IRRITABLE BOWEL SYNDROME (IBS)

Irritable Bowel Syndrome is one of those common complaints nobody ever talks about. Studies show that it affects up to 30 % of the UK population. In the USA it rivals the common cold for the major cause of absenteeism in industry. Technically IBS is a functional disorder of the gut where the normal movement of the gut is hurried along or spasms occur. The main symptoms are diarrhoea -constipation - variable bowel habit -alternating diarrhoea and constipation -colicky abdominal pain, often relieved by passing wind or stools - bloating. Less frequently there may also be -heartburn - tiredness - back pain and rumbling in the tummy. There is no organic cause for IBS but that doesn't mean it is all in the mind. IBS may be worse at times of stress. It is not hereditary but it may run in families perhaps because of a dietary or environmental link. It may be constitutional, meaning you have extra-sensitive gut muscles, or an overreaction to certain foods and chemicals. Women may find IBS worse after a period or after the menopause pointing to a link with oestrogen production. An estimated 25% of IBS cases are triggered by a bout of gastro-enteritis or food poisoning. IBS can be made worse with certain drugs, such as long-term antibiotics, which kill off the normal bacteria in the gut, codeine, laxatives and alcohol. Diagnosis can be a problem because symptoms vary. IBS is a disease of exclusion - in other words if you can rule out all other possibilities IBS is what you are left with.

TREATMENT Treatment is aimed at alleviating the symptoms and the distress they produce. Reassurance and medical review help the patient to realise that although IBS is life- long it is not life threatening. Life-style changes such as reducing caffeine, alcohol and smoking all help. Diet can help if it's a high fibre one but the overuse of laxatives can make the situation worse. Treatment with connective tissue manipulation helps to reduce the tension around the gut, allowing the normal passage of stools through the system and more normal function to be restored. See Connective Tissue Manipulation

LYMPH SYSTEM

Any fluid, which doesn't return to the veins, passes into the lymph system. Any large fragments of debris that are too big to be reabsorbed into the blood stream and are filtered off into the lymph system. When the circulation is increased as a result of exercise the flow of lymph is also increased. Lymph passes into little open-ended vessels which become bigger and bigger as they travel towards the neck where the fluid empties back into the bloodstream. En route the lymph passes through some of the 600 lymph nodes in the body. These nodes filter out and trap harmful substances and bacteria, stopping their dispersion throughout the body. Headache is one of the problems that can be caused when the system goes wrong. The lymph from the head drains into the lymph nodes on the right side of the neck. If the outlet of lymph is blocked due to increased tension in the connective tissue in the neck the lymph can't get away and pressure builds up around the cells. This can cause headaches and is one of the ways that tension headaches can occur. By improving the drainage of lymph the headache can be alleviated. See Manual Lymph Drainage

MUSCLES

Muscles move joints, to which they are joined, by shortening and pulling one end of the muscle closer to the other end. A muscle is made up of lots and lots of muscle fibres which are held together in bundles. The muscle fibres are activated by the brain sending electrical impulses to each muscle fibre via the nerves. These impulses cause the muscle fibre to contract and shorten so moving the joint over which the muscle works. If a muscle can not work, due to injury or illness, each little muscle fibre gets thinner and the whole muscle gets weak. Muscles are capable of both power and endurance. If one washes one's hair in the shower or blow it dry one needs endurance to hold arms up for a period of time. Loading heavy suitcases onto a roof rack or putting them away in the top cupboard requires power to be able to lift them up. Power is for doing movements against resistance. Moving limbs, walking up stairs, getting up from a chair lifting a heavy shopping bag all calls for power. Muscle endurance allows the muscle to work at a lower level for long periods. The muscles that help us to maintain a certain posture need endurance. Having been in bed for a week with flu one would feel a bit weak at the knees when first up. This is partly because the Quadriceps have not been working and have become weak. Gradually asking the legs to stand and do more walking the muscles quickly regain some of their strength and endurance. Lets assume that the muscles that bend the index finger have 1000 muscle fibres. To beckon with the finger might ask say 10 fibres to work. Wanting to lift an empty bucket on the one finger might use 100 fibres. Whereas lifting a bucket that was full of water would ask most of the thousand fibres to work. By trying to lift a little more water each time would eventually train the muscle to lift a full bucket of water. When a muscle is damaged the muscle fibres are torn and the connective tissue around the muscle is also damaged. When the fibres are damaged fluid seeps out of torn fibres and causes localised swelling. This works like glue when squeezed from a tube. The glue tries to repair the damage and in its enthusiasm sticks everything to everything else. The individual fibres of the muscle, which are normally free to glide slightly one on the other, become stuck together and are irritated by the pull of even the slightest contraction in the muscle. It is important that the ends of the muscle fibres stick together but not that they stick along their whole length. Sprains and strains are not helped by "working through them" or by exercising and 'keeping it moving'. It is advisable to seek the help of a Chartered Physiotherapist as soon as possible. In the meantime resting and keeping the leg up if its a lower limb problem will allow the body to do its own repair job much quicker than if you try to carry on as though nothing had happened.

