Edinburgh Osteopath - Helen How

15/09/2025

01/09/2025

🦴 High-Risk Trabecular Bone Sites

1. Lumbar Spine (Vertebral Bodies)
• Why: Predominantly trabecular core, highly sensitive to estrogen deficiency.
• Clinical picture: Early site of bone loss in amenorrheic athletes or those with low energy availability; reduced BMD and trabecular bone score often show up here first.

2. Femoral Neck (especially superior side)
• Why: Critical load-bearing zone, with mixed cortical and trabecular composition.
• Risk: Stress reactions and fractures can progress quickly; high displacement risk if missed.
• Often linked with: Female Athlete Triad / RED-S in endurance sports.

3. Tarsal Navicular
• Why: High trabecular content but with limited blood supply.
• Clinical importance: Classic “high-risk” stress fracture site in runners; slow healing and recurrence risk.

4. Sacrum & Pelvis (P***c Rami)
• Why: Trabecular-dense structure, central load transfer in gait.
• Clinical picture: Stress injuries here often present subtly with vague buttock or groin pain; delayed diagnosis is common.

5. Calcaneus (Heel Bone)
• Why: Rich trabecular bone, bears high impact forces.
• Clinical picture: Seen in runners, military recruits; may mimic plantar fasciitis early on.

6. Proximal Femur
• Why: Combination of cortical and trabecular tissue, highly stress-sensitive during adolescence.
• Clinical picture: BMD deficits in this region often predict later hip fracture risk.

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⚠️ Why These Sites Matter
• Metabolically active → first to show deficits when hormones or nutrients are lacking.
• Structural importance → injuries here can end careers if not caught early.
• Poor healing potential → especially the navicular and femoral neck.
• Silent progression → symptoms often vague until stress fractures occur.

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👉 In short: Lumbar spine → femoral neck → navicular are the “classic first responders” to systemic imbalance. The pelvis, sacrum, calcaneus, and proximal femur follow closely as secondary vulnerable zones.

31/08/2025

Shockwave Therapy: 11 Years in Practice – and the Demand Has Never Been Higher

This month marks 11 years of clinical experience with Shockwave Therapy in my practice. In that time, I’ve seen it move from a specialist option to a cornerstone treatment — not only for tendinopathies and scar tissue but now increasingly for muscle injuries.

For the first time, we’re running a waiting list for Shockwave treatments. I’ve never seen such demand — patients, athletes, and colleagues are recognising the benefits of this non-invasive, drug-free option when paired with progressive rehabilitation.

The science is catching up with what clinicians have observed in practice. A 2023 Cureus systematic review (Mazin et al.) analysed 8 studies, 143 adults, using both radial and focused ESWT across functional strains, structural tears, contusions, and hematomas. Highlights included:
• Pain: VAS scores consistently dropped across acute, chronic, and tendinous injuries.
• Function: Better outcomes on validated scales (e.g., Tegner, Constant).
• Return-to-Play: Elite footballers returned in as little as 3–13 days, depending on injury grade. Chronic lesions took longer (~8 weeks) but still responded well when ESWT was combined with rehab.
• Re-injury: Low recurrence rates, especially in functional and structural injuries.
• Imaging: Evidence of reduced lesion size and improved tendon quality post-ESWT.
• Hematomas: Case reports showed faster pain relief and resorption, suggesting ESWT may be a minimally invasive alternative to more aggressive interventions  .

29/06/2025

🦵 Why Deep Squats Aggravate Patellofemoral Pain

🔺 1. Excessive Patellofemoral Joint Reaction Force (PFJRF)
• As knee flexion increases (especially past 60°), the contact area between the patella and femur increases, but the compressive force rises even faster.
• At 90° of flexion, the PFJRF can be 6–7 times body weight.
• This dramatically increases hydrostatic pressure within the joint — and while mild HP is chondroprotective, **excessive HP may lead to:
• Subchondral bone stress,
• Intraosseous hypertension,
• Pain from activated nociceptors**【Sheehan et al., 2016】.

