Back In Form are delighted to welcome Chiropractor Susan Hill DC, DACNB to the Poole Clinic

Susan Hill Joins the team at Back In Form.

Susan has been practising Chiropractic for 28 years and has worked in many locations before settling in Dorset. She has been working at Casterbridge Chiropractic Clinic for many years but has now decided to work closer to home.

Susan has a particular interest and experience in Functional Neurology and has attended and qualified to Chiropractic Board Certified level in Neurology. This puts her in an exclusive club of specialising Chiropractors. She is also a contributing author to Chiropractic textbooks.

Susan’s approach looks at the whole nervous system, particularly brain function. The brain controls how we function and interact with our perceived environment. Weaknesses result in patterns of weakness which can eventually manifest in functional problems.

Using standard Neurological tests and Optokinetic (eye movements) evaluation it is possible to identify weaknesses that could easily be overlooked. A program of exercises to strengthen the weak areas is then devised and if the problem is functional, positive changes will occur that help to rebalance the reflexes that control us. You can find out more from Sue by following this link. 

We will be updating topics regarding this in due course so if interested please follow us through facebook and we will post links to them there.



Triathlon 2016 season

After an encouraging 2015 coming on the back of glandular fever the year before I was keen to step it up and start to become competitive. I learnt a lot the year before regarding nutrition, preparation and recovery and was itching to get going again. The problem was I’d been injured from attempting to kite surf since October. A few months of DIY hadn’t helped the recovery and so when I had an MRI  of my right knee in Feb I had tough choices to make.

I wanted to revisit Mallorca and go sub 11 but I had a tear in my lateral meniscus, mild bursitis and tendon damage. Not from running I hasten to add. From failing to release from my binding when I wiped out mildly. So come the end of Feb I decided to take a gamble and book Mallorca. I also invested in a new bike to help trim some time of the ride. There could be no excuses then.

Training started slowly, mainly building up the bike which I hadn’t been on for 4 months. Running started slowly too but soon I was doing 50 mile rides without a sore bum and getting off feeling reasonably Ok. The running built up steadily to 7k over 3 weeks but then I stupidly went back to 10k followed a week later with 15k. That irritated the knee and I had to ease off. Rule of thumb 10%-20% a week from base of your normal run. Not 50% each time. Come April I was feeling good and took part in a tough sportive in Pembrokeshire. An upset stomach and back ache from the 7 hour journey to get there put paid to any decent time. I was disappointed but it was good base training. I didn’t feel ready for the first middle distance in May so booked up to the Breacon race again.

BRECON TITAN (Middle Distance)

So in mid June I headed off to Wales again hoping for a better journey. I got there in plenty of time and familiarised myself with the course again. This time for breakfast I had cold porridge (as they don’t do brekkie at 4am) with plenty of low fibre carbs. I had my bike loaded with gels and three water bottles as there aren’t bottle replacements on that race like Ironman. However it is half the cost and just as much fun. So the swim went OK, it was a better field this year, the lake is shallow so the weed was a problem until towards the end I realised it was quicker to pull myself along on it!

The bike started well passing a lot of better swimmers early on, including one who stopped for a pee. All that training ruined by a full or nervous bladder! The big descent was a little slower this year due to bigger profiles on the wheels making the handling a bit dodgy in the crosswind but the flatter sections were a breeze until a lorry coming the other way nearly blew me off the bike. Going back up the hill was much faster as I stayed seated this year. It’s much more efficient and shaved a lot of time. So I arrived back in T2 in a good position.  The run this year didn’t start with a cramp as I had trained a little better, but I had forgotten my salt caps so started to tighten up. The only solution was eating some crisps at a fed stop. Here’s a big tip, remember your caps, crisps aren’t easy to breathe. Mild choking over I continued on and nearly got to the end without cramp. It got me on a downhill about two miles out. End result over 37 mins faster than my first year, 6th in my age group. So getting closer to the silverware.


My next race was Swanage Olympic which went well apart from nearly crashing on loose gravel on a dangerous corner (that should have been swept). At T2 I was 4th overall for the first wave of athletes, I was holding my own and eventually overtook the chap in front. Stupidly though I let him pass me on a steep narrow section. I hate steep downhills as they hurt me behind my patellae. If I had kept him behind I would have been able to stay with him till the end. So I assumed I was 4th in my age group and went home disappointed. However I forgot that there were younger ones running with us older folk and I was actually 3rd. So I missed what would have been my first trophy presentations. Dumpkoff!


