Chiropractic case studies

The New Scientist says:

"Hypnosis is the most effective way of giving up smoking"

(‘Cognitive reactions to smoking relapse’, New Scientist, Vol 135)

Are you struggling to quit smoking?

If you are hypnosis could be the answer. Did you know that many smokers have been helped to quit with a single session of hypnotherapy?

This month at C1 the focus is on stopping smoking. As the resident Hypnotherapist I have worked with numerous clients who wanted to stop smoking, many of whom had tried previously and failed or who had struggled enormously when they attempted to kick the habit using other means.

Without an understanding of how hypnosis works and what goes on in the brain when we are "addicted" to something, it can be very difficult to imagine that a two hour session can rid you of a potentially long standing habit. However, in reality the process is relatively simple and effective. Many people have given up smoking with ease, for example some people stop smoking with no problem at all when they fall pregnant or get ill. These are the ones we don't tend to hear about but understanding how they are able to do this is key to the process used in hypnotherapy.

Mindset plays a big part in our experience of addictions and giving them up. Most of us can relate to truly deciding to do something like get fit or lose weight and experiencing how much easier it is to then do this once we have "made up our mind". This use of mindset and powerful suggestion therapy makes for a potent weapon in the battle against the cigarette.

To stop smoking a single two hour session is required.

If you would like to find out more about how hypnosis can help you to stop smoking, please get in touch.

In the words of The New Scientist:

"Hypnosis is the most effective way of giving up smoking"

(‘Cognitive reactions to smoking relapse’, New Scientist, Vol 135)

C1's Clinical Hypnotherpist, Zofie Kucia,  says:

Sleep Problems

Cause:

Sleep disturbances such as an inability to fall asleep or waking during the night can be caused by either stress or a lifestyle with too much going on.  What can happen is that as a result of a particularly stressful period such as a divorce, trouble at work, bereavement or similar we enter into a heightened state of anxiety and during this time, although we “consciously” understand that we are not in danger our subconscious doesn’t understand this.  Put simply, because it does not make sense to sleep when we are in danger we will either struggle to get to sleep or we might manage to fall asleep (often because exhaustion overrides the anxiety) and then wake during the night.  Because of how REM sleep and slow wave sleep interact out sleep can be interrupted as the body struggles to maintain the correct proportions of dreaming sleep and slow wave.

Simply doing too much can also lead to sleep disturbances.  Our body works in line with natural rhythms and if we completely override these by being on the go all the time and taking no breaks it can then be hard to relax and fall asleep when we want to.  We lie in bed, desperate to get to sleep but with a mind that is racing.  Typically the “law of reversed effect” will then kick in; this states that: “the harder you try the harder it becomes”, and this further perpetuates the problem.

Once a sleep problem has been established it then adds to our stress and we feed into a vicious cycle.  Many of us will then start to worry about it, focus on it and talk about it; this too unfortunately only serves to worsen the problem.  Because our subconscious cannot tell the difference between reality and our thoughts, every time we think about the fact that we cannot sleep we strengthen the association and eventually the behavioural template can become pretty entrenched.

The Solution:

Believe it or not, the actual process of dealing with a poor sleep pattern in simple.  In essence, we want to reverse the cycle that caused it!  So, firstly we need to create an environment which is conducive to a good sleep pattern.  Such an environment is a low stress one (OR, if there is moderate stress it is essential to employ healthy means of managing this) and also a daily schedule which includes some breaks- even if they are short!

Secondly, it is essential to stop focussing on the sleep issue; of course this is easier said than done but it is doable with some practice and dedication.  It is also important to start to stop engaging in any habits you might have understandably developed as a result of the sleep challenges.  An example might be going to bed slightly later; typically this involves relaxing more about the whole issue.

This is backed up with deep relaxation during sessions, which is enormously helpful in terms of reversing the cycle and letting both your body and your subconscious know that “everything is ok”.  In addition to this I focus on powerful suggestion work, essentially reprogramming your subconscious so that it gets the message that from now on you can sleep “normally”.

