Alex Spray and David Webster
State Registered Osteopaths in Derby
Sports Massage Teaching (ProActive Training Ltd)
Corporate Osteopathy Lloyd's Register Rail
Equine & Canine Osteopathy
Visceral and Cranial Osteopathy
Before discovering the benefits of Osteopathy, he was a keen martial artist and was fascinated by the role that exercise and stretching played in injury prevention and rehabilitation. He trained as a Sports Injuries and Spinal Manipulation Therapist prior to the completion of the five-year degree in Osteopathy. Alex has practiced yoga for nine years, and now practises Hatha Yoga five times a week. Alex is starting yoga teacher training in October with Bahia Yoga of Nottingham.
In June Alex is booked again for teaching the ITEC Diploma in Sports Massage to final year Loughborough University Sports Science and Physiotherapy students. This course provides these final year therapists with the additional hands-on experience using manual therapy for sports injuries and pre/post event preparation.
During his studies at the College of Osteopaths, Alex built up his own Derby Physical Therapy Practice that continues to grow, with a full-time dedicated city centre clinic. Alex uses active resisted muscle testing, bio-mechanical postural assessment, Orthopaedic provocation tests and gentle tissue palpation as his diagnostic screen. Alex works with patients from all backgrounds and addresses many different pain presentations although he has a particular interest in helping people with chronic pain.
All osteopaths must maintain their yearly registration which means recording all training and continuing professional development (CPD).
Alex is registered with the General Osteopathic Council and is a member of the British Osteopathic Association.
How can Osteopathy help you?
Osteopathy uses hands-on treatments including: massage, mobilisation, stretching, soft tissue release and joint manipulations.
Massage is the manipulation of your body's surface and deep layers of soft tissues. Effective massage treats firstly areas that are causing you discomfort and secondly supports your whole body. In this way massage can have different goals, for example enhancing circulation, reducing pain, relaxation or sports preparation.
Massage has powerful affects upon on all of your body's tissues, but most important is the way massage enhances circulation and the movement of fluid in and around your bodily tissues.
The smallest unit of life is the cell. Each of your cells does a vital job, be it building hormones or gobbling-up waste materials. Your well-being then, depends on each cell being supplied with the energy and raw materials it requires to carry out its role. Without suitable circulation the cells in your body will suffer starvation of energy and raw materials. A cell is like a tiny factory, it will produce waste products like lactic acid or free radicals, even when the supply of raw materials slows or stops. This means that waste products accumulate in your tissues, which can then lead to toxicity and discomfort. Massage then, limits this toxic build-up, while treating your body's tight muscles that allowed toxicity to occur in the first place.
Mobilisation is a movement ideally in a harmonic rocking motion where your body's tissues and joints receive a very gentle rhythmic passive movement that can help elongate shortened tissues, encourage the imbibition of synovial fluid into joint and create a passive fluid pump. Mobilisations also have a moderating affect upon your body's sympathetic nervous system. Sympathetic nerves gear your body up for fight or flight and prepare certain glands, organs and smooth muscles for this action. Mobilisations can reduce the firing of these nerves allowing the parasympathetic nerves to predominate. Parasympathetic nerves moderate the body's rest and digest functions. Thus if your fight and flight nerves are over-firing, the rest and digest function of the body will be reduced. This can lead to malabsorption of nutrients, constipation, anxiety and restlessness.
Soft Tissue Release (STR) The technique involves applying precise force during a specific stretch performed in multiple planes of movement. The aim is to appeal to the autonomic nervous system in a way that leads to spontaneous release of the injured muscle, thus regaining the original resting length of that muscle. The result: fast and permanent reorganization of scar tissue, the targeted muscle(s) return to the proper resting length, muscle imbalances are corrected, associated pain is decreased or eliminated altogether, and muscle performance is improved. Results are often obtained quickly and permanently.
Contract Relax stretching activates the target muscle fibres when we ask you to contract the muscle, and then we ask you to relax and exhale. As you change from contracting to relaxing neurologically an opportunity occurs where passively the contracted muscle fibres can be drawn apart. Gymnasts and martial artists use this mechanism which they term PNF. In this way tight muscles can be relaxed without the need to sit in a painful positions waiting for the muscle to give.
Joint Manipulations are particularly useful at neurologically relaxing joints that feel achy or in-bind. Your joint is placed in a position where it is nearly locked up, and a short thrust of energy placed through it. Often a popping or cracking can be heard. This technique activates a receptor in the muscle's tendon which then creates a reflex arc to the spinal cord, and back down the motor nerve to re-set the muscle's tone.
