Dan has a Masters degree in Osteopathy and is an Anatomy in motion and Neurokinetic therapy practitioner and Yoga anatomy teacher. In his spare time he can be found exploring everything dance and movement based. He runs his ‘Daniel Baines Osteopathy’ clinics from Hastings, Eastbourne and the One Aldwych hotel health club on the Strand in London.

What, when and where was your first experience of complementary therapies?

While I was touring with the show Stomp the rough and tumble of flipping around a stage with dustbin lids strapped to my hands left me with a string of chronic injuries. I was lucky enough to meet a fantastic therapist who patched me up, and enabled me to extend my career by another 3 or 4 years. That experience inspired me to study osteopathy.

What made you decide to treat others?

I love working with people and am intrigued by the human body. I love the challenge of unravelling the story behind a patient’s presentation and to understand the compensations that have led them there. Most importantly I love being a small part in an individual’s journey to rediscovering their potential for pain free human movement. What and incredible honour.

What influenced your treatments the most?

I am blown away by osteopathic philosophy, however it was a chance meeting with my now good friend Chris (a non osteopath) that really inspired me my on my current journey and led me study Anatomy in Motion and then Neurokinetic therapy. He constantly challenges me to think outside of the box when treating and never ceases to amaze me when I get the chance to sit in and watch him work.

Describe holistic in less than 10 words

As soon as holism is described it has boundaries which prevent you from seeing outside of the box. In ten words holism to me is:

‘Being in the moment without rules or preconceptions and asking why’ 

(ok that was 11).

What role do your therapies play in the way you live?

Movement never lies, so I constantly watch people as they walk down the street, train in the gym or stand at a bus stop. I have found myself following people with a curious limp or interesting gait pattern and mapping there movement in my body to try and understand how they feel and to embody their pain. I guess it has kind of taken over how I live and turned me into a ‘movement stalker’. How very worrying.

What do you hope your clients to experience when they get treated by you?

My sessions are unconventional from a time and treatment perspective. By the end I want my clients to understand why they have pain, have home work to help manage it and have enjoyed the process of unravelling their jigsaw.

What is the most rewarding thing about what you do?

I get to geek out every day exploring the potential of the human body, while helping people move out of pain. 

Do you eat ice cream, drink coffee or any guilty pleasures?

Yes, yes and yes!

I am currently off alcohol for 2 months, but my weakness is King Cobra beer (hard to find but oh so worth it when you do) and Zaibatsu restaurant on Trafalgar Road in Greenwich (check it out on trip advisor and you will see why).

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The Anatomy

Hopefully you can make out from the doodle above (sorry for my appalling drawing skills) that the superficial transverse perineal muscle (coloured in red) attaches from ischium to ischium on the bottom of your pelvis (just inside and slightly forward from your sit bones.) Its role amongst other things is to help support the perineum and the sphincters that sit within it. During episiotomy surgeries this muscle is cut to allow baby and mother a somewhat easier journey through labour, stitches then follow to tidy things back up and motherhood begins. The adductor muscles that are injured during a groin strain also have a direct fascial link to this superficial pelvic floor layer. In either case if you have chronically ‘tight’ adductors and no amount of soft tissue work or of foam rolling can make your inner thighs any looser then it may be time to start looking a little higher up at its fascial neighbour the superficial transverse perineal muscle.

Body phase II

When our bodies experience trauma do they ever really heal or do we just become really good at adapting and off we trot with the same body but just phase II of it? Imagine for one moment that you are a pelvic floor with an incision down the right side and a right hip facially connected to it. Would you chose to stretch and expose the surgery or protect it and keep it closed? In clinic I often observe the latter, resulting in a movement strategy that avoids placing any tension through the tissues both during the acute stages of healing  (useful) as well as long after the heeling has taken place (maybe not so useful). In the second scenario the strategy becomes a habit or a form of ‘movement amnesia’. When an area is not moved the nerve receptors in the area are not stimulated and the brain quickly forgets that there was ever a muscle or joint there in the first place (try taping two fingers together and see how long it takes for your brain to begin recognising them as just one digit).

To continue being successful post trauma (after all our driving instinct is one of survival) other joints and muscles now have to pick up the extra work and the muscles around the hip joint become unbalanced (some are facilitated and some become inhibited) resulting in an un-centred joint that becomes painful and can eventually result in future joint compression and unbalanced wear. The same is true for a right sided groin/adductor strain. The last thing that you want to do is hit box splits and stretch it as it hurts and will very likely tear some more. In both examples the bodies strategies are similar…avoid moving the injured part and re-callobrate around it as body phase II.

