Michael Nicolaou: what to expect from an osteopathic video consultation

An online video consultation is ideal for people who :

  • are working from home with no time to travel around,
  • live rurally far from osteopathic practices,
  • want to have the peace of mind that the session is 100% sterile,
  • are too incapacitated/in pain to travel to an osteopathic practice,
  • do not like physical touch,
  • want some more clarity/ a second opinion about a previous diagnosis.

Firstly, the video call shall established in a well-lit room with good Internet Connection.

I will then take a case history where I will be asking questions about the problem/issue that is concerning you and about your past medical history. As with a face to face consultation, the information you provide is confidential, and the video call is not recorded. 

I will then need to analyse your posture. I will be looking for any misalignments in your body that may cause/contribute to the problem, so please wear a pair of shorts and a bikini top or vest top.

I will then ask you to perform certain movements and some orthopaedic tests which will help me understand what is going on. Sometimes it is helpful if another person is also present at your residence to help with the tests although this is not a must. 

After that, I will explain to you what I believe the problem is, I will give advice accordingly and will go through with you a tailor made exercise program to help your body heal/recover. I will then ask you to perform the exercises yourself to make sure you are doing them correctly.

It will be helpful if you have an extra recording device so you can record me while doing the exercises so it will be easier for you to remember. You can otherwise take notes.

I will then answer any questions you might have.
 
Session length : 1 hour
24 cancellation notice.

Michael Nicolaou: Simple stretching exercises you can do at your desk to relieve pain

In this video I am showing you simple stretching exercises you can do at your desk to relieve pressure or strain from the most commonly affected areas.
Sitting in-front of computers for hours or working on laptops puts extra strain on our muscles and joints, which can cause neck stiffness, headaches, lower back pain, shoulder ache, and forearm, elbow or wrist problems.
Please watch my previous video on how to achieve correct posture at the desk.
Michael is a registered Osteopath and has over 20 years of experience in the field.

 

Shelley Hopkins: tools for a moment of calm when you cannot get a massage

Are you finding it difficult to relax or meditate?

The global pandemic has well…. I don’t even know where to begin…

During this time I’m sharing some relaxation videos to support my massage clients (and anyone else who’s finding it difficult to relax or meditate) with their health and wellbeing. I think at the moment a “one step at a time” approach is helpful and relaxation is a great place to start.

Relaxation Videos

These 1 to 3 minute relaxation videos can be watched on their own or combined with some simple breathing techniques or body scans. They are designed to relax body and mind with beautiful soothing colours and a range of natural sounds, binaural and ambient music. They could be used before a longer meditation. I always found meditation difficult until a teacher said you have to learn to actively relax first and then something clicked.

You can find more of these on my YouTube channel (hopkinsholistic), any feedback is welcome as this is a new thing I’m trying. I might include a guided breathing session or short body scan in the future.

Laura Hayward: the power of massage in pregnancy

Podcast hosted by Delia Muhammad on her website “Pregnancy without fear”.:

“The power of massage in pregnancy: interview with Laura Hayward”

The Power of Massage in Pregnancy: Interview with Laura Hayward

Laura Hayward White is a UK based Pregnancy Massage Therapist and Doula. Since qualifying in pregnancy massage in 2002, Laura’s passion has been to truly accompany mothers on the whole of their birthing journey, a passion re-enforced by becoming a Doula ten years ago.

In this interview, Laura shares her experiences of working with expectant and new mothers, and how by having a continuous sense of support, skill and understanding; women can develop and discover the inner confidence, power and strength they need to carry them through the birthing process and into motherhood.

Laura also runs a home visit service for Pregnancy, Postnatal and Baby Massage throughout Surrey and South West London.

Michael Nicolaou : how to set up optimally your desk at home

More people than ever before are working from home at the moment. Not having the right chair, table and/or using a lap top compromises our posture and puts extra strain on our joints and muscles, resulting in pain and discomfort.
In this video I will show you how to properly set up your home work space and how to overcome most problems arising from not having the ideal work station.

 

In addition, if you need specific help tailored to your own home work space and/or if you suffer from any back/musculoskeletal issue, I would suggest that you book a video session with me.

Conditions required for the session:

The room where the desk assessment is to be performed shall be well-lit.The video call shall be established with a good Internet connection,  preferably from a different computer than the desk computer to be assessed. 

