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.
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)
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.
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.
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).
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.
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!
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?
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!
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.
There are occasions when this could be very beneficial, but best left to younger generations or students.
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.
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
GPs are being advised to only use short courses of steroid injections to treat tendinopathies, after a systematic review found using them for longer can produce worse results than no treatment.
Instead they are being advised to use other methods of non-steroidal injections for treatment such as botulinum toxin and hyaluronic acid for conditions such as tennis elbow and other tendinopathies.
The extensive review – published in The Lancet – looked at 41 trials involving 2,672 patients and estimated the standardised mean differences between treatments and placebo.
Steroid administration was shown to be consistently effective over the short term but long term the benefit was unclear. For further information the full article can be found here, and the actual paper is here. Read more
“There is a high risk of poor long-term outcomes and higher recurrence rates with corticosteroid injections,” said lead author Bill Vicenzino, chair of sports physiotherapy in the School of Health and Rehabilitation Sciences at the University of Queensland.
“Other treatments, including exercise, some specific physiotherapy and possibly some other injections, should be used before corticosteroid injections,” Vicenzino said.
A critical review by L.Viola of the literature showed some evidence of increased effectiveness of medical acupuncture over steroid injection, however the study sample quoted was limited and further research is required with larger samples.
A study by Val Jones published in Shoulder and elbow concluded that Acupuncture is frequently used by Chiropractors, physiotherapists in the management of chronic tennis elbow . However, the very few acupuncture studies to date have failed to prove conclusively that the short term relief in pain seen gives rise to long term functional improvement. No trials to date have assessed, concentrated or commented on the potential adverse effects of this particular form of treatment. The most recentCochrane review concludes there is insufficient evidence to support or refute the use of acupuncture. Further trials utilizing appropriate methodology and adequate sample sizes are needed before firm conclusions can be drawn regarding this treatment modality.
In my opinion which is based solely on anecdotal cases, there is definitely a role for medical acupuncture in relieving short-term pain over general soft-tissue therapy alone. However it is likely that the combination of supportive taping, clasps, acupuncture, ice and heat therapy plus mobilisation and manipulation is probably the best route of care. This is due to the stimulation of repair, control of inflammation and restoration of accurate controlling reflexes.
From a personal view point just today I have been self administering acupuncture for a strain on my very own Tennis elbow, now I have to be disciplined and not play tennis tonight, pity as I was just starting to perfect my top-spin forehand, (probably wasn’t perfected, hence the injury). Physician heal thyself!!
This is a fundamentally important question when considering a “healthy” spine or body.
In the Western World health care is concerned mainly with getting you painfree, and unfortunately in general only lip service is paid to the preventative side of therapy. The commonest way of doing this is with medication until the pain goes, then you are healthy! This is fundamentally wrong and short-sighted.
Health is NOT an absence of symptoms, health is good function, everything working correctly, in a good environment, efficiently. Just focusing on being painfree will not result in good health.
In modern times we are all (well most of us) leading very busy lives, we are having to work harder, for longer, many of us travel ever increasing distances to work. We are under more pressure due to the cost of living, we have less time for ….
family and friends. There is an increase in the number of people being labeled as having behavioural disorders, ADHD, ADD etc and this is just a symptom of the environment that children are now being exposed to as a result of social changes that have taken place over the last 20 years.
All around the western world increasingly children are babysat with computer games or television, many complain of being bored in the holidays as many have reduced ability to partake in imaginative play.
There is a reason for this neurologically that relates to musculo-skeletal health, more on that in the next issue.
So what does western culture do about this growing epidemic? It gives it a name and medicalises what is essentially behavioural problems due to poor central nervous system stimulation. It prescribes drugs such as Prozac to make you “feel” better, but these drugs don’t make you better. Do you know that in the USA there is now a disease called shyness!! The cure? Prozac, but under a different name, how crazy is that?
Many of the serial killing gun sprees in America have been perpetrated by children who have been prescribed Serotonin re-uptake inhibitors SSRI’s. These affect the way the brain processes information and enhance the formation of repetitive patterns of activity, hence the multiple events. Consider also the relatively recent phenomenon of Fibromyalgia, how many people have you heard of that have been diagnosed with this condition. In my opinion this diagnosis should not be made as it labels individuals with a negative outlook that has detrimental effects on that persons prognosis, I’ll explain more on this subject in the next few entries.
