If it is due to a traumatic incident it is best to call for medical assistance as you need to ascertain if anything is broken.
This following advice is meant as a guide and you should seek advice for your particular problem.
Assuming it is due to an unguarded movement (by that we mean the muscles didn’t support your joint) the best thing to do is get a flexible ice pack over the painful joint. This must be wrapped in a thin cloth to protect the skin from a burn. The length of time depends on the depth of the joint.
As a general rule do 10 mins for neck, upper back and limbs and 20 mins for lower back. Try to apply 3-4x a day, mainly from mid morning onwards. You will probably feel best having a hot shower in the morning to loosen the overnight stiffness.
The next important thing to do is stay mobile on a regular basis if possible. This may be difficult to do initially. However as you move you will inhibit pain, so start gently and gain flexibility slowly. Do not test your movement in the direction of pain, as it will only aggravate your condition.
You would as a general rule benefit by going into the pain free direction. Please note with sciatica due to a disc prolapse you go into the direction that reduces leg pain even it the back aches a little. Please see the section on sciatica for further information.
In practice we are asked whether anti-pronation running shoes or orthotics are the best option for runners. This article will help you to understand pronation and guide you in your choice of running shoes to prevent over pronation.
Pronation describes the rolling in of the foot as it strikes the ground during walking or running. This rolling in is part of the normal mechanics of the foot. It allows the foot to absorb energy efficiently and reduce the impact forces up the leg and into the rest of the body.
For some people the foot will pronate too far, too fast or both. These situations will give rise to increased risk of injury as the impact forces will be greater and the stress on the supportive structures (muscles and ligaments) of the leg and low back will be increased.
Do This exercises to understand the mechanics better.
From this you can get a picture of what is happening to the movement of the joints in the leg. This is called a kinematic chain as it describes a chain of movement.
Go to any running shop and pronation will be on the radar. Since the 80’s running foot wear has been developed to help cushion and stabilise feet and pronation has been seen as the enemy. This approach sprang up following research that linked over pronation to running injuries. Further research corroborated this and manufacturers responded to prevent pronation. This lead to various approaches to aid stability at the ankle. The footwear had increased arch supports or a cant to change the angle of impact or both. This lead to a heavy and bulky shoe.
However, it is important to remember that the foot is supposed to pronate as part of shock absorption and normal mechanics to allow the foot to flex during the heel strike to toe off phase of gait. Stopping this is equivalent to trying to run on a stiff leg or stump. That is not going to help your prevent injury and may even make things worse. So it is important to maintain a balance that reduces excessive pronation and slows its rate if you roll in too fast.
Runners with feet that over pronate will generally need an anti-pronation shoe or an orthotic, runners that have high arches (supinate) will need a better padded shoe.
In 2001 Benno Nigg (1) proposed a new way of thinking on how these measures work. Rather than assume that they changed the position of the foot he postulated that they changed the pattern of firing of the muscles of the leg. This then created the stabilisation and slowing of pronation. This makes perfect sense as it is the firing of muscles in a coordinated fashion that stabilises and moves a joint. However as we saw in the exercise earlier the knee, hip and pelvis position also affect the ankle. So in order to achieve good ankle stability you also need top strengthen them.
A key muscle in this process are the Gluteal muscles. They stabilise the hip when you stand on one leg stopping the pelvis from dropping forwards on that side. Remember as the pelvis drops forwards it rolls in your ankle.
So in summary, if you want to run well, get your pronation assessed, select the appropriate stabilisation and strengthen the muscles around the hip, knee and ankle by following these exercises.
You may now be able to guess what I recommend to help the problem. In my opinion an orthotic in a neutral shoe is a good option. HOWEVER, it needs to be the right type. It should have an arch that is free to spring and not be a solid inflexible device such as the moulded bespoke carbon or plastic varieties that have little or no give in them.
Similarly it shouldn’t be a foam based orthotic that fills the arch up. Now if you look at the anti-pronation shoes they basically tilt or cant the shoe to take out some of the roll. The problem with this is the lack of spring but also you have a clumpier, heavier shoe to carry round for your 40000 steps. That extra bulk and weight will have an effect after that many reps.
At Back In Form we recommend SOLE orthotics as they give the spring required and they are relatively inexpensive when compared to tailored orthotics. If you’d like us to assess you or for more information on how you can save over 10% off RRP just call us on 01202 733355.
In our busy lives free time is precious and often in short supply. We don’t always have time for the gym workout. This research on speedy 20 minute work outs could be a option to help you get fit.