Session length : 1/2h
24 cancellation notice.
Michael is a registered Osteopath and ergonomics expert and has over 20 years of experience in the field.

 

Vitamin D: an atypical and unsung vitamin

Vitamin D is an atypical vitamin in many aspects including the fact that it is actually a hormone, involved in several endocrine tasks.

The specific problem of Vitamin D’s availability

Vitamin D3 is mainly produced in the body by the exposure of the skin to sun light, more specifically UtraViolet B rays.

(And similarly to humans, animals synthesize Vitamin D3 on their fur or feathers)

The darker the skin, the lower the production of vitamin D. As a result, people of African origin living in the northern hemisphere are more at risk of Vitamin D deficiency.

The more overweight the body, the lower the availability of vitamin D, as it is liposoluble and is not accessible when stored in fats. A a result, overweight and obese people are more at risk of Vitamin D deficiency.

Vitamin D3 is mainly present in standard animal foods such as eggs and cheese etc., but at insufficient levels for the body’s needs, unlike polar bear liver (++ !!), or cod liver (also overloaded with Vitamin A).

The vegetal version of vitamin D, vitamin D2, can be obtained from eating mushrooms which have been exposed to UV light, but an intake of D2 does not fulfil the same role within the body as D3, and even seems to decrease the level  of active vitamin D in the blood (1). Therefore D2 intake alone is not sufficient.

As a result, if this liposoluble vitamin is not produced and stored in sufficient quantities during sunny days, a deficiency can occur in winter from reduced UVB exposure.

 

Out of all the vitamins, Vitamin D is the only one that cannot be obtained from food alone (animal rather than vegetal). It therefore needs to be supplemented when the access to sun is limited,  even within a naturopathic approach which traditionally avoids supplements.

 

Natural commercial Vitamin D3 is often extracted from sheep lanolin (non-vegan).  As explained before, animals produce it on their fur.

The bad Vitamin D deal for Europeans compared to Northern Americans

The latitude of European cities is much higher than for those of North America. For instance, Madrid and Naples share the same latitude with New York, and Toronto has the same latitude as Nice on the Mediterranean sea.

This can come as a surprise to many of us, as we assume that Canada, a country with famously cold winters, must all be at a higher latitude than the UK.  We forget that our climate is kept unusually mild for its latitude by the gulf stream.

As a result, U.S. citizens are exposed to more UV light than their European counterparts  and might be less affected by Vitamin D Deficiency.

Therefore, any US Public health recommendations on Vitamin D intake can be taken with a pinch of salt by Europeans.

Vitamin D Public health policy in France

In France, pregnant mothers and infants up to five years old are systematically given megadoses called UVEDOSES: 100 000 UI of Vitamin D per ampoule, every three months. This equates roughly to 1000 IU per day.

This national public health policy has been implemented by paediatricians since the sixties, for all French children and expectant mothers.

So far, over a 60-year period, there have been no reports of health issues resulting from these megadoses of vitamin D (which does not mean that there are not).

Lack of Vitamin D Public Policy in the UK

In the UK, unlike France, no such Public Health Policy exists. This led to tragic consequences for some Afro-Caribbean couples who were convicted of « shaken baby syndrome ». But it turned out that their infants’ Vitamin D levels were so low that they had advanced rickets and would fracture easily. One successful court case appeal led to the release of all the other wrongly convicted couples.

https://www.standard.co.uk/news/shaken-babies-suffering-from-vitamin-d-deficiency-7311950.html

The UK NHS has since become more aware of the rampant vitamin D deficiency.

Elders and Vitamin D skin synthesis

Elders can have problems in producing enough vitamin D through sun exposure because their skin does not synthesize Vitamin D as efficiently.

For instance, even on the Mediterranean coast, laboratories often declare that they have yet to see a 75 yr. old  with replete serum Vitamin D level.

Therefore daily sun exposure alone does not always provide the body with sufficient Vitamin D.

The University of Manchester and the Norwegian Institute of Air Research have together created an algorithm to measure the UV exposure needed to supply enough Vitamin D according to several parameters (but not including “age”):

https://fastrt.nilu.no/VitD-ez_quartMEDandMED_v2.html

According to this website, an individual in London with Mediterranean skin will synthesize zero vitamin D from sun exposure during winter months, no matter how much daily exposure they receive .

