tag:chiropractor.blog.co.uk,2009-11-21:/MokoFeed2009-11-21T01:06:47+01:00tag:chiropractor.blog.co.uk,2009-11-12:/2009/11/12/can-hypnotherapy-help-you-quit-smoking-new-scientist-says-yes-7357791/Zofie-C12009-11-12T12:50:46+01:002009-11-12T12:50:46+01:00 <p>The New Scientist says:</p> <p>"Hypnosis is the most effective way of giving up smoking"</p> <p>(‘Cognitive reactions to smoking relapse’, New Scientist, Vol 135)</p> <p>Are you struggling to quit smoking?</p> <p>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?</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>To stop smoking a single two hour session is required.</p> <p>If you would like to find out more about how hypnosis can help you to stop smoking, please get in touch.</p> <p>In the words of The New Scientist:</p> <p>"Hypnosis is the most effective way of giving up smoking"</p> <p>(‘Cognitive reactions to smoking relapse’, New Scientist, Vol 135)</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/11/12/can-hypnotherapy-help-you-quit-smoking-new-scientist-says-yes-7357791/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-11-11:/2009/11/11/can-clinical-hypnotherapy-help-with-insomnia-7352636/C1CHC2009-11-11T18:31:23+01:002009-11-11T18:31:23+01:00 <p>C1's Clinical Hypnotherpist, Zofie Kucia,  says:</p> <p class="MsoNormal"><strong><span><span><span>Sleep Problems<br></span></span></span></strong><strong><span><span></span></span></strong></p> <p class="MsoNormal"><strong><span><span><span>Cause:</span></span></span></strong></p> <p class="MsoNormal"><span><span>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.<span>  </span>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.<span>  </span>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.<span>  </span>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.</span></span></p> <p class="MsoNormal"><span><span>Simply doing too much can also lead to sleep disturbances.<span>  </span>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.<span>  </span>We lie in bed, desperate to get to sleep but with a mind that is racing.<span>  </span>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.</span></span></p> <p class="MsoNormal"><span><span>Once a sleep problem has been established it then adds to our stress and we feed into a vicious cycle.<span>  </span>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.<span>  </span>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.</span></span></p> <p class="MsoNormal"><strong><span><span><span><br>The Solution:</span></span></span></strong></p> <p class="MsoNormal"><span><span>Believe it or not, the actual process of dealing with a poor sleep pattern in simple.<span>  </span>In essence, we want to reverse the cycle that caused it!<span>  </span>So, firstly we need to create an environment which is conducive to a good sleep pattern.<span>  </span>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!</span></span></p> <p class="MsoNormal"><span><span>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.<span>  </span>It is also important to start to stop engaging in any habits you might have understandably developed as a result of the sleep challenges.<span>  </span>An example might be going to bed slightly later; typically this involves relaxing more about the whole issue.</span></span></p> <p class="MsoNormal"><span><span>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”.<span>  </span>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”.</span></span></p> <p class="MsoNormal"><strong><span><span><span>Case History of Stress-related Sleep Disorder:</span></span></span></strong></p> <p class="MsoNormal"><span><span>A typical example of a client I helped to start to sleep properly again is client A.<span>  </span>She came to see me as she would sometimes wake during the night and at other times had difficulty getting off to sleep.<span>  </span>Her mother had died in difficult circumstances about a year earlier and this had caused her much distress.<span>  </span>She had a busy, stressful job.<span>  </span>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.<span>  </span>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.<span>  </span>At first she found it a challenge to think more positively but after a while it seemed much more natural.<span>  </span>She started to go back to the gym and yoga classes and felt much calmer through doing this.<span>  </span>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.<span>  </span>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;<span>  </span>she started to see that this might not necessarily be a helpful belief to have.<span>  </span>As a “side effect” of therapy she gave up smoking and reported feeling much calmer and happier.</span></span></p> <p class="MsoNormal"><strong><span><span><span></span></span></span></strong></p> <p class="MsoNormal"><strong><span><span><span><br>Case History of a busy lady with insomnia:</span></span></span></strong></p> <p class="MsoNormal"><span><span>Client B presented with a severe problem in getting to sleep which had been troubling her for some time.<span>  </span>She ran her own company with sole responsibility for the organisation.<span>  </span>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.<span>  </span>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.<span>  </span>I gave her a CD along with my usual explanation of the causes of sleep problems.<span>  </span>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.<span>  </span>After some sessions focused predominantly on relaxation, client B began to come up with some solutions that would help her.<span>  </span>She made some changes at work, made inroads into her perfectionist tendencies and booked two holidays!<span>  </span></span></span></p> <p class="MsoNormal"><span><span>Following on from this she found it easier to focus away from the sleep issue and relax more.<span>  </span>The combination of changes both lifted her mood and enabled her to start to sleep properly once more.<span>  </span>During therapy she stopped taking her prescribed sleeping tablets. <span>  </span>She also learned that once her life was in balance her sleep could then balance itself- and not vice versa!</span></span></p> <p> </p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/11/11/can-clinical-hypnotherapy-help-with-insomnia-7352636/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-11-06:/2009/11/06/sense-about-science-gm-funded-front-organization-surely-not-7318888/C1CHC2009-11-06T13:01:59+01:002009-11-06T13:01:59+01:00 <p><span>Zoë Corbyn of the Times writes:<br></span><a href="http://www.timeshighereducation.co.uk/story.asp?storycode=405427"><br><span><a href="http://www.timeshighereducation.co.uk/story.asp?storycode=405427"><a href="http://www.timeshighereducation.co.uk/story.asp?storycode=405427">http://www.timeshighereducation.co.uk/story.asp?storycode=405427</a></a></span></a></p> <p><span>Can you belive it? </span></p> <p><span>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.</span></p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/11/06/sense-about-science-gm-funded-front-organization-surely-not-7318888/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-11-05:/2009/11/05/leg-length-inequality-the-whys-7313331/C1CHC2009-11-05T16:56:19+01:002009-11-05T16:56:19+01:00 <p>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:</p> <p>Anatomical:<br> 1. Fracture or disease loss of bone. The classic one.<br> 2. Genetic conditions.<br> 3. Nutritional deficiency leading to leg-length loss.</p> <p>Functional:<br> 1. Sacroiliac joint dysfunctions leading to pelvic obliquity – and I think the most common, at least in my clinic.<br> 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.<br> 3. Hip joint dysfunction causing compensatory alterations by the joint and muscles that move the joint.<br> 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.<br> 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?<br> 6. Likewise, short hamstring muscles as these are short because of the leg-length inequality.<br> 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.<br> 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.<br> 9. etc.<br> 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.</p> <p>Any others?</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/11/05/leg-length-inequality-the-whys-7313331/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-11-02:/2009/11/02/can-chiropractic-help-with-sciatica-7292784/C1CHC2009-11-02T15:51:06+01:002009-11-02T15:51:06+01:00 <p class="MsoNormal"><strong><span lang="EN">Posted by Rupert Clements of C1 Chiropractic Health Centre.</span></strong></p> <p class="MsoNormal"><strong><span lang="EN"><span>Sciatica needs chiropractic care, and possibly some other options, to reduce pain in your back and legs.</span></span></strong><span lang="EN"></span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><span lang="EN">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.<span>  </span>I’m fed up with having to disabuse patients of this rotten diagnosis; it’s not far off “I have lumbago”.<span>  </span>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.<span>  </span>Quite often this has nothing to do with the sciatic nerve and is still called sciatica.<span>  </span></span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><strong><span lang="EN">The anatomy</span></strong><span lang="EN">:<span>  </span>The sciatic nerve is the longest and widest single nerve in your body. <span> </span>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.</span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><strong><span lang="EN">The pain</span></strong><span lang="EN">:<span>  </span>If you've ever experienced sciatica, you know how debilitating this pain can be. <span> </span>I've seen patients, who could barely walk, couldn't bend over or even stand.<span>  </span>With good care you will be back to your normal self within 2-3 weeks.</span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><strong><span lang="EN">The solution</span></strong><span lang="EN">:<span>  </span>Chiropractic </span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><span lang="EN">oh, and try:<span>  </span>massage therapy. <span> </span>I have patients who I see in my clinic that need gentle massage for their sciatic pain.<span>  </span>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.</span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><span lang="EN">Last but not least, a highly effective technique for treatment that is being used more and more is acupuncture.<span>  </span>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</span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><span lang="EN">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. </span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><span lang="EN">For more information on treatments and alternatives to protect your back, go to <a href="http://www.c1healthcentre.co.uk">www.c1healthcentre.co.uk</a> or contact me personally.