Exercise isn’t a choice, it’s a must. Movement is one of the key driving forces for brain activity giving us many benefits.
However, making time for hours of running, cycling or gym work is difficult, and perhaps impossible for those with children !
A recent study Gillen et al(1) found that 3 minutes of intense exercise per week has many health benefits. It is as effective as 150 minutes per week of moderate-intensity training for increasing insulin sensitivity, cardio-respiratory fitness and skeletal muscle energy release in previously inactive men. In plain English, it gets you fitter just as fast as long sessions.
That’s right, 3 x 20 second burst of maximum intensity cycling, separated by 2 minutes of low intensity cycling, a total commitment of 7 minutes 3 times per week. This gave the same benefits as a 45-minute session 3 times per week! Of course, you want to add on a warm up, and cool down so let’s call it 3 x 20-minute sessions per week. Easy!
You don’t have to own a bike, the same principle applies for any form of sprint interval training. You might choose to sprint for 20 seconds, perform squat jumps, burpees, skipping etc. It can be any exercise as long as it is maximal intensity.
Research suggests that your genes will have an influence on how much of a benefit you will receive. Huge gains can be acheived by some, but for others the benefit will be limited. However, variety is the spice of life and your health program should reflect that, so at the very least try to include some sprint training a couple of times per week.
Important: Please check with your chiropractor, health professional or sports therapist before performing high intensity exercise.
(1). Twelve Weeks of Sprint Interval Training Improves Indices of Cardiometabolic Health Similar to Traditional Endurance Training despite a Five-Fold Lower Exercise Volume and Time Commitment Jenna B. Gillen, Brian J. Martin, Martin J. MacInnis, Lauren E. Skelly, Mark A. Tarnopolsky, Martin J. Gibala Published: April 26, 2016 https://doi.org/10.1371/journal.pone.0154075
If you were asked ‘how is your sense of balance?’ how would you reply?
For many people their idea of good balance would be whether they are good at walking along a wall or narrow beam, or if they are comfortable to go up scaffolding and clamber around on a roof. Indeed, these things do require a good sense of balance but day to day we all need our balance systems in order to know where we are in space when just sitting or standing still. Even more so to stand up from a chair and simply walk across a room, let alone turn around.
Now, when our balance is acutely disturbed we can experience a feeling of spinning (vertigo) or falling. There are various different reasons for this including alcohol, which is particularly toxic to the cerebellum, (the area that is associated with balance and co-ordination), is just one reason. Think of the clumsiness , slurred speech and stumbling of someone who has had a few too many.
When those changes are more gradual or a subtle loss of balance we may not even realise we have a problem.
Our brain and body will do its upmost to compensate but these adaptations can result in changes of posture and maybe spinal problems. Slowing of general movements occurs. Walking speed is a common sign as are changes in tolerances of movement around you, this can manifest as travel sickness or feeling uncomfortable in supermarkets and busy streets.
Another common complaint of people with giddiness, dizziness or balance issues is anxiety and nausea. It is estimated that 15-35% of the population will experience a complaint of dizziness and at least a third of those will develop a secondary psychological disorder. (Ref: Susan Herdman PT, PhD Vestibular Rehabilitation 2nd Ed)
Are you noticing these changes in your balance, co-ordination, speed of movement or someone else’s .
Do you think you might benefit from having your posture, balance and co-ordination checked? Chiropractors at Back In Form are trained and practiced in looking at the integration of these systems and may be able to improve or resolve your complaint with treatment and ‘vestibular rehabilitation’. If you’d like to know more then please call the clinic for further advice or to make an appointment.
In August our amazing Olympic team brought home life time best performances and medals galore. The joy and delight on their faces was moving and something you can share to an extent by joining the para-olympic athletes as they inspire even more through their heroism in the face of adversity.
The common theme from the Rio games is one of inspiring the next generation to compete, but what about the current and former generation? Yes that’s us lot, who have probably been mainly sat on the sofa while watching, possibly with a glass of wine and a few crisps and nibbles. Well, we all need a break from the usual bad news don’t we?
But why not participate yourself next time you settle down to watch some sport. You could do a stretching routine or even some floor exercises and feel the burn with those on the screen. I’ve been doing it for F1 for years as it stops me falling asleep, even on the highlights program!
If that seems a little too much there are exercises you could do while barely leaving the sofa. Here are a few to help you.
