Bradley Blair Osteopath

09/03/2026

The iliocostalis is the most lateral column. It originates broadly from the posterior iliac crest, sacrum, and thoracolumbar fascia, then runs upward to attach to the angles of the ribs and cervical transverse processes. Its subdivisions include iliocostalis lumborum, thoracis, and cervicis. Functionally, it contributes to extension of the spine when both sides contract and lateral flexion when acting unilaterally.

Functionally, the erector spinae muscles do more than simply extend the spine. They provide segmental control of spinal motion, resist flexion forces acting on the trunk, and assist in maintaining an upright position during activities such as standing, walking, lifting, and bending.

09/03/2026

Every clinic has them.

The patient who gets upset about a missed appointment fee.

They’ll argue about the $50 cancellation charge like it’s the most unreasonable thing in the world… and meanwhile they’ve just pulled up outside in a brand-new, top-of-the-range Mercedes.

That always makes me laugh.

Not because of the car. People can spend their money however they want. That’s none of my business.

But it does highlight something.

When someone books an appointment, that time is set aside specifically for them. Once that slot passes, it’s gone. Another patient who may have needed help couldn’t take that appointment because it had already been booked.

So when someone doesn’t show up or cancels late, the clinic absorbs that lost time.

A cancellation fee isn’t there to punish anyone. It’s simply there to make sure appointments are respected and that the clinic can run properly.

If you book the time, that time is yours.

And if you miss it, the cancellation policy still applies.

But yes… it does always make me smile a little when the loudest complaints about a $50 fee are coming from someone who’s just stepped out of a brand-new Mercedes. 🚗

08/03/2026

When I first started treating injuries, cold therapy was almost automatic. If something hurt, the advice was simple: ice it. Ice the ankle, ice the knee, ice the shoulder. It was one of those things that was repeated so often that nobody really questioned it.

But my approach changed over the years.

I stopped using ice in treatment a long time ago because cooling tissue reduces blood flow to the area. Blood flow is part of the healing process. When tissue is injured, the body increases circulation to deliver oxygen, nutrients, and the cells involved in repair. When you apply ice, you slow that process down.

That doesn’t mean ice has absolutely no place. If someone has just had an injury and the area is extremely painful, using cold for a short period may help reduce pain in those first few hours. Some people also like the numbing effect. But beyond that early stage, repeatedly icing an injury can interfere with the body’s natural healing response.

In practice, I don’t use ice anymore. Instead, I focus on helping the patient gradually return to comfortable movement and normal loading. Tissues respond well to appropriate movement and circulation, and that tends to support recovery far better than repeatedly cooling the area.

This is one of those things where clinical practice evolves. What we were all taught 15–20 years ago isn’t always what we do now.

And yes, I know some people will disagree. That’s fine. But for me, ice hasn’t been part of my treatment approach for many years. ❄️ Save it for your drinks. 🍸

08/03/2026

The quadratus lumborum (QL) is a deep muscle of the posterior abdominal wall that sits lateral to the lumbar spine and deep to the erector spinae. It forms a muscular bridge between the pelvis, lumbar vertebrae, and the 12th rib, which is why it contributes to both spinal and pelvic motion as well as respiratory mechanics.

The muscle originates from the posterior iliac crest and the iliolumbar ligament. From there the fibres travel upward to insert onto the inferior border of the 12th rib and the transverse processes of L1 to L4. It receives its nerve supply from the anterior rami of T12 through L3, which are branches of the lumbar plexus.

When the quadratus lumborum contracts on one side, it produces lateral flexion of the lumbar spine toward the same side. Because it also attaches to the pelvis, unilateral contraction can also elevate the pelvis on that side, a motion commonly referred to as a hip hike. This action becomes particularly relevant during walking, where the QL helps control pelvic position when the opposite leg is off the ground.

08/03/2026

Sounds like I touched a nerve 😂

07/03/2026

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07/03/2026

Oh no! 🤦🏾‍♂️😂🤦🏾‍♂️

07/03/2026

Some patients are late occasionally. That happens. Traffic, work, kids, life — things don’t always go to plan. But every practitioner knows the type of patient who is late every single time. Five minutes becomes ten, ten becomes fifteen, and before you know it the whole schedule is under pressure.

In my practice, if a patient arrives late, they simply get a shorter treatment. It’s not something I particularly want to do, but I’m not going to run behind for everyone else because one person couldn’t make it on time. Other patients arrived when they were supposed to and they deserve the same respect for their time.

Running late creates unnecessary stress in a clinic. It puts pressure on you, it puts pressure on the receptionist, and it often leads to frustrated patients sitting in the waiting room wondering why they’re not being seen on time. That’s not fair on anyone.

My patients know the rule: if you’re late, your appointment becomes shorter. The appointment still finishes at the scheduled time. Simple as that.

Keeping to time is part of running a professional practice. Boundaries matter.

