A question I am asked at least once a week and more likely once a day.

IMHO: At one time more than 10% of the UK’s population suffer from headaches and they are one of the main reason for seeking advice from a GP. Over 90% of all headaches are primary headaches – this includes all tension-type, migraine, cervicogenic and cluster headaches. Primary headcahes have no other underlying medical condition to cause them - so, if you have a headache is is very unlikely to have a serious medical condition as the cause.

In a report published in 2001 by researchers at the ‘Duke University Evidence-Based Practice Center’ in the USA they found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had this form of treatment had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

We've certainly had real success here in C1 Chiropractic Health Clinc with these headaches and give us a ring if you want to know more.

And, I suspect there is more - far more, out there and I'll try and find it and add it as I see it.

Well firstly, what is it?
Carpal tunnel syndrome (CTS) is an injury caused by a compressed nerve in the wrist, resulting in pain and numbness in the index and middle fingers and weakness of the thumb. The carpal tunnel receives its name from the eight bones in the wrist, called carpals, which form part of the "tunnel" through which passes the nerve leading to the hand.

What you should expect to feel:
Some signs and symptoms of CTS include the following:

Night-time painful tingling in one or both hands that frequently cause sleep disturbance.
A sense that fingers are swollen, even though little or no swelling is apparent.
Daytime tingling in the hands, followed by a decreased ability to squeeze things.
Loss of strength in the muscle at the base of the thumb.
Pain shooting from the hand up the arm as far as the shoulder.

We commeonly treat CTS at the clinic - C1 Chiropractic Health Ccentre. The methods we and most chiropractors use to treat CTS include manipulation of the wrist, elbow, and upper spine.

And there are some good studies that support the use of chiropractic treatment for CTS.

In the first study, 25 individuals diagnosed with CTS reported significant improvements in several measures of strength, range of motion, and pain after receiving chiropractic treatment. Most of these improvements were maintained for at least 6 months.

A second study compared the effects of chiropractic care with conservative medical care (wrist supports and ibuprofen) among 91 people with CTS. Both groups experienced significant improvement in nerve function, finger sensation, and comfort. The researchers concluded that chiropractic treatment and conservative medical care are equally effective for people with CTS. Now this one is the most significant bearing in mind the damage ibuprofen can do to you.

And the good news is that most people's symptoms clear up within a few months with conventional treatment. If left untreated, CTS in advanced stages can become quite serious, involving a loss of sensation, muscle deterioration, and permanent loss of function.

If you need to ask us more contact us at: info@c1healthcentre.co.uk

or have a look at: www.c1healthcentre.co.uk
Supporting Research:

Banner R, Hudson EW. Case report: acupuncture for carpal tunnel syndrome. Can Fam Physician. 2001;47:547-549.

Bonebrake AR, Fernandez JE, Dahalan JB, Marley RJ. A treatment for carpal tunnel syndrome. J Manipulative Physiol Ther . 1993;16(3):125-139.

Bonebrake AR, Fernandez JE, Marley RJ, Dahalan JB, Kilmer KJ. A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. J Manipulative Physiol Ther . 1990;13(9):507-520.

Branco K, Naeser MA. Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies -- an open protocol study. J Altern Complement Med. 1999;5(1):5-26.

Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. J Manipulative Physiol Ther . 1998;21(5):317-326.

We always knew this at the clinic but now....

it’s official and available to read in the British Medical Journal published June 17 2006 in an article called "Diagnosis and Treatment of Low Back Pain". This study looked at over 1000 randomized controlled trials of all low-back treatments. Chiropractic management fared very well in the study, with spinal manipulation recommended for both acute and chronic LBP.

Invasive procedures are hit hard. Facet joints, epidural, trigger-point, and sclerosant injections, and all surgery except surgical discectomy in selected patients who have not responded to conservative management are not recommended.

Most acute patients recover from their pain but up to 73% will have a recurrence of the pain in a year. Only 5% develop chronic pain – but identifying these is the real priority and something we work hard at doing.

Interestingly some of the treatment recommendations from 11 National Clinical Guidelines for acute low Back Pain are:

• Stay active
• Prescribe medications if necessary
• Discourage bed rest
• Consider spinal manipulation for pain relief
• Do not advise back-specific exercise.