All of 2016 had been building up though for another shot at Ironman Mallorca. This time I was better prepared with my feeding strategy and had support with nutrition for the run. In hindsight I hadn’t done enough run training again.

The day started with thunder and lightening off to the East in the pre dawn sky. Adding to the nerves was a late announcement allowing us to use wetsuits as the sea had cooled from the day before. This lead to mass stress and lots of haunted looks as people ran around trying to get back to cars to get kit. Not the best preparation but with about 15 minutes to spare I was at the start and ready as I’d ever be.

The swim started in calm waters and I found myself in the usual washing machine wondering why on earth I do this sport. That was soon followed by me repeatedly trying to sight the turning buoy which seemed to be off in infinity somewhere. After an age we were making the first turn and heading back to shore only to do it all again. From there it was off to T1, at this point I was 1 minute down on 2015. Thankfully I had been given a good spot in transition and didn’t have to run the bike too far. The bike leg was a breeze to begin with and I made good time until unexpectedly (and it’s never happened since), the chain came off and jammed in the back brake. Thankfully a support mechanic was passing at the time on a motorbike and assisted me. I then got cramp in my thigh getting back on the bike. He gave my leg a massage, which was very kind and off I went to catch up the 100 people who had gone past!

As the bike leg went on thunder clouds started to build and the main worry by this point was how I would survive slick tyres and carbon rims in heavy rain coming down the mountain. Having had a similarly traumatic experience earlier in the year I was pushing hard to get down from the mountain before the rain came. Thankfully I made it down in the dry. By this time the wind was picking up and heading back to Alcudia where it all started was hard work into the wind. I was very annoyed by some cyclists who were grouping together and draughting. This makes it a lot easier and is illegal. There were no Marshalls in sight which was equally annoying as there should have been penalties aplenty. Anyway as I headed back to T2 the sky was black as ink and riven with flashes of lightening, the second time up the high street to T2 there was hardly anyone in sight and it was all a far cry from a couple of hours earlier. The bike was over 30 mins faster than the year before.

T2 went well, a quick stop for necessities and I was on my way to great encouragement from my wife Karen who was there in the rain trying to give me fluids and gels. I was fully loaded so declined and splashed my way round the first 10k in good time. The run was 4 laps of about 10k plus a little bit. At lap 2 Karen was still there getting wet and I still didn’t take on some fluids and gels. That was a mistake. I soon started slowing my pace and no matter how hard I tried couldn’t get faster. This was partly due to fatigue but also down to lack of nutrition. Lap 3 I took some on board as it was need badly, but also Karen was going to murder me as she was still in the rain and feeling like a spare part. I trundled o and got steadily slower, but importantly I didn’t walk. Last year I had walked at the feed stations as it was the only way to get fluids down. This time I carried mine round and it made a big difference to my time. Eventually I was on my last lap and running faster than those around me. It was still slow though and I had run out of salt caps. When that happens cramp is far away. So with just 2k left out of the 42 I got a twinge of cramp, slowing didn’t help and it grabbed me hard in the hamstrings as usual. Trying to stretch just set of another and I was immobilised. Lots of panting and swearing at my legs later I managed to shuffle along and eventually got back my pace. So finally after what seemed an age the finish line was in sight and I put in one last sprint to overtake a bearded chap ( Karen wanted me to beat the beards) and virtually collapse over the line in 10:53 hours. My marathon time was 4:01 so I was gutted that it wasn’t sub 4 due to the cramp.

I was overcome with emotion and had to have a lie down for 30  mins while I recouperated. That helped me feel better but I had stiffened up significantly in that time. The lessons I learnt this time round. Run more as it gets hard on the run when you pass your normal training distance of 15 and there’s still 27 to go! Take on fluids when you feel you don’t need them on the run. Don’t stop moving when you finish.



Probiotic bacteria help reduce symptoms of Hay fever.

Eating a bio-active yoghurt a day can help reduce Hayfever.