06/03/2026

This clip from The Pitt is a good example of something that unfortunately happens in real life. The patient is in a Sickle Cell Disease crisis, which is extremely painful because the abnormal red blood cells can obstruct small blood vessels and reduce blood flow to tissues. When that happens, the pain can be severe and chaotic to watch. The problem is that racial bias in healthcare has historically led to some Black patients with sickle cell being dismissed as “drug seeking” rather than being treated for a genuine medical emergency. So for the racist scumbags who follow my account and pretend this kind of bias doesn’t exist, this is exactly the type of situation people are talking about. It’s not about feelings or opinions, it’s about recognising that these disparities have been documented and they affect real patients.

06/03/2026

More treatment does not equal faster healing.

I see this quite often. Someone comes in with back pain, has a treatment, and then the very next day they want another one. Or they go and see someone else as well, thinking that stacking treatments on top of each other will speed things up. It rarely works like that.

After treatment, the body needs time to respond. There can be some post-treatment soreness, which is completely normal, and this usually settles within 24–48 hours. That period is when the tissues and the nervous system are adapting to the stimulus that was just applied.

When people keep adding more treatment during that window, they often just irritate the area again rather than allowing things to calm down. More input is not always better input.

Healing takes time. Once the appropriate treatment has been given, the sensible approach is often to step back and allow the body to do what it is very good at doing—adapt and recover.

06/03/2026

Craniosacral therapy (CST) is often presented as a very gentle, almost mystical technique that supposedly influences the circulation of cerebrospinal fluid by lightly touching the skull. The theory behind it suggests that practitioners can feel subtle rhythmic movements of the cranial bones and then manipulate them to improve health. The problem is that this idea simply does not hold up when you look at anatomy or research.

In adults, the bones of the skull are essentially fused. The sutures do not open and close in the way CST theory claims. Multiple studies have also shown that practitioners cannot reliably detect the supposed “craniosacral rhythm.” When researchers test whether different practitioners can feel the same rhythm in the same patient, the results are inconsistent and essentially random. In other words, what they believe they are feeling cannot be measured or reproduced.

The second major claim is that CST alters the flow of cerebrospinal fluid. Cerebrospinal fluid is produced mainly in the choroid plexus inside the brain’s ventricles and circulates through the ventricular system and subarachnoid space. Its movement is driven by physiological processes such as arterial pulsation and pressure gradients. Light touch on the outside of the skull cannot meaningfully influence this system. There is no plausible mechanism for that to occur.

When it comes to headaches specifically, the situation becomes even more problematic. Headaches are a broad group of conditions with different mechanisms. Tension-type headaches, migraines, and cervicogenic headaches all involve different biological processes, including neural sensitivity, vascular changes, and interactions between the neck and the trigeminal system. There is no evidence that altering cerebrospinal fluid flow has anything to do with these conditions.

This is why the research base for craniosacral therapy remains extremely weak. Systematic reviews generally conclude that the evidence is low quality and inconsistent, with no convincing demonstration of a specific therapeutic effect beyond relaxation or placebo responses. Gentle touch can certainly feel relaxing, and relaxation can temporarily reduce symptoms, but that is very different from the claims that cranial bones are being manipulated or that cerebrospinal fluid is being “balanced.”

The popularity of CST in headache discussions is largely due to its intuitive appeal. The treatment focuses on the head, so people assume it must be relevant to head pain. But anatomical location does not equal clinical relevance. Many headaches have far more to do with the nervous system, sensitivity of tissues, sleep, stress, or neck function than anything happening within the cranial sutures.

In short, craniosacral therapy is built on a set of assumptions about skull motion and cerebrospinal fluid that are not supported by anatomy, physiology, or reliable research. For headache patients, its reputation far exceeds the evidence behind it. Relaxation can help people feel better, but the underlying explanations used to justify CST simply do not stand up to scrutiny.

06/03/2026

The image you shared shows a lateral lumbar spine X-ray with a superior endplate compression fracture at L4. In this example the report states there is approximately 25% loss of vertebral body height, which is typical of a mild-to-moderate compression fracture.

A compression fracture occurs when the vertebral body collapses under load. In the lumbar spine this most often affects the superior endplate, because the upper surface of the vertebral body is structurally more vulnerable to compressive forces transmitted through the intervertebral disc. On a lateral radiograph the vertebral body often appears wedge-shaped, where the anterior or superior portion of the vertebra has lost height.

In the case described in the report, several factors increase the likelihood of this injury. The patient is 86 years old, which means bone density is likely reduced. The patient also has rheumatoid arthritis and has been on long-term corticosteroids, both of which significantly increase the risk of osteoporosis. Corticosteroids reduce bone formation, increase bone resorption, and impair calcium metabolism, which weakens trabecular bone. Because the vertebral bodies contain a high proportion of trabecular bone, they are particularly susceptible to collapse when bone density is reduced.

The report also mentions extensive degenerative disc disease and grade 1 anterolisthesis of L3 on L4. Anterolisthesis simply means that L3 has translated slightly forward relative to L4. Grade 1 indicates a mild slip (less than 25%). This is a common age-related finding and is often associated with disc degeneration and facet joint changes.