A useful web site to check these on is :
www.backpaineurope.org
and of course contact us if you want to know more:
info@c1healthcentre.co.uk
or:
www.c1healthcentre.co.uk

Koes BW, van Tulder MW and Thomas S (2006) Diagnosis and Treatment of Low Back Pain British medical Journal 332:1430-1434

I'm getting increasingly unsettled by the 'tight hamstring' cry of many of the patients I see at the clinic. Why is it only hamstrings that get tight - I've rarely heard of someone complaining of tight biceps.

Hoskins et al. explain that hamstring injuries are the most common injury in running-based power sports. Conventional sports medicine‘s thinking is that poor flexibility, fatigue, lack of warm-up and weakness are factors for injury – but there is no good scientific evidence to support this thinking.

Hoskins’s RCT took 59 adults from two Australian Rules football teams. One group continued to receive the typical gold standard care as directed by the club staff for the season. The other group received massage, as directed by the club staff, and chiropractic management, as directed by the chiropractor, with a minimum treatment schedule of one treatment per week for 6 weeks and 1 treatment per fortnight for 3 months then one treatment per month for the rest of the season.

Injury diagnosis was done by the club staff blind to which treatment has been received.

After 24 matches there was a significant difference in favour of those in the chiro group. There was also a significant difference in the number of weeks missed due to hamstring injury: 4 weeks total verses 14 in control, low limb muscle strain (4 vs 21), non-contact knee injury (1 vs 24).

Hoskins w Pollard H, Bonello r (2007) the effect of sports chiropractic on the prevention of athletic injuries in Elite athletes: a randomised controlled trail. Abstract in Proceedings of the WFC’s 9th Biennial Congress, 163-164

A start in the addressing of this testing condition, any thoughts or better yet, any better evidence?

Glucosamine - and that other good stuff

I have found myself recommending the benefits (now proven) of taking some form of supplements to support joints to loads of our patients here at C1 Chiropractic Health Centre and I thought a summary might help get the message out and clarify understanding.

What should you take?
What you are after is called glucosamine and chondroitin. This stuff is described as the ‘cement of the connective tissues’. These connective tissues include the cartilage that covers the ends of your bones which acts as a shock absorber and helps the joint move smoothly.

Chondroitin
Chondroitin is produced mainly from shark cartilage extract. Unfortunately there is huge inconsistency in the concentrations of chondroitin extracted from this source, so its benefits are somewhat dubious and no conclusive studies are available at present. Helpfully, the body manufactures its own chondroitin from glucosamine and so its addition to your supplement is probably unnecessary.

Why should you take a supplement?
The matrix that your cartilage is built from is relatively inert stuff, it has little or no direct blood supply and a few cells to keep it maintained. The stuff itself is not widely available in your diet and it is not well absorbed by the body. If you damage your joints or they are suffering ‘fair wear and tear’ then this cartilage will be damaged. If this occurs the body tries to repair it but with little of this building material available. The idea behind supplements is that you make sure that your body has enough of the stuff to allow the cells in the cartilage matrix to effectively repair the cartilage.

Which type of Glucosamine is best?
If you don't have a shellfish allergy D-Glucosamine Sulphate 2KCl is the stuff. This is manufactured from shellfish.

If you do have a shellfish allergy D-Glucosamine Hydrochloride (HCl), which is synthesised from a protein taken from shellfish, is the stuff for you. Generally speaking, shellfish allergy is caused by other constituents within the shellfish, not the protein!

Powder v Liquid v solid
Glucosamine is available in the following forms:
• Pure Powder
• Capsules
• Tablets / Caplets
• Liquid (Joint Formulas)

Pure powder is the best option – mixed with liquid of your choice, it is the most bioavailable and economical.
Liquid joint formulations are best for absorption however you are often paying for the suspension liquid when it's the Glucosamine that does the job.
Tablets – you are paying for the ‘binding and bulker’ in the tablet and they can pass straight through.
Capsules without any bulking ingredients or flow agents are good.

So it's best to buy pure powder and add it to a liquid of your choice however this may not be available and any is better than none.

And where possible they should contain HCL and Sulphate
How much should you take?
The recognised dosage for Glucosamine is 1,500mg per day but evidence has shown that:
If you weigh less than 180 lbs take 1500 mg/day
If you weigh more than 180 lbs take 2000 mg/day

This can be taken either in one dose ie 1,500mg or split in to three equal doses ie 500mg three times a day.and it is best with food.

What does it taste like?
Glucosamine Hydrochloride (HCl) is naturally sweet tasting with a hint of bitterness - hard to describe but not at all unpleasant.
Glucosamine Sulphate 2KCl tastes sweet and very slightly fishy! Something like very, very mild prawn cocktail crisps, again with a touch of bitterness.
Glucosamine Sulphate NaCl tastes slightly salty and fishy.

