Category Archives: head, neck and back

Thoracic Outlet Syndrome

Your thoracic outlet is located at the junction of your shoulder and torso, it is the internal opening where the nerves and blood vessels enter your arm from your body. Thoracic Outlet Syndrome (TOS) is a condition where the thoracic outlet becomes constricted which creates pressure on the nerves and blood vessels that pass through it. This pressure creates localised pain in your neck, shoulder and upper back accompanied by pain, numbness, weakness and tingling in your arm and hand.

When TOS occurs 95% of the time it is the result of pressure on the nerves in the thoracic outlet rather than on the veins and arteries. The most common causes of TOS are trauma to the shoulder and neck, from poor postural habits and from sport and other activities that  strain the neck.

In the case of trauma a broken collar bone might bend downwards at the fracture line creating pressure on the thoracic outlet. A whip-lashed neck, particularly from a side on impact can create inflammation and swelling that likewise pressurises the nerves, veins and arteries in your shoulder.

When TOS is caused by poor posture and repetitive strain the scalenes (muscles at the side of your neck)  stiffen to the point where they start to occlude the thoracic outlet  thus creating symptoms in your arm and hand.

Less commonly a minor deformity of the vertebrae (bone) in your neck might create TOS taking the form of a false short rib.

The symptoms and causes of TOS are similar in many ways to that of carpel tunnel syndrome (CTS), with the important distinction that CTS can be exclusively a problem of repetitive strain to the muscles of the forearm.  CTS also affects the whole hand whereas TOS affects only the little finger side of your hand.

Sport and other physical activity that requires repetitive raising of your arms above your head can cause TOS, these activities include weight lifting, swimming, volleyball and working above your head as often experienced by plumbers and electricians. Avoidance of these activities lessen the likelihood of getting TOS.

Sitting for long periods infront of your computer screen can give you TOS, always remember that your body is made to move, that is why we have muscles and joints. Doing regular neck stretching exercises can go a long way to protect you from getting TOS.

TOS is described as being positional or static. If your symptoms only occur when you arm is held in a particular position your TOS is positional. If your TOS is constant it is static.

The most effective therapies for treating TOS include osteopathy, chiropractic, physiotherapy, acupuncture, massage and stretching. Avoiding activities that have caused the symptoms are obviously helpful too but if you cannot do this because it is part of your job you are best advised to get regular preventive treatment and exercise.

If your TOS is the result of a deformed vertebrae or depressed fracture of the collar bone you may require surgery.


Fibromyalgia is an autoimmune disease that effects up to 5% of the population. Being an autoimmune disease it has no definate cause, no permanent cure, no definative diagnostic test and it does not manifest the same in all the people who have it.

A person of any age can get fibromyalgia, even children. Women suffer from it more often than men do and one in four sufferers can no longer work because of it.

The symptoms can be severe and varied, everyone who suffers from it will have muscle and joint pain which is where it’s name comes from (fibro-fibrous tissue such as tendon and ligament, myalgia-muscle pain), but other symptoms can include insomnia, fatigue, rashes, weakness, depression, headaches, nausea, menstrual problems, poor memory, foggy thinking and weight gain.

Some sufferers can notice a big improvement after a year while others others  have a hard time with it for much longer. One single “magic bullet” will rarely bring the symptoms under control, the best results usually come from using several different strategies and treatments together.

Medications both pharmacuetical and non-pharmacuetical, massage, chiropractic, osteopathy, acupuncture, stretching exercise and alkaline based diets all work to some extent for fibromyalgia sufferers.

Fibromyalgia like polymyalgia rheumatica is most intense first thing in the morning, it can make you feel much older than you really are. Sufferers tend to loosen up a bit as the day progresses but even on a good day with active fibromyalgia resourcefulness is required to go about your daily business.

If your knees are effected getting on and off the toilet can require extra thought and planning, showering will be easier than getting in and out of baths and using a long handled shoe-horn might come in handy too.

If your shoulders are effected getting in and out of coats might become an embarrassing task on a crowded bus and reaching objects off the top shelf at the supermarket might make you feel like a croc too.

Maintaining an upbeat outlook on life can be seriously tested with fibromyalgia and it can create pressures in even the best relationships. Despite how bad you might feel with it you can still look quite normal and because blood tests cannot detect it you might feel like a hypochondriac, it is hard to avoid suffering over your suffering with fibromyalgia.

Unfortunately it is not just hale and hardy physical people who get down about this condition because of the way fibromyalgia can effect your powers of concentration, even something passive like reading a book is more difficult than usual.

If meditation isn’t your thing learning some other form of mental relaxation using breathing techniques or even hypnosis might help you take your mind off it. If you are not a person who would normally entertain using alternate medicine you might need to change your mind because being stubborn won’t do you any good atall with this condition. Likewise if you don’t normally like “taking drugs” you might need to if want to keep working.


If you have ever been to the beach and saw somebody walking around with a pattern of large round bruises on their back they have probably been treated by an acupuncturist with cupping.

Cupping is a procedure that uses suction cups to help draw the extra fluid that is present in sore and stiff muscles closer to the surface. When this happens relief is experienced because pressure is removed from the nerves in the muscle tissue. Lactic acid contained in the fluid is likely to be drawn out of the muscle tissue through this suction action also.

Bruising does not always result from getting Cupped but if you are quite fair or anemic it is likely to show more and this can put people off getting it which is a shame because when used appropriately cupping brings relief of muscle pain and stiffness.

The use of cupping is common in Chinese Medicine but cupping has been used a long time in Eastern Europe too and in recent times has been discovered by many physio therapists.