MUSCLE WEAKNESS

If a muscle is not given any work to do each little muscle fibre becomes thinner and the whole muscle begins to lose its strength. Some groups of muscles become weak faster than others. When a footballer has a knee injury his quadriceps, the muscles on the front of his thigh get weak very rapidly. These muscles need exercising early on in order to increase their strength so that he can return to his team as soon as possible. It is also very important that all patients are given exercises to restore muscle strength as soon as possible and so minimise the amount of weakness that occurs. These early exercises, therefore, have to be carefully designed so as to complement the other Physio techniques. Exercises are needed for all the muscle groups in the affected area and they are adapted to suit each patient's requirements. Ideally exercises are part of the ongoing treatment once the initial pain has subsided. Muscles only respond to the demands placed on them. When an injury has healed the muscles will recover in response to the amount of work they are asked to do. If the limb is favoured then the muscle will never recover its normal function. After a period in bed, during which time the leg muscles have been completely inactive, one feels weak at the knees when up. Stay in bed too long and the muscle fibres become so weak that one wouldn't even be able to stand up. So in the case of a long illness or a long-term injury the muscles have to be given specific work to do to build up and restore the power required for every day living. In so many cases, due to the absence of specific exercises, a compromise is struck and the body has to make do. People are heard to say - I've never had any strength in my back since my accident - my shoulder has always been weak since the car crash - that's my bad leg - I'm always going over on that ankle - I've never been able to open a jar with that hand since I broke my wrist - etc. etc. All of these situations are examples of inadequate muscle power. Even after a long period of time muscles can still adapt and strengthen in response to stimuli from the right type of exercises. Muscular imbalance can lead to problems in the future. For instance a calf injury will result in weakness of the muscles and if not restored to normal strength running and even walking will be slightly out of kilter. This puts strain on other muscles and joints. By being aware of and practising 'special warm-up exercises' prior to any bout of violent exercise many of the torn muscles, trapped nerves, sprained ankles or back problems which occur can be prevented. Exercises only increase the strength in muscles when they are done on a regular basis.

MIGRAINE

Migraine is essentially a nasty headache, even a sick headache, which comes on suddenly in a healthy person, lasts a few hours or even a day or two and afterwards the sufferer is restored to full health once more. During an attack the patient feels and looks very ill and may vomit. It is this repeated and unexpected onset of attacks, which characterises migraine. A diagnosis of migraine is made if there are headaches, which come and go and if two of the following features are present. A dislike of light and noise - pain limited to one side of the head only - vomiting or a feeling of nausea - disturbances of vision - queer sensations before an attack - a history of migraine in the family. It is not known what happens in the head to cause the symptoms of a migraine attack. One theory is that in the early stages of an attack when the patient looks pale and strange things are happening to the eyes, skin or limbs, the blood vessels of the brain suddenly become narrowed. Later the throbbing headache develops when the blood vessels widen and become larger than usual. The headache continues until the blood vessels resume their normal size again, usually whilst sleeping. Headaches can affect the lives of every one. One in ten people suffer directly with moderate to severe headaches on a regular basis. The lives of those around them can also affected in many ways. The sufferer will probably often need to go and lie down, have difficulty driving, put off household tasks, find their work is disrupted and wish to be alone. Migraines are twice as prevalent in the population as asthma; in fact it is one of the commonest of chronic disorders. Women suffer more severe and more frequent attacks. The condition is age related and strikes in teens and early twenties, meaning that ¾ of sufferer are under 45, having a serious impact on work and family. The cost to industry of headaches is between £600 and £750 million every year in lost productivity due to time off work. Over 4 million working days are lost per year from men alone and there are 4 times as many women as men who suffer from headaches. In between attacks headaches can interfere with relationships, cause anxiety and depression and lead to an inability to cope with every day life. Migraines are usually headaches which feel like a moderate or severe pulsing or throbbing pain, usually one sided, which may increase on movement and can last from 4 hours to 3 days. Migraines can be at intervals of between a few days to a year or more and the sufferer is usually symptom free between attacks. There is sometimes a pattern, they may be menstrual related or so-called 'weekend migraine' or food, alcohol, stress or even hunger may trigger them.

