Mattress: how to find the right one?

One frequently question asked in clinic by patients: What is THE ideal mattress?
Some say the mattress must be soft to allow spine alignment and avoid joint pains from compressions, other state that mattress should be firm in order to offer the optimum support. The answer? There is no specific answer, or universal rule. Confusing? That’s what we thought!

The truth is: the ideal mattress depends on the individual’s needs, body shape/weight, sleeping pattern etc.
For example recent studies suggested that mattress with medium firmness improves pain and disability in people suffering from non specific low back pain (here).

So we tried to summarise for you the different kind of mattresses available, their pros and cons and their ideal sleepers (if you don’t want to read all descriptions there is a table here).

Signs that your mattress is not right for you:

  • You are feeling restless at night,
  • You are waking up in pain,
  • You are not sleeping through the night or just not feeling well rested,
  • Your mattress is older than 8-10 years old

Types of Mattresses:

  • Open Spring Mattress

Composed of springs held by one bar, the springs are moving together. They are the best price value mattresses on the market. However, you do not pick them for their comfort and support. They are great mattresses for occasional or temporary use, with regular replacements; which makes them perfect for guest bedrooms and children bedrooms.

 

  • Pocket spring Mattress

This is a more advanced version of the open spring one, as in this one the springs are moving independently. It is also considered as being more breathable structure than the memory foam mattresses. However, there can be risks of allergies as some of them can be stuffed with furs or feathers. There are ideal for non allergic people, couple/or bed for two and sleepers that get very hot at night.

Brand: Sealy Pocket Teramo 1400 (from £650)

  • Memory foam Mattress

Made from mouldable material, it has hypoallergenic properties. It is the prime choice for anyone with poor backs or joint pains and they are considered one of the best support as it allows your spine to be aligned horizontally (if sleeping on your sides). Although they are known to generate a lot of heat by wrapping the body, some models are being made with more breathable material (Eve mattress). They are then ideal for anyone with pains in their body (especially back), couples with different needs of support, people who sleeps on their side and sleepers that do not mind getting a bit hot at night.

Brand: Casper (from £350); Eve (from £350)

  • Latex Mattress

Made by latex based foam, those mattresses are very breathable and avoid any over heating. However, you may find them a bit too firm at first. You also do not want to pick the first prices as cheap latex mattress will cause you trouble and pain (irregular bumps)!
Those kind of mattress are great for people with allergies or asthma, anyone that feels too hot at night and those that prefers firmer beds with still a good bounce!

Brand: Zenhaven (from £1600)

  • Hybrids mattress

Those are a combination of latex, memory, polyurethane foams, coild and/or other materials. They are designed to maximize benefits and minimizing certain cons. They are all round the safest options of all kind of sleepers!

Brand: Leesa Mattress (from £690) OR Simba (from £599)

  • Mattress topper

You can find all types of mattress topper, with all the different structure and composition as stated above. They are usually an addition to a hard mattress to empathize softness and cushioned comfort.

CONCLUSION:

To chose the right mattress you need to:

  1. Do your research, set up your budget, read the different reviews. Never go too cheap as you will definitely have a poor quality mattress. However, you probably do not need to spend £2000 on one either. And do not be fooled by any brand that claims there are “orthopaedic” or “medically approved” because they are none existing.
  2. Have a chat with your doctor/osteopath/physio. If you have any specific back pains or issues, in order to have their guidance on what you need to look for.
  3. Make sure you have a trial period. Nowadays, the great thing is that plenty of start-up companies offer 100 days trials (eg: Eve, Simba..). This allows you to really have a good sense of how the mattress fits your need on the long-term. Mattresses sold in stores will have the tendency to be a bit more expensive and without such a long trial, but you can always try to hassle.
  4. Check the warranty. They usually should be for 10 years.
  5. Protect your mattress. Use a waterproof mattress protector, as stains will void your warranty/trial allowance.

In here you can read a further description of the various mattress brands mentioned above: http://www.independent.co.uk/extras/indybest/house-garden/best-mattress-side-sleeper-kids-review-tempur-a6950396.html

Choose well, sleep well, live well!

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How and why Stretching?

