1. Stretch regularly – Yoga and Pilates are brilliant to improve your posture, the better you move, the better your posture and the less problems you will experience. If you feel tight in one particular area or are not sure where you are moving incorrectly then your teacher (yoga/pilates) or manual therapist (e.g. Chiropractor) can help you.
2. Correct your ergonomics at work, if you sit at a desk for long periods at work for example then make sure you ergonomics are perfect. A lot of companies will assess this for you, however make sure it is kept up to date as it is very important for your posture and to prevent injury.
3. Take regular short breaks, if you have to stay in one place for a long period of time (e.g. sitting down) make sure you take a break and move about for at least 5 minutes every half hour. This will allow the structures within your body to recover from a prolonged period of stress in one position which can lead to poor posture.
4. Drink lots of water – staying hydrated keeps your muscles and joints supple and strong preventing your body from getting lazy and adapting a poor posture.
5. Feel free to fidget! Fidgeting is your body telling you that you need to move to get comfortable, listen to your body. If your body needs to move to be comfortable then let it be comfortable, just don’t let it be comfortable in one position for too long .
Always remember, keep moving and stay loose, keep your back straight when bending and use your knees!
If your company would like us to pay you a visit to conduct free postural assessments please get in touch!
Within this post I’ll explain why seeking treatment for your back pain earlier will potentially save you a lot of money.
Take a quick look at these well researched statistics:
80% of the population will experience back pain at some time
40% of the population are affected by back pain currently (16 million)
2.5 million people have back pain every day of the year
119 million working days are lost
1.2 million people are affected by musculo-skeletal pain and 500.000 by work related stress
The Hard Working Citizen
The sooner a person with back pain sees a well trained therapist such as a Chiropractor, the sooner they will get better, simple. Recently I and my colleagues have noticed how patients are presenting with incredibly chronic (>3weeks) back pain. People seem to be putting up with pain without seeking help for longer than ever before, we think this may be due to the recent recession (or double dip recession as it is for us Brits). People are really feeling the pinch, but if you think you are saving money by not getting your back pain treated now, you are very mistaken. In fact, it’s not cost effective at all! Its actually uneconomical! I’ll explain why.
Scary but (potentially) true
I’m going to use a common lower back problem as an example, a lower back disc bulge, a disc bulge usually occurs because the underlying supportive back structures are working incorrectly. The forces within the lower back are therefore repeatedly falling upon structures that cannot cope with the increase in load (the discs, among other things). This leads to failure, if the bulge is not correctly managed and the forces continue to be incurred in a region that has already failed then its ability to heal is diminished. It may take months or years to get better with a very high chance that it will recur in the future due to the mechanism of micro tearing in the outer layers which heals incredibly slowly, if at all (Read more here on disc bulges). Disc bulges can progress and in a lot of cases may even lead to surgery, the likelihood of this increases if you do not seek effective advice and treatment. The earlier you seek treatment, the quicker your disc bulge will resolve itself and with the correct prevention strategy provided you will have a lower back that will be less susceptible to having disc bulges in the future.
“And financially this affects me how?”
The financial implications of this are simple, by letting your back pain progress and possibly worsen it may end with you requiring surgery and months off work with no guarantee it won’t recur. Due to the reasons above you may even require multiple surgeries in the future. Therefore, costing you even more in lost wages with time off work and possibly even your job! This is all theoretical of course and I’m not trying to scare you well, maybe a little lol… as more than likely if it is your first episode of back pain it may be nothing serious but for the price of a consultation fee it’s still best to get it checked out now to be better safe than sorry. The best way to treat the problem and find out the cause is to seek help from a well trained manual therapist such as a Chiropractor. A good therapist will offer you a variety of treatment and prevention options (or referral if required) and an insight into how your problem could progress if left untreated. So what I would recommend is to save yourself money and seek help now rather than later, trust me, your future pain free self will be thanking me in the long run.
From the 3rd to the 7th of September Kate will be practicing 8am until 8pm massage shifts. She will be taking care of the masses of media, support and technical teams that lug heavy cameras and equipment around the stadiums, catching those perfect shots of the athletes that we are all waiting for with eager anticipation. She’s ready for a tough but fantastic week, gaining ever more experience to bring back to patients here at the Longlevens Chiropractic & Sports Injury Clinic.
The Paralympic Torch was lit this morning and I heard someone say on the radio – “it’s a chance to really concentrate on people’s abilities, not their disabilites…” Absolutely. We can’t wait.
Best Wishes and Good Luck to all those participating in any aspect of the event – including Kate!!