18 million people suffer from hayfever in the UK to some extent. For some it can be life changing and for most just annoying. Hayfever is triggered when pollen proteins are recognised by an over-sensitized immune system.

The result is an aggressive response by your immune system to neutralise what it thinks is a mass invasion. Recently scientists in the US reviewed 23 studies involving 1900 people and found that those that ate a probiotic yoghurt a day had a significant reduction in symptoms.

It is now thought that a variety of allergies are triggered by a lack of good bacteria in the gut. Overzealous cleaning and lack of exposure to naturally occurring pathogens in the soil and on our food have lead to a reduction in our gut flora. This news is further evidence that a healthy gut flora of probiotic bacteria can help desensitise your immune system.

Why does the immune system get sensitive without the bacteria?

A gut that is populated with good bacteria is less inflamed and the endothelium or lining of the gut is healthier. An inflammed gut can lose it’s ability to protect and can become “leaky”. This simply means that larger molecules can cross it’s wall and enter the body than normal. As around 70% of your immune system is sensibly placed where it is needed most i.e. around the gut, it can easily be stimulated to attack larger molecules such as proteins. The result is the body’s policemen get a bit carried away and indiscriminately go on patrol attacking things that are in effect harmless. In severe cases the immune system can start to attack the body itself. Indeed there has been a large body of evidence recently where this association has been noted.

The friendly bacteria also help to breakdown food stuffs that we are unable to deal with. So that can aid digestion and reduce the feeling of bloatedness. A word of caution though, the Yakult, Actimel type handy shots contain a lot of sugar and should be avoided. It is much better to supplement with a broad spectrum or high concentration probiotic. Alternatively live cultures of natural yoghurts should be used. Again beware some have a lot of sugar added. At Back In Form we stock or can order a variety of high quality probiotics as this is such an important contribution to overall health.


You Can’t Teach an Old Dog New Tricks….Or Can You?

The difficulty of re-wiring your brain or why we’d all be better off if we were 6 years old!!

Backward Bike


As a Chiropractor who looks at a functional neurological approach to pain and poor function I was delighted to find this article and video on the phenomenon called Neuroplasticity.

Neuroplasticity is the ability of the nervous system to adapt to changes in the environment. These changes in stimulus result in a re-wiring of the connections, so that you can effectively learn a new skill, recover from injury or adapt to a stimulus. If the stimulus is significant you can learn instantly. For example you generally won’t keep touching a hot surface.

However sometimes the complex associated tasks that we learn as part of our development are so ingrained that it takes an age for an adult to un-learn them and learn a different set of rules to achieve the same thing. Here it is brilliantly and entertainingly demonstrated by a backwards steering bicycle.

The interesting thing is how it demonstrates how easily a child can adapt. This is due to the plasticity of the developing brain. From a treatment perspective this demonstrates why it takes time to make lasting changes with respect to chronic pain. The same un-learning of pain and promotion of pain suppression takes time to learn and is only done through repetition of positive stimulation such as adjustments , exercises and focusing on movement. The bigger the stimulus the more wiring that occurs. This is why adjustments have a greater effect.


Anyway here’s the video, hope you enjoy it.



What is Pain?

Fact: Pain is being sent to your brain by every pain nerve in your body all the time.



Thankfully the action of the nerves that detect movement and pressure suppresses this pain at the spinal cord and you don’t feel it. However loss of movement of an area means the suppression is reduced and pain can start to be felt. Anyone who’s sat through a long film will know that. Your body is literally telling you to move so that you don’t damage it. The brain itself can also suppress pain from above if it is busy doing other tasks that are deemed more important, ie running away from danger or doing something more pleasurable.

Pain is felt when the impulses from those pain fibres actually manage to reach the sensory cortex of the brain. So you register pain in the head. To achieve this you must have  increased excitation of the pain nerves. This can be down to an increase in stimulus or a lower threshold to fire the nerves. The chemistry of your body and level of electrolytes can influence pain generation. If your body is lacking in nutrients that are used for the building blocks of natural anti-inflammatories then you will generally be more likely to experience pain. Or if tissue is injured, chemicals released by the damaged cells lead to easier excitation of pain nerves and you feel pain.



So if pain is neurological is it right to perform surgery when changes are seen on x-ray or scans.