These approaches aim to improve the inherent motion of the body, that jobs, driving, diet, hobbies, age and stress limit.
Discover how you can recover from injuries faster, relieve your pain and aid your body's recovery from injuries.
We specialise in applying sports massage, facilitated stretching, harmonic articulation, soft tissue release (STR), inhibition, Cranial Osteopathy and long and short lever joint-release techniques to ease your aches, pains and sprains, so that you can quickly return to your normal life.
What is Osteopathy?
Osteopathy is a drug-free, non-invasive, manual therapy that focuses on total body health by treating and strengthening the musculo-skeletal framework, which includes the joints, muscles, tendons, ligaments and the spine. Its aim is to positively affect the body's nervous, circulatory and lymphatic systems. Osteopathy considers the wider impact context of the patient including their medical history, medication interactions, diet, occupational and hobby stressors.
How is Osteopathy different from Chiropractic therapy?
Osteopathy and Chiropractic Therapy have shared techniques like joint manipulation, trigger point therapy and exercise prescription. Principally the two methods are similar in that both place great emphasis upon the correct functioning of the whole body as a unit, but also remarkably different in the approaches used to manipulate the body. A chiropractor will encourage health by focusing primarily on the health and correct alignment of your spine, where after adjustment the spinal nerves can correctly function allowing your body to work properly. (Chiropractors are now divided into two political camps, the Mixers and the Straights, where the purest "Straights" believe and treat non musculoskeletal conditions like Asthma and Colic. Mixer chiropractors mix and use many different therapies as well as vertebral adjustments.) It is interesting to read Dr Simon Singh and Dr Edzard Ernst's book "Trick or Treatment" regarding the evidence to back-up the straight chiropractors attempting to treat non musculo-skeletal diseases! Osteopaths just find areas of your body that are restricted and encourage correct movement in those tissues. Chiropractors tend not to use soft tissue techniques like massage, typically they treat more often but allow less time per session, giving between ten and twenty five minutes per session, whereas osteopaths typically treat from between twenty and thirty five minutes.
What Happens on the Initial Visit?
A full medical case history will be taken followed by an examination during which you may be asked to perform a few simple movements. Some clothing may need to be removed so that the area can be examined and treated. Based upon the findings of your case history you will asked to perform active movements, for instance you might be asked to bend your knee or hip. Then the osteopath will perform certain passive movements. Active movements tend to implicate muscle pain whereas passive movements tend to implicate connective and ligamentus. Where you might complain of a clicking or snapping hip the osteopath would perform special tests to identify the cause of the pain, perhaps arthritic, labral, musculotendinous and joint. To implicate a labral tear your hip would be placed into extreme flexion and internal rotation.
Additionally the osteopath will use their highly developed sense of touch to palpate and assess areas of tenderness, strain, restriction or weakness within your body.
After examination the osteopath will discuss their findings with you and advise whether osteopathic treatment is suitable.
Osteopaths usually start any treatment by releasing and relaxing muscles and stretching stiff joints, using gentle massage techniques, rhythmic joint movements and muscle release techniques. The osteopath may also carry out manipulation using short, quick movements to spinal joints. The treatment may be a bit uncomfortable at times as painful areas are being treated but the osteopath will work within your level of tolerance.
In The News
What Is Chondromalacia Patellae? (PF)
The majority of clients that present to the clinic with anterior knee pain over the coming year will more often than not have a patellofemoral (PF) problem.
- Alignment is important!
It may be a slight bit of biomechanical mal-alignment that has stirred up the knee cap - this is the good, or they may have started to wear the cartilage on the under surface of the knee cap and as a result it has softened - chondromalacia – this is the less good. They may even have worn a hole into the knee cap cartilage and they now have a chondral defect, or worse still an osteochondral defect - the downright ugly.
These problems affect runners, cross fitters, group exercise enthusiasts (Les Mill`s PUMP classes!), and simple recreational walkers who spend a lot of time on hills and stairs.
The bio-mechanical irritations and the chondromalacia versions can be managed conservatively with a combination of local treatment modalities and correcting the bio-mechanical faults. The more serious chondral/osteochondral defects often need some surgical intervention as often the pathology is too advanced to respond to conservative treatment alone. Chris Mallac
Understanding the exact mechanical contributions of the knee cap in relation to the femur is critical for the therapist to effectively manage these problems.