After a break from exercise it is easy to get carried away and bite off more than you can chew. If you don’t take a sensible controlled view you will be more likely to get injured. So here are a few steps to consider when you restart……
The Technical Bit:
Anti-Cholesterol drugs such as statins reduce your cholesterol by slowing down the production of cholesterol by the liver. They do this by interfering with the action of a key enzyme, HMG-CoA-Reductase. Cholesterol production is not fully blocked nor is the production of other substances that are derived from the same pathway, such as steroid hormones and vitamin D.
Because cholesterol synthesis is reduced, the liver takes up more cholesterol carrying LDL particles from the blood. The net result is a reduction in circulating LDL-cholesterol (bad cholesterol).
Statins also help to stabilise the fatty plaques (fatty deposits or atheroma) within the lining of the arteries. This is why people who are at high risk of heart disease or stroke or who have diabetes, may be prescribed a statin even if they have a normal cholesterol level.
There’s no doubt that a healthy lifestyle helps lower cholesterol. The question is whether it can lower your levels enough – and that depends on how high your levels are and what your doctor has set as your goal.
Eating a heart-healthy diet can lower LDL cholesterol at least 10%. If you lose 5% to 10% of your body weight, you can cut LDL cholesterol 15%, and reduce triglycerides 20%. If you exercise at a moderate intensity — meaning you have enough breath to talk but not sing — for at least 2 ½ hours a week, you can further cut triglycerides 20% to 30%. (Exercise can also increase your HDL, the “good” cholesterol.)
That’s a great start, says Michael Miller, MD, director of the Centre for Preventive Cardiology at the University of Maryland Medical Centre. “Lifestyle changes certainly are the cornerstone of cholesterol reduction.”
Of course not. Doctors say the best way to protect your heart is to make healthy lifestyle changes while taking a statin. I say the best way is to make healthy lifestyle changes and avoid the statin unless you are diabetic or have recently had an acute cardiac event.
If you look at the medicine supported websites you’ll see the following:
Like many pharmaceutical drugs, statins can have body wide side effects and may also interact with other medicines you take. potential side effects can include:
Did I just hear that right? 60% of people on statins get no benefit from reduction in heart attacks! I wonder what the figures are for reduction in heart attacks by adopting a healthier lifestyle. When you consider that 9% of people on statins will get adverse effects on every cell in their bodies. This is due to a reduced ability to release energy from the mitochondria (the powerhouses of the cell) due to the reduction of Co-Enzyme Q10. This is well documented to adversely affect muscle, but it can also lead to fatigue of nerves too. However some studies have found that Statins may help improve dementia. These studies however are not high quality and further research is needed. (3)
When I see data like that and patients who are stiff and ache all over I begin to question if this reliance on statins is worth the loss of quality of life for at best a 40% reduction in CV events. I also wonder why time and time again patients who are on statins don’t get advised to take Co-enzyme Q10 when statins adversely affect your ability to produce energy through the inhibition of Co Q10.
Here’s another little known fact. After a year of taking Atorvastatin any increase in HDL (the good fat) is gone and in fact a reduction in the good fat from the starting baseline is often found. It is also noted that the first dose is the most effective, subsequent increases in dose have a much reduced benefit at 6% reduction in LDL as opposed to around 50% for first intial dose.
If your GP recommends that you go on a statin and you have struggled with commonly associated significant stiffness aches and pains; there are alternatives available. Colesevalam is a statin that works more specifically at a “gut level”, so does not produce side affects of muscle and joint pain and stiffness. It can for some however cause constipation and flatulence. So neither is perfect but may be a more favourable solution. It is however much more expensive that a generic statin.
Here’s a viewpoint from a GP;
The important bits: Nice (the National Institute for Health and Care Excellence) has issued guidance that proposes reducing the cardiovascular primary prevention risk threshold – the level of risk at which statins can be prescribed – from 20% to 10%. In other words an increase in prescribing of statins.
In May 2014 a national conference of general practitioners passed a unanimous motion calling for Nice to recommend such changes only on the basis of a full disclosure of trial data. This was followed in June by an unprecedented open letter to Nice (click link to read) from a number of senior doctors and academics expressing four main areas of concern: medicating healthy people; non-disclosed side-effect data; relying on industry-funded statins trials; and conflicts of interest within Nice.
There needs to be more transparency with respect to statins. Eat a diet high in good fats and lower in bad fats. There is plenty of info out there and we will add some suggestions in the near future.
A viewpoint on statin effects – benefits and problems Thomas F Whayne, Jr, MD PhD FICA Int J Angiol. 2008 Winter; 17(4): 178–180.
