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Caring for Carers – Back Pain Awareness Week

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This week is Back Pain Awareness Week – a campaign run by the charity Backcare – http://www.backcare.org.uk/. Visit their website to find out more, and to see their useful tips and information.

Back Pain is well documented for costing the UK economy millions of pounds in time lost to sickness, each week. What is less documented is the strain on the backs of people who are carers – lifting, carrying and helping others everyday, despite the toll on their back. This is the theme of this year’s Back Care Awareness Week.

If you are a carer and would like advice on posture and lifting, or are suffering with back pain due to your lifestyle as a carer, please do get in touch with us to find out about our consultations and our posture analysis.

Email leah@longlevenschiro.com

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The Anti Inflammatory Diet

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Lots of you have been asking us for more information about anti-inflammatory diets recently. We’re very interested in nutrition and believe that following an anti-inflammatory diet can bring great health benefits. So, for all those of you who would like more information here is a good starting point provided by Danny Adams:

This diet is ideal for both Athletes and the general public but be aware that some of these recommendations may not apply to people with certain diseases and it is worth mentioning any concerns or diet changes you’d like to make with your consultant.

The majority of the population eats a diet with completely the wrong balance of nutrients, vitamins and minerals along with an unhealthy balance of pro-inflammatory to anti-inflammatory foods. A pro-inflammatory food is one that contains Omega-6 fatty acids, an anti-inflammatory food is one that contains Omega-3 fatty acids. Pro to Anti- inflammatory food ratio should be 1:1, the ratio of the average United States diet is 25:1 (as an Englishman, may I state how similar our diets are to the US with studies showing recently that we have the most obese population of women in Europe and the second most obese population of men second only to Malta which is basically a mini England as it has so many ex-pats from our country. In my opinion our ratios should therefore be considered similar).

An unequal ratio of pro to anti-inflammatory foods can lead to slower recovery and healing rates and is linked with the increased chance of onset of a host of diseases, from Depression to various types of Arthritis.

Maintaining your current diet may be exacerbating a condition or injury that you currently have. (E.g an ongoing shoulder problem, back pain, menstrual irregularities, chronic disease)

By changing your diet now you may feel a difference within one or two weeks. Now that I have covered the benefits of changing your diet, I will explain what is recommended:

Eliminating grains and unhealthy snacks: including bread (E.g Whole wheat bread pro- to anti-inflammatory ratio is 27:1!!) and Crisps (ratio 60:1).

Increase fruit and veg: Broccoli (ratio 1:3), Kale (ratio 1:1.3), Fish (ratio 1:1 to 1:7)

Increase Anti-oxidants/phytonutrients to battle inevitable free radicals as a result of our systemic processes: adding supplements of Vitamin C, E, lipolic acid and Coenzyme Q10 to a diet rich in fruit and veg.

Increase Potassium intake: Achieved with increased fruit and veg and decreased grains as already mentioned.

Consider taking daily supplements that are lacking in the modern diet: recommended are; Multivitamins, Magnesium (1000mg/day), omega-3/fish oil (1000mg/day), if older than 25 yrs take Coenzyme Q10 (100mg/day for 6 years has been found safe).

Try to achieve a Carbohydrate: Protein: Fat ratio of 40:20:40

Recommended fluids are water, red wine (small amount and disease dependent, i.e may exacerbate gout) and decaf green tea

Meats and protein recommended are those that are grass and not grain fed, including the chickens that lay the eggs! (the packaging must state grass fed as otherwise the product is highly like to be grain fed)

Recommended cooking oils are Organic extra virgin olive oil, butter, and coconut oil.

Recommended desserts include fruit with half or heavy cream (berries and cherries for example)

Eliminate foods containing refined sugars (sweets etc) to avoid diabetes and hyperinsulinemia (syndrome X).

Try to eat organic and stop smoking if you are a smoker.

If you have suffered an injury from a sport then proteolytic enzymes are recommended: Bromelain daily 200-2000mg taken immediately after injury for no longer than a week.

My Experience:

This all sounds like a lot of work and a bit extreme, I tried it on myself for a couple of weeks to see how I felt and to see were potential hurdles occurred. I did notice a mild increase in energy (mainly because I realised just how tired I was when I stopped the diet after two weeks). My main hurdle was breakfast, as no grains means no bread or cereal (English staple breakfast). I ended up eating a large amount of eggs which did become rather sickly as I began to dislike the texture. I stopped after 2 weeks as I lost quite a bit of weight (not bad, but not intended). I am about to start again, the plan this time is that for breakfast I will be varying the way I cook my eggs and to pre-prepare or buy canned fruit and fruit salad for a change at breakfast time. I will also increase my portions of fruit and veg to avoid losing weight, I’ll let you know how I get on!

References: Hyde, T.E, Gegenbach, M.S (2007). Conservative management of sports injuries. 2nd ed. London: Jones and Bartlett. 1067-1092.

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Safely Does it with the Christmas Decorations!

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There’s lots of helpful information on the British Chiropractic Association’s website.  We thought this particularly relevant and useful right now!:

Buying the Tree: When buying your Christmas tree, take care when getting it into the car. Use a trolly and ask for assistance when loading into the car. Same when you get home; don’t tackle it on your own – wait until you have someone to help. Don’t lift with your arms straight out, keep the elbows bent and to your side to minimise the stress on your back. Bend knees and not your back to pick items up.

Time for the decorations!: When putting up the Christmas decorations, try not to overstretch and use a step ladder to hang up your garlands or to put the decorations higher up your tree. When using the ladder or steps, make sure you are always facing them, keeping your shoulders, hips and knees pointing in the same direction. Rather than leaning or reaching, move the ladder or step regularly to keep up with where you are.  Any kind of ladder must be firmly and safely planted in position and, if possible, have someone else there to keep an eye on things.

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Sciatica…

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…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’.

Disc Bulges

The most common cause of Sciatica is what is known as a Disc Bulge (Click here for a complete description of what a disc bulge is). A disc bulge between the vertebrae of L4 and L5 or between the vertebrae of L5 and S1 can lead to ‘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

 

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What Makes a Good Chiropractor and a bad Chiropractor?

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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 bad things that from my experience I would recommend to watch out for when you go to see a Chiropractor:

  1. Treatment times less than 15 minutes long.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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:

  1. Treatment times 15 minutes or longer.
  2. Recommendation by a trusted friend, family or colleague.
  3. A clean, open friendly practice environment centered around the patient.
  4. 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.
  5. Prescribed exercises or stretches at the end of the consultation, checked regularly and progressed in following treatments.
  6. Accessible staff by phone and e-mail in case of complications.
  7. 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.
  8. 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.
  9. 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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Mr G, Gloucester

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“Tracey really listened to what my concerns/needs were, and then used her knowledge to explain how she would proceed, given all the information. Tracey makes you feel relaxed the moment you walk into the room. As she talks to you and prepares for your massage, you can tell she really has an interest in not only what’s going on with your body, but in whom you are. You find yourself feeling comfortably assured that you will be receiving a wonderful therapeutic experience.”She encourages me to be an active part in my own treatment by putting me to work with passive resistance stretches or offering me suggestions for moves I can do at home. She is open to ideas and interested to know what works for you. My weekly treatment has become a part of my life, some time for me, and my well being, its working!!…….. Thank you Tracey”

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