At the local (PF) level, the fault is usually a malposition of the patella in the femoral trochlear groove. Often the knee cap is being pulled too far laterally and superiorly in the groove, creating an uneven contact situation between the knee cap and the great leg bone. The (PF) compression force during loaded knee flexion (squats, lunges etc.) is no longer optimal and usually a smaller portion of the patella cartilage is taking all the load. This wears the cartilage down and creates pain and pathology. This is most noticeable as the knee flexes to 30 degrees and onwards as it is this knee flexion angle where the knee cap enters the femoral Trochlear groove.
What is Synergistic Dominance?
When a group of muscles which perform the same or similar role change the muscle which is the main mover, several muscles bend your leg up towards your chest, your body allows this main muscle to have a holiday and the other helper muscles take over.
Here the helper muscle becomes the main mover and has synergistic dominance.
Problems start to occur when we use the incorrect muscles to do an important or repetitive role. Try slowing your car down using the hand brake before you use the foot brake and apply this to running, squatting or cycling. In the short-term changes in synergistic dominance can work but all-to-quickly the new primary mover will tire too quickly and may struggle with its other roles.
In the push-off phase of running the stability in the core allows the Glutes, Lumbar Erectors and Hamstring straighten your body launching you forward, except as a consequence of your seated job your Glutes are switched off/inhibited, and your hamstring has taken over synergistic dominance which now starts to feel tight and sore despite stretching after work outs.
What To Do?
Stretching alone seems to not fix this issue, rather add work with therapy balls or foam rolling into the new primary mover muscle which will have the affect of releasing it by the process of the roller or ball supplying an over whelming pain stimulation which can undo the spasm and pain. Consider also a variety of sports to avoid over repetitive movements.
Passive Straight Leg Raise (PSLR) Is it useful?
The PSLR is a diagnostic test where the tester slowly lifts the clients leg off the treatment table where the client makes no movement. Reproduction of back pain suggests impingement of the Sciatic Nerve as the lifted leg stretches the Sciatic Nerve as it exits the gap in the spine, most probably due to disc pathology.
Lower back pain (LBP) is the most common disability in western industrialised countries. One of the causes of LBP with leg pain can be nerve impingement from a herniated lumbar disc. (So called slipped disc). The value of being able to diagnose a so called slipped disc is valuable as it limits certain treatment options and encourages other options.
Primary care clinicians use a combination of patient history and physical examination to assess the likelihood of the symptoms being attributable to a herniated lumbar disc.
LBP is one of the most common musculo-skeletal complaints seen by osteopaths in
practice and Rebain, showed in their postal survey of UK osteopaths that the PSLR
test is routinely used to assist in the diagnosis of LBP.
Konstantinou conducted a study to develop a consensus on the content of a
clinical assessment for adults presenting with low back and leg pain to primary care.
They also aimed to establish the most important items for diagnosing spinal nerve root
involvement. A multidisciplinary group of participants took part and rated various
items for their importance in the clinical assessment. PSLR, with other neural tension
tests such as femoral nerve stretch, was rated as important in the assessment of low
back-related leg pain by 89.6% of the respondents. Their recognition of the clinical
presentation of lumbar disc herniation and their use and understanding of the straight
leg raising test were in keeping with the literature.
Adapted from: Martin Pendry
Yoga Teacher Training! 200 Hours (RYT)
Alex commenced 200 hours yoga teacher training at Bahia Yoga Nottingham on 25th and 26th October. The course is delivered between October 2014 and July 2015 with a combination of yoga postures, philosophy, history, Sanskrit, chanting and Anatomy and Physiology. Upon completion Alex can register with Yoga Alliance as a registered yoga teacher RYT.
The Bahia approach has added awareness of the wider subject of Hindu history and life style. We had strict vegan lunch on both days which was refreshing! As part of the wider awareness of yogic life styles we sat on the floor for the entire weekend which caused my hips to ache and release significantly.
See http://bahiayoga.com/ for further details.
Is it a Disc Bulge?
Recently we have had a number of new clients present with symptoms which included:
- Pain which sounds like it might be originating from "nerves"
- Pain in the lower back
- Pain on bending forward and twisting
- Pain on coughing
- Pain goes down the back of the leg
- Weakness in the leg
Often after gentle treatment the client improves quickly which shifts the possible diagnosis away from a disc bulge. Discs classically take at least 2 months to improve and as such a quick improvement in symptoms excludes a primary disc bulge.
