Concerned about your child's posture

Concerned about your child’s posture?

Are you concerned about your children’s posture?

Heavy backpacks and increasing use of technology is causing a marked increase in the prevalence of back and neck pain in younger people.

Over the years I have seen a gradual increase in the number of school children presenting with back and neck pain – a recent study cites that 40% of 11-16 year olds in the study reported back or neck pain. In the past I thought it was excessive ‘gaming’ or ‘playing’ on computers and laptops but as my children get older I see that it is also the large reliance of technology for their schoolwork and homework. As a family we have always tried to limit ‘screen-time’, however, I also recognise that this is their future. Children need to understand the technology and utilise it as it has become the norm in our society.

No longer is it sufficient to limit their time, we now need to look for other avenues to minimise the risks that the technology poses. Like preparation for a sport, I believe, we need to strengthen the body to deal better with the new postural strains that it is exposed to – as well as being mindful of the amount of time spent with digital activities.

Young bodies are highly versatile and supple, adapting to new environments. However, they are also developing and growing and structural stresses at this stage can cause long term damaging effects. Often the aberrant patterns are setting in from the ages of 7 or 8 but the bodies versatility accommodates the change. As the body becomes more defined in it’s structure the altered patterns lead to altered muscle and joint function and this ultimately leads to pain and dysfunction. Back pain and neck pain are most common from around 12 years of age in school children. This may also correlate with an increase in the weight of their schoolbags and an alteration in their levels of physical activity as they enter high school.

I’m always amazed at how, despite the technology available, schoolchildren still carry excessively heavy backpacks plus the extra bags of sports uniform, musical instruments, etc. Guidelines indicate that backpacks should be no more than 10% of a child’s body weight, however, this is not enforced and, in my opinion, rarely adhered to.

It is equally important to pack the backpack correctly to ensure that the weight travels evenly down the spine with strong support from the hip bones. Children should be offered training on how best to pack the back pack and how to fit and wear it correctly.

Our children are the society of tomorrow and we are arming them poorly to cope well with their health. I do not believe in giving children the best of education and opportunities for the future at the expense of their physical wellbeing.

Tips to help improve your child’s posture.

  • Ensure when using technology that your child sits upright with both feet flat on the floor.
  • Use a desktop computer where possible instead of laptops or tablet. If using a laptop – place it on a table.
  • Set aside a separate area to study with a good ergonomic set up.
  • Placing a cushion on their lap will support their arms and raise the device to reduce forward arching of their necks – if they have to use a laptop or tablet on their laps.
  • Take regular breaks – no more than 30 minutes in one session.
  • Regular and varied physical exercise will assist muscle growth and development – reducing the adverse impact of hunched postures. The Government advises a minimum of 60 minutes physical activity every day.
  • Reduce the weight of the backpack to below 10% of child’s bodyweight.
  • Ensure back pack is well fitted.
  • Teach your child to pack their backpack effectively.
  • Never let your child carry the backpack on one shoulder.

It is imperative that we address the challenges of the digital age by educating our children on :

  • How to reduce the adverse impacts of technology
  • How to strengthen their bodies to deal with the altered positioning.
  • How to pack and wear a backpack properly
  • How to set up their workstation to optimise their wellbeing.

Over the coming weeks we will be releasing articles to help with each of these areas. In the meantime, if you would like personalised guidance and support to help you children to be fitter, healthier and stronger please don’t hesitate to call the practice on: 9413 4674.

During these Easter holidays Melissa Jhey is offering a comprehensive  “No Gap” Osteopathic assessment and treatment to all school children. This session will include a full structural examination to identify their areas of weakness, personalised exercise program to address the weaknesses, guidance on ergonomics and advice on fitting and packing of backpacks. This session is available on a “No Gap” basis – so will be at no cost to you. If you do not have a health fund then a reduced fee of $50 is charged.

Take this opportunity to give your kids a better chance – they deserve it!

Melissa is available in Chatswood Tues – Fri 8am – 6pm & Sat. 8am -12pm

Standing Desk

Should I get a Standing Desk?

