Motion Forword - Words of a Therapist: Climbing New Heights, Cramps and Clinical Audit Fun
Welcome to Motion Forword - Words of a Therapist! Number 21!
Motion Forword is about discussing the combined benefits of movement with a positive mental attitude. Using my personal/professional experiences, evidence-based research and some of your own experiences.
Bringing some hope, positivity, happiness and maybe usefulness to those, perhaps like yourself, that needs a pick me up.
Something about me…Hiking Snowdon - Pushing to New Heights
I was looking forward to the Easter Bank Holiday for several reasons:
A break
A trip to Snowdownia, Wales where I’d never been before
A chance to hike the tallest peak in Wales: Snowdon/ Yr Wyddfa.
It was important to me that the short-break away was a mixture of keeping active and actively chilling. Too much of one or the other ends up not feeling like a break at all.
After the long 7hr drive there on a bank holiday Friday, I woke up Saturday keen to get it done despite the slightly gloomy weather. We started with a hearty breakfast and headed off.
Arriving just after midday we thought it sensible, as inexperienced hikers (and myself not the keenest of walkers) to start with the easiest but longest route to the peak from Llanberis. The sign at the bottom of the 14km hike was estimated to take 6 hours. S**t! We’re going to be walking back in the dark!
Undeterred we pushed on.
Holy moly the first 500m of going up the very steep route was quite the opener! Fortunately only the start. The rain was light and refreshing with our body heat rising with every step up the stony path.
But we got into a good rhythm only needing to slow on the more steep areas and when holding our footing when the gusts almost forced us off our feet!
The 7th kilometer was by far the slowest and steepest with my Garmin watch noting a pace of 22:44m/km which had been increasing with every kilometre we marched. With the same stretch heading down much faster at 9:43m/km!
We reached the 1085m summit in 2 hours and 15 minutes.
And the total time down was: 1:39
Our total time was 3:54:33. Shaving more than 2 hours off what we were expecting!
Overall a really insightful and fun excursion to push yourself physically and mentally to reach new heights.
‘‘At the top’’ - was a bit windy…
1085m up…
Sorry this is so big! Couldn’t make it smaller!
Something for you…Cramps: Causes and Solutions
Cramps are a common complaint in my clinical practice. Usually affecting the hamstrings (back of thighs), calfs and/or feet.
They are sudden, involuntary, and often painful muscle contractions which can have a variety of causes.
Fortunately, cramps didn’t plague our hike up Snowdon probably thanks to a good rest previously, an electrolyte infused water bladder and light snacks to keep us going.
I usually boil cramps down to 3 main things: Dehydration, Electrolyte imbalance and Under/Overuse but I have pooled a bit more knowledge here to help cramp sufferers understand what could be going on…
🥵 1. Dehydration
When fluid levels drop, electrolyte balance gets thrown off, which can trigger muscle spasms.
Common during or after intense exercise, especially in hot conditions.
🧂 2. Electrolyte Imbalance
Low levels of sodium, potassium, magnesium, or calcium affect how muscles contract and relax.
This is especially common in endurance athletes or those on restrictive diets.
🏋️ 3. Muscle Fatigue / Underuse followed by Overuse
Overworking a muscle group can lead to cramping — especially if it’s not used to the level of exertion.
Often seen in athletes or during unaccustomed activity. I often see people getting hamstring cramps when I ask patients to do a pelvic bridge for the first time.
💤 4. Poor Circulation or Nerve Compression/Irritation
Limited blood flow or nerve signals can lead to cramping, especially in the legs and feet.
Can happen with prolonged sitting or standing, or conditions like spinal stenosis.
😴 5. Night-time (Nocturnal) Cramps
The exact cause isn’t always clear, but it may be related to:
Resting muscle position
Aging
Nerve excitability
💊 6. Medications
Certain meds can contribute to cramping:
Diuretics (fluid loss → electrolyte imbalance). E.g. Furosemide, bendroflumethiazide. Caffeine and alcohol can also act as a diuretic.
Laxatives (fluid loss → electrolyte imbalance)
Statins and Beta-blockers are often prescribed along-side diuretics to help manage high blood pressure and high blood cholesterol.
⚠️ 7. Medical Conditions
Cramping can be more frequent or severe in the following conditions. These all affect how the kidneys work and how much water we pass.
Diabetes
Thyroid dysfunction
Kidney disease
Peripheral artery disease
Pregnancy
In essence, anything that disrupts fluid levels or electrolyte imbalance or exercise-induced muscle fatigue will increase risk of cramping. If cramping is persistent or long-lasting it may be related to conditions that implicate these changes.
Tips for Cramp Prevention
Water Intake:
Don’t just chug water after you feel thirsty or crampy — aim for regular intake throughout the day.
Mineral Water tends to be better than still (tap) water as it contains more of the electrolytes we discuss below.