</span></p> <p class="MsoNormal"><span lang="EN"> </span></p> <p class="MsoNormal"><span lang="EN">Rupert</span><span></span></p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/11/02/can-chiropractic-help-with-sciatica-7292784/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-29:/2009/10/29/leg-length-inequality-what-s-going-on-and-can-chiropractic-help-7268588/C1CHC2009-10-29T15:23:53+01:002009-10-29T15:23:53+01:00 <p class="MsoBodyText2"><span><span>          </span>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:</span></p> <p class="MsoBodyText2"><span> </span></p> <p class="MsoBodyText2"><span>Firstly, leg length inequality (LLI) is really common.<span>  </span>A bloke called Knutson found:</span></p> <p class="authors3"><span><span> </span></span></p> <blockquote> <p class="MsoNormal"><span>“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).”</span></p> </blockquote> <p class="MsoBodyText2"><span>So that’s all of us; but, as he adds:</span></p> <p class="MsoBodyText2"><span> </span></p> <blockquote> <p class="MsoBodyText2"><span>“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").”</span></p> </blockquote> <p class="MsoBodyText2"><span> </span></p> <p class="MsoBodyText2"><span>So it has got to be about 2 cm to be clinically important.<span>  </span></span></p> <p class="MsoBodyText2"><span> </span></p> <p class="MsoBodyText2"><span>However, for most of our patients it is not anatomical differences in leg–length that actually cause the change but <strong>pelvic rotation</strong>.<span>  </span>Rarely do people’s arms grow to be different lengths so why should their legs.<span>  </span>What really happens is that their pelvises get rotated.<span>  </span>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.<span>  </span>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.<span>  </span></span></p> <p class="MsoBodyText2"><span> </span></p> <p class="MsoBodyText2"><span>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.<span>  </span>However, this doesn’t tell you what’s causing it.<span>  </span>To do this we need to look at the height of your hips without the legs in the equation, so sit down.<span>  </span>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.<span>  </span>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.</span></p> <p class="MsoBodyText2"><span> </span></p> <p class="MsoBodyText2"><span>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.<span>  </span>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:</span></p> <p class="MsoNormal"><span> </span></p> <blockquote> <p class="MsoNormal"><span>“The overwhelming majority of patients examined for low back pain of uncertain origin had LLI with asymmetric load distribution. <span> </span>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. <span> </span>The pain, with or without sciatica, if non caused by herniary pathology, almost always affects the side of the greater load.</span></p> </blockquote> <p class="MsoNormal"><span>Leg Length Inequality, Scoliosis And Low Back Pain.<span>  </span>A. Manganiello.</span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>And then I took a breath in.</span></p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/29/leg-length-inequality-what-s-going-on-and-can-chiropractic-help-7268588/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-23:/2009/10/23/can-chronic-neck-pain-by-helped-with-chiropractic-of-course-it-can-durrr-7229867/Acupuncturist2009-10-23T15:45:34+02:002009-10-23T15:45:34+02:00 <p>Research shows that chiropractic can help with chronic neck pain.  Check this artical out:</p> <p><a href="http://www.ebp-clients.co.uk/c1/wordpress/index.php/chiropractic-can-it-help-chronic-neck-pain/"><a href="http://www.ebp-clients.co.uk/c1/wordpress/index.php/chiropractic-can-it-help-chronic-neck-pain/">http://www.ebp-clients.co.uk/c1/wordpress/index.php/chiropractic-can-it-help-chronic-neck-pain/</a></a></p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/23/can-chronic-neck-pain-by-helped-with-chiropractic-of-course-it-can-durrr-7229867/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-21:/2009/10/21/solid-study-demonstrates-the-cost-effectiveness-of-chiropractic-care-7213751/C1CHC2009-10-21T09:09:39+02:002009-10-21T09:09:39+02:00 <p>This massive study (<a class="taggedlink" href="/news/20091021/Addition-of-chiropractic-care-increases-value-for-dollar-in-US-employer-sponsored-health-benefit-plans.aspx"><span>Addition of chiropractic care increases value-for-dollar in US employer-sponsored health benefit plans</span></a> 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: </p> <blockquote> <p>The results of the researchers’ analysis are as follows:</p> <ul> <li><span><strong>Effectiveness:</strong></span> Chiropractic care is <em>more effective</em> than other modalities for treating low back and neck pain. </li> <li><span><strong>Total cost of care per year:</strong></span> </li> </ul> <p>-For low back pain, chiropractic physician care <em>increases</em> total annual per patient spending by $75 compared to medical physician care.</p> <p>-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.</p> <p><span><strong>Cost-effectiveness:</strong></span> When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is <em>highly</em> <em>cost-effective</em>, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.</p> </blockquote> <p>And I'd hate to say told you so, but....</p> <blockquote><p>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.”</p></blockquote> <p> </p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/21/solid-study-demonstrates-the-cost-effectiveness-of-chiropractic-care-7213751/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-19:/2009/10/19/can-chiropractic-help-with-low-back-pain-with-leg-pain-or-sciatica-7199570/C1CHC2009-10-19T11:39:06+02:002009-10-19T11:39:06+02:00 <p>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. </p> <p>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.</p> <p>But why is the leg hurting?</p> <p>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.</p> <p>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. </p> <p>They set out the mechanisms that cause low-back related leg pain as follows:</p> <p>• 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.</p> <p>• 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.</p> <p>• 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.</p> <p>• 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.</p> <p>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:</p> <p>• 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).</p> <p>• Denervation - structural nerve damage with altered motor strength, deep tendon reflex, and/or sensation in a dermatomal pattern.</p> <p>• Musculoskeletal - absence of gross neurological deficits and absence of nerve root tension and positive joint provocation manoeuvres or centralization/peripheralization.</p> <p>• Peripheral nerve sensitization - absence of gross neurological deficits and presence of nerve root tension – referred leg pain with neural movement during testing.</p> <p>And of course not forgetting that you can have more than one at once – and this is not uncommon:</p> <p>• 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.</p> <p>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. </p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/19/can-chiropractic-help-with-low-back-pain-with-leg-pain-or-sciatica-7199570/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-15:/2009/10/15/c1-chiropractic-health-centre-simon-singh-david-tredinnick-7174901/C1CHC2009-10-15T14:29:37+02:002009-10-19T11:31:48+02:00 <p>Look what they are saying in Parliament about the GCC and the faintly obsessed:</p> <blockquote><p>There are also serious problems in chiropractic, which one might call an assisted discipline to osteopathy. The <a href="http://en.wikipedia.org/wiki/General_Chiropractic_Council"><span>General Chiropractic Council</span></a> 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 <a class="glossary" title="Ministers make up the Government and almost all are members of the House of..." href="/glossary/?gl=35"><span>Minister</span></a> look at this very unsatisfactory situation, which arose following an individual losing a court case against the <a href="http://en.wikipedia.org/wiki/British_Chiropractic_Association"><span>British Chiropractic Association</span></a>?</p> <p><a title="See more information about David Tredinnick" href="/mp/?m=1436"><strong><span>David Tredinnick</span></strong></a> MP</p> </blockquote> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/15/c1-chiropractic-health-centre-simon-singh-david-tredinnick-7174901/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-14:/2009/10/14/how-much-water-should-i-be-drinking-a-steer-from-my-chiropractor-7168925/C1CHC2009-10-14T17:44:46+02:002009-10-14T17:44:46+02:00 <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>We are always banging on at our patients to drink more water and suggesting the right amounts that they should be drinking.<span>  </span>They rightly ask how much and we tell them.</span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>This is the score:</span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>You lose:</span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><strong><span>Normal Weather<span>        </span>Warm Weather<span>          </span>Warm Weather </span></strong></p> <p class="MsoNormal"><strong><span>No exercise<span>                </span>No exercise<span>                </span>Exercise</span></strong></p> <p class="MsoNormal"><strong><span> </span></strong></p> <p class="MsoNormal"><strong><span>Skin (not sweat)<span>       </span></span></strong><span>350 ml<span>                          </span>350 ml<span>                          </span>350 ml</span></p> <p class="MsoNormal"><strong><span>Sweat<span>                        </span></span></strong><span>100 ml<span>                          </span>1400 ml<span>                        </span>5000 ml</span></p> <p class="MsoNormal"><strong><span>Respiratory Tract<span>    </span></span></strong><span>250 ml<span>                          </span>350 ml<span>                          </span>650 ml</span></p> <p class="MsoNormal"><strong><span>Urine<span>                         </span></span></strong><span>1400 ml<span>                        </span>1200 ml<span>                        </span>500 ml</span></p> <p class="MsoNormal"><strong><span>Faeces<span>                       </span></span></strong><span>100 ml<span>                          </span>100 ml<span>                          </span>100 ml</span></p> <p class="MsoNormal"><strong><span> </span></strong></p> <p class="MsoNormal"><strong><span>Total<span>                          </span>2,300 ml (2.3l)<span>             </span>3,300 ml (3.3l)/<span>            </span>6,600 ml (6.6l)</span></strong></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>So, a fair bit every day.<span>  </span></span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>Now you do get water from your food and from metabolic water production (Google it), typically about 1.5L, so we suggest:</span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>Sedentary individuals drink at least 2L or about 8 cups of water per day </span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>Athletes in normal climates drink at least 3L or about 12 cups of water per day. </span></p> <p class="MsoNormal"><span> </span></p> <p class="MsoNormal"><span>Athletes in hot weather climates drink at least 4L or about 16 cups of water per day.