This is a common question I often get asked about, I have written this post as a recent study looked at the effects of high heels >10cm on the lower back.
The paper is called “The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait” by Mika A, Olesky Ɫ, Marchewka A, Clark BC published in October 2012.
The conclusion they found was “wearing high-heeled footwear may have clinical consequences, including increasing general or muscular fatigue, creating swelling or limited movement, raising the possibility of cumulative strain, promoting fibrosis in the paraspinal musculature, altering joint loading profiles…this list could go on and all these factors could be both consequences and potential causes of LBP.” LBP is short for ‘Lower Back Pain’.
As usual like most research papers state there is always more research required. However, as you can see this paper found good reason to suggest high heels >10cm as a cause of lower back pain.
My answer to the question is usually that the high heels may be a contributing factor but not the sole reason for your back pain. There are usually lots of individual reasons that all add up to the crescendo that is the back pain. Eliminating/treating each small reason bit by bit is the route to a healthy back. Maintaining a healthy back requires continuing exercises and stretches at home to combat the inevitable compensations your body has to make due to the activities of daily life and our hobbies.
If you are going to wear heels, I would recommend doing the exercises and stretches necessary to reverse the effects they cause. Some of which are stated by the above stated research paper. A good Chiropractor should be able to help you with these problems and any back pain you may have.
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!
What a fantastic yet exhausting week at the paralympics! The response for the massage was brilliant everyone kept coming back for more!
Most clients were media people carrying cameras all day long who were looking for relief for their shoulders. Firstly I would ask them to take 3 deep breaths in to relax. Then I started on their lower back to make sure they felt a release of tension all over the back, not just at the shoulders. Every person I saw had shoulders up by their ears with tension and the muscles that run parallel to the spine (Paraspinals) were solid too. I would use broad techniques with the palm of my hand to begin with to warm up the muscles, then move onto using my thumbs (butterfly technique) to increase the pressure to release tension. I then moved onto specific stretch technique, in which I apply pressure down into the muscle as the client stretches out the muscle that has been pinned by me. This is a fantastic technique that has instant results, however it is sometimes quite tender. I used this technique on the paraspinals, upper trapezius, and neck muscles with which you can see visible increases in range of movement of the cervical spine (neck) straight after the technique has been used.
The therapists I got to work with at the paralympics were fantastic, it was lovely to meet new faces and learn from other people. All in all it was a great experience and I even got to meet some famous faces!!
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
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.
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