I’m sorry if this is getting too morbid, but we really do have a health crisis on our hands if we don’t take steps to encourage children to explore imaginative play, exercise, challenging balance, eating well, communicating with friends and family, the same goes for adults too, although I’m not expecting you to get out the figurines from the attic if they are still there!
These are all positive feedback tasks that enhance and stimulate the central nervous system and lead to a sense of well-being.
Before I finish for now, ask yourself how you can make gentle, progressive and positive changes to your lifestyle that can help you feel better in general and also help you stay free of pain, both physical and emotional.
I’ll be covering the research on these subjects in the next few updates so do have a look soon. If you have children or are thinking of having them, this is information that you really should look at as a matter of utmost concern.
Until the next time.
In order for your body to move well with minimal effort and maximum control you need a nervous system that detects and modifies muscle tone accurately.
If there is poor detection of movement, the nerves fail to fire correctly or at the correct time, so the muscles cannot be contracted to protect your joints. Most of the time this will hardly be noticed, but you may feel a bit lethargic. If you play sport you may find you are a bit slower round the court or less accurate on the driving range.
Think of your body as a V10 Ferrari engine, now take off one of the HT leads (loss of spark to one cylinder), now slightly time another one wrong. The result a poorly engine that sounds bad and if pushed could get badly damaged. Fundamentally there’s nothing wrong with the engine but if it’s spark (nervous system) is not firing or out of time the result can be serious.
If you are feeling sluggish, or you’ve lost form in your sport you need to think about getting your muscles (engine) tested to get the timing back.
Chiropractic uses muscle testing to identify weaknesses and can use provocative challenges to accurately re-tune you. The result is you have increased power, work more efficiently and therefore have more stamina and also more accuracy. In short you could end up feeling great, when was the last time you felt great? Not after a bowl of Frosties I’m sure!!
Now if you then add in exercises that groove normal movement patterns, and build that up into strengthening and stamina building exercises which enhance the correct movement pattern, you have the recipe for a healthy musculo-skeletal system that is energy efficient.
In short you’ll be firing on all cylinders with a turbo-charger bolted on for good measure!
All the best
When you get low back pain it can be excruciating, it can also be quite frightening for the uninitiated. Most of the time the damage caused is actually slight and the body’s reaction is disproportionate to the damage present. The reason for this is due to the high sensitivity to pain, of the structures of the back. These are the facet joints and the capsule and ligaments that hold the vertebrae together.
When theses structures are stressed beyond their normal range due to poorly functioning muscles, excessive force or lax ligaments they send pain signals that cause a reflex contraction of muscle to splint and protect the joint from further damage. For further information click here.
When we don’t have back pain we tend to get lazy and take route one to pick things up etc. When you have back pain you don’t because the body won’t let you. This is the type of movement pattern that you should be striving for when you don’t have back pain.
Very simply it is using your body’s muscles to form a corset around the lumbar spine, or neck for that matter that gives stability and control to help protect the spine from any excessive motion. This co-contraction of the trunk flexors and extensors (stomach and back muscles) stabilises the spine and gives it support. This photo shows bracing of lower back and abdominal muscles to provide stability when sitting.
Correct bracing of lower back and abdominal muscles
The easiest thing to do is tense your back muscles so that you hollow your back, then tense the abdominal (stomach) muscles as if you were avoiding someone poking you in the stomach. Then to bend, you have to flex from the hips and not the low back. If you have good Hamstring length you’ll only be able to get about 40 degrees of flexion, which means you’ll struggle to reach your knees!
Great, not very practical really is it? So you have to bend the knees if you want to get lower, but unless you were in the circus you still will struggle to reach the floor if you keep the back locked out. Especially if your hips are a little stiff. If you want to reach the floor you’ll probably have to flex the lower spine, but by this time your lower back will be supported a little by the thighs. To minimise stress further keep one leg flexed and kneel on the other, ie for tying up laces.