</span></p> <p class="MsoNormal"><span> </span></p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/14/how-much-water-should-i-be-drinking-a-steer-from-my-chiropractor-7168925/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-08:/2009/10/08/why-is-my-back-going-wrong-7124076/C1CHC2009-10-08T12:04:10+02:002009-10-13T09:23:14+02:00 <p>Well, this is a philosophy piece from me and I want to take a few steps into the wide blue on this one which may challenge some of you and interest others as I start to look at what is really causing all the back pain we encounter.</p> <p>Firstly, here’s a thought to kick off with: seen any cats with back pain recently? Seen your local herd of cows queuing for anti-inflammatory drugs at your GP? No, didn’t think so but, as I tediously hammer into my kids, the key question is why? Why is this? What are they doing right and what are we doing wrong? (and at this point I accept that some dogs and some horses do see chiropractors but this may well support the point I’m making, so hold on).</p> <p>The answer lies in what they were designed to do. Cats are designed to be cats and cows, cows and they generally haven’t changed much in what they do – yes, cows have got fatter and bigger and more milky and cats have got more manipulative and cooler but they are essentially what they were designed to be and they are essentailly doing the things they were designed to do.</p> <p>Now, is this the same with you and me? Well, your design criteria landed on your designers’ desk some 4.5 million years ago, your prototype did its first test-lap 1.5 million years ago you came into full production ½ a million years ago. The original, glossy, design criteria manual had a load of chapters setting out what you should be able to do, such as run fast for a short distance to dodge sabre-tooth tiger, run long distances to chase down mammoth, throw rocks and whittle sticks. But, and this is a big but, it didn't have an annex called “Future Proofing”. This missing annex should have had chapters such as sitting down for 8 hours a day, moving your arms in a 2 foot by 4 foot square in front of you and eating enormous amounts of calories whilst doing nothing and expecting to survive.</p> <p>And this is the key. You are designed for one thing - active, upright, hunter-gatherering, and doing another – sedentary, desk-flying, computer operator. So this is similar in its wrongness as using the family car as a 4X4 cross-country thing (which yours may be but then you are morally wrong and must change it). Yes, it’ll do the job but it will eventually go wrong.</p> <p>The brutal detail and the exceptions to this rule are legion however the essence is here. If you have something going wrong with your back the question you must ask yourself is: “would my Palaeolithic ancestor be doing what I am doing” and if the answer is no you have a feel for why you are failing.</p> <p>Now, all we need to do is sort it out…</p> <p>And that’s another hill of beans.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/08/why-is-my-back-going-wrong-7124076/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-06:/2009/10/06/what-is-my-chiropractor-has-suggested-i-take-glucosamine-why-7111892/C1CHC2009-10-06T17:53:41+02:002009-10-06T17:54:33+02:00 <p>Glucosamine - and that other good stuff<br> We’ve been banging the drum about this stuff for some time now and the evidence is very clear that this is good stuff. But what should you take? What you are after is called glucosamine and chondroitin. This stuff is described as the ‘cement of the connective tissues’ and this includes the cartilage that covers the ends of your bones. This acts as a shock absorber and helps your joints move smoothly.</p> <p>Not Chondroitin but Glucosamine<br> Chondroitin is, spookily, produced mainly from shark cartilage extract. Unfortunately there is a huge inconsistency in the concentrations of chondroitin extracted from this source and the source has just got to be wrong. Also, 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 unnecessary.</p> <p>So, why should you take a supplement?<br> The matrix that your cartilage is built from is inert stuff; it has little or no direct blood supply and only few cells to keep it maintained. Add to this the fact the stuff itself is not widely available in your diet and, as a double whammy, it also is not very well absorbed by your guts. Now, if you damage your joints or they are suffering from ‘fair wear and tear’ then your cartilage will be damaged. If this occurs the body tries to repair it but with little of this building material available. So 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.</p> <p>Which type of Glucosamine is best?<br> If you don't have a shellfish allergy then D-Glucosamine Sulphate 2KCl is the stuff. This is manufactured from shellfish. If, however, you do have a shellfish allergy then 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!</p> <p>Then there is the Powder v liquid v solid debate<br> Glucosamine is available in the following forms:<br> Pure Powder<br> Capsules<br> Tablets / Caplets<br> Liquid (Joint Formulas) </p> <p>Pure powder is the best option and then mixed with liquid of your choice (a fine deep red is my suggestion). It is the most bioavailable to your digestive system and the most economical. Liquid formulations are best for absorption however you are often paying for the suspension liquid when it's the Glucosamine that does the job. Tablets mean that you are paying for the ‘binding and bulker’ in the tablet and they have a tendency to pass straight through. Finally, capsules, with out any bulking ingredients or flow agents, are also pretty good.</p> <p>So it's best to buy pure powder and add it to a liquid of your choice. If, however this is not available, then any is better than none. And where possible they should contain HCL and Sulphate</p> <p>How much should you take?<br> The recognised dosage for Glucosamine is 1,500mg per day but evidence has shown that:<br> If you weigh less than 180 lbs take 1500 mg/day<br> If you weigh more than 180 lbs take 2000 mg/day</p> <p>This can be taken either in one dose ie 1,500mg in a go or split in to equal doses ie 500mg three times a day and it is best with food.</p> <p>What does it taste like?<br> 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 and knowing how it is made this seems reasonable.</p> <p>Side Effects<br> 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)</p> <p>In 1999 the first case of an allergic reaction to oral Glucosamine Sulphate was reported (Ref 2). And pregnant or lactating mothers should not use it due to lack of data on long-term safety and if you have a reaction or one of the symptoms mentioned above, stop taking the supplement and consult your G.P.</p> <p>Links with Diabetes<br> 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)</p> <p>Until more is known, people taking glucosamine supplements for long periods may wish to have their blood sugar levels checked.</p> <p>And those with High Blood Pressure<br> Some Glucosamine Sulphate is processed with sodium chloride (salt), which is restricted in some diets (particularly for people with high blood pressure).</p> <p>Alternatives to Glucosamine<br> 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!<br> 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</p> <p>References<br> 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.</p> <p>2. Matheu V, Bracia Bara MT, Pelta R, et al. Immediate-hypersensitivity reaction to glucosamine sulfate. Allergy 1999;54:643-50.</p> <p>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.</p> <p>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<br> 1995;96:132-40.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>8. Russell AI, McCarty MF. Glucosamine in osteoarthritis. Lancet 1999;354:1641; discussion 1641-2 [letters].</p> <p>9. Rovati LC, Annefeld M, Giacovelli G, et al. Glucosamine in osteoarthritis. Lancet 1999;354:1640; discussion 1641-2.</p> <p>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.</p> <p>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.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/06/what-is-my-chiropractor-has-suggested-i-take-glucosamine-why-7111892/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-06:/2009/10/06/what-exercises-can-i-do-to-help-disc-herniation-7110377/C1CHC2009-10-06T13:56:04+02:002009-10-19T13:10:00+02:00 <p>These are the exercises – but check with your Chiropractor before you go wild.</p> <p>McKenzie exercises for disc protrusion</p> <p>Stand by, stand by: Lie face down with your hands under your shoulders in the press-up position. Focus on letting your low-back muscles relax and lightly tense up your gluts. Breathe normally. Typically this can take a couple of minutes.</p> <p>Then: Slowly raise your shoulders off the ground until you are resting on your elbows. Let your low-back ‘sag’ with gravity to the ground. Hold this for a couple of minutes.</p> <p>And then: If comfortable lift your shoulders up a little further and hold, and hold, and hold, and rest.</p> <p>What’s it doing: Your pain should reduce and shrink towards the centre of your low-back, or ‘centralize’.</p> <p>Here's great link to show you what I mean:<br><a href="http://www.youtube.com/watch?v=wBOp-ugJbTQ"><a href="http://www.youtube.com/watch?v=wBOp-ugJbTQ">http://www.youtube.com/watch?v=wBOp-ugJbTQ</a></a></p> <p>It stretches some of the muscles that compress the low-back and reduces the internal pressure of the disc by levering the disc apart and encouraging the contents of the disc to move back into the disc body.</p> <p>Some don’ts though:<br> • Don’t do them for 1 hour after getting up. Let gravity work on your discs and let them settle down. <br>• If you have been diagnosed with spondylolysis. But there will be some discomfort so work with this but don’t push through the pain, it’ll do you no good.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/06/what-exercises-can-i-do-to-help-disc-herniation-7110377/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-10-05:/2009/10/05/clinical-hypnotherapy-and-the-treatment-of-insomnia-7105057/C1CHC2009-10-05T18:30:42+02:002009-10-05T18:30:42+02:00 <p>Zofie, our Clinical Hypnotherapist writes:</p> <p>As a practicing Clinical Hypnotherapist I have worked with many clients presenting with sleep problems. These have ranged from clients not being able to get to sleep, to some individuals who have the ability to fall asleep but then wake during the night as well those suffering from terrifying nightmares. A number of clients presenting with such problems have suffered in this way for many years and arrive with little hope that I can help. As such it is often quite difficult to persuade people that insomnia and poor sleep patterns can be helped in a matter of days or weeks.</p> <p>In my role as a therapist I firstly ask all sorts of questions relating to the sufferer’s lifestyle and daily schedule as well as probing into their stress levels and what stressors are present in their life. In every case in my experience, what the client is unwittingly doing on a day to day basis to keep the problem going has become apparent very quickly.