In the short term acute phase, reduced movement and exposure to load are important as the tissue is repairing itself, HOWEVER if scar tissue is robbed of low level force due to immobilisation or fear of movement, it no longer has the stimulus to realign its collagen fibres resulting in haphazard, shortened, week tissue which further restricts movement – and so the cycle continues. When we suddenly need to ask this now weakened tissue to help out as we accelerate to avoid a bicycle jumping the lights or during a weekend kick around with the kids, we are now faced with 2 possible scenarios:

1. Stress exceeds capacity and the groin “goes” again.
2. The other areas of the body no longer have the capacity to help out and we run out of movement options. In clinic people will present with hip pain, lower back pain, knee pain, neck pain, issues with continence and pelvic discomfort. It is like a water pipe in a closed central heating system that can no longer hold the pressure asked of it and the weakest link (that cheep plastic compression fitting from B and Q) goes pop.

Gait – a whole body experience

While every one is slightly different there are definitely patterns that start to appear when you begin to watch people move. I have filmed a quick video below which might be easier to visualise rather than to read.

Hopefully you can see how an issue in your pelvic floor or groin could cause anything from plantar fasciitis and varicose veins on the right, all the way up to shoulder pain and sacroiliac joint discomfort.

How do I approach things

Well I guess the answer is “it depends”. Everyone is unique in their history as well as where they are in terms of time scale (a recent acute trauma would be handled very differently to a chronic long term issue) so please please get assessed by a good health care practitioner before just diving straight in (google and youtube do not count). That being said…

Post pregnancy I like to treat the episiotomy scar tissue (or any pelvic floor tearing for that manner) directly. This can be done very non invasively using P-DTR techniques which are incredibly fast and effective and we often see immediate changes in movement as soon as we reassess. Hips start to move and pelvises start to swing symmetrically from side to side.

In the case of an adductor strain we may need to figure out why the adductor was susceptible in the first place. Was it just a simple case of too much load to a tissue that was not prepared for it or was the adductor compensating for something else (I often see this with chronic ankle sprains on the same side) and it just did not have the capacity to help out any longer?

In both of the above cases I start tinkering with movement as soon as possible to create resilience, confidence and more movement options. If you tried the experiment mention above where you tape up 2 fingers and notice that they quickly behave as one, this movement exploration is equivalent to noticing the tape, removing it, then wiggling the two fingers till they once again feel separate.   In the videos below I run through a couple of quick exercise examples I like to use (shout out to Gary Ward, Diane Lee and Andrea Spina who inspired them).

Half – Janu Sirasana

This stretch works on lengthening the adductor muscles and all the fascial connections up into the pelvic floor. This is great if there is a history of chronic scaring post surgery. Go gentle.

Happy baby pose

This is a modification of the happy pose in yoga. It might get some funny looks but when performed gently separates the attachment points of the superficial transverse perineal muscle and gives it a lovely gentle stretch. It also a great place to observe how when you inhale you can feel the pelvic floor lengthen like a balloon being blown up which then relaxes as you exhale.

4 point kneeling adductor PAILs

This is similar to a happy baby pose but in kneeling. When approached methodically it allows us to introduce load to the injured area while staying within the capacity of the damaged tissue. It is a little like training in the gym. Over do it and the body suffers; under do it and nothing happens at all; hit the sweet spot and your body adapts by getting stronger and fitter.

Shift/lateral lunge

The final video is ‘shift phase’ from anatomy in motion. This is not only a whole body exercise but is the first one which lengthens the adductors in the frontal plane (from side to side) but also in the sagittal plane (by tucking the pelvis under into a light posterior tilt). With a little playful exploration this posterior tilt can give the most lovely deep stretch. Its a little like hearing a note played on a violin compared to the same note on a cello. It just feels deep and heavenly. Add a little rotation to open up the inguinal area at the front of the hip and this somewhat complicated exercise can be right on the money.

Conclusion

“If you do not move it you loose it.”

Don’t let your pelvic floor hold you back and stop you from moving. A little gentle, pain free movement exploration can often create a ‘safe space’ where your pelvis can once again be reunited back with the rest of the body.

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3 ways to treat frozen shoulder

Although this can be a stubborn issue to treat in clinic I find a 3 pronged approach to be very successful.