Stretches: you know about them, you are doing them, your doctor give them to you but actually what their actual benefits are, and how to do them properly seems to be a bit of a blurred area in common knowledge, with a lot of myths and misconceptions.

So here is an article that attempted to summarise and explain stretches; and hopefully will make everything a bit clearer to you:

Lets start with some definitions:

Static stretches: the ‘classical’ way of stretching, with no specific action. This is the dry, simple way of stretching a muscle, moving a limb to its full range of motion and hold it for a certain time.

Dynamic Stretches: this is a more functional way of stretching, involving repetitive movement and functional active movement; again bringing a limb to its full range of motion but repeating movements.

Ok now lets have a look at the common says and misconceptions on stretching:

  • ‘Stretching prevents muscle aches’

FALSE
Stretching has been found to NOT prevent aches; especially static stretching.

Although long thought to be caused by LACTIC ACID building up in your muscles, soreness post work out is now known to be caused by microtears in the muscle cells themselves. This happens when you work a muscle more than it is used to; if you repeat the activity several times, allowing the muscle to rest and recover in between, the muscle will gradually adapt and you will soon not feel sore anymore doing this same activity. (remember you first legs bums and tums class ladies?). This is called the ‘repeated bout effect’. And apparently if you increase the activity less than 10% you should not experience soreness too much, so quite a good way to increase your performance without suffering too much.

THE TRUTH
Stretches can be part of a warming up routine that would involve low intensity muscle action (at least it should), increasing blood flow to muscle tissue, which is known to reduce post workout muscle soreness or damage.

Methods that increased the blood flow to muscle include: massage, hot bath, sauna, low intensity muscle warm up

Past and Recent researches agree on its benefit in RECOVERING from aches. Dynamic and static stretches.

  • ‘Stretching reduces the risk of injury’

FALSE
Injuries are caused and predisposed by many different factors and isolated ‘stretching’ before an effort is not what keeps you from an injury.

Good stretching routine does not help in preventing overuse injury either.

THE TRUTH
As mentioned above, increased blood flow to muscle reduces risk of injury. Anyone is prone to injury, amateurs and athletes, and to minimize the risk of injury a nice and appropriate warm up is needed. This involves dynamic stretches (preferably, depending on the activity you are preparing for), functional movements and light cardio. And should last more 10 min at least!

  • ‘Stretching makes muscle longer’

UNDECIDED
This a topic highly debated:

Is increased range of motion in a joint from stretching due to increase in muscle length or an increase in stretching tolerance?

Most researches support that static stretching promote increase in tolerance to stretch; one study found actual muscle lengthening.

  • ‘Stretching improve athletic performance’

TRUE if they are appropriate for the activity

Dynamic stretches while warming up have been found to increase performance in activity involving jumping and running; so they are great for activities like involving floor impact like running, basketball, handball.

Static stretches have been found to be inefficient and even dangerous as a warm up for activities involving running and jumping as the muscle is losing its full strength capacity (it’s called ‘stretch induced strength loss’). However, as they are still increasing flexibility they are appropriate and more recommended before activities involving core and flexibility like ballet, dancing and gymnastics.

  • ‘I am already flexible I do not need to stretch’

FALSE
The nightmare of all osteopaths. Flexible does not always mean your muscles are not tight and noded. Some people, especially girls, have hyperflexibility in their joints, and if generalised in the body, it is called ‘benign hypermobile syndrome’. This is a tricky condition because people tend to think they are quite flexible when actually they are just very bendy. Not training properly and not stretching accurately will predispose to injury and muscular fatigue. (you can read more about hyperflexibility on my post here).

THE TRUTH
Regardless your joint flexibility you should always be aware of your muscle tone and balance. And if you are double jointed you might find yourself having to exercise a bit harder than the average to promote better support of your body and prevent pain and injury.

