020 8393 3038

Cheyham Lodge, 11 Cheam Road, Ewell Village, Epsom, Surrey KT17 1ST


We treat & advise on the management of osteoarthritis of the knee for many people in the Epsom, Ewell & Chessington area so I though i’d post the following short abstract which was published in Medscape & whilst not much detail is given it was an interesting bit of research.

Wearing a soft knee brace has been shown to reduce self-reported knee instability in persons with knee OA. There is a need to assess whether a soft knee brace has a beneficial effect on objectively assessed dynamic knee instability as well. The aims of the study were to evaluate the effect of a soft knee brace on objectively assessed dynamic knee instability and to assess the difference in effect between a non-tight and a tight soft knee brace in persons with knee OA.

Methods:Thirty-eight persons with knee OA and self-reported knee instability participated in a laboratory study. A within-subject design was used comparing no brace vsbrace and comparing a non-tight vsa tight brace. The primary outcome measure was dynamic knee instability, expressed by the perturbation response (PR). The PR reflects deviation in the mean knee varus–valgus angle during level walking after a controlled mechanical perturbation. Linear mixed-effect model analysis was used to evaluate the effect of a brace on dynamic knee instability.

Results:Wearing a brace significantly reduced the PR compared with not wearing a brace. There was no difference between a non-tight and a tight brace.

Conclusion:This study is the first to report that wearing a soft knee brace reduces objectively assessed dynamic knee instability in persons with knee OA. Wearing a soft brace results in an objective improvement of knee instability beyond subjectively reported improvement.

Richard Katesmark commentsGenerallyour aim here at Epsom and Ewell osteopathic clinic is to manage Knee osteoarthritis with treatment & stabilising home exercises so that supports are not needed. However there is no doubt that a good well fitting support can help particularly in the more severe cases. 

Any army personnel in Epsom & Ewell with back pain ?

Results of a moderately large trial in America was recently published. A summary of findings were as follows;

Adding manipulative treatments to standard medical management of low back pain (LBP) in a military population reduced patient-reported pain and disability and improved satisfaction scores compared with standard treatment alone, new data show.

The findings, reported by Christine M. Goertz and colleagues in in the US & published online May 18 in JAMA Network Open, confirm results from the team’s pilot study.

In addition, the new data align with recent guidelines from the American College of Physicians that recommend inclusion of spinal manipulation, among other nondrug treatments, as first-line therapy for acute and chronic low-back pain.

For the current study, Goertz and colleagues enrolled 750 active-duty US service members aged 18 to 50 years with LBP from three military facilities in a pragmatic comparative effectiveness trial.

Patients were screened between September 28, 2012, and November 20, 2015, and 250 patients from each of the study sites were allocated to receive usual medical care with manipulative care (375 participants) or usual medical care alone (375 participants). Usual/Standard medical care was defined as any care recommended or prescribed by nonchiropractic military clinicians to treat LBP, including self-management advice, drug treatment, physical therapy, or referral to a pain clinic.

Additional therapies, such as rehabilitative exercise, interferential current therapy, ultrasound therapy, cryotherapy, superficial heat, and other manual therapies, could also be included in manipulative care.

The primary outcomes of self-reported pain intensity & disability & associated patient satisfaction, as measured by the Numerical Rating Scale, and disability, showed clear benefitsof manipulative care compared to standard care.

Manipulation-related adverse events included short term muscle or joint stiffness, but no serious treatment-related adverse events were reported.

Mr Katesmark comments; “On reading the research methods in detail I note there were some design ‘flaws’ in the trial including very generalised/non specific definitions of back pain & of couse the patients were not ‘average’- consisting of young, fit army recruits ! However I welcome further evidence showing that manipulative approaches can be of benefit ( although it is worth noting that other therapies were included in treatment – as would be the case here at Epsom & Ewell osteopathic clinic).  ” 


Ewell and Epsom Osteopathic Clinic now open all weekend.

Good news ; Epsom & Ewell osteopathic clinic is now open Saturdays AND Sundays.

As it can be difficult to find time for appointments during the working week we have made the decision to offer appointments on Saturdays & Sundays .

So anyone locally in Ewell , Epsom, Banstead, Cheam, Sutton, Chessington , Kingston or elsewhere in Surrey who is suffering from back or neck pain, sciatica , joint pains and stiffness, sports injuries such as tennis elbow or painful shoulder can now make appointments at their convenience .