Side Effects
Allergic reactions to this supplement appear to be rare. At the suggested adult dosage of 1,500mg per day, adverse effects have been limited to mild, temporary gastrointestinal upset e.g. mild nausea, vomiting, constipation, diarrhoea and dyspepsia, and, rash, drowsiness, headache and insomnia. In one trial, people with peptic ulcers and those taking diuretic drugs were more likely to experience side effects. (Ref 1)

In 1999 the first case of an allergic reaction to oral Glucosamine Sulphate was reported (Ref 2). .
Pregnant or Lactating Mothers - should not to be used by women who are pregnant or breastfeeding due to lack of data on long-term safety.
If you have a reaction or one of the symptoms mentioned above, stop taking the supplement and consult your G.P.

Links with Diabetes
People with diabetes should consult with a doctor and have blood sugar levels monitored if they are taking glucosamine.
Animal research has suggested the possibility that glucosamine could contribute to insulin resistance (Ref 3,4). Theoretically, this could result from the ability of glucosamine to interfere with an enzyme needed to regulate blood sugar levels (Ref 7). However, available evidence does not suggest that taking glucosamine supplements will trigger or aggravate insulin resistance or high blood sugar (Ref 8). Two large, 3-year controlled trials found that people taking Glucosamine Sulphate had either slightly lower blood glucose levels or no change in blood sugar levels, compared with people taking placebo. (Ref 9,10)

Until more is known, people taking glucosamine supplements for long periods may wish to have their blood sugar levels checked.

High Blood Pressure
Some Glucosamine Sulphate is processed with sodium chloride (salt), which is restricted in some diets (particularly for people with high blood pressure).

Contraindications
At the time of writing, there are no known drug interactions with glucosamine.

Alternatives to Glucosamine
If you've tried the different forms of Glucosamine and they didn't suit you then try MSM (Methylsulfonylmethane). MSM has a much smaller, biologically active sulphur molecule than any of the glucosamines and rarely causes an allergic reaction!
Natural pine tree source MSM is highly bio-available according to radio-labelled studies. Again, it's important to check the source as most MSM is manufactured from petrochemical source

Recommended Manufacturers
www.a1msm.co.uk
180g Bio-Pure D-Glucosamine Sulphate (2KCl) powder – @ £17.95 which should last for a month and so works out at about £4.48 a week.
Distilpure natural pine tree source MSM.
www.alimentnutrition.co.uk
Two good products:
Ultimate Glucosamine and Chondroitin Effervescent @ about £11.89 for 30 sachets so £2.77 a week (with 200% RDA for Vit C as a bonus)
Liquid glucosamine @ £4.95 a bottle so £1.75 a week (and 100% RDA for Vit C)
References
1. Tapadinhas MJ, Rivera IC, Bignamini AA. Oral glucoseamine sulfate in the management of arthrosis: report on a multi-centre open investigation in Portugal. Pharmatherapeutica 1982;3:157-68.

2. Matheu V, Bracia Bara MT, Pelta R, et al. Immediate-hypersensitivity reaction to glucosamine sulfate. Allergy 1999;54:643-50.

3. Virkamaki A, Daniels MC, Hamalainen S, et al. Activation of the hexosamine pathway by glucosamine in vivo induces insulin resistance in multiple insulin sensitive tissues. Endocrinology 1997;138:2501-7.

4. Rossetti L, Hawkins M, Chen W, et al. In vivo glucosamine infusion induces insulin resistance in normoglycemic but not in hyperglycemic conscious rats. J Clin Invest
1995;96:132-40.

5. Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol 1999;26:2423-30.

6. Drovanti A, Bignamini AA, Rovati AL. Therapeutic activity of oral glucosamine sulfate in osteoarthritis: a placebo¬controlled double¬blind investigation. Clin Ther 1980;3:260-72.

7. Barzilai N, Hawkins M, Angelov I, et al. Glucosamine-induced inhibition of liver glucokinase impairs the ability of hyperglycemia to suppress endogenous glucose production. Diabetes 1996;45:1329-35.

8. Russell AI, McCarty MF. Glucosamine in osteoarthritis. Lancet 1999;354:1641; discussion 1641-2 [letters].

9. Rovati LC, Annefeld M, Giacovelli G, et al. Glucosamine in osteoarthritis. Lancet 1999;354:1640; discussion 1641-2.

10. Reginster JY, Deroisy R, Rovati L, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357:251-6.

11. Vaz AL. Double¬blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthritis of the knee in out¬patients. Curr Med Res Opin 1982;8:145-9.