TREATMENT In order to start to take charge of the headaches the patient needs to find out what triggers their attack. The aim is to find best possible treatment and manage the headache or migraine with as little disruption to daily life as possible. Treatment can be for the acute stage or preventative but the idea is to resume normal activities as soon as possible. There are many ways in which migraines can be helped. These include medication, lying down and resting, fighting the headache, keeping busy, sleeping to try to ease the pain. Most sufferers do take medication for headache but very few want to bother their GP and say that it is 'only a migraine'. They believe that there is no effective treatment available. Treatment with drugs may relieve the symptoms of pain and nausea. Certain foodstuffs and activities can trigger headaches and a change in life-style avoiding these triggers may reduce the number of attacks. Treatment with Manual Lymph Drainage improves the blood flow and reduces some of the effects of increased pressure due to circulatory problems. Connective Tissue Manipulation releases the tension around the blood vessels and helps to reduce not only the severity of the attack but also the frequency at which they occur. The effects of Connective Tissue Manipulation are cumulative. Once the tension has been reduced by treatment that reduction is maintained. The degree to which it is maintained is conditional upon the stress put into the system by the patient's lifestyle. By using a combination of reducing the tension, increasing the blood flow and improving the lymph drainage the altered circulation to the brain, which occurs during a migraine headache, can be returned too normal. See Circulation

NECK ACHE

Most people over the age of 35 show some wear and tear on an X-ray of their necks, but not everyone over 35 has neck pain! X-rays only show the bones in the body and do not show the disc or soft tissues around the bones and joints. Therefore a patient can have a bad X-ray but be pain free or alternatively have a normal X-ray and be in agony because it is not the bones causing the pain. Cricked neck, trapped nerve and pulled muscle, are all terms which patients use to describe pain in the neck. In fact most neck pain is the result of a disc problem causing a trapped nerve. A neck problem can result from sleeping awkwardly and 'cricking' the neck; it can be due to prolonged bad posture such as sitting at a computer or at the wheel of a car; or it can be sudden in onset as a result of suddenly jarring the neck, or from lifting or pushing heavy objects. Patients usually complain of constant pain in the neck, across the shoulders or into the shoulder blade. Pain may even be referred from the neck up to the head or down the arms - referred pain - Neck pain may be one sided or both sides.

TREATMENT Treatment relies on the reduction of the disc bulge by changing the mechanics of the spine and reducing the tension in the connective tissue with Connective Tissue Manipulation and Manual Lymph Drainage. Correct posture is very important to improve the neck pain and prevent recurrence. Pillow height should be sufficient to maintain the neck in a neutral position and prevent problems whilst in bed.

PAIN

Pain is necessary as a warning that damage may occur if we continue with our current activity. By producing pain the body tries to stop the activity and allow time for the repair mechanism to do its work. If the activity persists the pain gets worse as the damage increases. By taking painkillers a patient can block out the warning signals and may continue with the activity. It is not surprising, therefore, that once the painkillers have worn off the pain can be worse than before. No one would tread on a drawing pin and take painkillers to kill the pain, instead of removing the drawing pin. However if the pain is very severe, taking painkillers, resting and avoiding the activities that provoke pain, may be beneficial as long as the reason for the pain is also addressed.

PAINFUL KNEE

Pain in the knee can occur from a wide variety of activities and several different structures can cause pain. Pain in the knee can result from:- torn cartilage Kneecap- chondromalacia strained ligaments pulled hamstring Referred pain from the spine or hip (See also sciatica) All can result in pain, swelling, stiffness and loss of movement in the knee joint. See tendon injury.

TREATMENT By treating with Connective Tissue Manipulation the circulation is improved, inflammation and pain reduced and the range of movement improved. Connective Tissue Manipulation is a very useful technique for a large variety of knee injuries.

PERIOD PROBLEMS

How many women have painful periods and yet still think of themselves as normal? OK their periods may not be painful enough to seek help from their doctor but they perhaps take the odd painkiller and may be even lose a day off work and yet they still look upon this as normal behaviour. Periods usually start in the early teens but occasionally they don't start until a girl is 14 or 15. This can be due to increased tension, causing a reduction in hormone production which in turn causes late onset or erratic periods. A pain free period every 28 days lasting 4 days is considered normal Periods are controlled by hormones. If for some reason the hormone levels are abnormal then the length, frequency and heaviness of the period changes. If the tension in connective tissue in the abdominal area is too high the normal constriction of blood vessels, prior to shedding of the lining of the womb, can feel much like cramp and be very painful.

TREATMENT Taking painkillers can help painful periods and balancing hormone output by taking the pill can sometimes ease heavy periods. Connective Tissue Manipulation helps to restore normal hormonal function. Connective Tissue Manipulation also reduces the connective tissue tension and allows the reproductive system to continue its normal cycle without discomfort.