It is possible to have a lot of wear and tear and have no pain at all. Similarly you can be in agony when there is very little damage showing. So if you have an x-ray or scan of a recently injured joint that was previously pain free and it shows degeneration or a tear of a structure don’t go straight for the surgical option. There is little correlation between tissue damage and pain. Think twice or even three times, seek an opinion of someone who isn’t a surgeon. You may be in pain simply because the pain nerves are more excited and the suppressive mechanisms aren’t working. If this is the case surgery won’t make any difference as the torn tendon might not have been the source of the pain. It could be coming from somewhere else entirely.

Surgery should always be a last resort, once it’s done it can’t be reversed. There are risks of infection and risks of further pain due to the inflammation and excitation of pain nerves from the surgery itself. In some cases this can trigger a complex pain syndrome that is self fulfilling and perpetuates.

The natural approach begins by activating the neurological mechanisms that suppress pain. Stimulation of these nerves anywhere in the body can help, the strength of the effect is variable depending on what area is stimulated and is related to the representation on the brain itself. Movement, mobilisation, manipulation, taping all help reduce pain. However they have to be applied correctly to ensure the balance of neurological activity is helping rather than hindering.

If the physical therapy approach you choose isn’t successful, try a practitioner in a different discipline such as Chiropractor or Osteopath, or vice versa. Or even two different practitioners within the same profession as they do work quite differently a lot of the time. After you’ve exhausted all options consider the surgery but remember the pain won’t just disappear after surgery, you will still have a period of 6-12 weeks of recovery and rehabilitation to go through.

Also you should look closely at your diet. Lack of fresh fruit, whole foods such as nuts, seeds, dark leafy green vegetables and oily fish can mean the body does not have the raw materials to create anti-inflammatory chemicals. Furthermore smoking and alcohol can aggravate inflammation.

The use of the painkiller Gabapentin alongside manipulation and stimulation can also be helpful to suppress the nerves so that treatment can be gently started in chronic pain syndromes. We do not recommend the use of Non Steroidal anti-inflammatories or paracetomol as the former is detrimental to gut, heart, liver and kidney health and the latter has no benefit long-term and will reduce your emotional as well as your pain sensation.



Back Pain Prevalence

Back Pain Audit shows worrying trend.


Recent National Pain Audit figures show a worrying trend. A staggering 20% of health expenditure in the UK is now spent on back pain services. Chronic pain affects 8-60% of the population depending on the definition of pain (1). Severe pain affects 11% of the population and 8% of children. Yes 8% of children, a group that are generally ignored as problems are put down to” growing pains”.

If more attention was put to diagnosing and recognising that young people start their journey to chronic pain young then maybe something could be done to redress the trend.

Severe chronic pain affects relationships, work status, sleep, mood, general ability to do daily tasks and all aspects of general health. Even more worryingly, daily back pain is linked with increased risk of a coronary event. This makes sense as less activity means reduced cardio-vascular fitness. Movement of the spine and joints also feeds activity into the brain and the resulting reflexes help to support and drive not only movement but also the autonomic responses that control body functions such as blood pressure and heart rhythm.

So why is back pain so common and getting more common?

The simple reason is that as a population we are less active. People drive to work or school nowadays then many have sedentary roles that mean the body is held still for long periods. This will cause mild pain as your body will want you to move. That in itself is not a problem until it is repeated day after day for long periods. Gravity is a very strong force and even when you are not moving it exerts constant pressure. For example looking down at your smart phone will increase the weight of your head threefold. That’s a heavy load on your neck muscles and discs.

If you are also getting heavier then the forces become greater and the stress on structures and changes in posture results in a greater chance of back pain. If you are active you will generate reflexes and fire nerves that help to suppress pain, for more on this go here.

The more you fire, the more you wire.

Nerves love to fire if they are healthy. If you fire them enough they will grow new and stronger connections and the result is healthier tissue and better faster, more accurate responses. If you don’t fire the body will remove the connections and the opposite occurs. You get less energy, less accuracy and tissues that are supplied become weaker.

However if you are already weakened, then firing too much can fatigue the nerve to the point that it can become so tired it will actually become very weak and eventually die. This is a process known as apoptosis. So if you are weak already or have nutritional compromise then you may overdo it and cause harm.

How Do You Strengthen The Nervous System?