1) Soft tissue work

Massage and stretching is as old as the hills, and for good reason – it works! Focused hands on work along side sound clinical reasoning is always my first go to with any shoulder problem. Without movement, tissues around the shoulder joint lay down collagen in a haphazard pattern which leads to fibrosis and restricted motion. Using external pressure via massage and internal tension from muscle contraction (see the work of Andrea Spina and his Functional Range Release techniques) we can positively impact this collagen formation, begin to create space for movement and improve the flow of healing blood into the area. When we have worked on the muscles we can then begin to get deeper into the joint capsule itself using lovely distraction and rotational movements to work on the inner fascia of the capsule and gently encourage it to stretch. For a shoulder that has not moved in a while this gentle articulation can feel phenomenal.

2) P-DTR

I have written about Propriceptive deep tendon reflex therapy here, but in a nut shell this technique allows us to work on the nerve receptors that surround the shoulder joint and that feed information back to the brain. With frozen shoulders I find that the receptors which monitor stretch are incredibly important and working on these can often result in a staggering increase in range of motion nearly instantaneously. Although the exact cause of frozen shoulder is not entirely known, we often uncover a history of immobilisation of the joint or an incident of falling on an outstretched hand. In such cases we can stimulate the receptors that detect pain by putting a gentle thrust through the joint and seeing whether they are still causing an issue, resulting in the muscles locking down around the area or becoming inhibited and weak. Again this can be incredibly powerful when it comes to freeing up more motion.

3) Movement

Although I have put this last this is the most powerful tool of all and if I was only allowed one of my 3 go to s this would be my modality of choice. Assessing and treating with movement allows us to work on the soft tissue and the nervous system all at the same time and to start tying together the reasoning behind why the shoulder became compromised in the first place and where to start the process of unravelling it. Using Gary Wards Flow Motion model of gait we can see where the inner capsule of the shoulder should spiral and decompresses as we walk, which then allows us to use exercises as we would massage to work deep into that capsule as well as into the connecting structures of the neck spine and all the way down into the feet. A truly whole body solution.

Movement is also the glue that ties together all the work that we have done on the couch. Without movement ‘speaking’ to the structures we have worked on in clinic, it is highly likely that the new found range will shrink back to where it was. It is a real use it or loose it situation where tissues can now be restructured along the lines of force that exercise homework creates enabling the patient to become their own therapist. This is often where manual therapy on its own struggles to create lasting results.

Conclusion

A frozen shoulder can really start to affect a person’s quality of life, be it sleeping, exercising or even getting dressed in the morning. Unfortunately there is not always a quick fix to the problem but there are ways to gently offer back mobility and to empower the person suffering with movement strategies to help fast track their own recovery.

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An osteopathy clinic with a difference

Moving out of London allowed me to break the mould and make my clinic space everything I always wanted. If you already know how I work then you know what to expect but if you don’t here’s a little heads up

Taking the time

When ever I see a therapist I love to natter. I love to find out what they think is going on, I love to chat about the therapy they use and I love them to take the time to figure out where my body is, what it is up to and then explain it to me. I never believed in the ‘half hour session’ model or even less the 10 minute crack, whack and see you next week philosophy. I truly believe that our bodies re-organise themselves around old injuries and to unravel this case history takes some time and detective work by both myself and the person I am working with. Not rushing means we can actually enjoy this unravelling process and marvel at how ingenious our bodies are.

Movement

Without watching movement I quite simply have no idea where to start (click here to see a video clip of what to expect from our initial movement assessment and treatment). As the saying goes “if you are not assessing you are guessing”. My first patient in Hastings was my step mum. Her left knee had been giving her all sorts of trouble, so on went the detective hat and we took a case history then watched her walk to see if we could figure out what was going on. The first couple of steps gave it all away. Having broken her right leg a couple of years previously, her body in all its wisdom had decided to avoid putting weight into it – the result was a very over worked and extremely annoyed left knee. We could have treated that left knee till we were blue in the face, but her solution was to reintroduce her right leg back into her body using movement, then sit back and allow things to reorganise. What a rewarding start to working from home.

Empowering

It is all well and good to balance a pelvis while on the treatment table or to reduce the symptoms of a stiff back, but what happens when we stand up and find ourselves stepping off with exactly the same compensations as before. I am a great believer in hands on couch based work, be it massage, manipulation, acupuncture or cranial osteopathy, they all create a window of opportunity but that window has to be kept open and explored outside of clinic and this is where movement comes in. Movement homework allows you to break the cycle of repeat visits and to start training back in the good habits that make a difference. Before you know it tissues start to strengthen, joints become more mobile and stable and body amnesia is exchange for body awareness, agility and coordination. Treating/Teaching/Training all morph into one therapeutic hybrid.

See you soon

If you live in Hastings (or fancy a short journey for a lovely day trip to the coast), please pop in and say hi. In the mean time to find out more pop over to https://www.facebook.com/DanielBainesOsteopathy/ where I share loads of exercises and tips that I hope you you will find useful. See you soon!