Coenzyme Q10 and statin-related myopathy. Drug Ther Bull. 2015 May;53(5):54-6. doi: 10.1136/dtb.2015.5.0325.
Statins and cognition: a systematic review and meta-analysis of short- and long-term cognitive effects.Swiger KJ1, Manalac RJ, Blumenthal RS, Blaha MJ, Martin SS. Mayo Clin Proc. 2013 Nov;88(11):1213-21. doi: 10.1016/j.mayocp.2013.07.013. Epub 2013 Oct 1.
Take a look in a full length mirror at yourself and see if the following applies to you.
A commonly seen aberrant posture in clinic is one where your foot is turned out, the arm on the same side is held slightly flexed at the elbow and is rotated inwards so that you can see more of the back of the hand than the other side when looking face on. The same shoulder will also be held forwards. Typically this is due to weakness of the anti-gravity muscles down one side of the body and is a milder presentation than Pyramidal Weakness found in some typical stroke patients.
The anti-gravity postural muscles hold the shoulder back and rotate the arm outwards. They also lift the leg and foot from the floor. Commonly this pattern of weakness leads to rotator cuff problems, tennis elbow, hip pain, shin splints etc. If you have had any of these problems or get them repeatedly despite having had treatment then you possibly have a functional weakness of a relay area in the brain called the Ponto-Medullary-Reticular-Formation or PMRF for short.
You can have as much Physiotherapy, Chiropractic, Osteopathy or whatever other therapy you like, but if the weakness is established the problem will keep recurring. Why? Because the brain will keep pulling you into the poor posture. If you are exercising and getting stronger you will have less symptoms, but push it hard and you’ll be likely to get your injury again. This is because the area in the brain will fatigue one side faster than the other and your control will diminish. The result, yet another injury. Just think how many sports people have struggled through their careers with hard to treat injuries. The list is endless.
By specifically treating to enhance function in this area we can help to restore normal function. If we combine this with visual exercises we can help to hard wire the pathways to strengthen them. This requires repeated stimulation over a short period to get the nerves to express genes that lead to growth of new connections. It won’t happen without repetition.
So if you’ve ever had a car accident or a whiplash type injury from sports such as horse riding, skiing, boarding and obviously boxing then you may be prone to these problems. If you’ve ever had a concussion or been knocked out the chances of this are significantly increased.
Make sure you find someone who can look at these patterns to help you for the longer term and not just a quick fix.
Last week (April 2015) a study was published in the British Medical Journal that got a lot of headlines. An analysis of 13 quality trials showed that Paracetomol is no better than a placebo for treating back pain, arthritic pain and disability. What’s more, those patients regularly taking Paracetomol for back pain or arthritis were 4 times as likely to have abnormal results on liver function tests. So taking this medication for your pain will make you less healthy.
Similarly taking Non Steroidal Anti-inflammatories (NSAIDs) such as Ibuprofen and Naproxen can lead to health problems related to gastro-intestinal inflammation. Interestingly Aspirin did not cause inflammation of the small intestine (2). This inflammation leads to increased permeability of the intestine. If you consider that the intestine is the barrier between you and your food, bacteria and powerful enzymes it’s good to keep it healthy.
If larger molecules cross the gut wall they can stimulate your immune system to attack them. Unfortunately, this reaction can then continue on similar molecules within you. Therefore increased gut permeability (caused by expression of a protein called Zonulin) contributes to the development of auto-immune diseases such as coeliac disease and diabetes type 1. (3) It has also been recently hypothesised that joint inflammation in relatively benign osteo-arthritis is also a product of this process. If that is the case then taking Nsaids could actually contribute to the cause of the problem you are taking it for.
The research paper from the BMJ recommended exercise and manipulation to help stay pain free. Manipulation stimulates the nerves that regulate muscle tone and also inhibits pain. Most people will have pain from either over doing things or not doing enough. So if you are not active start by taking walks and then think about swimming, cycling and general workouts. Build up slowly over time and you will soon start feeling better. If you are a weekend warrior make sure you do regular consistent exercise to build up your conditioning or you will get injured. If you do have pain don’t take painkillers and NSAIDS. Use Ice, get help from an expert who understands biomechanics, athletic training, neurology, anatomy, diagnosis in other words us!! Don’t pop a pill, it will make you less healthy in the long run. If something’s wrong find out what and why and do something constructive about it. Your liver, kidneys and gut will thank you for it.