Technology appears to be affecting our posture and our health more than ever. The average Australian is currently spending an average of 8.5 hours per day staring at a screen. So whether this is done sitting behind a desk all day or looking straight down on to your smartphone or tablet, the effects on your health could be profound. Research indicates that spending too much time sitting down increases your risk of diabetes, certain cancers, heart disease and early death. We also know that you utilise less muscle activation and therefore burn less calories when sitting all day. This means we are getting weaker and slowing down our metabolisms.

The healthcare and ergonomic industries are constantly looking for solutions to keep up with our rapidly changing postural demands. Over the past few years these industries have been encouraging the use of standing desks, promoting them as the solution to recurrent back and neck pain at work and creating a more ergonomic workspace. While they appear to be encouraging better posture and health, there are some negative consequences to prolonged standing.

In comparison to sitting, standing forces our circulatory system to work against gravity to send blood to the brain, and prolonged standing has been linked to poor concentration, headaches and occasionally dizziness. Standing for too long can also lead to swelling in the legs and ankles and if you have the tendency to have a ‘swayback’ posture, can also lead to back pain.

So what’s the best solution?

I believe adjustable desks are the best option on the market. A combination of sitting and standing, alternating every 30 minutes appears to be the safest, healthiest and most ergonomic solution. If This isn’t an option the best alternative is simply regular breaks from the desk and short walks to break up the day.

For more information on adjustable desks, brands and ideas to make your workplace more ergonomic go to or come and visit your osteopath at The Osteopathic Centre for some advice tailored to your posture.

Dr Anna Quillfeldt (Osteopath)

Stress and Tension

Stress and Tension

How does it feel in your body when you hear that word? Is it a heaviness? Do areas contract, tense up, brace for impact? Is it associated with a lot of things to juggle, deadlines to meet, many things on your mind and demands on your time? At such times, a massage or yoga would be most useful.

Perhaps you might be curious to learn that pressure is constantly working in your favour. Let me elaborate.There is the air pressure outside our body and an internal pressure of our bodily tissues and fluids. The diaphragm is a divider. From the lumbar vertebrae this muscle forms a big parachute or umbrella shape attaching to the lower inside section of our ribcage. Above the diaphragm are our lungs. Below it, lie the internal organs of our abdomen.
As we breathe in, the diaphragm draws down, which creates a cavity above it, where the lungs are situated. In order to balance the same pressure as the external environment air is drawn in to fill this space. Breathing out, the diaphragm relaxes into its large domed shape and the air is pushed out.
What’s going on below the diaphragm? The internal organs get a bit of a massage, moved around by the motion of air coming in and pressing down on them. Then when we breathe out, a similar mechanism to what creates the intake of air, takes place, where substance fills a space that is created, to equalise distribution of pressure and lymphatic fluid is drawn upwards.
The lymphatic system is the bodies cleaning system, where it processes waste products and fights disease. The vessels of the lymphatic system don’t have any muscles of their own to move the fluid. Instead the transport of lympahtic fluid relys on movements of surrounding tissue, such as during physical activity, exercise or massage, with one way valves stopping backflow, so that it can be filtered at our various lymph nodes which are often located in the sites of large joints such as the armpits. The body capitalises on body movements as a pumping mechanism, a very clever design!
The upward drawing effect of the diaphragm as a pressure pump is vitally important as this fluid,
from the whole body, can only return to the bloodstream at the venous angles where our right
lymphatic duct and the thoracic duct empty into the subclavian veins, located just underneath our clavicles (collar bones) at the base of our neck.

Back to the pressure definition meaning stress…..Did you know that stress from any form of pressure creates chemicals (hormones) in the bloodstream. These hormones have to be broken down and dealt with – a job for the lymphatic system, which is why we become more vulnerable to catching a cold when we are frantically ‘burning the candle at both ends’. Our immune system is preoccupied with processing stress hormones, instead of its full defensive capacity allocated to warding off foreign pathogens.
With that in mind, do areas of your body that feel a bit heavy or sluggish, take on a new meaning
in your understanding? Might it be congestion in your tissues, which as it accumulates, adds more pressure / resistance for the pumping motion to work against and transport through your system.
Massage can help kick start the process of shifting things from areas that are stuck so that they can continue through the circulatory (lymphatic) system of the body to be dealt with. Moving is key for a greater sense of wellbeing and vitality. The Yoga, Pilates and Tai Chi classes at our new studio space Feel Great are all about opening up your body for greater circulation and ease, releasing pressures from a hectic pace of life.