Here's and interesting artical I found that I think neatly sums up the current position on this:

CHIROPRACTIC AND STROKE - THE EVIDENCE

The following information addresses the often exaggerated concern that chiropractic adjustments cause cerebrovascular accidents (stroke). Putting it plainly, there is no link, it is a red herring and perhaps is quite the opposite.

Chiropractic is one of the safest forms of healthcare in the world and is at the forefront of spinal care and the wellness movement.

Unfortunately there have been many unethical and anti-competitive attempts to discredit chiropractic (refs 1-3) which is the largest drugless health care profession in the world, and one of the fastest growing.(4)

A suggestion has been mooted which cannot be proved or disproved that chiropractic might be associated with stroke (not linked to or causing but associated – confused? Read on), one study showing showed that stroke occurred a short time after 1 in 5.85 million chiropractic neck interventions. One in almost six million?? Huh? How many strokes occur after a cup of tea? Or even any other daily activity – what about looking up? Straining to go to the toilet? What constitutes an association?

To create a study capable of proving or disproving an association or not, you would have to adjust 6 million people with a higher than average risk of stroke to see if one of them had an event related to that adjustment. To prove or disprove a link, a study would have to involve 600 million people to get a study group of perhaps 100 adjustment related strokes. This is an impossibility and the reason why such a red herring has continued to exist.

On examination, many of the strokes quoted in the literature have been falsely attributed to chiropractors when in fact the person carrying out the manipulation was not a trained chiropractor (examples include a kung fu practitioner, a blind masseur, someone’s wife, an Indian barber, GPs, osteopaths, and physiotherapists).(5)

In a German study published in Neurology in 2006, an attempt was again made to link chiropractic and stroke when in fact none of those adjustments/ manipulations were carried out by chiropractors.(6) Half of the manipulations (not skilled chiropractic adjustments) that resulted in stroke were carried out by orthopaedic surgeons the other half by untrained unqualified heilopraktkers masquerading as ‘chiro-practitioners.’

The point here should have been public protection, the safety record of manipulation by chiropractors and the need for legislation to protect both the public and the profession instead it was used to libel a profession. Indeed these same incidents in Germany were brought to public attention by a chiropractic researcher, Dr. Adrian Wenban, in such a vein at the 2005 European Chiropractic Convention, a full year previous to its publication in Neurology.(6)

In over thirty years involving billions of chiropractic adjustments in the US, there were ten cases of death within any sort of period of time that followed neck manipulation. Nine of these were carried out by medical doctors, even though chiropractors perform 94% of the cervical manipulations/ adjustments in America. In other words, medical manipulators caused 90% of the lethal complications in less than 6% of all those being manipulated, which sends out a strong message for the quality of care and safety of chiropractic.(7)

Sorry now hold on; it follows then that if the figure of association was one in six million for neck manipulation that figure now looks more like one in 60 million for chiropractic adjustments. The study group then needed to prove or disprove it? Yes that’s right, it would require six billion people all at a higher than average risk of stroke being adjusted and monitored pre and post adjustment for twenty four to forty eights hours after and then all that information collated, collaborated and reviewed – now you can see why it can neither be proved nor disproved. It is a red herring.

Put into perspective, what are the risks for every day activities and medication promoted everyday? Reversing the car, jogging, taking HRT, blood pressure medication, cholesterol lowering medication, even taking a neurofen, a pain killer or an anti-inflammatory instead of being adjusted?

Even if we were to agree this estimate of association of one in six million, this is over 700 times lower than the established risk of death from taking anti-inflammatories such as aspirin and ibuprofen, yet these are prescribed everyday for head, neck and back pain. The figure of association is also much less than that associated with many everyday activities including reversing a car, jogging, tai chi, various sleeping positions, coughing, stooping to get a bucket and even yawning.(8-10) Yes you are more likely to die from yawning than a chiropractic adjustment. Now do you see it?

In 2002, researchers announced they were calling a halt to a study after it had become clear that the risks of HRT, including stroke, outweighed its benefits. The study results, which appeared in the July 17, 2002 issue of the Journal of the American Medical Association, were released early because of the importance of the researchers' findings. (11) HRT is still being prescribed, long term, despite this.