POOR CIRCULATION

Each of the billions of cells which go to make up the body need a regular supply of oxygen, gasses, nutrients and vitamins which are dissolved in the plasma - the liquid component of blood. As the blood is pumped round the body the blood vessels gradually get smaller and smaller until they form tiny little capillaries. The walls of the capillaries are so thin that some of the fluid can seep out into the area around the cells. This fluid carries nutrients and dissolved oxygen with it and has several jobs to do. Carbon dioxide, any dead cells, waste products, bacteria and other debris are removed in the fluid plasma which acts like a refuse collector. The fluid is then reabsorbed into the blood through the walls of the capillaries and makes its way back to the heart. A common form of poor circulation is cold hands and feet.

PRE-MENSTURAL TENSION

PMT is a term used to cover the changes that occur just prior to a woman's period. Very often there are emotional as well as physical changes which can sometimes have quite profound consequences in relationships. A pre-menstrual woman needs great understanding which is not always forthcoming. Often the emotional side of PMT comes on incipiently so that by the time the woman has realised why she feels so ratty her period has started and the PMT has passed! Most women 'grin-and-bear-it' thinking its normal but their friends and relatives can go through hell. Excess fluid is often kept retained just prior to a period, which can cause a feeling of bloatedness and general discomfort.

TREATMENT with Manual Lymph Drainage can help to reduce the swelling and enable the body to manage periods more easily. Medically hormone treatments or tranquillisers can be prescribed for severe cases. PMT can be helped by Connective Tissue Manipulation reducing the tension in the connective tissue around the nerves helping them to conduct impulses more easily and so improving hormonal control. Tension in the connective tissue around the brain and spinal cord is also reduced which allows the brain to function more normally giving relief to the emotional consequences of PMT.

PULLED HAMSTRING

The hamstrings are the muscles down the back of the thigh, which are responsible for bending the knee and extending the hip. They are used most when running especially at speed. The hamstrings are often torn as a result of a sudden burst of running, often without warming up first. Hamstring injuries are usually sport related. The commonest cause of problems being football, rugby and athletics. See Muscles for information about how muscles work. After a thigh injury the power in the hamstrings is greatly reduced and the patient will often limp when walking and have difficulty in bending the hip and straightening their knee. At first the patient needs to take small steps and not put any strain on the torn muscle fibres. Only when a return to full muscle strength has been achieved, under medical supervision, is it sensible for the patient to indulge in any form of sport, training or additional exercise by way of keep kit classes, working out in a gym, aerobics etc.

TREATMENT Rest and the application of techniques are very important to improve the circulation and reduce the amount of adhesions between the muscle fibres. Treatment with Connective Tissue Manipulation and gentle exercises, once the limb is comfortable, speeds up the repair process and helps the patient to return to normal activities as early as possible.

REFERRED PAIN

In between every vertebrae in the spine is a cushion of jelly (the disc) which acts as a shock absorber and cushions each and every step. When the disc bulges backwards it traps the nerve where it leaves the spinal canal. This causes pressure which results in pain but where the pain is felt depends on how much pressure the disc is exerting on the nerve. The body works like a telephone exchange. If there is a problem on the line you can only tell which phone line is out of order not where the fault actually lies. The body is very similar. If there is a problem between the brain and say the ankle the brain can not tell exactly where along the nerve the fault lies. The brain doesn't know whether you hit your ankle on a chair, or whether the nerve between the brain and the ankle is being trapped in the back. Each nerve is arranged so that the nerve fibres which have furthest to travel lie in the centre of the nerve and those which are going to branch off sooner lie around the outside. Therefore the more pressure the disc exerts on the nerve the further away the patient feels the pain. For example pain in the hip would result from less pressure on the nerve than pain in the ankle. This is called referred pain. When there is so much pressure on the nerve that its conduction of messages is affected the sensation of pins and needles is felt. If the pressure is enough to stop the nerve working completely the part of the body supplied by that nerve feels numb to the touch. See slipped disc and back pain.

TREATMENT Removing the cause of the irritation of the nerve by changing the mechanics with the MacKenzie Exercise Regime and reducing the inflammation with Connective Tissue Manipulation treats referred pain .

RSI

Tendon problems in the forearm wrist and hand are currently banded together under the heading Repetitive Strain Injury. Whilst this relatively, new, name accurately describes the cause of the problem an accurate diagnosis needs to be made to determine which tendon is affected. RSI occurs when the patient is doing the same repetitive action over and over again during a working day. If their posture is wrong or they are putting undue strain on the body a RSI may develop. Usually RSI only develops in people who have tight connective tissue and are unable to allow the body to accommodate the new activity without causing pain.

TREATMENT Treatment with Manual Lymph Drainage and Connective Tissue Manipulation reduces the tension in the connective tissue in the area, improves the circulation and settles the inflammation. See Golfers Elbow, Tennis Elbow, Tendon Injury