Medicare and Osteopathy

Medicare and Osteopathy

Osteopathy and Medicare.
Increasingly more of you are asking if you can claim a Medicare rebate for Osteopathic treatment. Medicare has in place a Chronic Disease Management plan which enables clients to claim a Medicare rebate for osteopathic treatment – amongst other therapies.

The Chronic Disease Management program enables GP’s to utilise the skills of many therapies and therapists to provide a structured approach with the GP co-ordinating the care of the clients. Research indicates that this integrated approach to chronic diseases is one of the most effective avenues to long term results. This is a collaborative approach recognising that often, no one therapy will have all the answers. .

As one would expect there are eligibility criteria to claim this service from Medicare and the assessment of eligibility is conducted by your GP. The program allows for you to request the Practitioner of your choice. Effectively, the program is aimed at assisting people with a chronic medical condition (one that has been, or is likely to be, present for 6 months or longer) and can include musculo-skeletal conditions.

In the last six months we have seen a dramatic rise in the number of GP referrals based on this CDM program. We are pleased to be able to offer our services and work as part of a co-ordinated healthcare team and delighted to see excellent outcomes for our clients.

If you feel you would qualify for the CDM program you can discuss your options with your Osteopath or your GP.

To stretch or not to stretch

To stretch or not to stretch?

Recently I have taken up wrestling as a sport and just like when I did gymnastics as a child and teenager, the training sessions follow a very similar format – a long warm up period followed by the main training session and ending with a cool down. During one class I was involved in a discussion about new studies that have been done suggesting that warm up sessions should not involve static stretching. Static stretching for those who don’t know is the method whereby you hold the stretch for a period of time, then relax.

Two new studies have been published recently that have set the sports and exercise worlds talking, casting doubt into whether the way we have been warming up for all these years, is not only a waste of time but actually counter-productive.

The studies basically found that static stretching in top atheletes:

-Reduces strength in muscles by 5.5% with a greater impact if the single stretch is held for 90 seconds or more (for less than 45 seconds the impact is minimal)

-Reduces power in muscles by approximately 2%

-Reduces explosive power by a maximum of 2.8%

With these results in mind you could therefore say that static stretching of 45 seconds or more would disadvantage top athletes or for those competing in strength or explosive power sports. The study however doesn’t specify for what period of time following the stretch that this effect lasts.

So, how does this study affect us and the way we warm up? Looking at the percentage decrease in strength, power and explosive power, for the professional or top athlete, where every ounce of force or mille-second of speed is essential, these quantities are significant. For most of us however this is not the case. Also mentioned in the study is the duration of the stretch. For the majority of people a warm up stretch lasts for approximately 10 seconds, well under the 45 second limit where static stretching can have an impact on performance. Finally, the study doesn’t mention anything in regards to endurance sports and so therefore cannot really be included in the discussion.

Stretching does exactly what it says it is supposed to do. It stretches muscles, tendons and fascia, allowing easier and less restricted ranges of movement. The downside to this being that as the muscle fibres are less contracted, they are less able to store energy resulting in decreased strength and explosive power.

Whilst playing sports most of us use our bodies more dynamically then we do with other activities in our lives. Typing at a desk has our arms in front of us. To suddenly play tennis without opening up our shoulders means that the muscles which have become accustomed to a shortened position, are suddenly stretched without warning. A warm up stretch beforehand, makes the motion less of a shock and the muscles more able to handle the increased range required. If not, sprains and strains can easily occur.

Stretching has another function however not mentioned in these studies and that is of increasing body awareness. Whenever we slow down, notice our breath, sense our bodies and the feelings of tension within our muscles and ligaments, we immediately become more in tune with ourselves and less likely to cause harm or injury.