Posture problems & Chronic Pelvic Pain in Postmenopausal Women

A small study from Spain and reported on Reuters Health suggests postmenopausal women who have chronic pelvic pain may also have problems with their balance and posture.

“Women with chronic pelvic pain presented with poor balance including anticipatory, reactive postural control, sensory orientation, dynamic gait. Posture showed a head forward position, higher values on the dorsal angle, and lower sacral inclination,” Dr. Marie C. Valenza and colleagues from the Faculty of Health Sciences of the University of Grenada report in Menopause.

“They also presented less spine alignment and a more prevalent posture with increased kyphosis and lumbar lordosis,” 

Between 2016 and 2017, the research team performed a cross-sectional study of 48 women with CPP who were recruited from the gynecology departments of two academic hospitals and 48 control women matched according to age and body characteristics. The women in the chronic pelvic pain group had a normal neurological examination and pelvic pain lasting over six months.

Potential participants were excluded if they had had radiation or pelvic cancer, pelvic or abdominal surgery, or had been diagnosed with neurological or muscular disorders, fibromyalgia or irritable bowel disease, diabetes, or pregnancy, or if they had a psychiatric disorder, cognitive impairment, or dementia.

The control group of women – without chronic pelvic pain – were matched with the experimental group by age, weight, height, body mass index (BMI) and similarity of muscle development.

The authors found significant differences in all Mini Balance Evaluation Systems Test incl: anticipatory/reactive postural control, sensory orientation & dynamic gait .

Using photogrammetry and a hand-held inclinometer, the researchers demonstrated that the women with CPP also had significantly different spinal cervical angles compared with the controls, indicating forward head posture. Their global spine alignment deviated significantly more than the spine alignment of the controls, and a higher percentage of them had increased thoracic kyphosis and lumbar lordosis.

Richard katesmark comments; Over the years I have had good results treating women with pelvic pain, many of whom have been referred to me by gynaecologists (once they have ruled out any overt illness). So it’s nice to see some research showing definitive links between musculoskeletal factors & pelvic pain.

The Case Against Sitting for long periods.

I thought the following article is from medscape was relevant as everyone returns to work in 2018;

Sitting and back pain

If anyone should know about the danger of being sedentary, it’s Bethany Barone Gibbs, PhD. A professor of health and physical activity at the University of Pittsburgh, Pennsylvania, she was writing grant proposals to study just that topic when her back began to hurt.

“I’m 30 years old,” she thought to herself. “How do I already have back pain?”

It didn’t seem to be a matter of getting more exercise. Dr Gibbs takes spinning classes twice a week; runs after her two kids, now aged 5 and 8 years; and traverses campus on foot rather than sending emails to her colleagues.

All that activity, she eventually realized, couldn’t compensate for the time she had to spend sitting still to write about the problem of sitting still. Fortunately, that same research provided the solution. After looking at the data on sit/stand desks, she got one for herself. Soon, the back pain ended.

In a pilot study, Dr Gibbs has now shown that she is not alone. Alternating positions between sitting and standing can go a long way toward alleviating back pain.

Most of the research into the problems of sitting has focused on damage to circulation and metabolism. Perhaps the most striking finding is that too much time sitting can increase the risk for death, even among people who meet standard exercise recommendations. To overcome the effects of sitting 8 hours a day, you’d have to exercise at least 1 hour, according to the authors of a 2016 meta-analysis.

This discovery has sparked interest in desks that allow the user to stand or even walk in place while working. Studies have shown that people burn more calories when standing than sitting at their desks and suggested that some people could lose weight that way or improve cholesterol levels.

Counterintuitive Findings 

Of course, there’s a reason that people usually sit at desks. When researchers began looking at the benefits of standing at a desk, they immediately worried about muscle and skeletal pain. Previous research had shown that workers who spend more than one half their time standing up are more likely to experience this sort of discomfort.As a result, many of the early studies considered musculoskeletal pain as a possible side effect of standing at a desk. Whereas some studies found a slight increase in pain, most found no effect or a slight benefit.

Why might standing hurt less than sitting? Both postures can exert compressive forces on the intervertebral discs. But in a sitting position, the lumbar muscles are minimally activated, shifting their burden to passive structures, such as ligaments and discs. In addition, says Dr Gibbs, while sitting long-term, hip flexors may shorten. Standing up after a long period of sitting puts stress on these muscles, forcing the low back compensates for their lack of flexibility. About 60% of office workers experience back pain, and prolonged sitting is thought to be a major reason.