Also, if we rely solely on the skin to provide us with our Vitamin D needs, we can also end up being deficient due to washing, as the vitamin D created on the skin can easily be flushed down the drain due to the use of soaps and detergents during showers or baths.

There is a similar issue with sun creams: by blocking UVBs, they will prevent the skin from producing Vitamin D. This is the eternal subject of discordance between dermatologists and endocrinologists.

The long cascade of conversion for the synthesis and activation of vitamin D.

Actually, it is possible to live in a dark cave and still have good levels of vitamin D3 if it is taken orally (cholecalciferol).

 

 

However, in order to assimilate Vitamin D, vitamin A and Magnesium are needed as co-factors.

 

 

Vitamin D is transported in blood, bound to vitamin D–binding protein, and the activity of vitamin D–binding protein is also a magnesium-dependent process.

Furthermore, the enzymatic activity of both hepatic 25-hydroxylase and renal 1α-hydroxylase is a magnesium-dependent process.

  • Vitamin D3 (Cholecalciferol) is synthesized in the skin upon UVB exposure,
  • Vitamin D3 is transported to the liver where it is hydroxylated into calcifediol (25OHD3 ) which is the molecule tested in blood tests.
  • The 25OHD3 is hydroxylated a second time in the kidneys to the active metabolite calcitriol : 1,25(OH)2D3
  • Calcitriol  travels into each cell nucleus and binds to the vitamin D receptor (VDR) in the cell nucleus. The VDR is expressed in numerous tissues and for instance highly expressed in the small intestine and colon. Once calcitriol binds to the VDR, the Vitamin A (retinol) receptor (RXRA and RXRB) is involved in activation of the VDR targets.

Figure extracted from [2].

Possible roles of magnesium in vitamin D synthesis. Magnesium is involved in both activation and inactivation of vitamin D.

 

Abbreviations:

Ergocalciferol, D2                  vitamin D2 (from non animal sources); CholecalciferolD3                   vitamin D3 (from animal sources);

25(OH)D,                                calcifediol (inactive form);

1,25(OH)2D,                           calcitriol : 1,25-dihydroxyvitamin D (biologically active form);

24,25(OH)2D,                         24,25-Dihydroxyvitamin D;

DBP                                       vitamin D–binding protein;

Mg                                           magnesium;

VDR                                        vitamin D receptors.

The broad spectrum action of active Vitamin D (calcitriol)

BONES

The role of calcitriol begins in the intestine, where it plays an essential role for calcium absorption. Therefore it is involved with bone mineralization, by regulating the blood levels of calcium.

IMMUNE SYSTEM

Calcitriol has also been shown to act on T and B lymphocytes, and antibody-producing function of lymphocytes. It can alter the cells of the immune system to suppress autoimmunity, the reaction of the body against itself. Therefore it might improve conditions such as Diabetes type 1, Hashimoto thyroiditis, Vitiligo, Celiac disease, etc….

CANCER

Calcitriol slows the growth of cancer cells isolated from breast, prostate, and colon, and kills cancer cells in-vitro. But there is not enough evidence yet  that it can slow or even kill cancer cells in humans.

CARDIOVASCULAR

In animals studies, calcitriol has been shown to lower blood pressure, amongst other ways, by relaxing blood vessels and it can decrease the risk of an enlarged heart.

NEUROLOGICAL

NGF (nerve growth factor) is enhanced by activation of the VDR receptor in contrast to ß-amyloid plaque which inhibits NGF and leads to Alzheimer disease of the brain.

THE MOOD

Calcitriol is involved in the synthesis of serotonin in the brain. A Calcitriol deficiency may participate in the onset of depression, and supplementing with Vitamin D3 might help lift mood back from depression. The “winter blues syndrome” might be alleviated by taking Vitamin D3 during less sunny months.

 

Wrong tracks ? : Vitamin D in vegetables belonging to the solanacea family

It is currently not clear whether metabolites of Vitamin D3 are present in the edible fruits of the Solanaceae, although vegetal and not animal, but they are certainly present in their leaves [3],[4].

The nightshade leaves are considered as “calcinogenic »; they cause calcinosis, a toxic calcification of soft tissues when eaten by animals. This happens because they contain calcitriol (1,25-dihydroxy vitamin D), the most active form of vitamin D.

The level of calcitriol found in cell cultures varies according to the origin of the culture, i.e., stem > leaf > fruit. However, vitamin D-like activity could not been found in tomatoes.