So, when you consider all of the above it is crazy to take paracetomol and anti-inflammatories as part of your training. Pain is there to warn you. If you listen to it properly it can be your best friend as it will keep you healthy and aware of issues before they become established. If you ignore your warning systems you are heading for trouble.
Yes!! Studies have shown the efficacy of taking a concentrated turmeric formulation (4). Turmeric contains Curcumins which have been shown to reduce inflammatory cascades in the early phases of inflammation. It is not heat stable so cooking will nullify it’s effects. So a curry on the way home is not good practice. It won’t act instantly like a drug but is a useful supplement to help with a number of problems caused by inflammation if taken daily. We stock it as part of our holistic approach to improving musculo-skeletal health.
For more information on any of the above topics contact us on 01202 733355 or email us.
(1) Machado GC, Maher CG, Ferreira PH et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials.The BMJ 2015;350:h1225. doi:10.1136/bmj.h1225.
If I asked you what was the most important vitamin for fighting colds what would your answer be? Many people think it’s Vitamin C. It is certainly important in helping to mop up free radicals which cause damage through a process known as oxidative stress, but it’s not the most important. Vitamin D3 has been shown to boost immune function thereby helping you fight the invaders before they get a foot hold. To put it another way, Vitamin C helps you fight the effects of the chemicals released by inflammation, vitamin D3 helps to stop it in the first place.
Vitamin D3 is synthesized in the skin when exposed to sunlight. Vitamin D2 is found in plants. Vitamin D has long been known to support the absorption of calcium and formation of bone. A deficiency leads to softening of the bones and Ricketts (bandy legs). This disease is on the increase again, due to people covering up for cultural reasons and lack of sunlight in higher latitudes, especially for those of darker skin.
More recently Vitamin D3′s role in immune function regulation has been studied extensively and new research is confirming it’s importance as a vital supplement. Poor immune function obviously can leave you more susceptible to infections such as the common cold and flu. It can also reduce your ability to recognise and destroy cancerous cells, and can lead to the development of auto-immune disorders where your immune system actually attacks your own body. This process has been implicated in some inflammatory arthritis, multiple scerosis, systemic lupus. A correlation has been found between low levels of Vitamin D3 and all of these disease processes. In addition macular degeneration (blindness), hayfever, chronic rhinitis have all shown signs of being affected by low vitamin D3 levels.
This depends on your location, skin colour, diet and sun exposure. In the UK 90% of the population are below recommended levels. 75% of young adults are deemed deficient. 20-40% of young adults 19-24 years old, care home residents and children of British Asians have been found to have only a third of recommended levels. The amount needed varies according to who you read, the Endocrine Societies Clinical Practice Guidelines state from 400 iu to 800 iu as a daily requirement. With an optimum of 1000 iu to 1500 iu. In cases of deficiency 2000iu to 10000iu. You can read the guideline here. One thing is clear, if you are wrapped up for several months of the year in low sunlight you won’t be getting as much as in the summer.
Is this why you are more likely to have “bugs” in the winter? Is it also why cancers such as colo-rectal cancer are more common at higher lattitudes? There is also a possible link between latitude and multiple sclerosis and diabetes. Also have a look at this site which has a good deal more on the topic.
Natural food sources are oily fish, such as salmon and sardines and eggs. It is also in fortified cereals, spreads and powdered milk. The NHS site states that most people should have enough, but latest clinical guidelines dispute this. Supplementation should be 1000iu for babies and children (be aware that baby formula milk commonly contains vitamin D, so adjust accordingly). 1500-2000iu for adults 18+ years of age.
Generally because vitamin D deficiency is so widespread in the UK routine measurement is deemed unnecessary. A more cost-effective approach is routine supplementation with sensible sun exposure in the spring summer and autumn. High risk groups should be screened, these include people at high risk of inflammatory bowel disease, cystic fibrosis, gastric bypass patients and patients taking medication that effects vitamin D metabolism (anti-seizure meds, glucocorticoids, AIDS meds).
Historically there have been concerns as very high levels can be toxic and cause too high a level of calcium and phosphate in the blood leading to bone conditions. However it is now well established that toxicity is extremely rare. Doses of up to 10,000iu a day have been used for up to 5 months with no adverse effects, suggesting that only long-term over supplementation is an issue. However it is important to stick to the guidelines.
If you live in northern latitudes, are inside alot and use sunscreen extensively you won’t get enough from the sun. Especially with our weather!
There are many products on the market, I would recommend a natural food source variety and not a synthetic one. A quick search online should provide a wealth of information to help you choose.