A recent meta-analysis of studies on standing desks found that offering employees sit/stand desks reduced their back pain by 0.30-0.50 on a scale of 0-10 points, where 0 is no pain and 10 is the worst pain imaginable. That may not sound like much, but in some studies, that meant a reduction in pain of about 50%.

For example, researchers at Stanford University, in Palo Alto, California, randomly divided 46 university employees into two groups. One group received work stations that could be adjusted to either a sitting or standing position and had access to them for 12 weeks. The others got nothing but a promise of such work stations at the end of the trial.

After 12 weeks, the people who got the sit-work desks reported a 55% improvement in back pain on their worst days, compared with a 15% change for the control group, a statistically significant difference. And importantly for employers, those who got the sit/stand desks reported a 60% improvement in their ability to concentrate, compared with 34% for the control group.

But few, if any, researchers believe that office workers would benefit simply by standing instead of sitting. One problem is that blood flowing to the legs while standing has more trouble returning to the heart. This pooling effect can result in clotting and varicose veins, says Jamie Burr, PhD, an assistant professor of human health and nutritional science at the University of Guelph in Canada. “Standing at your desk for hours and hours is probably not the answer.”


Richard Katesmark comments ; “Seems to be more research just confirming what we already know anecdotally; ie Staying mobile at work with frequent changes of position reduces the likelihood of musculoskeletal ( and other medical ) problems .

It’s worth noting that some research shows compression through the lower lumbar discs on sitting is 3x that on standing. However it is also worth pointing out that certain spinal problems may be aggravated by long periods of standing . Hence my advice to try & have a mixture of both, ideally with some walking on & off throughout the day .

Happy New year to all.

Don’t just sit there !

According to a consensus statement from a panel of experts published online June 1 in the British Journal of Sports Medicine, if you work in a predominantly desk-based occupation you should be getting out of your office chairs and accumulating at least 2 hours a day of standing and walking during working hours. Workers are recommended to break sitting tasks by periodically standing up to work, using sit-stand desks, and taking short active standing breaks, advises an expert panel led by John P. Buckley, PhD, an exercise physiologist at the University of Chester’s Institute of Medicine in the United Kingdom.

American ergonomist Allan Hedge, PhD, a professor in the Department of Design and Environmental Analysis at Cornell University in Ithaca, New York, agrees; “The research evidence supports action now,” he told Medscape Medical News. “Numerous studies show that interspersing periods of sitting with standing and moving/strolling benefits circulatory function and helps regulate risk factors for obesity, diabetes, cardiovascular disease, and some cancers. In the last 5 years, mounting observational evidence has linked sedentary living and working with cardiovascular disease, diabetes, cancer, depression, musculoskeletal problems, and even death..

The panel also cautions that prolonged static standing postures need to be avoided as much as their seated counterparts, and that “movement does need to be checked and corrected on a regular basis especially in the presence of any musculoskeletal sensations.” As for concerns about harms from working on your feet, the statement notes that occupational standing with seated and walking breaks has not been causally linked to low back and neck pain, and can even provide relief, it says.

There is a growing market in sit-stand attachments for desks and adjustable sit-stand desktops but it is relatively small & in the meantime a simple first step could be just to get people standing and moving more frequently as part of their working day.

Despite supporting the immediate launch of the standing campaign, the panelists cite the need for large-scale prospective randomized trials assessing the effects of standing and light activity interventions in real office environments. These studies should evaluate such initiatives as movement-friendly spaces at work; computer-based activity prompts; alarmed personal motion assessment devices; locating washrooms, kitchens, and meeting places on different floors; promoting stairs over elevators; standing meetings; and delivering messages in person.

Br J Sports Med. Published online June 1, 2015. Full text

Mr Katesmark comments “It is important to realize that if your job involves primarily sitting, it is not enough to exercise occasionally in your leisure time (by going to the gym etc). Daily activity during working hours is also vital to keep your joints & circulation healthy. Using the stairs, occasionally standing whilst using the phone, gentle stretching exercises (such as those recommended for long haul flights ), and a stroll at lunchtime are all effective yet easy ways to incorporate activity into office life”

For more specific postural advise or exercises please contact the clinic on 020 8393 3038