As flexibility is a key area of health and protection against injury, my general advice would be to spend a minimum of one hour, at least once a week, stretching or taking part in a yoga class to maintain flexibility and tissue elasticity. During the remainder of the week shorter periods of stretching can be done working on areas specific to each individual. Having an assessment carried out by one of our qualified osteopaths will allow maximum benefits to be achieved in minimal time. I believe for those who take part in sports and activities, a warm up is essential and should be a combination of static and dynamic stretches and other movements designed to get the blood pumping and the heart beating a little faster.

For your personalised stretching assessment, book an appointment with one of our trained osteopaths.

Christian Paesano
Osteopathic Physician
B Sc(Hons) Ost. Med, D.O. D.N.

Osteopathy in the Press

Osteopathy in the Press

The Sydney Observer June 06, 2014 / by Kamdha Editor

From multivitamins to osteopathy, alternative medicine has become mainstream. Two-thirds of Australians are expected to use some form of complementary or alternative medicine in 2014, spending up to $1.8 million.

Government funding for alternative medicine has skyrocketed over the past 10 years and universities across Australia are running courses in osteopathy, chiropractic science, traditional Chinese medicine and naturopathy.

Osteopath at the Osteopathic Centre in Chatswood, Dr Christian Paesano, believes osteopathy plays a critical role in primary healthcare.

“We run through quite a lengthy case history during which we go through the reason that people come in. We ask questions around lifestyle, work, sport and sleep. We put the health condition in context of the person’s life,” Paesano said.

“After carrying out an osteopathic assessment during which we hope to come up with a diagnosis we then lay out a treatment plan based on how long we expect to be seeing the person. Osteopaths are hands on, so treatment can involve massage, adjustments, manipulations, mobilisations and hydrotherapy exercises.”

However, as with all forms of alternative medicine, the practice of osteopathy does not always adhere to evidence-based medicine (EBM). Despite only few research studies suggesting osteopathy is effective, the National Institute for Health and Care Excellence in the UK recommends osteopathy for the treatment of persistent and recurring lower back pain.

With lower back pain sending more people to the doctor than any condition other than the common cold, and around 80 per cent of Australians expected to suffer from lower back pain in their lifetime, Paesano said GPs are now regularly referring patients to osteopaths.

“We work alongside local GPs and get quite a few referrals. In the past I think doctors were more likely to refer onto physiotherapists but nowadays osteopaths are a critical part of primary healthcare. We work closely with GPs when it concerns conditions like lower back pain, headaches and arthritis,” Paesano said.

In Australia, all osteopaths complete a minimum of five years university training in anatomy, physiology, pathology, general medical diagnosis and osteopathic techniques. They are also trained to perform standard medical examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems.

While Australians continue to look towards alternative solutions to their health problems, Paesano believes complementary medicine is an effective and reliable way to treat common and persistent health conditions.

“In osteopathy for example, there are obviously limits to what we can treat. However, we do treat a number of conditions highly successfully with repeated results,” Paesano said.

“I think our main strength is that we can give a lot more time to each individual person and we get the results people hope for and consequently patients come back again and again.”

Upper crossed syndrome

Upper Cross Syndrome.

Although you may not be familiar with the term upper Cross syndrome (UCS), you have more than likely seen people with this type of postural imbalance. UCS is characterised by rounded and elevated shoulders, forward positioning of the head and a rounding of the upper spine and neck or an increased thoracic kyphosis and a cervical lordosis.

Although this is a posture we often see in the elderly. It is becoming increasingly common earlier in life, especially in those who work at desks, hunched over a computer, those who drive vehicles for long periods and those who slouch in sofas and are relatively inactive. Over an extended period of time, the muscles at the front of the chest and rear of the neck become shortened and tight whist the flexors of the neck and the muscles stabilising the scapula, become weakened and lengthened.

This creates and maintains the muscular imbalances we see in UCS. The term UCS refers to the positioning of the weak and tight muscle groups. As viewed from the side, the muscles in the mid back and the upper neck create a line of weakness that is intersected by a line of tension travelling from the posterior neck to the upper chest wall. This creates a cross shape as seen in the diagram below.