<br> Sometimes a particular event can act as a trigger for the sleep problem and although the event is subsequently dealt with, unfortunately by this time the sufferer has got into the habit of not sleeping or not sleeping well. When facing this challenge alone, the habit can be incredibly hard to shift. For others there doesn’t appear to be a particular trigger although sometimes it is set off by progressively rising stress levels.</p> <p>In either event, through obtaining help in managing stress levels, which is then backed up by suggestion work and guidance to help you break old habits, longstanding problems can be shifted quickly. For many individuals coping with a lack of sleep they are stuck in a difficult vicious cycle which can seem almost impossible to break without help; the fear of not sleeping ultimately leads to certain rituals or habits being formed which further serve to strengthen the fear and as a consequence, the problem. </p> <p>Many sufferers will relate to the idea of the law of revered effect which states: “the harder you try the harder it becomes” and this is especially true for sleep! But it can be incredibly hard to stop trying when it has become habitual which is where intense relaxation and confidence building can help.</p> <p>Hypnotherapy can help you to bridge the gap between the fear of not sleeping and breaking the mould thereby creating new and healthy sleep habits. If you would like help and advice on how to deal with a sleep disorder or anything similar please get in touch. I can be contacted on 0117 922 1542 and 07966 094 979.<br> Zofie<br> Clinical Hypnotherapist<br> DHP.HPD.MAPHP.MNCH<br> CBT Trained</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/10/05/clinical-hypnotherapy-and-the-treatment-of-insomnia-7105057/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-23:/2009/09/23/i-in-6-patients-are-misdiagnosed-in-nhs-hospitals-and-by-gps-7023517/C1CHC2009-09-23T10:40:53+02:002009-09-23T10:40:53+02:00 <p>The case rests, m'Lud:</p> <p><a href="http://www.telegraph.co.uk/health/healthnews/6216559/One-in-six-NHS-patients-misdiagnosed.html">http://www.telegraph.co.uk/health/healthnews/6216559/One-in-six-NHS-patients-misdiagnosed.html</a></p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/23/i-in-6-patients-are-misdiagnosed-in-nhs-hospitals-and-by-gps-7023517/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-23:/2009/09/23/are-gps-good-at-diagnosing-and-handling-low-back-pain-or-are-chiropractors-a-better-bet-7023479/C1CHC2009-09-23T10:34:50+02:002009-09-23T10:34:50+02:00 <p>Gaaaagggghhhh, what the pfwwwth. That’s it. I’ve had it up to here with these lot. </p> <p>I’ve got a patient at C1 who’s got a raging sacroiliac joint and low-lumbar posterior facet syndrome (see this earlier post: <a href="http://chiropractor.blog.co.uk/2009/08/21/posterior-facet-syndrome-what-is-it-and-can-chiropractic-help-6775867/)">http://chiropractor.blog.co.uk/2009/08/21/posterior-facet-syndrome-what-is-it-and-can-chiropractic-help-6775867/)</a><br> He had to go and see his GP so that his BUPA cover can be validated (which alone makes me spit - and see why later). The patient said, in an equally exasperated tone as this post, that the GP failed to look at any of his notes from his previous GP, who, incidentally, agreed with the chiro diagnosis. He then told the patient that the diagnosis and treatment we’d been advocating was wrong and that he should start stretching and get some exercise – on a sprained joint with some PFS to boot! Good grief, that’d be like me telling you to stretch an acute sprained ankle and walk about a bit on it. He then added that the only practitioners the patient should see should be osteopaths and then only those with a medical background (such as the one his wife was seeing). Good God, so the MSc level training is not enough to cover musculoskeletal issues such as this. Tellingly the patient, a wise man, said to me:</p> <p>“I wanted to hit him and was thinking I do not like you now” </p> <p>and, God bless him, he got up and walked out.</p> <p>Well this was irritating enough but add to it this gem of resent research and I’m still gritting my teeth. There have been two bits of work done recently in the really solid journal Spine:</p> <p>The first: Buchbinder R, Staples M, Jolley D. Doctors with a special interest in back pain have poorer knowledge about how to treat back pain. Spine 2009; 34(11): 1218-1226.</p> <p>The second: Orthopaedists’ and family practitioners’ knowledge of simple low back pain management. Spine 2009; 34(15): 1600-1603.</p> <p>The background for these studies is that low-back pain (LBP) patients usually first consult with their GP (and then perhaps a specialist). Back pain is the most common musculoskeletal reason for consulting a GP. So you’d think it would be sensible if these GPs had a pretty high level of competence in managing these patients. However these studies show that, taken together, those who are consulted first (in most cases) for LBP are not managing this condition in an evidence-based manner. </p> <p>The Buchbinder study compared GPs with no special interest to those with a special interest in LBP. Those with a special interest were more likely to believe that complete bed rest (17.8% vs. 9.2%) and work avoidance (24.5% vs. 15.8%) are appropriate management approaches for acute LBP!</p> <p>The studies showed that:<br> • 53% of surgeons incorrectly recommended treatment with cyclooxygenase-2 (COX-2) selective NSAIDs as their preferred treatment, versus only 8% of GPs;<br> • 67% of surgeons and 46% of GPs recommended some form of bed rest;<br> • Although both groups acknowledged the potential benefit of spinal manipulation, 51% of surgeons and 57% of GPs incorrectly suggested that it was appropriate in all cases of LBP;<br> • 29% of GPs and 46% of surgeons failed to rate patient explanation and encouragement as “extremely important”;<br> • 53% of surgeons and 8% of GPs felt imaging was always necessary;<br> • Overall, seniority was not related to questionnaire scores, and surgeons performed significantly worse (roughly 25%) than GPs (p < 0.0001).<br> The authors, rightly, then state: “Taken together, these results provide strong evidence that poorer beliefs about management of back pain is driven by a special interest in LBP. These findings raise serious concerns about how back pain is currently being managed among general practitioners with a special interest in LBP.”</p> <p>Also, it is particularly terrifying that orthopaedist knowledge surrounding simple LBP is lacking, especially when you consider the major risks and poor prognosis linked to their primary intervention (the dreaded and dreadful surgery).</p> <p>And there is a great quotation in the review where it says that there is a “disappointing picture of medical management of simple LBP.”</p> <p>More details are available at:</p> <p><a href="http://www.researchreviewservice.com/content/view/1031/131/">http://www.researchreviewservice.com/content/view/1031/131/</a></p> <p>And you wonder why I rage at idiots like this GP.</p> <p>And breathe </p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/23/are-gps-good-at-diagnosing-and-handling-low-back-pain-or-are-chiropractors-a-better-bet-7023479/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-17:/2009/09/17/can-chiropractic-help-with-paediatric-conditions-6985108/C1CHC2009-09-17T17:53:12+02:002009-09-17T17:53:12+02:00 <p>Chiropractors successfully treat a wide variety of paediatric health conditions. The evidence for this care rests primarily with clinical experience, descriptive case studies and very few observational and experimental studies. A good recent review done by two chiropractors examines this very elegantly. The review was done on the biomedical literature from January 2004 to June 2007 and it was designed to get a feel for the extent of new evidence about chiropractic manipulation for a wide range of paediatric health problems over that period. The review updated a similar, previous review published in 2005.</p> <p>Tellingly, this systematic review concluded that:</p> <p>1. There is no convincing evidence that spinal manipulation alone can affect the duration of infantile colic symptoms; (look a colon, you don’t see many of those about there days!)</p> <p>2. The effect of spinal manipulation on sleep time, parental anxiety, quality of life and the number of infants meeting diagnostic criteria for colic could not be determined using available evidence;</p> <p>3. The potential harm from the spinal manipulation of infants with colic could not be determined using evidence available from controlled trials.</p> <p>There were also two trials carried out on enuresis one involving 171 children and the other 46 children. The first trial concluded the study results do not support the claim that chiropractic care in enuretic children is effective. However, the second trial concluded that the study results strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis! </p> <p>There is a fair amount of evidence but it is clinically based and consists of 177 descriptive studies which are mainly single case reports and, so, interesting but not significant.</p> <p> So we have some negative and a few positive results depending which way you are looking at the whole thing and what are we to make of it all?</p> <p>The key thing is this: there is just not enough science out there to make a real judgement for and against and, as the chiropractic profession will freely and regularly admit, far more work is needed. Disappointingly the study added that there has been no “substantive shift in this body of knowledge during the past 3 1/2 years”. However it is worth bearing in mind that this is far from core business for the profession and far, far, more research is being carried on other subjects such as low-back pain in adults over the same period.</p> <p>But if you are a practitioner who has numerous successful outcomes on single case basis you may arrive at some ‘premature’ conclusions and with some justification. However, generalizing such premature conclusions to larger patient populations is a position not well grounded in science and should be avoided if possible.</p> <p>The health interests of paediatric patients would be advanced if more rigorous scientific inquiry was undertaken to examine the value of manipulative therapy in the treatment of paediatric conditions.<br> Let’s get it done.</p> <p>Chiropractic manipulation in pediatric health conditions – an updated systematic review</p> <p>Allan Gotlib and Ron Rupert<br> Canadian Chiropractic Association, CMCC Homewood Professor,<br> 30 St. Patrick St. Suite 600, Toronto, Ontario, M5T 3A3, Canada<br> Parker College of Chiropractic, 2500 Walnut Hill Lane, Dallas, Texas 75229, USA</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/17/can-chiropractic-help-with-paediatric-conditions-6985108/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-17:/2009/09/17/sports-massage-therapy-can-it-help-the-athlete-prepare-for-an-event-6982728/C1CHC2009-09-17T10:56:02+02:002009-09-17T10:56:02+02:00 <p><strong>Rebecca Strange</strong>, one of our sports massage therapists, writes:</p> <p><strong>Sports massage treatment during training</strong>. The pre-event massage is most effective up to two days before any event. A sports massage can help the muscles perform at a high level during the event and during run-up training without over training and injury.