Latterly we had a semi-pro athlete into the clinic who hurt his back doing power-lifting squats, he normally did high reps with less weight on the bar, but had shifted his training up! He felt his back go upon lifting up and then the day following the lift he felt awful. He described the above vague symptoms and we suspected the possibility of a disc bulge in a super fit 19 year old athlete!
The intervertebral disc is strong, but can absorb the load as your muscles tire. Heavy squatting, digging, lifting can weaken the annular outer disc. In young people the inner polysaccharide gel is very liquid and therefore more prone to bulges.
People do recover from disc injury but can develop a weakness as the damaged disc allows new arteries to grow into the damaged area, to support healing, and with the artery grows a new nerve which then can report pain!
Be careful when you lift and hold your breath to build extra abdominal stability, as this held breath in extreme cases can place the disc under further pressure.
Alex is developing his yoga practice with an additional Monday Ashtanga yoga vinyasa class with Clare Brooksbank. Ashtanga yoga is a form of dynamic yoga where yogis focus upon the movements between the traditional yoga postures, where there are jumps into and out of the postures! Ashtanga is criticised perhaps unfairly for being more vigourous than normal yoga and as such encourages more injuries, as it links the traditional Hatha postures with movements in-between the held postures, adding dynamic movements to the mix, which in some way addresses the valid criticism that non dynamic yoga fails to increase the person's VO2 Max score (Broad J 2013). Like all exercise forms there are risks and rewards, ballet is beautiful but the dancers accumulate injuries as the purpose of ballet is to appear graceful and poised not improve health, which is not the case with Ashtanga yoga, rather correct postural alignment is encouraged syncronised with calming mindful breathing, similar to the breathing techniques used during the birthing process where the mother maintains a slow steady in and out breath keeping the body in a parasympathetic state! Yoga is not a panacea.
A little knowledge can be dangerous. The Pilates system is often accused of teaching people to "brace", where they scrunch their pelvic floor up into a tight ball of stability. This is not the case, rather a simplification of a technique cue. Where people have lost the connection with their pelvic floor, they need to re-integrate with its use, and use it when needed , rather than that which some critics claim that Pilates teaches people to over-use their pelvic floor. Pilates un-learns inefficient movement patterns which use bad technique, and inculcates functional precise balanced movements in their place!
I started Pilates in 2007 and immediately benefited from the feeling of my belly button being pushed back against my spine. Later when I moved to Virgin Active I attended three classes a week and worked in these classes from the most basic and apparently straight forward movements. My whole body was aching and yoga at that point was jarring, and often made me sore. Pilates taught me to refine and move my body in a manner that did not hurt it. I did Plank on my knees and worked at the bottom of the exercise ladder. Over time my body changed and my focus shifted towards yoga. Now I can plank much better, but it was Pilates that reset me.
Anterior / Posterior Balance
In green you have a group of muscles which bend you forward. In blue the opposite. If you sit / drive a lot the green bend forward muscles get used to being shorter, and the blue back bender muscles get long.
Short muscles lack strength. The back bender muscles adjust their strength so as to not over power the opposing muscles. This means your powerful glutes / buttock muscles struggle to support you as you straighten your body or bend forward.
Over time you can develop a permanent postural adaptation called Lower Cross Syndrome in red.
Massage helps with lower back ache
My Hamstrings are always tight and I stretch all-of-the time!
The Hamstrings are long powerful muscular movers which are really good at bending your knee or bending you backwards. (They also have a role as weak hip rotators)
You will use these muscles as you bend forward to slow you down and when you run in the flexion phase.
Hamstrings are in a group of muscles called Global Movers, which means they shift your body in space, other Global Movers include: Gluteus Maximus, Latisimus Dorsi, Iliopsoas, Rectus Femoris and Quadratus Lumborum.
What you may be doing is using your Hamstrings as a stabiliser rather than a mover. Here you are using a fast twitch muscle as if it were slow twitch. Fast twitch muscles are powerful but tire quickly.
Q. Why then are you stabilising your pelvis using the wrong muscle?
A. The local stabilisers of the pelvis are not working properly.
Q. What can I do to help this?
A. Firstly activate your local pelvic stabilisers, specifically the deep corset muscle called Tansversus Abdominus. Secondly seek appropriate physical therapy to diagnose why this has happened?
Q. Do these muscles work alone or in combinations?
A. Common sense dictates that our muscles co-activate in groups and should fire up in a sequence.