The Guru believes Soulla’s osteophytes may not be the cause of her pain but a stiff thoracic spine could be

Hi Soulla

I doubt the osteophytes are painful – you’ve got  a painful neck and shoulder and you’ve got osteophytes which are seen when you had an X-ray or MRI, but they may or may not be painful.

Once you’ve got osteophytes, you’ll always have them – but it’s by no mean an indication that you’ll have pain….and you’ve probably had the osteophytes longer than you’ve had the pain for!

The osteophytes (specules of boney growth) form when a joint has too much joint play and motion – it’s common in the neck. The excessive joint motion (not gross range of joint movement) happens when you loose control of the joint play at a specific joint or joints. This can happen due to either pain and or posture – over a protracted time period.

I’m not quite sure why you’d need a US scan as it sounds as if you’ve got a pretty bog standard (sorry!) issue with your neck – you need to establish why…..most likely you’ve got a stiff thoracic spine causing you to poke your chin out to see where you’re going. Poking your chin out causes a small but significant “hinge” in your neck. This hinge is where you’ve got this excessive joint play and excessive joint motion…and the osteophytes.

You need to limit the amount of movement in the hinge, this is why you’ve got a sore neck and shoulder….Do this by making your thoracic spine move so you don’t need to keep constantly irritating the hingey bit of your neck…

Make sense?

The Guru

Soulla has had on-going issues:

You claim to treat tendinopathy…after 10 treatments it hasn’t worked for me and I have been told to manage the tissues.

The Guru answers with: 
Hi Soulla

Sounds like some pretty dubious advice you’ve been given.

Yes, we treat lots of patients with tendinopathy and patients that feel like they’ve got a tendon issue. I think we do a pretty good job either way! We can diagnose, assess and rehab.

10 sessions may be a massive amount of treatment or it mighty be not enough to improve the loading of the tendon. Either way the issue is with the tissue and yes it needs to be managed, but if you don’t know how to it probably won’t get better!

As a rule of thumb, stretching the tendon is a pretty poor thing to do – but releasing the muscle that attaches to it is a good thing. Getting the appropriate load through the tendon is important from day 1 – be this (commonly) isometrically then (commonly) eccentrically and then (commonly!) concentrically, either way load it! Rest from aggravating factors and identification of the cause are key……

Rehab, as always is key

But Soulla is still struggling with osteophytes:
​I had 10 Pilates classes on the reformer, they still can’t take the stiffness away from my shoulder. I have osteophytes in my neck quiet painful so I get pins and needles in my fingers. Last Pilates class I had more pins and needles and my tendinopathy was worse.

The Guru’s response:

Unfortunately there is “Pilates” and there is this thing called pilates which involves waggling your arms and feet around, but not really doing very much!

Anything that makes you worse can’t be good for you – so stop.

As long as you’ve got the ability to move better through your thoracic spine, and so taking the excessive load off of your cervical spine, Pilates – as in the real deal, done by someone who can relate your pain and pathology to your dysfunction, you’ll be in pretty safe hands.

As with most things, it’s not what you’re doing, but why.

The Guru

Six Physio