</p> <p>Use a sports massage to aid in warming up the muscles just before training or before the event. A sports massage can help stretch the muscles as well as stimulate blood flow and relaxation. By having the muscles well stretched and relaxed it can help prevent sports injuries.</p> <p><strong>Sports massage after the sporting event</strong> This is done to help in muscle recovery. A post-event sports massage can also aid in reducing muscle spasm and soreness. Post-event massages are short and direct lasting only 10-15 minutes. The post-event focuses on the muscles used specifically for the sport.</p> <p>Sports massage is useful not only for its physical benefits but also for its psychological benefits. Using a sports massage can improve the performance of the serious athlete as well as the recreational athlete. By reducing body tension and increasing confidence through massage therapy an athlete can reach its potential.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/17/sports-massage-therapy-can-it-help-the-athlete-prepare-for-an-event-6982728/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-09:/2009/09/09/core-stability-what-do-we-recommend-at-c1-chiropractic-health-centre-6930013/C1CHC2009-09-09T13:13:19+02:002009-11-18T11:16:40+01:00 <p>We’ve had a few of you ask what core exercises should you be doing. Now, there are reams about this on the web but my spin, based on experience and study, is get the foundation right and you can build a really legendary back – mess up the first steps and the thing will fail. </p> <p>Firstly let’s cover the don’ts as they are stuffing loads of backs up and a lot of good work is being thrown away. Here they are:</p> <p>1. No more sit-ups, never, ever. Crunches, yes; sit-ups no, and for good biomechanical reasons that I can explain another time if you ask me to.</p> <p>2. No more dorsal raises. Ditto.</p> <p>So here are the things we, and Professor Stuart McGill (uber back Guru), suggest you start off with. I’ve searched the web a bit for youtube examples of the exercises we suggest as pictures speak a thousand words and this should make the explanation a bit clearer. These seem good examples of the exercises. </p> <p>Always start with 6 cycles of these to 'neurologically' warm up your low-back:</p> <p><a href="http://www.youtube.com/watch?v=CXRsjICsGnc">http://www.youtube.com/watch?v=CXRsjICsGnc</a></p> <p>then start the core stability exercise itself THE PLANK (whoop, whoop):</p> <p class="center"><img src="http://data5.blog.de/media/341/3873341_26a6a63e89_s.jpg" alt="plank1"></p> <p>or have a look at this:</p> <p><a href="http://www.youtube.com/watch?v=9Ar2iRusnnc">http://www.youtube.com/watch?v=9Ar2iRusnnc</a></p> <p>Each plank/bridge position you do should be done to the point that you start shuddering (which usually is a neurological control issue rather than a muscle fatigue problem) or until you reach the 20 second point and rest for a bit and then do it again, and again. The next time you do the exercises try to increase the time you are in the bridge position with the goal being that you can crack 30 seconds in the plank.</p> <p>How often, as often as you like and more the merrier. </p> <p>Then tell me and we can go to the next step. Hope this helps.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/09/core-stability-what-do-we-recommend-at-c1-chiropractic-health-centre-6930013/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-07:/2009/09/07/the-epley-manoeuvre-maneuver-for-you-lot-over-there-done-by-a-chiropractor-worked-for-bppv-6913792/C1CHC2009-09-07T18:19:37+02:002009-09-07T18:19:37+02:00 <p>There, done it. My patient from last week with BPPV came in today and said "Great, I've not felt dizzy all week-end". Now I know this may just be luck, timing or placebo but it seems to me that if you follow the protocol you do get success. Give it a go. </p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/07/the-epley-manoeuvre-maneuver-for-you-lot-over-there-done-by-a-chiropractor-worked-for-bppv-6913792/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-07:/2009/09/07/benign-paroxysmal-positional-vertigo-can-my-chiropractor-help-6910775/C1CHC2009-09-07T11:05:36+02:002009-09-07T11:05:36+02:00 <p>Benign Paroxysmal Positional Vertigo, or better BPPV, sounds crazy but it is what it says on the tin, it’s just that the language on the label could be Russian for all it mans to you or me. However, benign is a good word, it is one of those words you want to hear when anyone is talking about medical things about you, and I suspect we are all pretty familiar with it. Paroxysmal means that the condition occurs in attacks rather than as a steady problem. Positional means it’s all related to what you do with your body, in particular with your head. And vertigo is a nasty feeling of relative movement, usually spinning, between you and your surroundings and has recently been described to me as “I feel like I’m falling backwards and to the right”.</p> <p>Now it may be benign but it can still be horrible with you, in some cases, stuck in bed because any movement causes you to throw up. In the later stages it leads to episodes of vertigo each lasting less than 60 seconds but all of this may settle after a couple of weeks. However, sometimes, it does not.</p> <p>There is a beautiful test for it called the Dix-Hallpike test. And here it is in this cracker of a link:</p> <p><a href="http://www.youtube.com/watch?v=eOuzUi5ckrk">http://www.youtube.com/watch?v=eOuzUi5ckrk</a></p> <p>I recently had a patient with undiagnosed, or more accurately un-treated vertigo. After a detailed history to rule out the other forms of vertigo I subjected her to this test and her reaction was a case-book response. I asked her to sit on the bench and rotate her head to the right. I then lowered her back towards the end of the bench where her head hung over the edge a bit. There was a second where nothing happened giving her enough time to say: “I feel OK” and then her eyes went crazy and she then went very quiet for about 20 seconds before saying “Ugg, that felt horrible”.</p> <p>The problem was a post-traumatic one for her as she was involved in a nasty crash some time ago (2 years!). The condition is caused by ‘debris’ in the semicircular canals of the ears which move about in response to gravity and so stimulate the position detecting structures in your ears giving a false reading. This is a bit like motion sickness where your eyes are out of synch with your body.</p> <p>The cure is a bit tricky. You can’t open these structures up and wash the debris out, at least not yet, and you can’t take drugs to dampen down your nervous system as you’ll spend most of your time flat on the floor. However, luckily, there are slight bulges at the ends of each of your canals that with some cunning manoeuvres you can get the debris to float (sink?) into and not stimulate your canals. The manoeuvre is the Epley manoeuvre. Now, this is a tricky manoeuvre and should be done by someone on you, so in this case by me, her chiropractor, not by you with a bit of paper in your hand. And I’d suggest that if you are about to do it on a patient then practise on a well friend first off a couple of times to get it right. Once you’ve got the hang of what you are doing then lay it on.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/07/benign-paroxysmal-positional-vertigo-can-my-chiropractor-help-6910775/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-09-02:/2009/09/02/someone-said-that-gouveia-is-a-piss-poor-scientist-6877032/C1CHC2009-09-02T17:54:36+02:002009-09-03T16:38:44+02:00 <p>Look at this appalling article for an example of rubbish dressed up as science:</p> <p>Safety of Chiropractic Interventions: A Systematic Review<br> Gouveia L, et al.<br> Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal<br> Spine 2009; 34(11): E405-13.</p> <p>Now, I’d have been really ashamed to publish such a thing and to attach my name to it. It is also a real shame that it got into <strong>‘Spine’</strong>, which is usually a great journal, without some questions being asked about the quality of the science behind the article, though it will be interesting to see what the editors say when the letters start to pour in. </p> <p>The utterly rubbish authors indicated that recent reviews on the effectiveness of chiropractic said that the efficacy of spinal manipulation was not demonstrated for the treatment of “any condition”, citing a chiropractic clinical practice guideline that was published in the Journal of the Canadian Chiropractic Association (the JCCA). However, there was no such statement in the JCCA article. What the guidelines actually said is:<br> “Treatment recommendation 2: Based on all the evidence…we also recommend manipulation…for patients with acute or chronic pain…”<br> Which I’d have suggested is about as far from “any condition” as you can get. </p> <p>In the article they provided background information on chiropractic, citing negative reviews by a known chiropractic detractor (namely Professor Edzard Ernst) which is fair and should happen but only if positive reviews are not ignored, which, you’ve guessed it, they were. This prejudicial handling of the evidence set the tone for the entire review. </p> <p>There were a series of shockers in the article:</p> <p>1. A literature search identified 151 potentially relevant articles, so a good number that should reveal something. However, a staggering 110 of these had to be discarded because the patients had an underlying disease that predisposed them to adverse reactions and other reasons. So, far form a glorious start.</p> <p>2. Only one RCT was included and the shockingly bad authors referred to it as “…the only randomized controlled trial published.” This gives the impression to the reader that only one RCT has ever been done in chiropractic. This is bonkers. There are loads of chiro RCTs and most of them have commented on the number of adverse events that occurred and therefore, you’d have thought would have been included in this shoddy review.</p> <p>3. In the study six other studies were included. The manipulations were by physiotherapists, osteopaths and manipulative therapists in two of them, so 33% of the study. It has just got to be inappropriate to include adverse events attributed to other types of practitioners in a study reporting on chiropractic safety, surely.</p> <p>4. And they ‘missed’:<br> Rubinstein SM, et al. The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study. J Manipulative Physiol Ther. 2007 Jul-Aug; 30(6):408-18.</p> <p>Which says:</p> <p>“Adverse events may be common, but are rarely severe in intensity. Most of the patients report recovery, particularly in the long term. Therefore, the benefits of chiropractic care for neck pain seem to outweigh the potential risks.”