…It can be such a pain in the bum… literally! ‘Sciatica’ is the term used to describe any pain that is originating from irritation of the Sciatic Nerve. This pain can be felt anywhere down a leg, from the bottom to the feet.
The Sciatic Nerve is the longest and thickest nerve in the human body, running from your lower back all the way in to your foot, with its thickest part being around 2cm in width! As you can imagine, a lot can happen to that nerve along its route and exactly what can happen is the subject of this post. The Sciatic Nerve originates as individual spinal nerves known as L4,L5,S1,S2 and S3, these nerves exit the spine individually but then converge to create the Sciatic Nerve. Bear this in mind when we discuss problems that can occur to the Sciatic nerve that lead to what we all know as ‘Sciatica’.
A disc bulge essentially only affects the nerve at which level the bulge is occurring, this therefore would affect the path of the Sciatic Nerve but particularly at the points at which the original nerve supplies the body. For example, a backwards and to the side (postero-lateral) Disc Bulge at L5/S1 usually causes pain/tingling/numbness/pins and needles at the sole and outside edge of the foot on the same side as the bulge. This is because the nerve exiting between the spinal segments of L5 and S1 is what is known as the S1 nerve root (like a tree a nerve has a root, another word for where it starts). The S1 nerve supplies both muscles (a Myotome) and skin sensation (a Dermatome). So as you can see the S1 nerve supplies sensation to the sole and outer edge of the foot which is why pain is felt here. This applies to all nerves exiting the spine. If one level has a bulge then the skin it supplies may have a change in sensation. The muscles that each affected nerve innervates may also not work correctly or may even begin to decrease in size and become flaccid, seen in severe cases. For example, The S1 nerve supplies lots of muscles in the lower leg and foot so it would be quite clear if there was something affecting its innervation severely as all these signs would be present. Chiropractors treat disc bulges all the time, worst case scenario is surgery for a disc but your Chiropractor or manual therapist will let you know if this is necessary.
Foraminal Stenosis
The word ‘Foramen’ basically means ‘a hole’, where the L4, L5, S1, S2, S3 nerves leave the spine between each vertebral segment is a hole called the ‘Intervertebral Foramen’. If anything decreases space at this Foramen then Sciatica can occur, problems such as bony spurs, inflammation, a Spondylolisthesis or a Tumor can all cause a decrease in space here and irritate the nerve as it exits. This can therefore be one of the causes that lead to irritation of the Sciatic nerve and the symptoms associated to it.
Piriformis Syndrome
In a nutshell ‘Piriformis Syndrome’ occurs as a result of the Sciatic nerve being irritated by the Piriformis Muscle. Though it’s not always simple to treat for the following reasons:
The Sciatic nerve’s relationship with the Piriformis Muscle in the general population differs from person to person. As you can see, most commonly it passes beneath the Piriformis Muscle, however in the minority of the population the Sciatic Nerve can actually pass through the Piriformis Muscle entirely, or even stay split around it and connect after.
The Piriformis is an external rotator of the the leg, if it gets too tight (common in a lot of people) it can become irritated, this leads to inflammation at the muscle and surrounding tissues, which in some cases includes the Sciatic Nerve. This irritation can cause symptoms down the leg that are often misdiagnosed as disc bulges due to their similar presentation.
If you have further questions or would like to know more about this topic please ring us on 01452309372 or email contact@longlevenschiro.com
It’s rare to that you find someone with the ‘perfect’ posture, but the idea is that it is aspired to. Below is a diagram of what we should all be aiming for.
There tends to be 3 types of ‘bad’ posture that practitioners see most often:
Sway back posture:
• Head is too far forward
• Neck has an increased curve
• Shoulders are falling forward and down
• Chest and Rib Cage The Upper chest collapses, flattening out the chest wall. Chest also moves back and in.
• Upper Back has an increased bend forward (Kyphosis).
• Lower Back flattens out
• Pelvis tilting under (Posterior tilt) and pushing forward.
• Knees locked
Flat back posture:
• Head is too far forward
• Neck has an increased curve
• Shoulders are falling forward and down
• Chest and Rib Cage falling forward
• Upper Back Straightening out as you move down the spine
• Lower Back flattens out
• Pelvis tilting or tucking under (Posterior tilt)
• Knees locked
Hollow back posture:
• Head is too far forward
• Neck has an increased curve
• Shoulders are falling forward and down
• Chest and Rib Cage collapsing
• Upper Back is rounding (Kyphosis)
• Lower Back has an increased curve (Lordosis)
• Pelvis tilting forward (anterior tilt)
Knees locked
Poor posture can effect the body massively. It can mean some muscles shorten and so cannot perform normally and therefore others lengthen which decreases strength. It can also effect blood flow through muscles which can lead to pain spasms.