There is interestingly enough evidence to show those being adjusted are less likely to have a stroke. When you compare estimates of the risk of stroke following neck adjustment/ manipulation (using the higher estimate of 0.00025%) to the risk of fatal stroke occurring in the general U.S. population (0.00057%) it is less than half.(12-16) There is also ample proof to show people adjusted regularly clearly benefit from regular chiropractic care and enjoy a higher level of health, mobility and an improved quality of life.

There is no link. An association has been mooted that cannot be either proved or disproved in an effort to smear the chiropractic profession in the public arena; a profession that has a high safety record and offers a choice for better health without the use of drugs or surgery. It is a red herring: neither proveable nor disproveable. What is alarming and is real is the risk of stroke from the very medications often given instead of being referred to a chiropractor.

Chiropractic does not cause stroke, it is not linked with stroke nor is it associated with stroke. Chiropractic is however linked with better health, a high safety record and established benefit.

References

1. Wilk CA. Medicine, monopolies, and malice. Garden City Park, NY: Avery Publishing Group; 1996. (renamed Chiropractic and Medicine: The Need to Work Together for Effectiveness)

2. Canadian Stroke Consortium

3. www.quackwatch.com and www.chirobase.com

4. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990-1997. Journal of the American Medical Association 1998; 280(18): 1569-1575.

5. Terrett AGJ. Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. Journal of Manipulative and Physiological Therapeutics 1995;18(4): 203-10.

6. Vertebral artery dissections after chiropractic neck manipulation in Germany over three years. Reuter U, Hamling M, Kavuk I, Einhaupl KM, Schielke E; J Neurol. 2006 Jun;253(6):724-730.

7. http://www.chiroweb.com/archives/17/05/05.html

8. Dabbs V, Lauretti W. A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain. Journal of Manipulative and Physiological Therapeutics 1995; 18(8): 530-536.

9. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs. New England Journal of Medicine 1999; 340(24): 1888-99.

10. Graumlich JF. Preventing gastrointestinal complications of NSAIDs: Risk factors, recent advances, and latest strategies. Postgrad Med 2001; 109(5): 117-28.

11. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. Principal Results From the Women's Health Initiative Randomized Controlled Trial. Journal of the American Medical Association. 2002;288:321-333.

12. Myler L: Letter to the editor. Journal of Manipulative and Physiological Therapeutics 1996;19: 357.

13. Cohn A. A review of the literature regarding stroke and chiropractic. Journal Of Vertebral Subluxation Research 2001;4(3):42-59.)

14. Shievink WT, Mokri, B, O'Fallon WM. Recurrent spontaneous cervical-artery dissection. New England Journal of Medicine 1994; 330: 393-397.

15. Shievink WT, Mokri B, Whisnant JP. Internal carotid artery dissection in a community: Rochester, Minnesota, 1987-1992. Stroke 1993; 24: 1678-1680.

16. Giroud M, Fayolle H, Andre N, Dumas R, Becker F, Martin D, Baudoin N, Krause D. Incidence of internal carotid artery dissection in the community of Dijon [Letter]. Journal of Neurology and Neurosurgical Psychiatry 1994; 57: 1443.

Chiropractors are always batting back the rumblings of the allopathic medicine junkies and the best way must be to use good research. Here's one of our favorates: the UK BEAM Trial, published in British Medical Journal online (19 November 2004).

The Trial was funded by the Medical Research Council and the NHS Health Technology Assessment Programme. It was prompted by a previous trial of chiropractic published by the MRC in the early 1990’s [the great Meade trial]. The Meade trial showed that chiropractic treatment was more effective than hospital management for chronic back pain.

Two main questions arose from the Meade study:
1. Is it chiropractic treatment, or is it treatment within a private practice setting, that caused the difference? (the chiropractors were all in private practice).
2. Is there something particularly effective about chiropractic, or could any suitably trained professional achieve the same benefits using a similar approach?

Before the BEAM Trial, the professional bodies of chiropractic, osteopathy and physiotherapy formulated an agreed package of care that uses spinal manipulation and BEAM compared this package of care in private practices and in NHS settings, with best GP care or exercises to see if private practice caused the difference. It demonstrated that spinal manipulation, as practised by chiropractors, is a cost effective treatment for back pain and compares favourably with GP ‘best practice’.

Here's a World Health Organisation definition

"A health care profession concerned with the diagnosis treatment and prevention of the disorders of the neuromusculoskeletal system and the effects these disorders on general health. There is an emphasis on manual techniques and/or manipulation, with particular focus on the subluxations."

Pretty all encompassing I suspect - any one to add anything?