Summary and Recommendations:

  • Stretching does not prevent injury
  • Stretching enhances muscle power when using dynamic stretch; but if using static, muscle strenght can be impaired
  • Stretching is needed before working out (dynamic preferably), FOLLOWED by a proper warm up of at least 10 minutes, involving functional movements and light cardio; in order to optimize muscle function
  • Stretching is needed post working out (static preferably), and will help muscles to recover quicker, diminishing aches
  • Do not confuse hyperflexibility in the joints with muscular flexibility, everyone needs stretching
  • Stretching alongside physiotherapy or osteopathy helps recovering from injury (especially shoulder, back and knee)
  • Be sensible in your stretching, learn to be aware of the different kind of pain, and listen to your body. ‘Pain’ does not mean you are doing it right all the time.
  • Include variations in exercise stretch, feel where the stretch feels the strongest
  • Bring movement and fluidity in your stretches.
  • Stretch BOTH sides!

 

How long How often:

You cannot expect improving flexibility by just stretching irregularly5a3a5e71d1c94c48502377bce6471d52 and inconsistently.
You can achieve the most benefits from stretching by doing so at least 3 times per week. Think about it like any other type of exercise.
The American College of Sports Medicine recommends static stretching for most individuals that is preceded by an active warm-up, at least 2 to 3 days per week. Each stretch should be held 15-30 seconds and repeated 2 to 4 times. Older adults and people with decreased activity need longer stretches according to studies.

Which Stretches

I generally advise my patients basic stretches inspired by yoga routine and rehabilitation exercise; but strongly advise them to find a good yoga class locally to them or to work, with less than 15 people and a good caring instructor. Usually after 2 months you should be able to get into a routine yourself and can apply the different poses and stretches at home. Most of my own stretch exercises are yoga based or strongly inspired from it.
Most of people nowadays need some core notion in order to improve their body awareness and prevent injury; hence alternating pilates and yoga classes is a nice (and highly recommended!) option.
Otherwise there are always nice stretches you can find on pinterest such as those basics ones on the picture.

 

 

 

 

 

“The impulse to stretch is built into the very pulse of life: it is the expansive moment, before the contraction, the filling before the emptying, the charge before the discharge. It is the child’s arms reaching for its mother, or the lover embracing her love. It is the legs stepping out into a walk, then a run. It is the propensity to go beyond where you have been, and once you have found comfort in that new place, to wriggle and move beyond that too. It is the wrapping of the heart around more, and the broadening of the mind past its own limits. Stretching will always have its place, and from the infinite creative potential it expresses, we will continually unfold.”

Gil Hedley – Doctor in Theological Ethics and Anatomy specialist

 

My experience with Paediatrician Rheumatologist Dr Hasson

Dr Nathan Hasson quote on osteopathy:

“Osteopathy is very important as many patients I see have musculoskeletal symptoms such as backache and neck pains with headaches and respond well to osteopathy. Osteopaths form an integral part of the multidisciplinary team that help treat my Rheumatology patients, and have skills other members of the team don’t have.”

Who is Dr Nathan Hasson?

Dr Hasson is a Consultant in General Paediatrics and Paediatric Rheumatology, with a special interest in hypermobility and juvenile idiopathic arthritis. He worked at Ealing Hospital before moving to Great Ormond Street Hospital in Paediatric Rheumatology.

Dr Hasson is a believer of multidisciplinary approach to patients using many different therapy referrals such as osteopathy, physiotherapy, podiatry, psychology etc.

Why did I want to sit with him for a day?

Rheumatology is a huge part of our work as osteopaths and Dr Hasson is an authority in his field. I find that observing consultants, and surgeons in practice gives me a better perspective and greater understanding of my patients, allowing me to perform at my best.

Children are mainly suffering from weakness and pore core due to lack of physical and outdoor activities. For those that are called ‘hypermobile’, ‘double jointed’or, ‘flexible’, this can become a problem as they lack  strength to protect their body and end up suffering from different aches, pains and joint inflammation.

Dr Hasson uses a physical muscle test of strength for different groups of muscles on both sides of the body:

  • Arms:
    . Shoulder muscles
    . Biceps,
    . Triceps
    . Forearm muscles
  • Pelvis:
    . Gluts
  • Legs
    . Quadriceps
    . Hamstrings
    . Calves
  • Core:
    . Abs
    . Chest
    . Trapezius
    . Latissimus Dorsi

He uses 11 different muscle power tests on both sides and has a final score out of 22.