Poor posture can be the cause of much discomfort and injuries due to the short/tight muscles or the lengthened muscles that allow too much movement possibly leading to injury.
Posture is something that everyone should be very aware of and be trying to correct every minute of every day.
References:
Kendall, 1993
NLSSM – North London School of Sports Massage
The term ‘Shin Splints’ (also known as “runner’s leg”) is in fact a general umbrella term used to describe quite a few different lower leg injuries. Each of the injuries can be grouped in to one of four different categories depending on where the area of pain is felt. I will mention each individual injury but not cover each one in depth. I will, however, give an example of one of the injuries from each of the 4 shin splint group types so as you have an idea of how each of the 4 types presents. I will however not be covering how to treat these areas as that is a whole different kettle of fish and I would recommend seeing a specialist if you feel you have any of the following to receive a personal treatment plan.
A summary of the four types: 1. muscular (various lower limb muscle strains) – tibialis posterior and anterior syndromes, soleus syndrome 2. periosteal (most outer layer of a bone) – periostitis of tibia 3. fascial (Fascia) – exertional compartment syndrome 4. osseous (bone) – tibial and fibular stress fractures
1. Muscular
Example: Tibialis posterior Syndrome
This type of shin splints essentially is as a result of a strain or incomplete tear of Tibialis Posterior:
caused by biomechanical dysfunction (esp. overpronation) of the foot and ankle.
pain usually appears at the beginning of a workout and later disappears, only to reappear afterwards.
palpable tenderness along the medial side of the lower leg.
tenderness is also elicited by resisting plantar flexion and inversion of the foot radiography helps to rule out stress fracture of tibia/ tibial periostitis.
additional treatment – lower leg strap (like elbow strap) for redistribution of muscle tension.
This type of shin splints involves painful inflammation of the outermost layer of bone called the periosteum specifically along the central border of the shin, usually the distal 1/3 .
Originally thought to be related to stress along the posterior tibialis muscles and tendons causing myositis, fasciitis and periostitis, it is now believed to be related to periostitis of the soleus insertion along the posterior medial tibial border. As a result of excessive pulling of the muscle. Excessive pronation or prolonged pronation of the foot causes an eccentric contraction of the soleus, resulting in periostitis.
May be as a result of a change in running distances, speed, form, stretching, footwear, or running surfaces.
Tenderness along the anterior side of the tibia and sometimes slight swelling and thickening above the bone can be noticed.
Additional treatment – ice and NSAID, soft running surface, cushioning of the heel.
3. Fascial
Exertional Compartment Syndrome (ECS)
This type of shin splints involves thick sheaths of Fascia divide the muscles of the leg into four compartments each with their own muscles, blood and nerve supply. The four compartments are the ‘Anterior compartment’, ‘Lateral Compartment’, ‘Posterior Deep compartment’ and the ‘Posterior Superficial Compartment’. The mechanism involved is as a result of fascia that is too tight along with an increase in muscle volume within the compartment as a result of increased activity which can lead to a decrease in compartment space around the muscles. This therefore increases the pressure within the compartment and diminishes the compartment’s veins ability to return blood therefore increasing the pressure further. If really severe the arterial blood supply in this compartment can also be cut off.
ECS is usually exercise induced aching leg pain and a sense of fullness, both over the involved compartment. These symptoms are almost always relieved by rest, usually within 20 minutes, only to recur if exercise is resumed.
Both legs is common
Activity related pain begins at a predictable time after starting exercise or after reaching a certain level of intensity
Many individuals with anterior ECS describe mild foot drop or paraesthesia (or both) which are amplified by physical exertion.
The most common compartment involved is the Anterior 50-60% then the Deep Posterior 20-30% and the remaining 10-20% is between the Lateral and Superficial Posterior compartments.
Home advice involves Ice and reducing the level of strain, though for an active individual fasciotomy provides a quicker and long-term solution (surgery to release the tight fascia and therefore decrease the pressure in the involved compartment.
This particular condition is notoriously difficult to manage conservatively, if there are any practitioners out there with suggestions then I would love to hear their experiences.
Do not confuse with an acute compartment syndrome which is in fact a medical emergency.
4. Bone
This type of shin splints involves stress fractures of the Tibia (shin bone)
as a result of repeated sub-maximal loading.
dull pain, swelling and palpable tenderness is confined within 2-3 cm in diameter.
Insidious onset.
Increased pain with activity/ decrease with rest.
Pain usually limited to fracture site.