</p> <p>5. However, the most unpleaseant error is an intentional, or not, misquote of an article by Michael Haynes who actually reported that “…there were perhaps fewer than five cases of manipulation-related stroke per 100,000 patients who had received cervical manipulation from a chiropractor.”<br> Gouveia and cronies turned this to read:<br> “5 strokes/100,000 manipulations”<br> Which in anyone’s book is a huge difference from what Haynes reported. To add insult to injury, this inaccuracy was repeated 4 times including the abstract. It has been reported that the typical chiropractic patient in North America is seen 12.8 times on average (7) and other studies have reported even more. Using the 12.8 figure, the statistic becomes fewer than 5 strokes per 1,280,000 manipulations.</p> <p>A review of this article said:<br> “Being so riddled with flaws, one cannot apply any of the findings of this article to clinical practice.”</p> <p>Which I have got to say I agree with. </p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/09/02/someone-said-that-gouveia-is-a-piss-poor-scientist-6877032/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-08-28:/2009/08/28/can-chiropractic-help-asthma-yes-and-no-6839635/C1CHC2009-08-28T10:16:33+02:002009-08-28T10:16:33+02:00 <p>The GCC state “There is some evidence, though more research is needed, that you may see an improvement in some types of:<br> • asthma<br> • headaches, including migraine; and<br> • infant colic”<br> The problem is not with claims, it‘s with the language. There’s no evidence for cure but if improvement means symptoms generally declining, which I’d say is an improvement in anyone’s book, then there is, if improvement means complete resolution then there isn’t. Language, you see?</p> <p>There is evidence that chiropractic can help, and I freely admit it is not strong and pretty hard to defend against pedants, but it is not a complete disaster and certainly not in the realms of bogus, particularly if improvement is an acceptable goal. See:</p> <p>Chiropractic care for nonmusculoskeletal conditions: A systematic review with implications for whole systems research<br> Hawk C et al. May 2008.<br> <em>The Journal of Alternative and Complimentary Medicine 2007; 13(5): 491-512. Chiropractic Guidelines and Practice Parameters (CCGPP) expert committee. </em><br> This was a comprehensive literature search (using PubMed, Ovid, Mantis, ICL, CINAHL) which identified studies evaluating spinal manipulation and/or mobilization (both chiropractic and osteopathic) or general chiropractic management of NMSK conditions.<br> The aims of this study were to:<br> • evaluate the efficacy of chiropractic “care”, not meaning only spinal manipulation, on NMSK conditions and,<br> • identify specific deficiencies in the literature in order to develop a whole systems approach to researching this topic. </p> <p>The bit covering asthma, in summary, is:</p> <p>“Asthma (15 citations total):<br> 3 RCTs reported no adverse effects from spinal manipulative therapy (SMT) although physiological measures did not improve in any study, medication use generally declined, and symptoms were generally reported to improve.”</p> <p>Now, at:<br> <a href="http://www.bio-medicine.org/medicine-news/The-Adverse-Effects-Of-Asthma-Medication-2935-1/">http://www.bio-medicine.org/medicine-news/The-Adverse-Effects-Of-Asthma-Medication-2935-1/</a><br> it states that:</p> <p>“Latest research shows that a common class of drugs used for acute asthma attacks might be causing the very thing it aims to treat. Many people with asthma rely heavily on these medications, sometimes taking them several times a day.”</p> <p>So what would you do if it was you who was suffering with asthma – give it a go and see if it led to “medication use generally declined, and symptoms were generally reported to improve” or press on with the drugs?</p> <p>I know what I would do and I’d be right chuffed if things improved.<br> Language, do you see?</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/08/28/can-chiropractic-help-asthma-yes-and-no-6839635/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-08-24:/2009/08/24/our-duplicate-blog-don-t-be-surprised-6809138/C1CHC2009-08-24T14:16:33+02:002009-11-16T23:28:35+01:00 <p>Our other blog is attached to C1 Chiropractic Health Centre's web site or is here:</p> <p><a href="http://www.ebp-clients.co.uk/c1/wordpress/">http://www.ebp-clients.co.uk/c1/wordpress/</a></p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/08/24/our-duplicate-blog-don-t-be-surprised-6809138/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-08-24:/2009/08/24/preventing-low-back-pain-at-work-the-answer-6808082/C1CHC2009-08-24T11:14:12+02:002009-08-24T11:14:12+02:00 <p>Low-back pain at work – what really does prevent it happening?</p> <p>Well, I’ve banged on about it enough to my patients and now, as always, I’ve been proved right.</p> <p>Firstly, you have got to understand that you are built on the design brief of Palaeolithic Man. In this massive design brief slapped down by God (or what ever supreme deity you want, such as ‘The Force’) there was no chapter on sitting on your butt and peering into a computer for 8 hours on the trot and there was no annex that that covered ‘Future proofing’ the structure. No, the main pages would have covered: ‘Running fast for a short distance to avoid predation’ and ‘Walk/Running for a long distance to improve chances of killing mammoth’. </p> <p>So, your work posture is a real challenge to your body as it is a demand that is wildly outside the design brief, similar to using your car to climb trees, so no wonder it hurts. </p> <p>The next point is that no manner of fancy chair, desk height re-alignment is going to make THE difference – yes, it will be less-bad for you than a really crappy one but you’ll still be in the region of bad and it will never be the answer. (And the best would be a height changing desk that allows you to stand at the thing every now and then – search the web). So, get a decent desk, a decent chair (IKEA £50 is what I am using) and save the money on some of the ‘orthopaedic products’ out there.</p> <p>Why do I say this? Well look at this bit of really solid recent research:</p> <p>The paper is called:<br> High-quality trials on preventing episodes of back problems: systematic literature review in working-age adults</p> <p>It was produced by Bigos SJ, Holland J, Holland C, et al. from Department of Orthopedic Surgery at the University of Washington and published in the serious Spine Journal in 2009; 9: 147-168.</p> <p>The study looked at clinical or educational approaches (exercise or education), personal appliances (back supports or shoe inserts), ergonomic equipment (lift assists etc.), changes in physical activities or work duties and administrative or social interventions such as work policies or social changes. All trials included had high quality scores, 90% investigated workplace settings, and 50% involved health care workers and, eventually, 20 prospective controlled trials were included and evaluated. Of these 20 rigorous trails 5 measured objective outcomes and the remaining 15 measured only subjective outcomes.</p> <p>At the end of the day exercise was the only intervention found to be effective. 7 out of 8 exercise trials reported statistically significant reduction in back pain and 5 of the 7 successful exercise programs included 45-60 minutes of supervised exercise, twice per week for 3-12 months (most also encouraged additional exercise without supervision).<br> The exercise techniques included McKenzie (Google that one), active and passive back extensions, core stabilization, “Williams” exercises and Mensendieck trunk exercises (again, Google).</p> <p>NO other intervention was found effective in reducing back pain.</p> <p>And, negative results were found in all studies on ergonomic/back education, stress management, lumbar supports, shoe inserts, and programs for reducing lifting tasks.</p> <p>So, the story is that the exercise that your Palaeolithic ancestor did is exactly the stuff you need to do to survive doing strange things with your back to prevent it going wrong. No wonder we advocate core stability, rehab and sports therapy at C1. We can get you right but you must keep yourself there.</p> <p>So stop putting your faith in futuristic looking mesh back multi adjustable seats and desks made from dolphin-friendly ethically resourced wood and get some core stability into you and then go for a run.</p> <p>Makes sense, yes? </p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/08/24/preventing-low-back-pain-at-work-the-answer-6808082/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-08-21:/2009/08/21/posterior-facet-syndrome-what-is-it-and-can-chiropractic-help-6775867/C1CHC2009-08-21T18:50:06+02:002009-08-21T18:50:06+02:00 <p>Posterior Facet Syndrome – an injury of the joints in the back</p> <p>I’ve had a hell of a day explaining to a very important lawyer why his back is hurting him. He has had a hell of a day refusing to hear what I have said and done, even though I’ve allowed him to stand upright for the first time in a few days (I suspect this is because he’s in the thrall of his denialist shrew of a wife).</p> <p>However, the thrust of what I was banging on about is this:<br> Firstly, where are these Posterior Facet Joint things? The facet joints, or incredibly the zygapophyseal joints, are the relatively small joints on the outside of the bridge of bone that protects your spinal cord. They control the range of motion available at each level of the spine and you have them at every level. However, they do look different as you move up or down your spine, because ‘form follows function’ and they have to do different jobs in different parts of your spine- see?</p> <p>Each joint, like most joints, is enclosed in a joint capsule which is a complex structure that provides feedback to the brain about the state of the joint, as well as a host of other tasks such as supplying synovial fluid to the joint space as well as some joint stability. Research has shown that in the low-back there can be a 'meniscoid' structure in the joint space, just like a mini version of the meniscus in the knee joint.<br> So that’s what the thing is like. Now what can go wrong?</p> <p>Posterior Facet Syndrome (PFS). Contrary to what the physios may say this is a hugely prevalent problem and is, arguably, our bread and butter. It is a syndrome because the injury it involves far more than one structure and a whole raft of unpleasant things can go on.</p> <p>In a severe, acute, PFS there may be some injury to the faces of the joint but rarely. There have also been several theories put forward about some nipping of the joint capsule or the meniscoid tissue between the two bones. However, there will certainly be some sprain/strain of the very sensitive structures of the capsule, the surrounding micro-ligaments and local muscles. Your body will rightly respond to this injury by stabilising the joint with whatever it can – in this case it will be the surrounding muscles and in the low-back these muscles are really powerful. </p> <p>Your brain can stabilise your back very quickly and is why you will have seen people bending over and suddenly being unable to move or coming into work unable to move their heads. What your brain does is sacrifice these powerful muscles in favour of the PF joints and force the muscles to remain contracted for as long as required. Now, try holding a weight in your flexed arm for any length of time and you’ll see how painful this continued contraction can be. This is the same thing that is going on in your back BUT the contraction will be even stronger as it has to hold your body still and so far more painful. Also, your brain will not turn these stabilising muscles off until the problem is resolved and nor should you – so no early massage madness and NO MUSCLE RELAXANTS (aaahhhhh).