His general findings in initial consultations are the following:

  • Children have a general score of 5 out of 22 of normal muscle strength: Right biceps, both hamstrings and calves
  • Children are weaker than their parents, even if they train at the gym or are rugby players (I witnessed a 16 years old boy, training at the gym every day, being weaker than his mother and the previous patient who was 8 years old)
  • Their shoulder on the non-dominant side is atrophied, shorter and higher, due to its lack of use.
  • The best management to hypermobile weak children is symmetrical activity, such as dancing, swimming, climbing etc. Physical activity and rehabilitation of muscle strength will decrease aches and pains and prevent injury.

According to recent researches here are some interesting – but worrying facts:

  • 1/3 of teenagers in UK suffer from knee pain due to chondromalacia patella caused by discrepancy in leg muscles (weak underdeveloped quadriceps, chronically tight hamstrings and calves)
  • An Australian study found that modern children perform less well when running compared to their parents at the same age.
  • Hypermobility is not a disease, it is a just a genetic version of tissue elasticity, children suffer from being weak, not hypermobile
  • Anxiety is coded by the same gene, hence the hypermobile child tends to be prone to anxiety
  • Hypermobile children can also suffer from tiredness (lack of stamina), poor balance and coordination, easy bruising, abdominal pains, headaches, dizziness and, poor concentration

So what can we do about it?

There is no medication for hypermobility, and the best treatment for weakness is… EXERCISE! And this would be for their life-time.
Children would have to do exercises daily, designed to improve the strength and fitness of each muscle group specifically. The key point is to carry out significant number of repetition and low weights. There is no point in being able to do a few repetitions with heavy weights, this will not help build up stamina, although the muscle would appear bigger. Stamina or endurance is known to decrease anxiety, depression, chronic pain, fatigue, etc. With more stamina, children would also perform better at school, sleep better, and be able to focus more.

Supports such as pen grip or insoles may be useful according to the child’s needs, but it would be in combination with their exercise programme.
Occupational therapy and osteopathy are found to be useful too.

My intake on my day with Dr Hasson:

I had such an enlightening time. Dr Hasson is brilliant with his patients and on the top of his field. His way of explaining and talking to his patients and their parents is admirable, and I could observe how much trust he inspires in all his patients.
I learned so much from Dr Hasson in such a short time and I know that has already made me a better practitioner. I am very thankful to have had this amazing opportunity.

Why sitting is the new smoking

Wondering why we keep saying sitting for too long is bad for you?

Nowadays, it has been found that the average person spend more than half of their time in a day in ‘sedentary pursuits‘. This fancy term basically is a broad expression envelopping effortless, energy saving behaviour such as: sitting watching tv, playing video games, working sitted at the computer, reading, sitting in the tube, taking the elevator instead of stairs etc. Sounds familiar to anyone?

Did you know that, compared to people sitting for little time, people that sit for too long have:

  • 112% increase in risk of diabetes
  • 147% increase in cardiovascular events
  • 90% increase in death caused by cardiovascular events
  • 49% increase in death from any cause

It is commonly said and recommended to spend 150 minutes of ‘exercise’ per week, but everyone has different needs and metabolisms.

But why is sitting so bad for us? Here are some reasons:

– you don’t spend energy, your body is shutting down and there is little muscle activity. your metabolism is slown down.
– you adopt poor posture, overstraining some muscles and underusing some other, collapsing your back and overusing your neck
– by not moving and having a poor stature you don’t stimulate blood flow and general fluid mechanisms responsible for the good health of your tissues (muscles, ligaments, nerves, organs etc) and you end up having aches and pains, head aches and poor digestion.

So how to fight sedentarism in your every day life? Little things and changes such as:

– taking the stairs instead of lift or escalator,
– walking 20 minutes instead of taking a bus or a tube for couple of stops
– having regular breaks from your desk work and go for a walk, do some stretches
– find an exercising activity to do regularly: running, yoga, spinning whatever works for you the best

Movement is health, so keep up with it and your body will thank you 😉

10 reasons why I think children are the best patients

What I deeply love about our profession as osteopaths, is that we all have the opportunity to find fields we feel passionate about and where we are at our best.
I do love treating everyone from any age and background and I feel fulfilled and thankful every day for doing what I love.