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💥 2. Increased Octahedral Shear Stress (OSS) at the Cartilage Interface
• During deep squats, malalignment (e.g. patellar tilt, femoral internal rotation, or valgus) amplifies OSS at the patellar cartilage.
• OSS is strongly linked to:
• Cartilage matrix breakdown,
• Nitric oxide and inflammatory cytokine release from chondrocytes【Smith et al., 2000】.
• These stresses are worse in flexion due to the smaller, less congruent posterior patellar contact zone engaging with the femoral trochlea.

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⚠️ 3. Poor Neuromechanical Control at High Flexion
• Many patients with PF pain have:
• Delayed or underactive vastus medialis obliquus (VMO),
• Hip weakness or dynamic knee valgus,
• Poor proprioception.
• These deficits lead to abnormal tracking, worsening mechanical stress and increasing shear.

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🔬 4. Reduced Load-Sharing Through Other Tissues
• In high degrees of knee flexion:
• The quadriceps tendon compresses into the femur,
• The load is disproportionately shifted into the patellofemoral joint rather than shared through other soft tissues (e.g., ITB, hamstrings).
• This means that target tissues receive excessive force, especially in the lateral facet of the patella, a common site of degeneration.

29/06/2025

🔧 Key Reasons Why Sitting Stresses Lumbar Facet Joints

1. Loss of Lumbar Lordosis (Flattening of Spine)
• When you sit, especially in a slouched position, the natural lumbar lordotic curve flattens.
• This reverses the normal loading pattern of the lumbar spine and transfers more load posteriorly onto the facet joints and disc annulus.
• Result: increased shear stress and joint compression, especially at L4-L5 and L5-S1 levels.

2. Prolonged Flexion and Sustained Loading
• Prolonged flexion (bending forward) of the lumbar spine during sitting causes creep in spinal ligaments, discs, and capsules.
• This reduces spinal stability and delays reflex activation of the spine-stabilizing muscles.
• Facet joints become more vulnerable because they help limit excessive anterior shear.

3. Disc Pressure Increases → Facet Joint Compensation
• While the discs bear the brunt of compressive loads during sitting, over time they bulge posteriorly, altering joint mechanics.
• The facet joints compensate to stabilize the spine under altered disc alignment—causing microtrauma, especially if repeated daily.

4. Muscle Deactivation & Spinal Instability
• Sitting deactivates key stabilizers like the multifidus and transverse abdominis.
• Without proper muscular bracing, the facet joints endure excessive stress to control segmental movement.

5. Axial Compression & Posterior Shear
• In seated postures, gravitational loading through the spine combines with posterior pelvic tilt.
• This increases posterior shear forces, which are resisted in part by the facet joints—again, leading to overload if the posture is sustained.

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🔁 Cumulative Effect

Even if no immediate pain is felt, repeated daily exposure to this postural stress:
• Increases risk of facet joint degeneration
• Promotes inflammation in the joint capsule
• Contributes to chronic low back pain

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📌 Quick Analogy

Think of facet joints like hinges on a door:
When used properly (standing, walking), they glide and function well.
But when they’re forced into load-bearing repeatedly (like when sitting hunched over for hours), the hinges wear down prematurely.

12/06/2025

🔬 Why Tendons Take post 12 Weeks Heal (Post-ESWT) Education for athletes who expect an instant cure !! Info for those using focused Shockwave

Research by Wang et al. (2003, J Orthop Res)

🟠 Weeks 1–4
• Molecular priming only
• ↑ eNOS & VEGF begin angiogenesis
🧠 Shockwave “wakes up” the biology, but no real structural change yet.

🟠 Weeks 4–8
• Neovascularization begins
• Fibroblasts active, Type III collagen laid down
🧠 Early capillary and tissue scaffolding forms — still fragile.

🟠 Weeks 8–12
• Transition to Collagen Type I
• Stronger cross-linking, tendon–bone anchoring
🧠 Now the tendon is truly load-ready. This is your green light zone for progressive running.

⚠️ Key Point: Loading too early disrupts immature vessels and disorganized collagen. Be patient or risk setbacks.

