When Osteopaths need to refer

Osteopaths are trained to diagnose and treat problems with your bones, muscles and joints. Unfortunately sometimes symptoms that seem like a muscle/bone problem can actually be a sign of something else, so we’re trained to screen for other causes and know when to refer on to someone else.

I’d like to share some examples, but please don’t be alarmed, these problems masquerading as something else are rare! If you’re concerned about any symptoms, do see your GP but know that if it’s a bone/muscle problem then your local Osteopath is likely to be able to help.

Niggling shoulder pains.

Pain and stiffness in both shoulders can be caused by a number of different things, such as arthritis, muscle strain or frozen shoulder. These problems can all be treated by an Osteopath, by we also screen for other causes such as polymyalgia rheumatica (PMR).

It’s really important to diagnose and treat PMR swiftly because of potential complications. Signs to look out for are pain in both shoulders and the hips/pelvis. PMR is very rare in people under 50 years of age. More telling is that these pains will usually come on without any reason or trigger and will not be relieved by anything like stretches, exercises or massage. A GP can check for PMR with a blood test and treatment is usually a course of steroids.

“Sprained ankle”.

While I was training I was treating a lady for low back pain, which was much improving. At one of her follow up appointments I noticed her ankle was swollen and she explained she wasn’t sure what had happened, but assumed she must have sprained her ankle somehow. I assessed it and was concerned that her ankle and calf were red, hot and swollen. I called my tutor in and she agreed she needed to go to hospital urgently to check for a blood clot (DVT) or infection, such as cellulitis.

At the hospital they did scans that confirmed she had a DVT. Thankfully they treated it successfully and she was fit and well afterwards, experiencing no complications. Awareness of DVT has increased in recent years, but it’s important to always look out for the signs, not just when you’ve been in an airplane.

Image: NHS.uk

Image: NHS.uk

Mid-back pain.

Mid-back pain can be caused by a number of different things, including muscle strain, arthritis and muscle spasm. However, when the pain has come on for no reason and is travelling down into the abdomen and sometimes the groin, it can be a sign of a kidney infection. I recently referred two patients in one week to their GP and they both had a kidney infection! Treated successfully with antibiotics they didn’t need any treatment for back pain, which is fantastic.

Kidney infections usually occur as a result of a urinary tract infection, so can be accompanied by symptoms such as pain on urination, blood in the urine, changes in urine colour and smell, increased or decreased frequency of urination and urinating at night. If you have any of these symptoms, call 111 for advice or see your GP urgently. Urinary tract and kidney infections are usually treated with antibiotics, but the quicker the intervention then the quicker your recovery. If left untreated they can be very serious.

General aches and pains.

General aches and pains are common and quite often are due to something that can be treated with manual therapy. However, it’s always worth being aware of vitamin D deficiency because low vitamin D can cause:

• General joint aches and pains
• Rickets in children
• Bone pain due to osteomalacia in adults

Most people get enough vitamin D from sunlight, but you can be at risk if you aren’t often outdoors or if you cover up most of your skin when you are. There are lots of food sources of vitamin D, but if you don’t eat many of these sources or don’t get much sunlight during the summer months it may be worth supplementing. Visit your GP to see if you need vitamin D supplements.

Food sources of vitamin D:

• Fortified foods, such as cereals and fat spreads
• Egg yolks
• Oily fish
• Red meat, liver

Severe bone or joint pain.

Bone and joint pains can be due to wear and tear arthritis (osteoarthritis) and can be incredibly painful. I’m therefore really pleased that Osteopathy, combined with tailored exercises, are able to reduce the symptoms. There are certain orthopaedic tests I do to assess whether a joint is arthritic and causing pain. X-rays are able to confirm, but because of the radiation, it’s best to only have an x-ray if you’re concerned about the symptoms or if it may lead to a change in your treatment plan.

There can be more serious causes of severe bone or joint pain that sometimes need to be ruled out. If the pain has come on for no reason, without a fall or trauma, or it affects your sleep, it should always be investigated. Most commonly it is something mechanical that can be treated, but it’s important to screen for other causes such as cancer or osteoporosis.

Osteoporosis causes thinning of bones, increasing the risk of fracture. The fractures can occur anywhere, but they most commonly occur in the hip, the spine or the wrist. You’re more at risk if:

• You have a family history of osteoporosis
• You’re a woman who has gone through the menopause early
• You have been on steroids for a long time
• You have a low BMI
• You drink or smoke heavily

You can reduce your risk by:

• Maintaining an active lifestyle with regular weight-bearing exercise
• Consume good amounts of calcium and vitamin D containing foods
• Reduce smoking and reduce alcohol intake

I promise the purpose of this post isn’t to scare you! The purpose is to raise awareness of conditions that are sometimes missed; it’s always better to get something checked quickly and get the all clear, than leave it longer when it may need treatment.

I also want to reassure you that Osteopaths are trained to a high standard and have to be registered with the General Osteopathic Council to practice in the UK, requiring continued learning each year. I have a duty of care to my patients that I take very seriously, so I always want to make sure that my diagnosis and treatment is spot on every time. If I have any suspicions that Osteopathic treatment isn’t the best thing for a patient, I will refer them to the appropriate person.

I also have a role sharing information about health in order to help the general public, which is why I enjoy writing these blog posts. I love having a job helping people improve their health and get back to activities they enjoy, if I can do that via my blog as well then I’ll be very pleased!

Zoë Clark is a registered osteopath trained at the British College of Osteopathic Medicine in London. Practicing in Howe near Norwich (01508 558373) and Burston, near Diss (07543 557746), Norfolk.

Twitter @ZoeClarkOsteo

Facebook www.facebook.com/ZoeClarkOsteopathy

Instagram @zoetheosteo

www.zoeclarkosteopathy.co.uk