Cupping is also commonly used in TCM (and Eastern Europe) to treat colds and flu, the cups are commonly placed on the upper back to do this. The rationale that is offered for this practise is that perverse energy enters the body through wind exposure which can give you a cold. By literally sucking out the pathogenic energy the symptoms are claimed to be reduced.

Whether you are employing the use of cupping to sooth over-exercised muscles or to alleviate the symptoms of a cold the results are often quite impressive, it usually does seem to work.

As already stated Cupping can leave bruises that might not go very well with your new backless ball gown but otherwise the appropriate skilled use of Cupping is quite side effect free, non-invasive and only mildly uncomfortable (if uncomfortable at all).

Bamboo or glass cups are briefly heated on the inside then quickly placed on the skin, as the air inside the cup cools a suction is formed, this is how Cupping is traditionally performed. In more recent times small pistol-grip styled hand pumps and plastic suction cups with valves have been designed to do Cupping, they both work quite well.

It is no doubt easier for many to visualize excess fluid being sucked out from stiff muscle than it is to think about invisible pathogenic energy being physically drawn from your upper back but there are many things in health science that we are yet to learn about. Whatever the case Cupping really does seem to help people feel better.

Cupping can be easily used with other types of therapy, after a Cupping is applied for instance it is easier to make an impression on stiff muscles with massage, stretching and manipulative techniques.

Hip Pocket Sciatica

Otherwise known as pseudo sciatica, hip pocket sciatica is usually brought about by carrying around and sitting on an object (usually a wallet) in your back pocket. Even a very thin wallet will have this effect because it is the equivalent of sitting on a chair with a bump on one side.

Men are the chief culprits of this, hip pocket sciatica can cause pain and tingling in the buttock area and cause pain to radiate to your lower back. The hard lump you sit on interferes with the blood circulation to the gluteal muscles and it tips your pelvis up on that side. This can have a kinking affect on the lower lumbar discs which in turn can be a contributing factor to the “real” sciatica that radiates down your leg from your lower back.

The prevention is simple- take your wallet (or other objects) from your back pocket before you sit down. It is even better to find another pocket to carry it in because then it won’t matter if you forget to remove it when you sit.

It is surprising how much better this simple act can make your hips and back feel, if you are reading this and thinking “I always have my wallet in my back pocket and I feel fine” take it out for a few days and see if you feel any different.

Hip pocket sciatica is also called pseudo sciatica because it feels like sciatica but it isn’t. Sciatica can make your buttock sore through pain referring along the sciatic nerve from lumbar nerve root pressure in you lower back, sciatica is an indirect cause of hip or buttock pain. Pseudo (or hip pocket) sciatica on the other hand is a direct cause of hip and buttock pain because of direct pressure from what you are sitting on.

The very act of sitting unevenly like when you cross your legs also creates uneven weight distribution on the buttock muscles and can have a pseudo-sciatica  like effect. You may get away with sitting cross-legged or on your wallet for a long time before it effects you and this is why that sitting in such a way may not be considered by yourself to be the cause of that searing pain in your butt.

Poor quality seating should be on the list of suspects for hip-pocket sciatica and lower back pain along with any objects that you my habitually carry in your back pocket. Some of us have sitting habits such as tucking a leg under your butt when sitting or maybe leaning towards one side, it is easy to do when you have been on the computer for a long time.

Hip-pocket sciatica is aptly named for more than one reason because it will end up costing you money to get it fixed.

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a progressively debilitating disease that primarily effects the spine. The small tendons and ligaments in your spine become inflamed which is bad enough in itself but as they heal they calcify, effectively turning into bone. The flexible tissue turning into rigid bone stiffens and eventually fuses the spine, your other joints, your eyes, heart, lungs and bowel can all be effected by AS too .

AS effects three times as many men as women and the average age for the onset of symptoms is 24. The pelvis and spine are effected in all adult AS sufferers, in women the pain is less severe but their wrists and ankles are more likely to be effected than with men. Children are less likely to experience back pain with AS but their hips and knees are worse and sometimes need replacement surgery at a relatively young age.

Weight loss and fatigue are common, the symptoms are worst in the early morning and improve with exercise, night sweats and fever are common too. The body in general will be better with regular stretching but more than anywhere else the muscles in the front of your thighs and hips (lateral to your groin) need to be kept flexible. If an AS sufferer allows their hip flexors to stiffen they will not be able to stand up straight, they can develop a permanent stoop forward at the hips.

There are effective drugs that can help control the symptoms of AS but you will be even be better still if you get regular body work or manipulative therapies, not just for your hip muscles but all over. Sometimes physicians may not specifically recommend other therapies such as remedial massage or chiropractic to their AS patients but this does not necessarily mean that these therapies will not help them. If you have AS and your doctor has no specific objections to other types of musculo-skeletal therapies it might be in your interests to try them.

Climate has it’s effects too, AS sufferers usually find that cold whether much more adversely effects them than warm weather. It may not be practical for you to move to a warmer place away from family, friends and work but something as simple as the way dress can make a difference. About a year ago I suggested to an AS  client that he wear a scarf to make his neck feel more comfortable and  it worked very well for him. He had never thought of trying this before, his doctor did not suggest it and it took me while to think about suggesting it too, sometimes simple things work very well.

The lungs of AS sufferers are effected through inflammation in rib joints making breathing uncomfortable, this can be helped by being posture conscious at all times, not wearing tight restrictive clothing, not eating large meals, bodywork and most importantly learn to breath from your diaphragm not costally (deep not shallow).

Get advice from your therapist about using Self Massage and stretching to alleviate your AS.