Therefore, calcitriol does not seem to be present in fruits eaten by human, only leaves eaten by herbivores, but this fact has not been researched extensively.

 

To be followed : the dysregulation of the VDR with chronic and auto-immune disease

Next episode

 

Resources :

[1] Ulrike Lehmann, Frank Hirche, Gabriele I. Stangl, Katja Hinz, Sabine Westphal, Jutta Dierkes. Bioavailability of Vitamin D2 and D3 in Healthy Volunteers, a randomised placebo-controlled trial. JCEM jc.2012-4287.

[2] Anne Marie Uwitonze, BDT, MS; Mohammed S. Razzaque, MBBS, PhD (2018) Review : Role of Magnesium in Vitamin D Activation and Function. The Journal of the American Osteopathic Association, March 2018, Vol. 118, 181-189. doi:https://doi.org/10.7556/jaoa.2018.037

[3] Talal Aburjaia, Suleiman Al-Khalila and Mustafa Abuirjeieb.(1998),″Vitamin D3 and its metabolites in tomato, potato, egg plant and zucchini leaves » , Phytochemistry Volume 49, Issue 8, 20 December 1998, Pages 2497-2499,

[4] Jäpelt R. B., Silvestro D., Smedsgaard J., Jensen P. E., Jakobsen J. (2012). Quantification of vitamin D3 and its hydroxylated metabolites in waxy leaf nightshade (Solanum glaucophyllum Desf.), tomato (Solanum lycopersicum L.) and bell pepper (Capsicum annuum L.). Food Chemistry. 138, 1206–1211 10.1016/j.foodchem.2012.11.064

Handling of Stress & Mental Health at Work

 

Below are listed several mechanisms behind stress and mental health, which can be greatly helped with “low tech, low cost” interventions such as therapies or fitness:

  1. Fight & flight mode closure. Stress holds the same main function for us as for our ancestors: it is aimed at preparing the individual for either “Fight” or “Flight” with increased blood supply to brain, lungs and muscles, and decreased activity of background tasks such as digestion. But in an office environment, we do not fight against predators but against dead-lines. Stress at work does not lead anymore to a physical outburst, instead we remain seated at our desk. Exercise allows the sedentary worker’s body to complete the expected neurological “Fight & Flight” loop cycle. The nervous system is then tricked into thinking that stress was aimed at the activity expressed during exercice, it can therefore come back to normal state afterwards. Medium to Strong Intensity exercise ( e.g. with a personal trainer)  is therefore a good way to regulate the nervous system, in times of increased stress.
  1. Acute stress takes its toll on the body when it lasts too long. Imagine a cat which is constantly startled with a round back and raised hair. His whole body would be quite uncomfortable to live in after a while. Physical therapy (massage, osteopathy, acupuncture, …) helps rebalance the different parts of the autonomic nervous system involved in stress and therefore reset the tone of the contracted tissues, to help the body to come back to “neutral mode”.
  2. Chronic Stress is also the body’s response to almost any lasting disturbance, inflammation, toxic load, etc… in addition to mentally challenging situations. It is the body’s attempt to best regulate itself when its normal physiological limits are challenged. Osteopathy and Acupuncture can help normalize the different systems of the body : endocrine, musculosketal, digestive, etc…and therefore decrease the general stress burden of the body. As a result the body will be more resistant to specific stressors including work-related stressors .
  1. Mental dissociation” starts when people are not in touch with their body. This state is common in sedentary office workers, when cerebral functions are over-stimulated to the detriment of somatic functions.  This can result in a lack of conscious acknowledgement of the signals from the multiple receptors in the body and a resulting lack of general awareness. This can affect the quality of the general perception of the employee, and as a result the quality of his decision making by altering his intuition. “Mental dissociation” is a condition which is also shared by PTSD (Post-Traumatic Stress Disorder) sufferers, for whom the connection of the individual to his body sensations has been severed as a coping strategy. Therapeutic touch has been widely studied and helps the individual re-integrate their body.
  2. Therapeutic presence, such as unconditional positive attention, and empathic understanding also conveys the intention of the therapist, which is at the heart of the healing process of the client, as studied in clinical psychotherapy.
  3. Hypnotherapy, psychotherapy and counselling are specifically targeted at mental issues, by reprogramming mental patterns .The position of the practitioner as an external stakeholder ensures that the problem is addressed outside the confines of the workplace.