Often associated with this type of posture is pain surrounding the base of the skull, at the midpoint in the neck and/or at the spinal levels between the shoulder blades. It is common for those with UCS to complain of headaches associated with the muscular tensions and restrictions of the cervical spine. Due to the altered positioning of the scapula, shoulder problems can develop along with radiation of pain into the arms.

As the sternum becomes depressed, breathing becomes more difficult and maximum lung

capacity is reduced which is of particular interest to athletes and those suffering pre-existing respiratory conditions.

So, is UCS treatable and how do we prevent it?

The treatment for UCS starts with the lengthening of the tissues that have become shortened

and tight. This means stretching out and increasing the length of the muscles in the front of the chest and the back of the neck. The spine and peripheral joints are assessed for restrictions and treated accordingly with gentle mobilisations, articulations and adjustments if needed. Finally, exercises are given to target and strengthen the specific muscles that are weak. This provides the basis for long term management as the combination of osteopathic treatment plus targeted exercise can successfully be used to treat not only the symptoms but the cause of this condition.

Once a correct posture has been achieved, maintaining this now becomes important. As working, driving and sitting postures play a major role in the the development of this condition, they should be assessed to minimise impact. In the office, the workstation should be set up so as to prevent hunching over the desk with regular rest periods. Driving and sitting positions can use supports for the lumbar spine as well as focusing on upper body position with shoulders down and back.

Increasing flexibility with a regular yoga practice and improving core strength with Pilates

have also been shown to be highly beneficial in the treatment of UCS and the maintenance of

a good body posture. Finally, regular remedial massage can help address tensions within the

musculoskeletal system whilst regular Osteopathic check ups ensure restrictions to movement are removed and optimal functioning of the spine and joints maintained.

If you experience any of these symptoms or recognise similar poor posture in yourself, why

not book an appointment with one of our qualified osteopaths today, to work out a treatment

plan tailored to you.

Christian Paesano
Osteopathic Physician
B Sc(Hons) Ost. Med., D.O., D.N.

How important is Movement of the Thoracic Cage ?

Every cell in our body requires oxygen to function and perform its internal processes, the self-regulating mechanisms that keep the body running in a state of equilibrium known as homeostasis. Oxygen enters the bloodstream via breathing. The pleural sacs of our lungs are the site where the exchange of carbon dioxide for oxygen takes place. Our lungs are a vital and delicate structure, protected by our rib cage, which is held in place and attached to the vertebrae of our thoracic spine.

With the attaching ribs, it makes movement through the thoracic spine more restricted than in the lumbar or cervical section which are less encumbered to flex, forward or laterally, extend and rotate. Movement is crucial because the less we move the stiffer the structures get, the tissues get stuck together, compacted, which doesn’t leave much space for blood flow to penetrate the area. It creates little patches of unhealthy musculature, which we notice as pain / soreness / tension. This tightness throughout the chest and upper back begins to restrict breathing as the rib cage has to expand against the pressure of a constricting band of tight fascia / musculature. Less oxygen intake in the circulation can lead to symptoms such as a headache or fatigue.

Have you ever noticed how people slump forward when they sit at a desk? This is partly due to their concentration being focused on whatever they are working on and they are not aware of their body and how long it has been in one position for. What happens when people are sitting this way for long periods of the day, repeatedly? With the arms held in place at the front of your body, the chest is closed with the upper back under a constant pull forwards. Not only does this inhibit the expansion of the ribcage for breathing, your neural feedback systems become so used to this posture from habitual exposure that they can “reset” that configuration of muscle lengths as “normal” (to you).

What can massage do to help? We work on opening the muscles of your chest from the sternum (breast bone) out to the tendons on the head of your humerus (upper arm bone). Applying pressure throughout the upper back; from your vertebrae to the scapulas (shoulder blades), has the added advantage of loosening your neck by freeing the attachments points where the muscles throughout your neck are anchored. Using little friction motions between your ribs can de-stick any intercostal adhesions, which makes it easier for them to expand. Manual therapy can also address any spasms that may be in the diaphragm which is the big muscle underneath your ribs, whose role is to perform breathing. If you are breathing incorrectly using the scalene muscles in your neck to lift the ribcage, your neck is likely to be sore from working overtime instead. Massage works to soften and lengthen taut, irritated muscles. Re / de-tensioning the body to a more neutral state provides the brain with muscle memory of how function feels easier in this state and it is therefore more likely to register when the stresses from our daily lives begin to draw it away from optimum mechanics. Signalling that it might be time for a massage!

