams, J. (2016). Prevalence and characteristics of women who consult with osteopathic practitioners during pregnancy; a report from the Australian Longitudinal Study on Women’s Health (ALSWH). The Journal of Bodywork and Movement Therapies (available via Science Direct subscription). V (20). p.168-172.
Licciardone, J., Buchanan, S., Fulda, K., Stoll, S. (2010). Osteopathic Manipulative Treatment of Back Pain and Related Symptoms During Pregnancy: A randomized Controlled Trial. American Journal of Obstetrics and Gynaecology. V (202). p.1-15.
Licciardone, J. (2017). Osteopathic Manipulative Treatment During the Third Trimester of Pregnancy. The Journal of the American Osteopathic Association. V (117). P.289-290.
Field, T., Hernandez-Reif, M., Diego, M., Schanberg, S., Kuhn, C. (2006). Stability of mood states and biochemistry across pregnancy. Infant behaviour and Development Journal. V (29). p262-267.
Saurel-Cubizolles, MJ., Romito, P., Lelong, N., Ancel, PY. (2000). Women’s health after childbirth: a longitudinal study in France and Italy. International Journal of Obstetrics & Gynaecology. V (107). P 1202-1209.
Lavelle, J. Osteopathic Manipulative Treatment in Pregnant Women. The Journal of the American Osteopathic Association. V (112). p343-346.
Keeping that New Year commitment to looking after yourself
The most beneficial thing you can do for yourself is engage in a daily movement routine. I say movement, because sometimes ‘exercise routine’ can conjure up thoughts of needing to ‘smash’ oneself by engaging in some sort of gruelling, physical activity where no pain, no gain is the mantra. This does have a place, but most people don’t need to do that to become mobile, happy and healthy.
Typically, if you are on ‘the comeback,’ or even starting from a pretty good base and looking to maintain, I always advised a regular mechanical check over to make sure all the moving parts are moving to their optimal. We look out for restricted areas that need to be released to allow you to return to activity and assess the functional capacity of the tissue to screen for injury risk and ultimately to prevent from injury in the first place.
If you have not regularly exercised in a while and you are starting back, remember slow and steady – build up! You have as much time as you need. There is no point going hard in January only to have to rest up in February and March….then struggle to get the motivation to start up again in April, which gets put off until May!
Along with appropriately warming up, cooling down, stretching and rolling, you can reduce your risk of injury, improve your recovery and performance by regularly attending a yoga class that is right for you and getting some regular massage treatment, especially in the early days…just like the professionals do.
Exercise that focuses on awareness and control of your movement, such as Clinical Pilates, is a necessary part of your regime along with adequate recovery and preparation. Clinical Pilates is one of the best movement regimes to help you understand and become aware of how you move, to re-learn movement that may be ‘out of sync’ and need improving and to strengthen your muscles and joints at angles just not achievable with ‘regular’ training.
It is important to move beyond ‘re-training’ and to work with someone like an Exercise Physiologist, to take what you have learnt about your movement through pilates and apply it to movement tasks of everyday living. It is important to start to replicate usual movement and challenge with load so that you become stronger to perform your ‘tasks of daily living’ – It’s like training for a sport. You break the game or activity into ‘drills’ and practice until your capacity to perform them improves and feels natural…….most people, with recurring or chronic pain, simply need to do something like this, but really, to do this properly, you need help and coaching from a group of experts. Preferably experts who work closely with each other and know who is the best person to be working with at any given time.
Finally through out, it is important to maintain nutrition. A great place to start is with hydration and electrolytes, where Water and Magnesium are the main ‘go to’s’. These will help to keep your energy up, reduce training soreness and maintain your muscle health and suppleness. A great deal of injury prevention and recovery can be achieved with diet and strategic supplementation.
Dr Giulian Di Venuto is principal Osteopath and Director of MOVE Osteopathy and is available for Osteopathic consultations at both Brisbane City and New Farm Clinic. Move Osteopathy also offers, Remedial Massage, Myotherapy and consultations with our Exercise Physiologists, personalised exercise programs in our own rehabilitations gyms and clinical pilates.
keeping routine with when you eat, exercise, go to bed and wake up in the morning can really help your body know when it’s time to wind down and relax ready to go to sleep. Shift work constant change in bed time or get up time can make it more difficult for some people to easily fall into restful sleep.