Goal: ~2–3 liters per day. You may naturally have more or less depending on your body size, climate and activity levels.
PEE WATCH: What colour is it? Simply put:
Light yellow = well hydrated. Dark yellow = more fluids needed.
The darker the yellow, the more dehydrated you are as your kidneys are reabsorbing as much of the water as they can!
Note: if your pee is clear, it may be because of diuretics (which make you pee more) such as caffeine, alcohol or medication which may make you feel more dehydrated leading to cramps.
Note note: if you feel thirsty and your mouth is dry,… drink some water!
If you’re sweating heavily, you're not just losing water — you're losing electrolytes too. (that’s why sweat tastes salty, yum!)
Use electrolyte drinks or add a pinch of salt to water if you’ve been sweating a lot. Also add chopped fruit and/or herbs to add flavour and small amounts of electrolytes to your water. E.g. cucumber (K), orange slices (K, Ca), berries (trace), mint (negligible), watermelon (K, Mg), lemon/lime (K, Ca).
Electrolyte Intake:
Cramps often link to low levels of certain minerals (Na, Ca, Mg, K). If cramping is a problem, try to add these foods to your diet.
Electrolyte Source Foods
Sodium (Na): Broths, salted nuts, pickles, olives
Potassium (K): Bananas, sweet potatoes, avocados, coconut water
Magnesium (Mg): Dark leafy greens, almonds, pumpkin seeds, whole grains
Calcium (Ca): Dairy, tofu, fortified plant milks, sardines
🥗 Food for thought…
🔹 Daily Habits:
Eat a balanced diet with adequate carbs, protein, and healthy fats.
Avoid over-restricting salt if you're active or sweat a lot.
Don’t skip magnesium-rich foods, especially if you cramp at night.
🔹 Before Exercise:
Hydrate ~2–3 hours before, include some salty snacks or electrolyte drink if it's intense or hot.
Include a light meal with carbs and a touch of protein (e.g., banana + nut butter, yogurt + granola).
🔹 After Exercise:
Rehydrate with electrolyte-rich fluids.
Include a recovery meal with protein, carbs, and minerals (e.g., grilled chicken, quinoa, roasted veg).
🌙 For Night Cramps
Magnesium before bed can help (food or supplement).
Try a banana and almond butter or Greek yogurt with berries as a nighttime snack.
Stay hydrated in the evening, but not so much you wake up to pee every hour! (A tricky balance)
A story… A 3 year in the life of Nathan Bull Osteopathy
So it’s not all fun and games at NBO…
To comply with my obligations and code of conduct with my registering body the General Osteopathic Council (GOSc) I have to complete an ‘objective activity’ for my continual professional development (CPD).
This means I have to obtain some objective feedback to help me reflect, inform and develop my clinical practice.
I decided to do a clinical audit looking at how my practice has been doing in the last 3 years.
Me doing my clinical audit
So here are some snap shot statistics into the day in the life of NBO.
The most common age range I saw was between 30-39 with the most frequently occurring (mode) age being 31 and an average (mean) age of 45. The least common was those in the 80+ range.
In 3 years, I saw 591 patients of which:
44.8% had lower back pain (LBP) (as their main complaint)
35.7% had neck pain,
31.1% had shoulder pain.
Taking the two most common complaints; neck and LBP, I looked at the time of onset of the problem:
<6 weeks = acute;
6-12weeks = sub-acute;
>12 weeks = chronic.
LBP: 43.4% acute, 6% subacute, 39.6% chronic.
Neck: 33% acute. 6.3% subacute, 46.2% chronic.
So I tend to see more people with acute LBP and more chronic neck pains.
Of the 591 patients:
15.6% mentioned having some form of stress*
12.9% mentioned having been diagnosed with or medicated for depression or/and anxiety
10.8% mentioned concerns at work
* Stress was my own interpretation (so quite subjective) of how a patient may have expressed and talked about aspects of their life when I asked them about mental health and stress.
Again looking at the two most common complaints. 26.5% of patients with chronic neck pain described having stress (over a quarter!) whilst 17.1% of chronic LBP patients described having stress.
In acute cases of LBP and neck pain stress was noted 14.5% and 13.7% respectively. Much lower than their chronic counterparts.
This all brings up really interesting questions that I have discussed with my peers about the influence of stress, what kind of patient I attract,the prevalance of painful presentations and influence of marketing (maybe I am not reaching the over 80s very well…?)
But all very interesting stuff.
Lastly, a big thank you to you guys. As 29% of people coming to see me were directly from recommendations and word of mouth. So thank you.
Because it is kind of funny, here is ChatGPT’s thoughts of me as a action figure serious Osteopath and a light hearted salsa dancer (who apprently needs an extra left shoe)!
Thanks for reading.
Until next month…
Motion Forword ⏩⏩
Nathan