Case History of Stress-related Sleep Disorder:

A typical example of a client I helped to start to sleep properly again is client A.  She came to see me as she would sometimes wake during the night and at other times had difficulty getting off to sleep.  Her mother had died in difficult circumstances about a year earlier and this had caused her much distress.  She had a busy, stressful job.  Client A took away the relaxation CD along with her “homework” of focussing away from the sleep issue and learning to use her imagination in a positive manner.  Over the course of several weeks she listened to the CD which got her off to sleep most nights, her nightmares began to cease and she felt calmer at work.  At first she found it a challenge to think more positively but after a while it seemed much more natural.  She started to go back to the gym and yoga classes and felt much calmer through doing this.  Using some CBT techniques she was able to deal with difficult people at work much more calmly; she also learned that nightmares can serve a useful purpose and not to dwell on these.  Over approximately ten weeks her sleep settled back to normal and one of the things that helped her enormously was learning that the mindset of “I need eight hours sleep a night” was putting pressure on her and serving to perpetuate her problem;  she started to see that this might not necessarily be a helpful belief to have.  As a “side effect” of therapy she gave up smoking and reported feeling much calmer and happier.

Case History of a busy lady with insomnia:

Client B presented with a severe problem in getting to sleep which had been troubling her for some time.  She ran her own company with sole responsibility for the organisation.  When we first met she told me that everything was fine in her life, the only problem was that she couldn’t sleep; if only she could sleep, everything else would be fine.  She had not been on holiday or had a proper break from work for around a year, had a very hectic lifestyle of work and play and was a perfectionist.  I gave her a CD along with my usual explanation of the causes of sleep problems.  At first it was difficult for her to see that it would be essential for her to get her life in order to sort out the sleep problem instead of wanting the sleep to magically fix which would then sort her life out.  After some sessions focused predominantly on relaxation, client B began to come up with some solutions that would help her.  She made some changes at work, made inroads into her perfectionist tendencies and booked two holidays! 

Following on from this she found it easier to focus away from the sleep issue and relax more.  The combination of changes both lifted her mood and enabled her to start to sleep properly once more.  During therapy she stopped taking her prescribed sleeping tablets.   She also learned that once her life was in balance her sleep could then balance itself- and not vice versa!

 

Zoë Corbyn of the Times writes:

http://www.timeshighereducation.co.uk/story.asp?storycode=405427

Can you belive it?

The impeccable Dr Simon Singh (see Kerching for Singh) has slightly bogus looking funding for his SAS and an association with an organisation rife with poor science by the sounds of things. How depressing.

We'll work up some more posts on the problems casued by leg-length inequality (LLI) but I wanted to create a shopping list of the causes of leg-length inequality and came up with the following:

Anatomical:
1. Fracture or disease loss of bone. The classic one.
2. Genetic conditions.
3. Nutritional deficiency leading to leg-length loss.

Functional:
1. Sacroiliac joint dysfunctions leading to pelvic obliquity – and I think the most common, at least in my clinic.
2. The iliosacral joint is restricted on the superior or inferior transverse, or the sagittal axes. This may result from many causes including joint, muscle, osseous or compensatory considerations.
3. Hip joint dysfunction causing compensatory alterations by the joint and muscles that move the joint.
4. I am told that a growth in muscle mass itself. The vastus lateralis muscle appears to push the iliotibial band laterally leading to femoral angle compensations to maintain a line of progression during the gait cycle. This is often misdiagnosed as I-T band syndrome and subsequently treated incorrectly.
5. And the internal rotators of the lower limb being chronically short or in a state of contracture though I hate this sort of diagnosis as there’s never a decent answer to the why?
6. Likewise, short hamstring muscles as these are short because of the leg-length inequality.
7. And apparently, failure or incorrect loading of the Back Force Transmission System (the longitudinal-muscle-tendon-fascia sling and the oblique dorsal muscle-fascia-tendon sling). See the proceedings of the first and second Interdisciplinary World Congress on Low Back Pain.
8. And one I found last week with a patient who has uber lax ligaments and has developed one hyperflexed knee leading to a subsequent low hip on that side.
9. etc.
But the bottom line is look for common things first, identify if they are leg issues or pelvic issues and the and only then start to panic if you can find nothing. However, after a cup of tea and once the ‘why’ is identified you can then start to get things moving.

Any others?

Posted by Rupert Clements of C1 Chiropractic Health Centre.

Sciatica needs chiropractic care, and possibly some other options, to reduce pain in your back and legs.

 

Right, that’s it, I don’t want to hear the cry of: “I have sciatica” ever again unless it has been diagnosed by someone who as a clue.  I’m fed up with having to disabuse patients of this rotten diagnosis; it’s not far off “I have lumbago”.  As a chiropractor here in Bristol, we often have patients coming in for treatment with low-back pain (LBP) and pain running down the back of their legs.  Quite often this has nothing to do with the sciatic nerve and is still called sciatica. 

