Interesting research from the Cochrane institute (who systematically review and combine research to increase its power) suggests that topical (applied externally) NSAIDS (non-steroidal anti-inflammatories) are safe and effective in treating mild to moderate acute musculoskeletal pain in adults.
Obviously I am not suggesting this as an alternative to visiting your osteopath but it is a great alternative to taking tablets orally, since the concentration required for those can cause unpleasant or even serious side-effects.
The research doesn't test one brand against the other, although they were able to identify that gel formulations of diclofenac, ibuprofen and ketoprofen, and some diclofenac patches, were the most effective, other formulations were more effective than placebo but not by much. Measured side-effects were no worse than placebo.
This research is not able to compare topical and oral preparations but other recent research has shown that topical diclofenac solution can provide as effective pain relief for people with knee or hand osteoarthritis as oral diclofenac, so the suspicion is that the results may well be similar across the board.
All in all this is really good news for those who can't take NSAIDs due to, for example the effect on their stomach, more info at the Cochrane website here
The upper back and ribcage (thorax) is, in my humble opinion, the most frequently implicated are of the body. It shouldn’t really be a surprise, after all it links the shoulders and through them the arms and the neck and the low back. Poor thoracic movement is so often a root cause of neck pain, shoulder and arm problems, even tennis elbow, mainly due to postural changes that cause stresses and strains further along the chain as the body tries to adapt and, of course, low back pain when it has to overwork to compensate for a rigid thorax.
Much though I’d love you to come and get a preventative treatment on a regular, even weekly basis I recognise that for most people that is an expense and also a time commitment. For most people going to the osteopath is about getting pain free and removing an impediment to the activities they enjoy. This makes it unlikely that longstanding postural habits or neurological conditioning are going to be fully reversed and the problem may recur, or at least there may be twinges from time to time.
I speak from experience. I remember having terrible problems with my neck and shoulder as a teenager, problems that recurred for years. The first time I went to an osteopath was to try and resolve this issue and he got me pain free for several years but it recurred, so I went back to the osteopath again…and again. I don’t have problems in that area now…now it is my mid-back…actually it probably always was…a slightly flexed and immobile area developed probably when I was a teenager and caused my slightly stooped posture that put more strain on the junction between neck and shoulder leading to the previous problems. I am working with my osteopath on it and feel that I have opened up my chest and am standing less hunched and lo I don’t get neck and shoulder problems, but I doubt I’ll ever fully resolve that flexed mid-back there is likely a skeletal change which will always be a mechanical point of strain…So I have to manage it.
So what works to help increase mobility in the thorax. (if you are elderly, unwell or disabled check with an appropriate medical professional before trying any of these)
b.Strengthen your back muscles – Rhomboids in particular, exercises such as reverse flies, and rows can help pull rounded shoulders back into line. Lateral pull-downs or pull ups can help strengthen muscles that hold you straighter, or, with a light weight can be a really nice and effective stretch. When I work out nowadays I work on the principle that whatever I push I pull, so I would superset a chest press with a row, a shoulder press with a lateral pulldown etc and I have found that to really help
b.Yoga, pilates – these can be great ways of keeping that mobility
c.Running – I find running really loosens my upper back. I don’t run far but I use my arms and find that often my mid back releases
d.Abdominal excerises – I do declined sit-ups with a medicine ball rotating to alternate sides and again often cause my back to release. Russian twists and plain old crunches with the knees to one side or the other are also good
e. Just hold your arms out and rotate, try it sitting with a cushion behind your low back to stop the movement coming from there
I hope these help. If it hurts, stop, if you think you shouldn’t be doing it, or you feel like you are injuring yourself stop!
Damian is the principal osteopath at Vauxhall Village Osteopathy and Oval Osteopathy