Firstly make sure you have the raw ingredients to support good nerve cell activity. A good healthy diet should give you this. So avoid fast food or ready meals with flavour enhancers. Monosodium glutamate will fatigue your cells very rapidly as it acts like a turbo, so will high sugar diets as nerve cells do not need insulin to absorb and use sugar. The result is like an engine over-revving, it will go pop at some point! Avoid too much caffeine, never drink energy drinks that is nerve cell suicide! Excessive alcohol and smoking are also highly detrimental to nerve health.

Leafy green veg is full of great nutrients to support cell health. Fish is a good source of protein and essential fatty acids, as are seeds, nuts and pulses. Magnesium is very supportive of energy release in cells and is found in dark leafy greens, nuts, seeds, fish, beans, whole grains,avocados, yoghurt, bananas, dried fruit, dark chocolate, and more.

Assuming your nutrition is good the next step is to start exercising your body and mind. If you are very weak start gently and build up incrementally at a round 5-10% increase in activity a week. If you feel very tired make a note of when that happened and only do 70% of that. Stay at that level for a few weeks and then start to increase activity. It may be a slow road but if it’s steady you will progress smoothly. If you try and jump activity too fast you may get more tired and / or injured.

Gradually you will start to feel a lot better. This isn’t easy though as the reason you got bad in the first place may be down to bad habits and these can be hard to break. So make gradual changes to your lifestyle and you will be more likely to keep on the straighter and narrower path.


  1. Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet. 1999 Oct 9;354(9186):1248-52.

Ongoing Spinal Manipulative Care Shown To Be More Beneficial Than Short Course Of Treatment.

It has long been a subject of hot debate between the medical profession and Chiropractors about the efficacy of longer term patient management programs. In a medico-socioeconomic model it has long been thought by the majority of the medical profession researchers that continual care for musculo-skeletal problems is not effective and that ongoing care is based purely on an economic basis for the benefit of the Chiropractor and not the patient.

This has on occasion put the professions at loggerheads when looking at care. It is important when considering this to question what is health? See previous post on this subject.

Are The Chiropractors Right? Continue Reading »


Don’t Slip Up Twice!

Slipping Once On Ice Is Unlucky But Not Getting Checked Out After Is A Second Slip Up!

With the recent cold snap we were all left taking tentative steps, for some the result was a crash down to earth. I saw 2 people do it myself. A fall onto one’s derriere at speed causes damage to the ligaments of the sacro-iliac joint and lower lumbar vertebrae.

In fact cadaver studies(1) show that as many as 20% have sustained damage to the lumbar interspinous ligaments that support the lumbar vertebrae.

This leads to increased motion at those levels and eventually disc degeneration and facet joint hypertrophy due to increased stress on these  structures. The result down the line is possible nerve impingement and sciatica or in long standing cases stenosis (a narrowing of the central canal that the nerves run through).

These conditions can require surgery to prevent nerve damage, but in most cases people just have to accept that they can only walk a hundred yards or so before needing to sit and rest due to the cramp like pains they get in the calfs.  Stenosis can also lead to bladder and bowel problems in old age.

Do you know someone like this? Do you know someone who’s slipped on the ice? Help them achieve a better old age by pointing them in the right direction. Fix it now and these issues can be reduced.


1: Rissanen, P.M.(1960)The surgical anatomy and pathology of the supraspinous and interspinous ligaments of the lumbar spine with special reference to ligament ruptures. Acta Orthop Second, (Suppl.46)


Ten Top Tips To Avoid Back Pain Or Other Injuries This Christmas.

A Look At Potential Pitfalls In A Festive Spirit.

It’s Christmas!!!

Well not quite, but the infamous words of Noddy Holder have probably been ringing out for a while now on the high street, but I wouldn’t know about that. Instead of doing this a bit at a time, I join the usual rush of stressed out men looking for that last minute present. So how do I keep from getting knots and aches when out? Buy vouchers and be done with it I hear you cry! Certainly an idea, but believe it or not I do carry bags and this is how I avoid the pains and aches over the Christmas period right up to New Year.

Tip 1: Take Your Time Shopping!!