Dan

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As you are reading this see if you can lift yours up off the floor as the ball of the big toe stays grounded. Do they rise equally? As you lift them up can you see the arch under your foot start to pick up and your shin start to rotate outwards? If the answer is yes pat yourself on the back, if no then we have some work to do!

This is not an uncommon asymmetry to find in clinic, which if discovered early can be treated with some osteopathy joint manipulation and Anatomy in Motion movement drills, however if left unchecked can lead to a host of clever compensations through out the body including the dreaded bunion. Three of the most common ‘cheats’ I see to enable the body to remain 100% functional are achieved by by-passing the big toe. Try standing up and taking the right leg behind you as if we were walking forward. As your weight moves forward the big toe  has to bend and this is where the problem starts. Out comes the road map and the brain looks for a detour.

Ingenious compensation number one:

Turn left.

Instead of bending the big toe the foot turns out and pivots over the inside edge of the big toe. For a short time this seems like a good strategy, but unfortunately with every step we take the big toe starts to adapt to the stresses and strains placed upon it and we develop a bunion or a condition called halux valgus (a big toe that ends up pointing towards the other toes at an angle). The other problem I often see is that as the bony rigidity of the foot is compromised we end up pushing off from the soft tissue under the foot instead. The result ‘plantar fasciitis’ or strain to the connective tissue under the foot which feels like walking on broken glass. Neither conditions ideal when wanting to slip on a pair of sling backs (so I’ve been told).

Ingenious compensation two:

Turn right.

This is less common, but the body can prevent pressure through the big toe by inverting the ankle (think inversion sprain), lifting the big toe off the floor and pushing off from the outside of the foot instead. This can lead to an interesting wear pattern along the outside of your running shoes, a tendency to repeatedly sprain the outside of your ankle and discomfort along your iliotibial band as the body uses this instead of the hip flexors to whip the leg forward into swing phase.

Ingenious compensation number three:

If you can not go round, and going under is not an option then the only other way is to go over.

By shortening your stride length and lifting the leg up early, the big toe does not have to bend so much. Apart from always walking in circles (actually the body manages to compensate further up the chain-it is always going to be successful!) this will result in a shortening of the hip flexors and inhibition of the core and buttock muscles, which can reek havoc around the body in terms of back pain, hip pain and even head aches. In fact the whole process becomes more metabolically taxing, as the leg is dragged forward instead of relying on the elastic recoil of the fascial system. We want movement to be pain free and effortless with a spring in your step as opposed to walking around with one concrete boot on.

If you are experiencing toe pain, a bunion, plantar fasciitis, knee pain, hip pain, back pain…….(the list is endless) start by taking a look down at our ostracised friend the big toe. He is nicknamed the ‘great toe’ for a reason and you may just be surprised about how powerful he really is.

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The majority of ankle sprains involve stretching the muscles and ligaments along the outside of the leg and foot. This is commonly known as an inversion sprain. In its innate wisdom our body decide that this is a position that should be avoided at all costs. Sensible you might think in the short term, however when this becomes a habit that is adopted long after the heeling process has taken place we open ourselves up to compensations that can be globally disastrous.

One case in clinic this week proved to be just such a puzzle.  A young lady presented with pins and needles down her left arm and weakness into her hands, that had come on slowly over the previous couple of weeks. On first examination it was a simple case of thoracic outlet syndrome, or was it? After a thorough case history and having ruled out any cardiovascular issues we started to unravel the puzzle and traced back through her case history until we came to an ankle inversion sprain that had occurred several years ago. Unfortunately she was unable to remember which leg, so we decided to map out her feet using an anatomy in motion assessment. Based on the findings we made an educated guess at it being the right leg as it was locked down into pronation protecting it from future trauma.

“Let me check a photo on my phone as I am sure there is a picture of me with a bandage on it” she said.

Bingo! There was the right leg clad in strapping.

We then proceeded to analyse her gait using the ‘flow motion model’ created by Gary Ward and saw that her pronated right foot was preventing her from accessing her left leg cleanly during walking. Gary has ingeniously mapped how every bone of the body should move as we walk and when we are missing one of these phases certain muscles will never get a chance to lengthen and this is what we were seeing here.

In terms of clinical diagnosis the lady was suffering from thoracic outlet syndrome, which is where a bundle of nerves that start at the neck and meander off down the arm are compressed under the collar bone by tight chest and neck muscles. The solution to her pain – reintroduce the foot back to the brain in a safe and controlled environment demonstrating that there was no longer a threat to the ankle, then re-integrate the foot back into the 3 dimensional movement that was missing during walking. This phase of gait also just so happened to stretch both the neck and chest muscles that were causing the nerves to be compressed in the first place. Would stretching the muscles around the chest and neck in isolation have worked as well – most probably yes. Would the results have lasted – I think probably less likely.

