This year for Chiropractic Awareness Week the British Chiropractic Association is focusing on taking care of your back as parents/guardians. We have some great advice on our Advice and Media page. You can obtain this in handout format from our clinic reception – do pop in if you would like to pick one up.
To celebrate Chiropractic Awareness Week we are launching one or two competitions to win a free massage therapy session – to enter make sure you either like our facebook page, follow us on twitter or put a completed feedback form into our competition entry box at reception!
Lastly – keep an eye out for us in the local paper….!
The Brugger Break, also known as the Brugger relief position is an exercise that is brilliant for desk workers as it reverses the effects of sitting at a desk for long periods. It is a quick exercise at only 10 seconds duration and is easy to perform. When performed regularly (every 20 minutes) it can be one of the answers to the nagging question “how can I improve my posture?”
Here is how to perform it: i) Sit forwards onto the front edge of your seat ii) spread your legs out to 45 degrees each side and lean forward slightly so that your body weight is distributed in to your feet as well as your back. iii) extend your arms and then pull them back and down behind your body with your thumbs turned outwards and palms open. iv) tuck your chin straight back in to your chin (essentially giving your self a double chin) v) push you chest forwards vi) take a deep breath in… then out, as you are breathing out push your chest even further forwards, remember to keep your hands back and to the sides behind you. vii) hold the out breath for 10 seconds and then return to work. viii) Set a timer or write yourself a post it note reminder for on your computer so that every 20 minutes it can be performed.
it only takes 10 seconds and will improve your posture, decrease your chance of back pain and aid any on-going treatment you are currently receiving.
Research carried out on behalf of Premier Inn suggests that you can tell a lot about someone’s personality by the position they sleep in. Your bed can also be the cause of back pain and the British Chiropractic Association has some great advice for sleep posture and how to choose your bed and pillow.
Choosing the right bed can minimise those factors that may lead to, or aggravate back pain. Research by the British Chiropractic Association in 2011 showed that of those experiencing back pain, 41% of women and 36% of men said that their pain could be brought on by a night’s so-called ‘rest’.
We come in different weights, shapes and sizes, but have one thing in common; we spend more than a third of our lives in bed, so should choose our beds carefully. Which is better, a hard or soft mattress? – The best mattress is a ’supportive one‘. A 16 stone person sleeping on a mattress may not get the same support as a 10 stone person sleeping on the same mattress.
How do I know which is the right mattress for me? – If you are lying on your side, your spine should be parallel to the mattress and your spine should not sag (bed too soft) or bow (bed too hard). The longer you can spend lying on a mattress before you buy it, the more accurate this feeling will be. – Your pillow should be an extension of this i.e. your neck should be a continuation of the straight spine and not too high or too low. What about my partner? – Always shop with your partner as your respective ideal mattress tensions could be very different. If this is the case, buy beds from a range that allow two single mattresses to be zipped together, so that you both get the support you need.
How do I know if my current bed/mattress needs replacing? – Are you and your partner getting comfortable nights sleep? If the answer is no, your bed may be the problem. -Can you feel the springs through the mattress? If the answer is yes, it is definitely time to buy a new one. – Is the bed more that 10 years old? If the answer is yes, consider purchasing a new one – beds wear out and may sag or lose support with time.
What things can I do to help prevent back problems even with my new mattress? – Try and adopt a sleeping position which creates less physical stress on the back. For example, lying on your side is better than lying on your front with your neck twisted to one side. – Keep moving and avoid being in any one position for too long.
No matter how comfy the position may initially feel, the longer you stay in one position, the more this will ‘load joints’. If your partner moves around a lot at night, try separate beds for a while as your partner’s movement could aggravate YOUR back condition! – Drink water. Keep well hydrated; dehydration can make muscles ache. – Don’t leap out of bed first thing in the morning. After you have woken up wake up, try some gentle stretches. – Wake up your body. Once up, avoid bending or doing anything sudden or strenuous until you back wakes up!
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.
…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.
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
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