Big congratulations to Bradley Wiggins for winning the Tour De France, supported by a medical team that includes Matt Rabin, BCA Sports Chiropractor. His testimonial for Matt, and for Sports Chiropractic, can be found on Matt’s website http://theperformancechiropractor.com/says-who/bradley-wiggins/ and reads as follows:
” I first started working with Matt at the end of 2008 following my success at the 2008 Beijing summer Olympics. After years of struggling with minor niggles that I had learned to live with, and having never really found the answer to my problems despite having sought numerous treatment options with no great success, I went to see Matt.
From my first session with him I had great results that were not short lived. That followed up with regular sessions I saw improvements that I had never seen before and that reflected in the way my body held up on a day to day basis which eventually saw me achieve 4th place in the 2009 Tour de France under his supervision.
Matt will undoubtedly remain an integral part of my medical support in the forthcoming seasons and lead up to the London 2012 Olympic Games.”
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.
The London Olympics is drawing very near and I am off to pick up my very important pass from the London Uniform Distribution Accreditation Centre (UDAC) in West Ham, East London. Its all very exciting but naturally quite strict on ID and security.
We have ID passes and pre-ordered T-shirts so that we will all look the part for our allocated massage time.
Very exciting!!!! We will keep you posted and post lots of pictures!
Sporty and Super fit Sue Smith has been successfully receiving treatment at this clinic for a long time and is highly regarded by all practitioners here…although we do think she might be a little bonkers… She is is travelling from Longhope in Gloucester to Longhope in the Orkney’s for charity… on a bike… 750 miles in 11 days!!!!!!!!!!!! Wow. It’s all in aid of the RNLI and her target, along with two friends, is to raise £3500. You can find out all about the story and reasons behind this fantastic fundraising effort at www.justgiving.com/longhope2longhope, www.longhope2longhope.wordpress.com, twitter @glos2orkney and facebook longhope2longhope. We know you are a generous lot…. :)
Thanks Danny for an excellent blog! Please read on…
As a practicing Chiropractor I have made 2 brief lists of things to be aware of when visiting a Chiropractor for the first time. The lists are also good to see how your current Chiropractor compares.
All professions have good and bad practitioners, as you can imagine people’s abilities to treat differ just as a persons abilities at sport can differ. Some people are naturals, some take time to improve and others well… the less said the better. There can also be differences in how one practitioner views a patient as a human being similar to how people in general life have different views on individuals in the human race. One practitioner may run a clinic with a patients health in mind whilst a minority would put the business overwhelmingly first and see patients as number rather than a person.
Here are some badthings that from my experience I would recommend to watch out for when you go to see a Chiropractor:
Treatment times less than 15 minutes long.
Offering of a full spinal x-ray on consultation rather than an x-ray of a specific area, an x-ray is only required in 10% of patients and is often not necessary straight away.
A “spinal scan” that miraculously highlights areas of the spine that need “correcting” or “re-aligning”. A spine with graph like projections coming out to the sides may be seen on the print out of one of these.
Being told you have a “subluxation” or “subluxations”. This is an old Chiropractic term that is in the process of being phased out in the UK due to its misuse by a minority of the profession and the confusion it causes to the public. I do not have a problem with the term when it is used correctly (rarely), however it has been abused and used as a scare tactic by a minority of individuals.
Treatment ‘pre-payment packages’ or ‘set number of treatments’, for example: “buy 10 treatments for the price of 9!” or “book all 20 treatments now and save 10%” or “you need 22 treatments for this problem” These are sales tactic, no practitioner can per-determine the number of treatments required for an injury as everyone heals at different rates. I tell my patients that it will take anywhere from 4-16 treatments. Post treatment the patients then usually books in the next 1 or 2 to ensure they get the times they want for the next session. I find on average 6 treatments is sufficient for most simple spinal problems with occasional management options to prevent injury in the future.
Not doing any soft tissue work. Chiropractors that only manipulate and mobilise joints are considered lazy and their treatment outcomes will be less effective as a result. A good practitioner will do soft tissue work whether it be with or without manipulation or mobilisation or they provide some one else such as a masseuse to do it for them.
Not providing home exercises or rehab. Again considered lazy as home exercises are great for the patient to maintain the benefits felt in clinic and to get involved with their treatment plan.
Here are some good things I would recommend to watch out for in a good clinic:
Treatment times 15 minutes or longer.
Recommendation by a trusted friend, family or colleague.
A clean, open friendly practice environment centered around the patient.
Soft tissue work before/after treatment with or without manipulation or mobilisations as manipulation and mobilisation are not always used whereas some form of soft tissue almost always has a use even in very acute patients.
Prescribed exercises or stretches at the end of the consultation, checked regularly and progressed in following treatments.
Accessible staff by phone and e-mail in case of complications.
Chiropractors registered with the British Chiropractic Association (BCA), the BCA is considered the “original and best” association to be a member of, they are currently leading the profession and are striving to further Chiropractic in co-ordination with the best chiropractic international and encourages the profession to better itself based on high quality research and interaction with other professions.
A PPQM (Patient Partnership Quality Mark) or a CMQM (Clinic Management Quality Mark) these are a sign that clinics have met high standards set by the “College of Chiropractors” in the UK. The clinic I am currently working in does not have these yet as the clinic is relatively new. Though we are in the process of applying for both of these for the first time, they are very long application forms!!. You can see if your clinic has these awards as they will be up on Bronze plaques in the clinic.