 

The anatomy:  The sciatic nerve is the longest and widest single nerve in your body.  It branches off at the base of the spine and runs down each side of your pelvic area, supplying nerve impulses to your gluteal region (butt), legs and feet.

 

The pain:  If you've ever experienced sciatica, you know how debilitating this pain can be.  I've seen patients, who could barely walk, couldn't bend over or even stand.  With good care you will be back to your normal self within 2-3 weeks.

 

The solution:  Chiropractic

 

oh, and try:  massage therapy.  I have patients who I see in my clinic that need gentle massage for their sciatic pain.  We use various forms of massage to relax patient's muscles, improve blood flow, and most important, the release of endorphins in the body that act as natural pain relievers.

 

Last but not least, a highly effective technique for treatment that is being used more and more is acupuncture.  A qualified and trained acupuncturist such as our great Zak can provide relief from back pain by simply using thin needles inserted in the area where you feel discomfort

 

There is no guarantee that this or any other combination of treatments will totally eliminate sciatica from reoccurring but if you follow the advice of your chiropractor and seek help early, you should prevent this from happening again in the future.

 

For more information on treatments and alternatives to protect your back, go to www.c1healthcentre.co.uk or contact me personally.

 

Rupert

          I was explaining to a Hungarian ex-gymnast patient about her slight leg-length inequality and the problems this was causing her low-back and she got me with the testing ‘Why?’ question – and, as you all know, this is the best question, and so I took a deep breath and started:

 

Firstly, leg length inequality (LLI) is really common.  A bloke called Knutson found:

 

“Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1).”

So that’s all of us; but, as he adds:

 

“The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches ~ 20 mm (~3/4").”

 

So it has got to be about 2 cm to be clinically important. 

 

However, for most of our patients it is not anatomical differences in leg–length that actually cause the change but pelvic rotation.  Rarely do people’s arms grow to be different lengths so why should their legs.  What really happens is that their pelvises get rotated.  Due to the cunning anatomy of the pelvis the bones do not rotate around the middle of the sacroiliac joints but about a point just below the bottom of the joint.  This means that if the bone rotates it does so like a cam with it getting higher as it rotates forward and lower as it rotates backwards – trust me on this one, it just does. 

 

Now a good way to test this if you have such a thing happening to you is to look in a mirror and see if your iliac crests are level, if they aren’t and your belt/pants are lopsided and one trouser hem and one shoe is wearing more that the other and then you may well have a leg-length inequality.  However, this doesn’t tell you what’s causing it.  To do this we need to look at the height of your hips without the legs in the equation, so sit down.  Now you are sitting on your ischeal tuberosities – the bits you sit on when you are on a bike and your legs are taken out of the equation.  If your iliac crest is still high when you are sitting then it must be a pelvis issue and we need to sort something out.

 

But how does it happen – well I recon for most of my patients it’s all to do with falling off the swings/tree/bike/footy/gymnastics and all that stuff as a child and it going unnoticed as the change was too small to see.  However, school screenings have shown that LLI is pretty common and I recon should be tackled at this point to prevent them from becoming a problem later because:

 

“The overwhelming majority of patients examined for low back pain of uncertain origin had LLI with asymmetric load distribution.  Furthermore, the overload at the lumbosacral level may produce muscular stress, premature degenerative diseases of the disc-somatic and the interapophyseal joints L4-L5 and/or L5-S1, as well as dysfunction (sometimes subluxation) of the sacroiliac joint, which might give rise to low pelvic pain.  The pain, with or without sciatica, if non caused by herniary pathology, almost always affects the side of the greater load.

Leg Length Inequality, Scoliosis And Low Back Pain.  A. Manganiello.

 

And then I took a breath in.

Research shows that chiropractic can help with chronic neck pain.  Check this artical out:

http://www.ebp-clients.co.uk/c1/wordpress/index.php/chiropractic-can-it-help-chronic-neck-pain/

This massive study (Addition of chiropractic care increases value-for-dollar in US employer-sponsored health benefit plans by Niteesh Choudhry, MD, PhD, and Arnold Milstein, MD) was done in the US and came out today (ish) .  It is a study that merges effectiveness of treatment with the cost of that treatment and compares the result with that of normal medical care.  The quotations I liked were: 

The results of the researchers’ analysis are as follows:

• Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain.
• Total cost of care per year:

-For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care.