Reduce or time your caffeine intake.
Essentially caffeine is a stimulant and can block the action of a natural brain chemical that is associated with causing drowsiness and slowing down of neural activity that naturally induces sleep. This is often very handy when you need a “kick” to ward off tiredness or drowsiness but obviously is not helpful when you want to sleep. Using caffeine during the day because you are tired from sleeping poorly can become a viscous cycle in sleep problems and tiredness. Caffeine can be found in is found in coffee, tea, cocoa, cola soft drinks and energy drinks, chocolate bars, energy bars and some medications, like cough syrup and weight loss tablets. The effects of caffeine can last for up to between 8-14hrs
Turn off computer and TV screens
Our normal body clock is affected by artificial light. Short wavelength blue light which is most commonly used on back lit devices like phones, laptops and ipads is the most disruptive. Because of the exposure the body does not produce as much melatonin which is the hormone that is usually produced in us as it gets dark and helps to naturally cause sleepiness.
Don’t go to bed on a really full stomach.
bloating or irritation of a full stomach can make it had for you to relax into restful sleep
Don’t go to bed on an empty stomach.
hunger can also leave you restless
Engage in regular exercise.
Studies that have been performed suggest that exercise significantly improves the sleep of people with chronic insomnia. Also noting if morning or afternoon exercise has an affect
Limit fluid consumption before bed.
waking in the night to go to the bathroom can disrupt your sleep and make it difficult for some people to fall back asleep again.
Keep your bedroom dark and quiet.
a dark environment promotes natural metatonin release which can naturally help induce sleep
Invest in a good bed and pillows etc.
Comfort is an important factor. Neck pain, back pain, headaches or other aches from ill supporting pillows, or mattress can make it hard to get to sleep and stay asleep for a good length of time as can being too hot or too cold.
Get in tune with your internal alarm clock – Try to go to sleep and wake by it.
If you are naturally tired early and are an early riser maybe don’t fight it and try staying up late in the evening to watch tv or to do things. When you’re in a good sleep routine and achieving quality sleep you often find your body will tire and wake and predictable times
Spinal manipulation endorsed as ‘best practice’ for back pain.
3rd leading disease burden in Australia with an estimated cost of over $9 Billion per year. The majority of sufferers will consult their GP seeking care in the first instance with half being prescribed medication as a first line treatment. In the past 5 years, prescription of pain relieving medication has increased from 5 million to 7 million prescriptions.
Paracetamol is the 4th most prescribed drug in Australia. The number of deaths from prescription pain medications – opioids – has increased 61% between 2004 – 2014. 58% of non–cancer pain medication prescriptions are for musculoskeletal issues The founder of Osteopathy, American Physician Dr Andrew Still, became disillusioned with the effectiveness of the medicines available to him in the 1800’s and developed an approach to health care to circumvent or at least complement drug prescription. Over a century later, after a relentless campaign to discredit the ‘hands on’ approach that Dr Still popularised, the American Medical Association has finally agreed with him and revised their best practice guidelines for managing back pain, endorsing spinal manipulation, massage and heat as first line treatments before medication is prescribed.
These recommendations are welcomed by Brisbane based Osteopath, Dr Giulian Di Venuto, who said ‘there seems to have been a ‘turf war’ for the back pain patient for a long time. Osteopaths have been advocating the use of spinal manipulation, massage, heat and exercise to help people with back pain since the 1800’s. It is good that the evidence base for what we do is starting to catch up and that eminent leaders in health care, such as the American Medical Association, are recommending with confidence that we are amongst the best people to assess and treat musculoskeletal pain such as back pain in the first instance.’ Osteopath, Dr. Di Venuto advises that most cases of back pain resolve within 6 weeks and whilst pain can be sever at times, it is best to try and keep moving.
‘People are vulnerable when they are in pain. They are often anxious and scared and believe that their pain will persist. I agree with drug therapy and the role it plays in pain medicine, but it is more important than ever that patients are referred to the most appropriate people for examination and treatment because the ‘quick fix’ is not working.
Medication dependency is real and so are the side effects. When there is evidence for interventions that are better and safer than medication, they should be used in preference and that is what the AMA is also saying. Osteopaths, physiotherapists and chiropractors have been advocating for a long time now that therapies such as spinal manipulation, massage and exercise, should be preferred to medication in the short and long term treatment of back pain.’