📚 Source: Wang CJ et al. (2003), Journal of Orthopaedic Research. 🧐
Link to study https://lnkd.in/emiWJgGy

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🦴

07/06/2025

A fantastic day of hands-on learning at the Scottish Osteopathic Society Scar Therapy Course in Dunblane on 7th June — expertly delivered by the ever-inspiring and brilliantly witty Hannah Poulton of .

We explored scar biology, rehabilitation strategies, manual techniques, and patient-led care — all underpinned by clinical insight and a lot of laughter.

Great to share the day with fellow delegate Pauline-Clare from the Men’s Edinburgh Health Group — a brilliant mind and passionate practitioner.

🩹 Empowering recovery, one scar at a time.

05/06/2025

This isn’t a “one pill fixes all” kind of deal. 💊❌
Managing chronic pelvic pain (CP/CPPS) takes a multimodal approach — that means:

✔️ Targeted meds
✔️ Lifestyle shifts
✔️ AND new therapies like ⚡️shockwave treatment from Ukraine that’s showing real promise!

It’s gentle. It’s non-invasive. But it needs expert hands and the right combination of care.
👉 Healing the prostate is about teamwork — not shortcuts.

01/06/2025

🎼 Poetic & Elegant

Crowdfunded gigs bringing world-leading musicians
into iconic independent venues —
raw, intimate, electric.
Classical music, reimagined for now.
🎶 Jack & Jack

classical music, raw and radiant.
A night to remember. 🎻

31/05/2025

🪑 Why Sitting Hurts Your Lower Back (Facet Joints) 💥

🔹 1. Lost Curves = More Stress
Slouching flattens your spine’s natural curve → facet joints take extra load.

🔹 2. Flex & Freeze
Long sitting stretches spinal tissues (creep!) → less stability, more joint strain.

🔹 3. Disc Bulge = Joint Overload
Bulging discs shift mechanics → facet joints work overtime to stabilize.

🔹 4. Core Muscles Switch Off
Key stabilizers go inactive → joints take the hit.

🔹 5. Compression + Shear = Trouble
Gravity + poor posture = excessive force on joints.

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💥 Cumulative Damage
Even without pain, daily sitting:
☠️ Increases degeneration
🔥 Triggers inflammation
⚠️ Fuels chronic back pain

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🔧 Fix it: Get up often, move your spine, activate your core!

📌 Think of facet joints like door hinges—too much pressure wears them down.

31/05/2025

🪑 Why Sitting Hurts Your Lower Back (Facet Joints) 💥

🔹 1. Lost Curves = More Stress
Slouching flattens your spine’s natural curve → facet joints take extra load.

🔹 2. Flex & Freeze
Long sitting stretches spinal tissues (creep!) → less stability, more joint strain.

🔹 3. Disc Bulge = Joint Overload
Bulging discs shift mechanics → facet joints work overtime to stabilize.

🔹 4. Core Muscles Switch Off
Key stabilizers go inactive → joints take the hit.

🔹 5. Compression + Shear = Trouble
Gravity + poor posture = excessive force on joints.

⸻

💥 Cumulative Damage
Even without pain, daily sitting:
☠️ Increases degeneration
🔥 Triggers inflammation
⚠️ Fuels chronic back pain

⸻

🔧 Fix it: Get up often, move your spine, activate your core!

📌 Think of facet joints like door hinges—too much pressure wears them down.

30/05/2025

Sleep loss has synaptic consequences — and it’s time we treat it that way. 🧠

A new neuroscience study offers a powerful insight for clinical practice:

🛌 During sleep, the brain rebuilds glycogen stores in astrocytes — fueling synaptic function.
🧠 During wakefulness (especially chronic), these stores are depleted, fragmented, and redistributed closer to synapses under stress.

The implication?

Sleep isn’t just about rest. It’s a critical phase of metabolic maintenance — especially for the brain’s energy-hungry synaptic networks.

As health professionals, we see the effects of chronic sleep deprivation daily:
• Cognitive decline
• Mood disorders
• Burnout
• Reduced resilience to neurological stress

This research reinforces what we already suspect:

🔁 Poor sleep ≠ just fatigue — it reflects biochemical disruption at the cellular level.