With a healthy thoracic spine, the neck is free to turn. The movement of walking can send ripples of movement all the way up through the curves of the spine to the head, which keeps everything limber, an internal massage via exercise, with the tissues sliding easily over one another. Areas of the body that are stuck /locked, mute this effect, so that anything above the congestion, it isn’t receiving the benefits of the same degree of mobilising and circulation.

Sounds like it’s time to free the thoracic spine and breathe easy. Give us a call and experience for yourself what more mobility in your upper body feels like.

Look out for the upcoming article on the mechanisms of breathing and what else it does for us other than supplying us with oxygen…..

Shona Lee
Remedial Massage Therapist
The Osteopathic Centre – Chatswood

Treatment of Back and Neck Pain

American Doctors shun the Guidelines in Treatment of Back and Neck Pain clients.

Research published this week looks at the treatment of back and neck pain in America. The study looked at 24,000 US Medical visits from 1999-2010 that were related to back pain. The research shows that Doctors are increasing the use of strong, addictive narcotic drugs in the treatment of back pain. The guidelines given to Doctors in America for the treatment of back and neck pain is to prescribe over the counter anti-inflammatories and to refer for physical therapy. It seems that many Doctors shun the guidelines and as well as prescribing narcotics and pursuing more aggressive treatments.

I find that this study raises many concerns and whilst the study was conducted in America I feel it raises concerns over the direction of healthcare and pain management worldwide.

The study expresses that the current approaches employed by American Doctors are not in keeping with the guidelines and, in many instances, are unnecessary.

  • Unnecessary treatment is not only expensive, but can also come with complications. A meta-analysis concluded that narcotics offer minimal benefit to relieve acute back pain and have no proven efficacy in treating chronic back pain.
  • At a time when substance abuse is a grave concern it seems worrying that Doctors are consistently prescribing such strong medication.
  • Overuse of imaging may not result in immediate problems but exposure to ionizing radiation can lead to further health complications.
  • Lead author of the study John N Mafi MD notes a study that linked regions with higher MRI use found an increase in back surgeries, which can be a very costly, stressful process and requires considerable recovery time.

Why do so many physicians seem to be ignoring the guidelines?

The study doesn’t offer insight into that question, but Mafi suspects the desire for a “quick fix” is at play. “The problem is that it really takes a lot of patience to manage back pain,” he said.

At the Osteopathic Centre we have seen a marked increase in the number of Doctor’s referring their back pain and neck pain clients for our integrative approach. The Integrative medicine philosophy is one of individualised, patient-centered care with no standardised, pre-specified clinical intervention. In 2012 referrals from Doctor’s to The Osteopathic Centre increased by 170% from the previous year.
Read more about this study

Osteopathy – the fastest growing health profession in Australia.

The Private Health Insurance Administration Council (PHIAC) is an independent Government organisation that oversees and regulates the private health insurance industry. It gathers information from all funds and all payments that are made through ‘extras’ or ancillary payments.The following statistics are available on the PHIAC website.

The trend over the past few years is continuing at a rapid rate. Amongst osteopathic communities it has been well known that the profession has gained wider acceptance as more patients have had the opportunity to experience the profession and as more clinics are opening throughout Australia. It is finally being expressed in solid research and facts.

According to PHIAC, the number of people choosing to visit an osteopath has increased by 48% over the last two years (June 2012). As a comparison, other manual practitioners such as chiropractic and physiotherapy increased by only 7% and 11% respectively during this time period. The rate of popularity and growth is a credit to all dedicated osteopaths with ideals in advancing quality of patient care and professionalism.
The statistics become more interesting the further you look into them over a longer period of time. Osteopathic treatments have increased 270% since 2005 further attributing to its rapidly growing popularity. Compare this to other health professions and you can see the difference is quite significant.