But you said “I do it last minute”. That’s true, but I give myself time and before I shop, I mentally prepare myself by remembering that Christmas is about being festive. So while sauntering around and letting everyone else twist and duck and dive past I hum a carol or two and get in the spirit of things. How does this help? Stress will lead to increased tension and more likelihood of muscle strains. So relax and enjoy it.

Tip 2: Park Where It’s Easy To Get Back To From All The Shops. (Or do it Online)

You know how it is, you’ve already got a load of bags and the shoulders are feeling sore, but you’ll just pop into M & S for a few more bits, then you come out looking like a sherpa on the Himalayas.


Disc Prolapse Here We Come!

Well don’t do it, when you’ve got a few things take them back to the car, lock them in the boot and feel the tension go as you stroll back to your next target. Better still, do it online! (it’s not the same though is it, you’ll miss the joy of seeing someone wrapped in tinsell after the office party).

Tip 3: Wrap Up Warm.

Simple this one, if it’s freezing and windy you’ll immediately be more vulnerable to a muscle strain, wear a scarf and layers so if you get hot you can always take one off.

Tip 4: Rest Every Now And Then And Keep Hydrated.

Why not do this after dropping off the first load in the car, then you won’t have someone standing on Mum’s new cardy in the cafe. Have a warming drink and a snack to recharge your batteries, if it’s caffeinated make sure you have water though so you don’t dehydrate. Muscles are more likely to strain if dehydrated. If you had a sneaky sherry or mulled wine somewhere this is even more important!

Tip 5: Care When Lifting (or hiding it for that matter).

You’ve been out all day, hopefully not fed up and hungry, but full of joy as you don’t have to go back again for another year! You now have a boot full of presents, some wanted, some useless, but it’s the thought that counts. When you lift, pull things towards you and keep your lower back locked out. Don’t try and do it all at once if it’s heavy. The same goes for when you stuff it under the bed, at the top of the cupboard or in the loft, don’t twist and lift. Keep your back straight. We all know that one, but how often do you really take care when lifting?

Tip 6: Exercise! Even if in a queue!

I’m not expecting you to get on all fours, but there are a few exercises that you can do when stood in a queue that can really help your lower limb strength and stability. Firstly, as you’re wearing a big coat you can do buttock tenses and no one will be any the wiser as long as you remember to breath! Stand with legs shoulder width apart, and simply tense buttocks while gently pushing feet outwards while they stay firmly rooted to the floor, you can combine this by tensing the lower abs too. Remember to breathe!! Another is to stand feet shoulder apart, grip the floor with your feet, and lean forward slightly keeping your body rigidly straight. Do this until your heels just start to lift off the floor, think of Eddie “The Eagle” Edwards (ski jumper extraordinaire for those too young to remember). Hold both exercises for count of 5 and relax and repeat. If you spend an hour in a queue you’ll have  had a great workout.


You don’t need to lean this far forward!

Tip 7: Sit Up Straight And Support Yourself.

Self explanatory really, you’ve had a few sherries, eaten too much, got bored with being cooped in with all the relatives, so you commandere the sofa or armchair and settle down for an assault on the chocolates, while watching a film you’ve seen before. Well, before that military manouveure make sure you have a cushion behind you, and if its a particularly soft sofa, have one underneath your hips as well so that they are level with your knees. Make sure you regularly get up and move around, even better go for a walk and stretch those legs. You’ll feel much better for it and it’ll help the lunch go down. If you’re having to travel, get out now and again and walk about too. Don’t lift your heavy bags straight after arriving, stand up for a while first, see our travel tips.

Tip 8: Never Play Twister!

There are occasions when this could be very beneficial, but best left to younger generations or students.

Tip 9: Care at Office Parties.

It’s pretty common to see a few self inflicted injuries due to overindulgence and temporary visual and reduced balance injuries! If your colleagues are dancing on the tables and you want to join them please make sure it’s sturdy, Limbo dancing is also best left to the professionals. Choose your dance partner wisely to avoid dislocated shoulders and whiplash.

Tip 10: Invest In Your Health.

Last and by no means least, if you’ve had problems before, have a check up so that you know you’re working better and not on the verge of an injury. Christmas time means less availability and it’s a time for enjoying yourself in the company of others. Don’t ruin it with a bad back or neck,pop in and make the most of it.

Have fun and enjoy it.

All the best