By taking the time to understand your history we can treat the cause and not the compensation. Instead of rubbing the painful spot, we can unravel the reason and remove the brakes preventing your body from healing itself. Sure the conventional 30 minute treatment becomes a 2 hour detective session, but the solution creates the home work and the home work makes me redundant. Just the way I like it.

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Biomechanics and pronation

The foot is a genius piece of engineering. As it hits the floor the bones unlock allowing it to blend to the rough terrain underneath (at least before the advent of pavements, carpets and hard soled shoes), where its intrinsic muscles can stretch like tiny trampolines ready to catapult our mass forward. As the foot melts a tiny bone with no muscular attachments called the talus, slides over the heel and the journey of pronation is transferred up through the knee, hip, back and into the arms and head. Each muscle that attaches over these joints is stretched and human locomotion takes place – a beautifully synchronised orchestra of anatomy that has enabled us to evolve into the creatures we are today.

Case history

So what happens when this all goes wrong? Today I had one such example walk through the clinic doors. This chap was a high level cricketer who on assessment was unable to pronate his left foot. He was suffering from long term back pain and had experienced disc prolapses between several of his vertebrae. When we analysed his cricket fast bowling technique we realised that his front foot never had the chance to pronate due to the follow through action of his arms and the need to abort to the left so he did not follow down the crease. A foot that does not pronate is a foot that does not shock absorb, and results in a spine which is most likely going to be loaded asymmetrically with every step it takes. The effect up through the body is equally immense, the buttock muscles do not get a chance to load, the stomach muscles switch off, the pelvic floor is only required to function in certain quadrants, even the eyes have trouble accessing certain positions. This gentleman could not look up and left without the muscle strength blowing out in his legs!
So is pronation bad? In one word no, however if we delve a little further this might need expanding upon. Pronation is essential for human locomotion however a difference between left and right is an issue and so is a lack of supination (pronation’s mirror image which is required for the foot to lock as we push off it). I would rather see in clinic two equally over pronated feet rather than one pronated and one supinated.
So how did the story end. We introduced the gentleman’s left foot to pronation using the Anatomy in Motion ‘flow motion’ model and a couple of yoga wedges and the body let out a huge sigh of relief. “My foot feels lighter and walking seems so much easier”. The buttock muscles sprang into life and when fully integrated, his body weight shifted forwards as his body found centre and the pain in his back reduced significantly – all from 5 minutes of pronation work.
For more information on how your foot can be scanned as part of our regular initial consultation please feel free to get in contact or take a look at the ‘consultation’ menu at the top of the page for more information.

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So how can this effect the body? Let us go back to the initial scenario and the patient who was a real patient of mine this morning. He had come in to see me with stiffness running between his shoulders and his neck, that he had been receiving monthly manipulation for but only gaining temporary relief. As usual I took a thorough case history and under the operations and scars heading I left a blank. From watching him walk and run I could see he was not keen to enter into his left leg, so I proceeded to muscle test him using the NKT protocol. To my amazement not one muscle on his left side had any kind of neural lock. It was hardly surprising that he did not want to load his left leg! So I set off in search of the muscle, bone or ligament that was working too hard to compensate for his left side. Low and behold I came across a scar that was barely 2mm across. “So what happened here then” I asked. “Oh I forgot about that. I had a mole removed from there 20 years ago. That’s not important is it?” Another imaginary crisp ten pound note better off, I gently placed my fingers over the scar and retested the previously weak muscles. Without exception every one tested solid. I had noticed earlier that the patient’s breathing was some what laboured and his ribs were not able to expand laterally. “Let me just try something” I said. Fingers over scar, ribs expanded, fingers off they stopped. “Hmm, I guess that scar was kind of important eh?” he smiled. Ten minutes later after some fascial release and some movement home work the pain was gone, and one fully functioning left leg had been integrated back into the body.

I would like to say this scenario is rare, however it is something I see time and time again. The hernia scar; the c-section scar; the scar under the chin that came from falling off a swing aged 3; they are all massive players and age or size does not seem to limit their importance when building a clinical picture. Scars are not just limited to those that we can see. The scar on a broken bone, the hole from a belly button piercing, even a tattoo can cause havoc to the system and possibly explain that lingering pain that will just not go away. If you think this might be you please feel free to get in contact and we can see what is hidden under the iceberg.

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