</p> <p>PFS will really sting. In a severe acute phase you may not be able walk and when I did mine after a rowing session I had to remain still until I was driven to stand by my bladder that was about to explode and even then I nearly passed out. The structures that hurt were the injured joint capsule; this will be the white hot sharp pain, and then the large paraspinal muscles that my body had wisely recruited in to span the joint like scaffolding which was a deeper burning pain. </p> <p>As with trauma to any joint, such as spraining an ankle, there will be an inflammatory reaction with loads of swelling and pain around the joint, which may last for several days. This may also irritate the spinal nerves that pass out of the spine at this point and you may get a referred pain. Typically, this will be less defined and usually a burning pain. To check if your pain is a referred pain give the area a gently prod and if you can’t get a finger on a pain generating structure then, as a rule of thumb, it’ll be a referred pain (clear?). Please don’t call it sciatica unless you are still using terms like lumbago and ague as sciatica is a description of pain along the sciatic nerve distribution which goes far further than the hip and groin.</p> <p>Typically, you’ll find back pain just to one side of the spine in the paraspinal muscles that are stabilising the joint. Side bending toward the affected side or backward bending will compress the facet joint faces together and make the pain worse – some physios find this concept a challenges as they tend to be muscle focused. The back will generally feel stiff in the morning as a post inflammatory response. Often the problem is made worse by prolonged sitting or standing in one position as the joints get compressed and start to sing. </p> <p>What causes PFS?<br> A severe acute episode of PFS pain may be due to sudden, aberrant, movement, which traumatises the joint such as the classic lifting injury as a result of poor core stability. More commonly PFS is chronic with the underlying cause due to long term changes in the joint that are often again associated with poor core stability, wear and tear and poor posture. </p> <p>What you can do?</p> <p>Ice – it’s an inflammatory issue at heart so DON’T heat it up. If you listen to the stabilising muscles you will hear them shouting for heat as this is a muscle injury but the contraction is intentional and unless you have torn these in the initial injury (unlikely) you must ignore the cry. Get this wrong with an ankle joint and it can extend the time to recover by up to 5 times and I’d suggest that PFS is an ankle sprain/strain of the back joints and so the same thing will happen – so no hot baths, please.</p> <p>It may be worth taking some non-steroidal anti-inflammatory (NSAIDs) with all the risks associated with these things.</p> <p>“Get thee to a chiropractor” who will manipulate the joint with a controlled thrust to reduce the compression, restore correct movement and so reduce inflammation and pain. </p> <p>DO NOT heat it up until much later. DO NOT wear a brace.</p> <p>However, what I found on the web!<br> This: “In a more chronic type of Facet joint problem, the management is more difficult. The treatment outlined above will usually be attempted first, with the Chartered Physiotherapist giving symptomatic relief of the stiffness using heat packs and mobilisation techniques. However, where there is persistent pain originating from a Facet joint problem, this has to be addressed. An injection of long acting local anaesthetic and anti-inflammatory corticosteroid into the Facet joint may be effective in relieving symptoms and, if successful, it confirms the diagnosis. In order for this approach to work the injection is best done by a Consultant Radiologist under an image intensifier. This device allows the doctor to see exactly where the injection is going. This approach can give very good pain relief, but the effects may wear off after a while. It may be necessary to repeat the procedure at a later date.”<br> Good grief! all that radiation and then some powerful steroids when all it really needed was a dose of ice and some decent care. Try anything else first, please. </p> <p>And then:<br> “In cases of Facet Syndrome that cause constant unremitting pain, a more lasting approach for pain relief is a procedure known as ‘Radiofrequency denervation'. Radiofrequency denervation is a technique where the nerves that supply the Facet joint are destroyed by ionizing radiation rather than surgery. This is effective for the relief of pain, but will not stop or reverse the underlying joint degeneration.”<br> Killing nerves! Can this really work?</p> <p>The evidence from NICE and MEADE and others is that chiropractic and other manipulative therapies are the way forward. Give it a go and see what I mean.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/08/21/posterior-facet-syndrome-what-is-it-and-can-chiropractic-help-6775867/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-08-19:/2009/08/19/can-chiropractic-help-with-neck-pain-6761324/C1CHC2009-08-19T19:33:48+02:002009-08-19T19:33:48+02:00 <p>We’ve had a recent rush of patients coming in with neck pain – something to do with added work stress, perhaps? I was irritated by how vague we are on neck pain and how difficult it was to describe in effective ‘lay’ (but not patronising) terms what the hell was going on. And this got me thinking…. </p> <p>How common is neck pain?<br> Well, you are certainly not alone - Hill and co-workers report that in the UK many as 31% of adults have had neck pain in the last month (the adult population of the UK has got to be over 50 million people so, as hey say in the US, “Go do the math”) and 48% of neck pain patients report persistent pain a year later.<br> - Hill J, Lewis M et al. (2004) Predicting Persistent Neck Pain. Spine 29:1648-1654</p> <p>What’s going wrong?<br> Well, this is trickier. Liebenson, Skaggs et al. say that it is ‘difficult to pinpoint the specific pain-generating tissue’ of neck pain and even if you can the reasons why ‘are often elusive’. Now, in my experience the most common neck problem we see is ‘Posterior Facet Syndrome’, one of the mechanical neck pains, and it is caused by compression of the facet joints as a result of anterior head carriage commonly aggravated by peering into the computer for eight hours a day.</p> <p>Though, try Googleing ‘Posterior Facet Syndrome’ and see what comes up as it is a hotly debated subject with some denialists saying it doesn’t exist though how can this be as I treat it daily and it responds very well. </p> <p>In trying to describle what I am treating I say that PFS is similar to an ankle sprain but of the neck joints and that, like an ankle sprain, a whole raft of different tissues may be involved in the injury depending on how it was done. This seems pretty plausible to me and covers all the bases and, as long as we are treating these tissues, we should have some impact on the problem - yes? </p> <p>There are some even stranger things happening out there in neck land. Up to 71% of patients who have chronic pain following whiplash have undetected vertebral end plate fractures at the spinal levels associated with the pain that were overlooked on standard medical imaging.<br> - Michael Freedman Dec 2001.<br> Not surprisingly, I suspect that this has some impact on the way things progress in a neck but, surprisingly, there may well be nothing that can be done about it and that even if the information was available it would not change the way the neck was managed anyway.</p> <p>Neck pan can be split into these broad categories: </p> <p>Grade 1 – neck pain with little or no interference with daily activity.<br> Grade 2 – limits daily activity.<br> Grade 3 – neck pain with accompanied radiculopathy (pinched nerve pain, weakness and/or numbness in the arm)<br> Grade 4 – neck pain with serious pathology – tumour, infection or systemic disease.<br> (Clearly, along with mechanical neck pain there are some real nasties out there; neck pain may be a symptom of meningitis and if any of the following symptoms occur, dial 999 or seek medical attention urgently:<br> • A rash develops that does not fade when you press it with a glass tumbler or a finger.<br> • You feel ill or are running a fever as well as feeling neck pain.<br> • It is to painful to bend the neck forward and put your chin on your chest.<br> • Light hurts.<br> • Your neck pain is accompanied by severe headache or continuous vomiting.<br> • Neck pain is accompanied by severe pain in the back.<br> And in some cases, neck pain can be a symptom of head injury or disc trouble in the neck, so. If any of the following symptoms occur, dial 999 or seek medical attention urgently:<br> • Neck pain is the result of a recent head injury and you are becoming drowsy, confused or are vomiting.<br> • Neck pain is accompanied by headache.<br> • If there is pain behind one eye.<br> • Vision, hearing, taste or balance are affected.<br> • Severe vomiting.<br> • The muscle power in your arms or legs is reduced.)<br> Treatment<br> Here’s the science bit:<br> Cleland et al. showed that manipulation of the thoracic spine produces immediate analgesic effects in patients with mechanical neck pain.<br> - Cleland JA, Childs JD et al. (2005) Immediate Effects of Thoracic Manipulation in Patients with Neck Pain: A Randomized Clinical Trail, Manipulative Therapy 10:127-135.<br> And Liebenson recommends manual therapy with some rehabilitation exercises. This has been supported by one of the strongest research trials in this field carried out by Bronfort, Evans et al. In this trial 191 patients were split into three treatment groups, like this:<br> • Spinal manipulation and low-tech exercise,<br> • Spinal manipulation and MedX exercise – receiving dynamic progressive resistance exercises on MedX machines,<br> • Spinal manipulation.<br> Outcomes were measured at 5 and 11 weeks and 3, 6 and 12 months after the trial. At the one year follow up the group that were receiving exercises and manipulation did significantly better than the group undergoing manipulation alone. </p> <p>In a literature review published by Hurwitz, Aker et al. in Spine and Aker, Gross et al. in the British Medical Journal, so hardly slack journals I’d suggest, manipulation and mobilization were both more effective than muscle relaxants and usual medical care in providing pain relief for patients with sub-acute or chronic neck pain. In a study (2003) in Spine Giles and Muller compared acupuncture, joint manipulation and standard medication (NSAIDs). Patients in the acupuncture and medications groups had no significant improvement during the trial on any of the outcome measures and the manipulation group showed significant improvement on all measures with no patient made worse or experiencing side effects. Giles and Muller then followed up their patients a year later and reported that the manipulation group gained ‘significant broad-based beneficial…long-term outcomes’ (I like Giles and Muller).