By the way can you spot what he is doing wrong? He is letting his head move forwards too far, he should be bracing his deep neck flexors as well. Click here to find out how to do this.
If you need to pick something up off the floor you can balance on one leg, lean forward from the hip and let your other leg counter balance you. Always a good idea to do this where you have a lot of space, or you could damage someone or something. Use a support for your free hand if there is one, like a golfer using his club to rest on when getting a ball out of the hole, but as I couldn’t find a photo of that here’s a close example of what I mean.
You’ve Should Have The Flexibility Now It’s Time To Go For Strength And Stamina. Only complete this part if you can comfortably get your arms flat to the wall and keep them there as you lower them on the Wall Angel. Make sure you read this first if this is the first you’ve heard of Wall Angel.
What? Equipment? I hear you say. Never fear this is where the wonderful world of exercise bands come in to play. These are relatively inexpensive but highly versatile rubber bands, the beauty of these is that they improve your control of joint movement while under resistance. As the rubber is constantly working against you you have to work harder to control the bounce back so to speak. They come in a variety of resistances that are colour coded.
The other great thing about them is that they fold away and you won’t stubb your toes on them like a set of dumbells just hidden out of sight beneath the bed!
Take a two metre length of band and fold it over, start with a resistance that is comfortable. Remember no pain no gain is frankly a stupid way to train, so if you are struggling after just a few reps, get an easier band.
It’s great to be able to do a huge lift, but after one go you’re bust, what practical use is that in every day life?
Take the band as shown below between the hands and make sure you have some tension, then lower the arms and the band will stretch. Hold for a few secs, SLOWLY raise the arms back up, pause for a few seconds and repeat until you feel that you are starting to lose good form or begining to tire between the shoulders. Remember if you are getting pain, reduce the resistance, if it continues to give pain STOP, go back to unloaded exercise, i.e. no band.
Start position (arms are actually not bent enough!)
Ladies, a little advice…don’t do this before going out, it can do strange things to the hair on the back of your head and you may end up looking like this.
Aim to do the exercise once or twice a day with a rest break of 2 days in the week. If you require more assistance you can contact me through the clinic website.
This exercise is called the Wall Angel, you start by standing about 6 inches from a clear wall, sit onto the wall so your lower back is comfortable. Then tense the deep neck flexors as you did with the Bruger’s postural relief. Now raise your arms up with the elbows at shoulder height and bent at 90 degrees.
Start position for Wall Angel Exercise
Here’s the side view:
Note the chin is tucked in
You should aim to get the elbows back to the wall and the hands flat to the wall WITHOUT letting your body arch like this:
This is wrong, back is arched too much
Now if you have a tight upper back and shoulders you won’t be able to get flat without the back arching. So you need to gently tense the stomach muscles to make your spine rigid, then just take the elbows back until you feel a stretch. Refer to do’s and don’ts of stretching for more tips before doing this. Remember this should not cause pain. If it does, go back to the previous exercise Bruger’s Relief Position.
Now you should be comfortable, back stiff and relatively flat to the wall, your arms will be somewhere between being on the wall or a long way forward. Now you need to lower the arms to your sides keeping the elbows bent at 90 degrees. As you do so you will feel a stretch on the front of the chest and tension between the shoulder blades on the Rhomboid muscles.
Note the elbows stay bent at right angles
If you have tight shoulders you will feel the hands lift away from the wall. This is fine, the trick now is to keep the spine still, so make sure you maintain tension in the abdominal muscles. As long as you feel some stretch on the front of the chest that is fine.
Note back is still flat against the wall
This shows the wrong way to do it:
Back over-extended, less specific for shoulder
OK, now you should be getting an idea that this is all about control, you really need to focus on the only movement occuring at the shoulder. Got that? Good.
Now you simply bring the elbows back up level with the shoulders, pause for a second or two and repeat about 15-20 times. Always remember quality is more important than quantity and if it hurts you stop straight away.
Within a few weeks you’ll feel alot more freedom in the shoulders.
All the best for now
Steve Oldale BSc, DC Chiropractor Back In Form Chiropractic Clinic 65-67 Commercial Rd Poole BH14 0JB