Look for the membership certificates for the associations and awards I have mentioned. If you cannot see them out on display, then ask to see if they have them.
I have to say, as you might expect, that the clinic I work at here in Longlevens, Gloucester is a very good clinic but hey! What do you expect me to say?!?! We advocate good practice within the profession and try to lead by example. Some practices put the business before the patient, this is wrong, the patient experience and treatment outcome should always comes first.
The standard of Chiropractic practice is constantly improving as the governing body clamps down hard on practitioners not adhering to the strict guidelines that are updated and handed out regularly.
A great piece of news I saw recently was that the The College of Chiropractors (a group dedicated to educating and furthering the profession) recently released a document. This document suggests guidelines of good practice for Chiropractors to follow regarding what is considered best practice during the management of a patient that has presented with an episode of acute lower back pain (back pain with an onset within 6 weeks). Though they are not strict rules to follow I feel this is a big step toward the profession locking down an identity as to what the public should expect from the Chiropractic profession. Feel free to read the document as it will give you a good idea of what to expect and what you should expect when consulting a good Chiropractor if you or those you know suffer from Acute lower back pain. It is available here: Chiropractic Quality Standard for the management of Acute Low Back Pain
If you have any questions regarding this topic please comment or feel free to e-mail me on danny@longlevenschiro.com
On 8 June 2012, the British Medical Journal http://www.bmj.com/comment has published a Head to Head debate: Should we abandon cervical spinal manipulation for mechanical neck pain? Those advocating this position were Benedict M Wand, Peter J Heine and Neil E O’Connell, and those arguing against are J David Cassidy, Gert Bronfort and Jan Hartvigsen.
The BCA was contacted by the Daily Mail on 7 June for a comment from the BCA and this was provided, emphasising that neck manipulation has been shown to be safe and effective and is the preferred treatment by thousands of people suffering from neck pain and headaches. Comparisons were made with other medical treatments and the use of drugs; the misuse of the term chiropractic for treatment carried out by non-chiropractors, and the training chiropractors have in spine care. The prospective study of cervical manipulation in 2007 in the UK has also been referenced, which found that in the study of 50,000 neck treatments, not one serious adverse event was reported.
The BCA has posted this notice on the public area of the website. If you need any clarification please call head office.
A debate has been published in the British Medical Journal (8 June 2012), questioning the safety of neck manipulation. Neck manipulation has been shown to be safe and effective and benefits thousands of people suffering from neck pain and headaches. In fact, the risk of a stroke after treatment is the same http://www.ncbi.nlm.nih.gov/pubmed/18204390 whether you see a GP and get a prescription or see a chiropractor and get your neck adjusted. Manipulation of the neck is at least as effective as other medical treatments and is safer than many of the drugs used to treat similar conditions. http://www.ncbi.nlm.nih.gov/pubmed/17258728
The term chiropractic is often mis-used for treatment carried out by non-chiropractors. This leads to over- reporting of incidents blamed on chiropractors, including in the BMJ.
In one report of 24 cases attributed to chiropractors, not one was shown to be a chiropractor http://chiromt.com/content/14/1/16#B21.
Chiropractors are highly trained in spinal care. In one UK study undertaken in 2007, of 50,000 neck treatments reviewed, not one single adverse event was reported.
The cherry-picking of poor quality research needlessly raises alarm in patients and does little to help the people suffering from neck pain and headaches to choose the most appropriate treatment.
If you have any concerns about your treatment, please discuss this with your chiropractor.
Massive congratulations to Stuart Calder who completed his first half marathon recently, in order to fundraise for the Bristol Children’s Hospital. His daughter Sofia, pictured here with Stuart on the left, was born with the same congenital heart defect as Simon and Leah Rose’s son, Edward. Both underwent successful, life saving heart surgery at the Bristol Children’s Hospital and so it is a charity that we actively support.
We are sure that you will join us in congratulating Stuart on his great achievement for a very worthy cause, and in wishing the Calder family well for the future. If you would like to top up Stuart’s very respectable total raised so far, you can do so at www.justgiving.com/clancalder.
We are very pleased to be able to introduce our new receptionist, Nicola Webb, to you. Nicola is a great addition to our clinic, she has lots of experience from previous “people focused” roles and fits into our team perfectly. She will be helping us out here on a part – time basis, working mornings.
Nicola, Mary and myself look forward to providing a first class reception service to you here at the clinic, to complement the best quality of patient care that our practitioners provide.
I completed it!! I’m very proud of my time of 1 hour 34 minutes, much quicker than I expected.
The water for the swim was 21 degrees, practically a bath compared to last time, so I actually found myself overtaking people. We were pulled up the bank by two men, then running into transition trying desperately to get my wetsuit off. I must somehow learn how to take my feet out of the wetsuit whilst running! Its very tricky! Onto the cycling which went so much quicker than my practice. Its amazing what a difference it being a race makes and the thought of people overtaking me spurred my legs to go faster.
Before I new it I was off my bike running back into transition to rack my bike and no more than 1 minute later running out the other side for the two laps of the lake.
At this point my legs were like lead mainly because I couldn’t feel them! I soon got into a rhythm that I thought was quite slow and steady but did manage to overtake some more people.
I know for next time that the run is something I need to push harder on as when I saw the finish line I managed to sprint to it…..clearly I had too much energy left and should have run faster!
I am already searching for the next one to sign up to…….I have the bug!