-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.

Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.

And I'd hate to say told you so, but....

Gerard Clum, DC, spokesperson for the Foundation for Chiropractic Progress and president of Life Chiropractic College West, says, “While some studies reflect cost efficiencies and others clinical efficiencies, these findings strongly support both for chiropractic care of neck pain and low back pain.”

 

Low-back pain is costly, debilitating and poorly diagnosed. It affects early everyone, about 80% of the population, at some point during their lives. And thousands of pounds (and billions of dollars and a shed load of Euros etc) have been spent trying to improve clinical outcomes but, incredibly, pain, disability and lost time from work have not improved dramatically over the past several decades.

In about half of all LBP cases have associated leg pain. These cases are the testing ones and they account for a disproportionately large amount of LBP related health care cash. Add to this the fact that LBP with leg pain is an important predictor for chronicity and severity of LBP, so if you have leg pain the problem tends to last longer and be nastier.

But why is the leg hurting?

Several structures are capable of producing referred leg pain. These can range from the neural to the musculoskeletal. And, clearly, a failure to identify the etiology of the referred leg pain can mean that the wrong cause is addressed and the wrong treatment is then, promptly, delivered.

There was an interesting article on this published earlier this year by a Schafer A et al. where they set out an interesting way of thinking about low-back pain with leg pain.

They set out the mechanisms that cause low-back related leg pain as follows:

• Inflammation: Internal disc damage or endplate fractures activate the inflammatory cascade which can cause discogenic referred leg pain or nerve root irritation. Inflammation of the nerve root can also increase the nerve’s sensitivity to mechanical compression and change neural mobility.

• Compression: Mechanical nerve root compression secondary to degenerative changes or a space occupying lesion may result in impaired blood flow to the tissues surrounding the nerve and the nerve itself. This, in turn, can cause increased fluid pressure and mechanical nerve fibre deformation. Nerve root compression can result in sensory and motor dysfunction and radiating pain.

• Central Events: This bit is a tad testing but neural plasticity can occur secondary to continued stimulus from nerve fibres associated with handling pain (nociceptive) input. This may result in a lowered threshold to nociceptive input, changes in subcortical and cortical brain regions, disinhibition and a phenotypic switch of non-nociceptive neurons to nociceptive neurons. This is called central sensitization.

• Musculoskeletal Referral: Pain generators can include the intervertebral disc, facet joint, sacroiliac joint, or a variety of myofascial structures. All of these structures have been sufficiently studied and identified as potential leg pain generators and their pain patterns well mapped by the likes of Travell and Simon.

So the authors of the paper propose that low-back pain with leg pain should be grouped into 4 groups that would be treated differently because their causes are different – sensible really. The groups are:

• Central Sensitization - with thermal and mechanical increased response to pain stimulus (hyperalgesia)/extreme tenderness of the skin (allodynia) and neurological evaluation may reveal altered pin prick thresholds or light touch allodynia (oh yes indeed).

• Denervation - structural nerve damage with altered motor strength, deep tendon reflex, and/or sensation in a dermatomal pattern.

• Musculoskeletal - absence of gross neurological deficits and absence of nerve root tension and positive joint provocation manoeuvres or centralization/peripheralization.

• Peripheral nerve sensitization - absence of gross neurological deficits and presence of nerve root tension – referred leg pain with neural movement during testing.

And of course not forgetting that you can have more than one at once – and this is not uncommon:

• Mixed Pathologies - multiple pathologies may be present at once but the authors think the existence of a primary mechanism responsible for a patient’s symptoms can be determined and therefore tackled.

So at C1 we are looking to make this call and we’ll include in our initial examination a comprehensive assessment of the patient’s subjective complaint. We’ll then carry out a physical evaluation, including a neurological examination, an assessment for nerve root tension, an evaluation of active ROM and joint provocative testing.

Look what they are saying in Parliament about the GCC and the faintly obsessed:

There are also serious problems in chiropractic, which one might call an assisted discipline to osteopathy. The General Chiropractic Council has been bombarded by complaints from bloggers—spurious complaints I would say—which it is obliged by law to investigate. I am very concerned that genuine complaints will not get through and that any practitioner, against whom a genuine complaint had been lodged, could continue to practise. Will the Minister look at this very unsatisfactory situation, which arose following an individual losing a court case against the British Chiropractic Association?

David Tredinnick MP