Osteopaths, Chiropractors and Physiotherapists are University trained, registered health care professionals, regulated by government agency, the Australian Health Practitioners Registration Authority (AHPRA) and specifically trained to assess, diagnose and manage musculoskeletal issues such as back and neck pain. Osteopaths and Chiropractors are trained in spinal manipulation during their undergraduate university training. If you are interested in seeking advice from a registered Osteopath, or you want to learn more about us you can learn more on our website or Osteopathy Australia.
Injuries in the game of AFL are increasingly common year after year, and can be the difference between a win and a loss. The best 22 players you can field will increase your chance of winning, wouldn’t it?
The best way to decrease the chances of sustaining an injury whether it be during pre-season, training or on game day, is to work on your body so it is ready for the tasks necessary to play at peak performance.
The game of AFL requires players to have a high level of aerobic endurance, the ability to be able to kick and handball with both sides of the body, and the ‘football brain’ in order to read the play. Whilst these are staples of the AFL player, the underlying flexibility, agility and core strength is what can elevate a player to the next level and equally important, reduce injuries!
The most common injuries sustained by AFL players according to the latest AFL Injury Survey are hamstring and calf strains, as well as knee and ankle injuries. These areas also coincide with the most missed games per club through injury.
A common myth around the sporting arena is that building muscle inhibits flexibility, and vice versa where being flexible requires less strength. This could not be further from the truth.
The most common strain to the football athlete occurs at the hamstring muscle/s. The strain occurs when the muscle in question has been overstretched and fibres of the muscle/tendon have torn. This tear can be classified as Grade 1, 2 or 3.
So this begs the question; What causes a muscle to be overstretched?
A muscle simply overstretches when the force required by the muscle is greater than the force the muscle is able to supply.
“Hamstring injury prevention and rehabilitation programs should preferentially target strengthening exercises that involve eccentric contractions performed with high loads at longer musculotendon lengths” (Schache et. al, 2012). What does this mean?
The calf and hamstring muscles are at risk of being overstretched when they have a lack of eccentric strength. A lack of eccentric strength alongside ‘stiffness’ and irregular intermuscular coordination cause a strain to occur. OK, why is this the case and how do I get calf and hamstring eccentric strength?
Eccentric exercises have been shown to add sarcomeres (basic unit of striated muscle tissue) and increase muscle strength at longer lengths. These adaptations act to protect a muscle against injury by reducing the damage caused by repeated eccentric contractions. Studies 1 have compared the effects of eccentric versus concentric hamstring strengthening exercises and showed that increases in strength at longer muscle lengths occur only after bouts of eccentric exercises. Therefore, training the hamstrings eccentrically may give them the ability to resist the high forces experienced during high-speed running and jumping in AFL and to avoid disruption of the muscle fibers.
It is important to note, a player is at higher risk of up to 30% of a calf or hamstring strain if they have had one previously.
You can train your body to be its best by being specific about what you need. AFL players a strong core, an evenness around muscle groups, a good level of flexibility, and a high level of aerobic endurance in order to give them the best chance at being and more importantly staying, injury free.
Stay tuned for the next post regarding specifics into how you are able to achieve this!
Dr Chris Fielder – Osteopath (B. Clin. Sc, M. Osteo) Chris is an Osteopath practicing at MOVE Osteopathy in Brisbane CBD. He has an interest in all things AFL and loves to help people playing AFL at all levels to perform better and enjoy their sport. If you love playing your footy have an injury or want to avoid injury and perform better make an appointment to see Chris ph: 3229 3661 and stay tuned for more great posts from Chris on this topic.
Kilgallon M, Donnelly AE, Shafat A. Progressive resistance training temporarily alters hamstring torque-angle relationship. Scand J Med Sci Sports 2007;17(1):18-24.
Mjølsnes R, Arnason A, Østhagen T, et al. A 10-week randomized trial comparing eccentric vs. concentric hamstring strength training in well-trained soccer players. Scand J Med Sci Sports 2004;14(5):311-317.
Schache AG, Dorn TW, Blanch PD, et al. Mechanics of the human hamstring muscles during sprinting. Med Sci Sports Exerc 2012;44(4):647-658.