I found myself having special interest in paediatric early, even before my life as an osteopath, I knew I wanted to work with children.

For me, children are the best patients, and here is why:

  1. Their body is full of vitality. They have not been worn out by life, they are only discovering the world and learning to grow up.
    This makes treatment more efficient and quicker but also challenging at times when they are jumping everywhere.


  2. They always, (always), tell you what they think and how they feel. Or if they can’t talk, they will make you understand in their own way (biting, gazing, avoiding your hands..).
    If you don’t do your job well, they won’t spare you. They are your best critics.


  3. They don’t care about what others think. They are their own mind and person and if parents do well they will manage to contain them. But they will do things the way they intend to do them and no one will change that. Even if it includes getting into their dippers for treatment when you don’t necessarily need them to undress.

  4. They are your best Personal Trainer ever: making you work out, muscle strength by lifting and carrying them, and cardio, by running after them when they decided that they didn’t want treatment this day.
    They challenge your mind, pushing you to your limit and make you tougher, reminding you how a toy thrown in your face is great and non painful (AT ALL).


  5. They push you to be fashionable, by making you change your top up to 2-3 times a day sometimes, due to food or ‘body fluid’ incidents.

  6. They make you become the best illusionist and multi-tasker of all time, as you need to find ways to distract them when you are treating them if they are having one of those days.

  7. They show you their gratitude with cuddle, drawing, smiles, screams, kicks, saliva, and only other great things they produced themself!

  8. They inspire you and remind you how life does not have to be so serious all the time. They make you travel and play by telling you all about their imaginary world.

  9. They are your best parenting training ever, as you have been treating so many of them. And if they have a tantrum during your consultation, you can let the parents taking care of it 😀

  10. Making them feeling better and helping them recovering, supporting their family is the best rewarding feeling as their osteopath.

These points are probably very familiar to most of parents but obviously nowhere near true parenting challenges 😉

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Cranial Osteopathy

Cranial osteopathy follows the same principles mentioned earlier and does not just apply to the head. There are subtle and light techniques used to diagnose and address strains or dysfunctions of the different structures within the head and the living anatomy of the body.

Throughout time, following old injuries or trauma (such as a car accident or ski fall), your body may have adapted and compensated around lesions, that may be asymptomatic but contribute to other symptoms you are presenting with.

Working cranially, I would look for those lesions and aim to restore balance, expansion and release through the different structures, including membranes, fascias, muscle, ligaments, fluid, inter/intra osseous spaces etc. This would promote self-healing of your body.
Those techniques can be very subtle and sometimes it may feel like my hands are just resting on your body, but actually there is a strong connectivity settled between the osteopath and the patient’s body, where the osteopath is deeply reading through the body’s expression and different structures, looking for a way to help it to unfold and heal.

You may find yourself very dizzy, light-headed or very tired after a treatment, especially if you’ve never had cranial osteopathy before. Sometimes you may feel very emotional and touchy, if the treatment released an old emotional trauma.
Drink plenty of water and avoid strenuous activity and you should be fine after couple of hours! I usually say that any sort of side effect (if any) of the treatment should last between 12 to 24 hrs post consultation.

Cranial osteopathy is a well-known approach to babies but is also nicely effective on children, adult, and the elderly! like any other type of osteopathy.

Visceral manipulation

Visceral Osteopathy is a way to approach tension and dysfunction of the body from an organ and its surrounding tissues, in order to improve movement and space dynamics from within.

In the general physical assessment, I may find a contributing factor to my patient’s problem and posture from altered or decreased motion in one or more organs. Although in most cases the organ itself would be asymptomatic, it does not make visceral manipulation less relevant. Alongside the principles osteopathy uses as reference, it is using the 3 dimensional dynamics of the body mechanics as a restricted organ will affect surrounding soft tissues and functions.

In addition to structural attachments, organs, membranes, blood vessels, share common nervous pathways with your ‘structural’ body (muscles, bones, joints) from your spine. This means that tissues receiving supply from the same area of your spine, influence each other via nervous reflexes. For example: a prolonged mid back pain may cause you stomach pain, or chronic heart burns could cause you mid-back discomfort.