</p> <p>In a great study by Haneline at Palmer College of Chiropractic, 79% of the patients improved to the point they had only minimal or minor restriction of movement and their satisfaction rates were an astounding 94% - and I suspect few trials can report the same, with 70% indicating they were very satisfied. When asked which provider helped the most 83% replied the chiropractor (this all sounds too much like a dodgy ‘election’ in North Korea for it to sit comfortably with me but….)</p> <p>However, and there’s always one, here’s what the GP’s advise on <a href="http://www.patient.co.uk/:">http://www.patient.co.uk/:</a></p> <p>Exercise your neck and keep active<br> Aim to keep your neck moving as normally as possible. At first the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able. You should not let it 'stiffen up'. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day. As far as possible, continue with normal activities.<br> In the past, some people have worn a neck collar for long periods when a bout of neck pain developed. The problem with collars is that they prevent you from moving your neck properly. Studies have shown that you are more likely to make a quicker recovery if you do regular neck exercises, and keep your neck active rather than resting it for long periods in a collar. Also, if you keep the neck active during a bout of neck pain, it is thought to help prevent chronic (persistent) neck pain from developing.</p> <p>(So good, reasonable advice so far but then…) </p> <p>Medicines<br> Painkillers are often helpful. It is best to take painkillers regularly until the pain eases. This is better than taking them now and again just when the pain is very bad. If you take them regularly, it may prevent the pain from getting severe, and enable you to exercise and keep your neck active.<br> • Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.<br> • Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac, naproxen, or tolfenamic need a prescription. Some people with asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.<br> • A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.<br> • A muscle relaxant such as diazepam is sometimes prescribed for a few days if your neck muscles become tense and make the pain worse.<br> (Awww, and they were doing so well. The problem in your neck has nothing to do with a lack of pain-killer in your blood so don’t do it. The evidence doesn’t support it so why advise it unless there is some other reason and I am not going to suggest that we are a drug reliant NHS, oh no. I will suggest that the muscle tightness has a purpose and is not a trick that your neck is doing just to irritate you, perhaps; just perhaps, your brain wants to immobilize the injured joints, just like an ankle sprain then, and is using the muscles surrounding the joint to do this. So why would you want to take a muscle relaxant to stop this happening, why would you want to over ride your clearly stupid brain and let your neck move freely during an acute phase?)<br> Other advice<br> Some other advice which is commonly given includes:<br> • A good posture may help. Brace your shoulders slightly backwards, and walk 'like a model'. Try not to stoop when you sit at a desk. Sit upright.<br> • A firm supporting pillow seems to help some people when sleeping.<br> • Physiotherapy. It is not clear whether this makes much difference to the outcome of mechanical neck pain. Therapies such as traction, heat, cold, manipulation, etc, may be tried, but the evidence that these help is not strong. However, what is often helpful is the advice a physiotherapist can give on neck exercises to do at home. A common situation is for a doctor to advise on painkillers and gentle neck exercises. If symptoms do not begin to settle over a week or so, you may then be referred to a physiotherapist to help with pain relief and for advice on specific neck exercises.<br> So, manipulation gets one word. Yet the recent report from the Bone and Joint Decade 2000 – 2010 Task Force on Neck Pain and Its Associated Disorders (made up by a staggering 50 researchers in 9 countries comprising of 14 different clinical disciplines and looking at over 31,000 research criterion and over 1000 met relevant criteria.) recommended that neck manipulation, acupuncture and massage are better choices for managing most common neck pain. It also recommended exercises, education and neck mobilization but to be less effective than adjustment. </p> <p>I know which one I’d chose.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/08/19/can-chiropractic-help-with-neck-pain-6761324/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-07-30:/2009/07/30/trapped-nerve-in-your-low-back-can-chiropractic-help-6619087/C1CHC2009-07-30T18:08:42+02:002009-07-30T18:08:42+02:00 <p>Agggghhhhh, so another utterly cod diagnosis arrives on my mat. A friend’s son is ‘diagnosed’ with a trapped nerve. He is 8 and has pain on extension, flexion and rotation but the pain is localised and really, really nasty and with some epic muscle tightness in his lumbar region.</p> <p>After a bit of questioning it is bloody obvious that he’s got a posterior facet syndrome which with a bit of care and a load of ice will come good fast – which it does and he’s ready to climb a Welsh mountain a few days later.</p> <p>But it got me fuming about ‘trapped nerves’ and what an utterly piss-poor diagnosis this is, it sits up there with lumbago and ague as a really lazy bit of work. Now, I admit a nerve entrapment is entirely possible – just google entrapment neuropathy and you’ll get some real spot-on diagnosis such as medial plantar neuritis and thoracic outlet syndrome. These nerve entrapments are crackers and really obvious and clear cut once you are thinking right. However, to achieve the same sort of thing in your lumbar region is a far, far trickier thing.</p> <p>Consider the anatomy and what you’d have to do to pinch or trap a nerve. The most simple to imagine would be a classic disc herniation or prolapse, the bulge in lay-terms. Now this can compress the nerve root in the back but these are rare, have a raft of pretty convincing signs and symptoms, such as electric pain down the nerve, and you don’t recover from these at all quickly. The second thing you could do is have some soft tissue structure compress the nerve root (a lateral or central stenosis) or a space occupying lesion (far more scary) but, again, this is rare and usually very obvious with a raft of red flags to watch out for.</p> <p>So, if you visit your doctor with low-back pain sometimes with pain running across the width of your back and possibly some referred pain down you legs to above your knee or knees and you are told you have a ‘trapped nerve’, like my friend’s son, raise a quizzical eyebrow and say the following:</p> <p>“Which nerve and where can it be trapped or are you just fobbing me off because I’ve spent more than my allocated 5 minutes in your office?”</p> <p>Because I bet you have a posterior facet syndrome with widespread muscle guarding which is chiropractic business.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/07/30/trapped-nerve-in-your-low-back-can-chiropractic-help-6619087/#comments">Comments</a> </small> </p>tag:chiropractor.blog.co.uk,2009-06-19:/2009/06/19/patrick-thanks-for-your-very-measured-and-reasonable-response-to-6340808/C1CHC2009-06-19T09:51:27+02:002009-09-07T15:13:39+02:00 <p>Patrick, thanks for your very measured and reasonable response to my ‘moment of frustration’ posting, I thought I'd get the fundamentalists on my case.</p> <p>However, I think these questions need to be answered:</p> <p>1. From the petition can Singh or the public continue to:<br> “criticise assertions (made by chiropractic) robustly and the public should have access to these views”<br> The answer is unreservedly yes.</p> <p>2. Again, from the petition, what has the BCA action done prevented<br> “The scientific community would have preferred that it had defended its position about chiropractic for various children's ailments through an open discussion of the peer reviewed medical literature or through debate in the mainstream media”<br> The answer must still be nothing – only a perceived prevention as a result of Singh’s spin.</p> <p>And so, I would challenge you to find one bit of evidence that demonstrated that the BCA are doing anything that would, as an example, prevent Singh and Ernst from publishing another book tomorrow that examined the evidence for and against chiropractic. Yet, the spin is that this action is stopping this from happening. It is not, and anyone can challenge the profession of chiropractic in any medium, in any language, any time and they’ll be safe to do so. What they can’t do is say that personally I am bogus or that the BCA is lying without having to prove it. </p> <p>Singh should have known better since he's a journo (and as an aside it is intersting to note that the BCA are not taking Ernst to court for his misrepresentations - he seems to be wiser than Singh). Singh made a mistake and he did it in the worst country in the world for libel. But, I also feel let down by him as I enjoyed his last few books and his TV work and by what seems a lack of judgement in using such poor science doloped out by Ernst. Here is the example from the Guardian article:</p> <p>“In 2001, a systematic review of five studies [oh, yeah, done by Ernst on studies by Ernst] revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the <u>limited benefit offered by chiropractors</u>.</p> <p>More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks [proven by what science – the say so of Ernst]. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures [what! – where, when, who? ahhh – good science provided by Ernst and not cross checked by Singh].</p> <p>Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.” [Controversial stuff and the publishing life blood of Ernst for a decade and it is just poor science to suggest this is the case – and again unchecked by Singh for this ill-considered article] </p> <p>Finally, the spun Sense in Science petition has the nerve to say:</p> <p>“Singh's <u>only</u> (only! not what I saw) objection, if you read the article, is evidentially unsubstantiated claims on the BCA website about chiropractic spinal manipulation curing such childhood problems as bed-wetting, colic and asthma. In the end, we have to support his support as a whole whilst examining if he is right to look at unsubstantiated claims”</p> <p>bloody misrepresentation in my and I hope anyone's book.</p> <p> <small> <a href="http://chiropractor.blog.co.uk/2009/06/19/patrick-thanks-for-your-very-measured-and-reasonable-response-to-6340808/#comments">Comments</a> </small> </p>