Pain on percussion and vibration.
If you are still unsure as to which of these problems you are experiencing or you wish to get more advice then feel free to message me for more advice. Otherwise I would recommend an experienced manual therapist such as a sports Chiropractor.
Whiplash – you hear the term used all the time but do you really know what it is and why it occurs? Here it is for you, put simply by Danny Adams, Chiropractor at Longlevens Chiropractic & Sports Injury Clinic:
Studies show that a rear-end collision of as slow as 5 Mph can result in what is known as a “Whiplash Associated Disorder” (WAD). (This is the correct term for whiplash used by medical professionals). Classically, most people will tell you that a rear end car collision is what leads to Whiplash. However, this is not the case, as you can see from the term ‘Whiplash Associated Disorder’ Whiplash can occur in many different ways. If you follow the definition you would be forgiven for thinking that Whiplash can only be as a result of hyper flexion and hyper extension. However, what is more common is that when a person experiences whiplash it is as a result of the person’s neck not being prepared correctly for the rapid change in movement. Whether the impact to the persons body came from behind or the sides. This is because the muscles of the neck are not prepared correctly to brace the neck bones and tissue (usually because the person was not expecting to injure themselves). Then by the time they have braced it is too late and the damage has been done. Also, mistakes are made in treating, where it is commonly thought that the ligaments surrounding the facet joints (little joints that connect each segment of the spine) get sprained due to hyperflexion (too much flexion) and subsequent hyperextension (too much extension) whereas, in fact, a large amount of joint compression occurs as the neck gets taken through and ‘S’ shape curve just after impact seen in the middle picture below.
Here is the classification of WAD injuries just to show you how different each Whiplash injury can be. There are a few different classifications though this one is most common at the moment, designed by ‘The Quebec Task force”. If you have suffered Whiplash then you would have fallen in to one of these graded categories.
Now, another very common mistake to make with Whiplash is that the injury only occurs within the bony part of the neck and local tissues. In fact a large part, if not the majority of your pain will be coming from the surrounding musculature that braced the neck too late. What happens is that the muscles that failed to respond quickly enough at the time of impact are kept in a state of neurologically controlled hypertension (too tight!) as they form their own protective brace around the bones and tissue of the neck. Don’t get me wrong, there may have been bone, joint and tissue damage but it is usually the muscles that are responsible for the long term effects of Whiplash. Often the segments of the spine, their joints and local tissue have often healed while the muscles can stay in a state of unnecessary tightness for years after.
A simple but frustrating mistake I hear time and time again when advice is given for Whiplash is “use heat to relieve the pain and symptoms”. For the life of me I do not know why this is suggested, if you get a bruise or you tear/strain a muscle why would you want to encourage the inflammation with heat in the early stages? Heat feeds inflammation, if you read the physiology behind inflammation you will see that inflammation is a genius evolutionary process but essentially quite crude. The body does a great job with inflammation breaking down and clearing out dead and diseased tissue, though it often goes too far and can in fact damage it’s own healthy cells, thus prolonging the recovery of an injury. By applying heat you will get relief at the time of application due to the over riding of the ‘pain gate’ at the damaged region. However, a few hours later the pain often will return and sometimes it can be worse. I’d suggest using ICE 10-15 minutes every 2 hours and observe the difference.
If you would like further information on whiplash please contact us on 01452309372 or email contact@longlevenschiro.com. See more of Danny’s articles here.
Myofascial Release is an effective, hands on technique that involves applying gentle, sustained pressure into the Myofascial connective tissue restrictions to eliminate pain, discomfort and get the body back to full function.
It is best performed directly onto the skin, without the use of oils or creams. This enables the therapist to spend time focusing on what they feel and sink into the layers of skin and fascia.
There are indirect techniques that are very gentle and slow which are applied in the direction the fascia wants to go, and direct techniques that require more pressure and encourage the fascia to go in the direction of discomfort to get a release of tension from the fascia.
The picture shows the fascia that lies between the skin and underlying tendons as described by Dr J. C. Guimberteau in the book Myofascial Meridians for Manual and Movement Therapists.
Arthritis is a massive subject, when some one says “I have arthritis” there is a huge variation as to which type they could have, each one differing in severity, characteristics and location. The word arthritis when broken down essentially means Arthr- meaning ‘joint’ and -itis meaning ‘inflammation’, this therefore encompasses a large variety of conditions that cause primary inflammation at the joints. The most common of all arthritis is Osteoarthritis (OA) Osteo- meaning ‘bone’, it is also known as degenerative joint disease (DJD) or “wear and tear” by the general public. Everybody at some point will get Osteoarthritis as they enter the latter years of life. Osteoarthritis can also come about as a result of a previous injury, where a joint has been affected and does not function correctly the joint can degrade faster and lead to recurring inflammation at the joint. The term used to describe the mechanism that explains how Osteoarthritis can occur at a joint is “a stable load on an unstable joint or an unstable load on a stable joint”.