Via gentle technique and assessment I will be looking for altered or decreased motion of a viscera and any restrictive pattern of the body. I would be aiming to encourage the normal mobility, motion and tone of a viscera and their connective tissues.

This would promote function of individual organs, surrounding systems, effective circulation and drainage of body fluid and support to body structure, contributing to restore self-healing and health.

Structural techniques

I find them efficient for acute injuries, muscular tension, decreased movement of a joint, stiffness and aches.
My treatment includes structural manipulations such as:

  • Soft tissue, massage, stretches
  • MET:
    MET is a direct active technique which uses isometric contraction in order to induce physiological changes promoting better joint movement and muscle health. Good alternative a simple stretch.
  • Strain counterstrain:
    It is a more indirect and subtle technique, using position of ‘ease’ of muscle and joints using complexe nervous reflexes from your tissues to the spine and from your spine back to your tissue in order to decrease muscle spasms, trigger points, chronic pain in one area.
  • High Velocity Thrust (HVT) or High Velocity Low Amplitude (HVLA) thrust:
    This is a joint manipulation achieving (not at all time) cavitation of a restricted joint, in your spine or peripheral joints. It is a short (low amplitude), quick (high-velocity) technique with the goal of restoring normal range of motion in the joint.
  • Articulation:
    Passive movement reinforced into a restricted joint. This would be a more gentle way of improving motion in a joint, breaking down fibrosis and scaring tissue.
  • Lymphatic drainage, pumping:
    Total body pumping techniques aiming to stimulate fluid drainage of your tissues and muscles in order to promote their best state and nutrition, avoiding building of wastage product and tissue damage. very efficient for oedema, heavy legs, poor peripheral circulation.
  • Recoil:
    It is a technique using the elasticity of a the connective tissue to correct a dysfunction. It implies pressure induced stretch and quick release, usually using breathing. It also influences the state of vegetative nervous system.

Women’s Health and Paediatrics

In pregnancy:
Osteopathy will assist and help you coping with or prevent problems like:

  • Low back pain,
  • Reflux, digestive discomfort
  • Ligament laxity
  • Pubic pain
  • Neck pain
  • Cramps
  • Fatigue
  • Sleeplessness
  • Heavy legs, poor circulation, swollen feet, ankles, fingers
  • Varicose veins (poor circulation)
  • Discomfort breathing, shortness of breath
  • Sciatica
  • Carpal tunnel syndrome82

After birth time:
In addition to the ones above, we can help recovering and coping with:

  • Healing from the epidural site,
  • Fatigue,
  • General tensions and aches from holding your baby,
  • Hyper flexibility of joint
  • Pelvic or low back strains
  • Bladder control, pelvic floor
  • Feeding techniques and postural advice

For little one:
Osteopathy is or may be useful for:

  • General health and function check up
  • Recovering from traumatic birth (fetal distress, ventouse, forceps, C section, resuscitation etc); relieving compressions, tensions and assymetries
  • Monitoring progress of developmental milestones (especially neuromotor ones)
  • Addressing the effects of any major physical mishaps or developmental lag to prevent problems developing in future61

Strains and trauma from the birth or pregnancy can predispose to unsettled behaviour and difficulties with feeding, winding, digestion and sleeping. With gentle osteopathic treatment relieving those physical strains can be very helpful and relaxing.

Here are some common conditions that babies and children can suffer from:

  • Premature birth
  • Fussy baby, unsettled
  • Feeding difficulty
  • Tongue tie
  • Sleeping disturbance
  • Colic, aerophagia, constipation
  • Reflux (general or silent)
  • Torticollis
  • Plagiocephaly (flattening of the head) or other head deformities
  • Teething
  • Chest infections
  • Irritation from vaccins
  • Congenital abnormalities (helping coping with symptoms associated with, eg: autism, epilepsy)
  • Asthma or other atopic problems (helping coping with symptoms associated with)
  • Cerebral palsy
  • Orthopaedic conditions (talipes, scoliosis etc)