So, Osteoarthritis is essentially a wearing out of a joint due to forces not being distributed through the joint evenly. The onset leading to this poor distribution of force varies with each cause, with obvious changes occurring with problems such as trauma, with fractures etc. This is in comparison to the onset of Osteoarthritis as a result of aging, in which case the mechanism is due to a change in the turnover of cartilage cells, which normally act as buffers to protect the bone which is pain sensitive. The body reacts to this by trying to stabilise the joint, this is where the complications begin to occur.
Treatment options Generally the options for Osteoarthritis depend on how severely the joint has been affected. The most common scenario is a patient presenting with joint pain which a manual practitioner will examine and determine if it is indeed arthritis causing the problem and following testing the clinician will refer for an x-ray to confirm the diagnosis. The patient’s joint is then managed so that mobility is increased or maintained and so that the joint and surrounding structures are strengthened to become more stable and slow down or prevent further degeneration. If the arthritis is too severe and begins affecting general daily activities then a manual therapist will refer their patient to their GP or directly to an Orthopaedic consultant as it is possible that the patient will need a replacement joint or other treatment such as an artificial synovial fluid injection.
Conservative treatment If you suspect having Osteoarthritis in a joint or in your joints I would always recommend seeking conservative treatment before choosing surgery. A manual therapist will do as much as possible to prevent or delay surgery though will make you aware if it definitely is the time to consult your GP or consultant. The reason for this is that surgery is not always succesful (as with any surgery) and there is also a chance that the replacement joint will need replacing again after a certain period of time which means more time off work and another spell of time spent in hospital. Conservative treatment would involve advice on how to look after the joint/joints at home with Ice, exercises and stretches and some physical therapy in the clinic to maintain or increase the range of movement at the joint and to make sure exercises and stretches are being performed with correct technique. A Chiropractor can manage your Osteoarthritis for you as well as Physiotherapists and Osteopaths. However to receive the best treatment I would always recommend researching the practitioner you visit prior to consulting by asking friends and family or others in the local area to the clinic as this is the best way to find out how good they are.
I hope this has helped you understand a bit more about your body and Chiropractic, If you have any questions on this topic send me an e-mail at danny@longlevenschiro.com
The results below are from a study, funded by the National Institute of Health, that tracked 272 patients with recent-onset neck pain who were treated using three different methods: Medication, Exercise or a Chiropractor.
After 12 weeks the patients who used a chiropractor or exercised were more than twice as likely to be neck pain free compared to those who relied on medicine. The patients treated by a chiropractor experienced the highest rate of neck pain relief with 32 percent saying they were neck pain free, compared to 30 percent of those who exercised. Only 13 percent of patients treated with medication said they no longer experienced neck pain.
A Chiropractors View
As a Chiropractor myself, I always recommend Chiropractic treatment along with a personally prescribed exercise plan. Part of your chiropractic treatment is to receive advice on which stretches and exercises to perform. The exercises are designed to train areas of your body so that it is less likely to re-injure itself. I also give ergonomic advice, advice for around the house and advice on the correct nutrition to aid you in healing faster. Exercises are usually given after one or two treatments once a patient is out of pain and can move a bit better. You must be careful as exercise during the acute phases may increase the pain levels and actually hinder progression. This is because the inflamed areas can get further irritated by the compressing, stretching and pulling movements aggravating the injury.
What to expect
It’s crucial for everyone to know that Chiropractic is more then just hands on treatment, Chiropractors assess all contributing factors and give you advice to correct each possible factor that may have led to the injury onset. Once out of injury or even before they get injured many people see their Chiropractor for a regular spinal and body check up. During these visits a Chiropractor will check to see if any part of the body could lead to future discomfort and to see if their patient has been performing their exercises correctly to prevent injury or re-injury.
This Chiropractor’s ‘Dream’
Chiropractic and exercise go hand in hand, on their own they are OK, but together they are unbeatable. In a perfect world everyone would see their Chiropractor on a regular basis for regular check ups, this is the dream as back pain is one of the leading causes of work absence. Think about it!! if we all saw our Chiropractor regularly we would have less days off work as a country due to back pain which would lead to a boost in the economy and decrease our taxes!!… what do you think? it’s a nice dream, make it happen .
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