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7 Steps to Combat Lower Back Pain in Pregnancy

Amanda Goring — Sun, 15 Apr 2012 20:08:40 +0000

Looking for top tips to prevent back pain in pregnancy or treat pregnancy pain? We may just have the answer.

1. Improve your posture during pregnancy

If you are getting back pain in pregnancy the best advice is to try and maintain the best posture that you can. The change in your centre of balance will be throwing you off just that. So the trick is to keep your ears and shoulders in line with one another to work as a harmonious, loving power couple. Neither is ahead of the other and both keep the other in line. The best way to check that is to catch yourself in the mirror to the side, or ask someone to keep an eye on you. The most common fault is to throw your head forwards. It is true that you head weighs the same weight as a bowling ball so imagine how that will pull your whole body forwards and put huge strain on your back.

2. Avoid standing up

Push to the front of queues. Well not literally perhaps but try to avoid standing for too long. Your postural muscles are already working overtime and with the hormone Relaxin. As this flows through your body and causes your muscles and ligaments to relax through pregnancy your support system is not at its best. And make the most of grabbing those priority seats on trains and buses.

3. Use a pelvic support belt

Before you were pregnant I am sure that Gok Wan coached you into buying those belts to cinch in your waist and create that elusive hourglass figure. Well now you won’t give a monkey’s about an hourglass but may still be picking up a belt – namely a specific maternity support belt. These support your bump in the later stages of pregnancy to relieve the strain through your back and now you can even get them for post-partum to continue the support until you regain your physical strength.

4. Sleep with a pillow between your knees

As odd as that may sound, straddling a pillow between your knees when lying on your side in bed may well be the support that you need to your bump and enough to relax the muscles of your pelvis, which will be having a tough time of things with all these changes going on. Ideally, if you are planning on going through more than one pregnancy I would absolutely recommend investing in one of the pregnancy pillows which you can buy from any good maternity store. Compare prices as they can vary tremendously and they may not look attractive but they are long enough to stretch along your whole body which minimises the chance of them slipping or being expelled from the bed during the night.

5. Computers make back pain in pregnancy worse

Your desk and workstation set up at work is incredibly important during your pregnancy so if your company has an internal occupational assessment team then now is the time to rope them in. Other problems can occur too. Not only does your desk height, angle, and distance matter to your back but so too does your keyboard and mouse use. Carpal tunnel syndrome is all too common during pregnancy (thanks to fluid retention) a wrist support is important for use with a keyboard and many women prefer to switch from a conventional mouse to an upright one which requires the arm to be at a more favourable angle of sideways; or else use a roller pad. Everyone has a different preference but it is worth bearing it in mind.

6. Have a bath to ease a bad back

A warm bath can help back aches. Enjoy lots of warm baths during pregnancy to help to relax your muscles as well as your mind but make sure that you can happily dip your toe into the water without jumping from the heat. The water should never be more than warm during pregnancy as it can be stressful for the baby.

7. Go shoe shopping

Finally an excuse to get the credit card out and hit the shops – this time however it won’t be for glamorous purchases. During pregnancy it is a good idea to banish the stilettos and kitten heels and opt for sensible lace ups. It isn’t the height of the heel that is important but the support of the shoe to the foot, and therefore rest of your body. As pregnancy progresses the foot arches can flatten and contribute to back pain. Imagine that your feet are the foundations of a house and that your pregnancy is akin to planning an extension on the property. You wouldn’t start without assessing that the foundations are excellent or the rest of the house would be under strain. Your body is the same, particularly during pregnancy where your centre of gravity is changed and your supporting tissues are less…well, supporting. And it is for this reason that cheap ballet pumps are also out I am afraid as they offer zero support to your feet.

If you would like an appointment to see if our chiropractors or physiotherapists can help you with pregnancy related back pain or sciatica then give us a call and we can book you in.

Back Pain in Pregnancy: Is it due to hormones?

Amanda Goring — Fri, 13 Apr 2012 15:14:40 +0000

Back pain in pregancy can be due to hormone changes.

Haven’t we all been told that hormones are always the cause of every problem known for a woman? Well in this case the hormone in question is ‘relaxin’. This little lovely is produced every month during a woman’s menstrual cycle and disappears if no pregnancy occurs. And if it does this hormone peaks in the first trimester, apparently to encourage implantation, and is then maintained throughout pregnancy to cause relaxation of the body’s soft tissues and so stretch out the joints of the body in preparation for the changes that will be occurring as the baby grows. Hormone changes can lead to lower back pain in early after conception too.

Back in Pregnancy due to Joint Laxity

You know those kids in the playground who are all mouth and who start trouble, only to stand back after it all gets a little too much, and pretend that they had nothing to do with it? Well this may be it. The theory is that this little guy causes the body’s joints to relax (hence the name relaxin) which then reduces the stability of the lumbar spine. And of course he gets help from progesterone and oestrogen with all the relaxation. Add to that the increase in load from the growing baby(s) in that very area and the fact that the abdominal muscles wade in with their stretching to allow for the increasing size of the abdomen and suddenly there is no support in the lumbo-pelvic region. But recent studies have found that relaxin may not be the main fall guy as the evidence is weak overall.

Previous back pain means your at risk

Although there is no definitive proof yet, studies have found that there is an increased risk of suffering from lumbar spine pain in those of us who have suffered from lower back pain before, most notably during menstruation, those who have had multiple children and whether an individual has had any spinal surgery before.
For PGP the risk increases with increased body mass index, any strenuous activity and as the pregnancy progresses – the latter of which I have certainly experienced to be the case in clinic.

Lower back pain in early pregnancy

This can vary. The general consensus is that pregnancy-related pain can start at any point when pregnant but that most cases occur in the second and third trimesters. If back pain initiates at the start of pregnancy it is often found that it not only continues through until full term but increases in severity as it does so. So something to look forward to then!

If you would like an appointment to see if our chiropractors or physiotherapists can help you with pregnancy related back pain or sciatica then give us a call so we can book you in.

Next article: 7 steps to combat back pain in pregnancy

References

Aldabe, D et al (2012). Pregnancy-Related Pelvic Girdle Paina nd its Relationship with relaxin

Han, I. (2010). Pregnancy and Spinal Problems. Current Opinions in Obstetrics and Gynaecology. Dec. Vol.22. No.6. pp.477-81

Kovacs, F.M. et al (2012). Prevalence and Factors Associated with Low Back Pain and Pelvic Girdle Pain During Pregnancy; A Multicentre Study Conducted in the Spanish National Health Service. Spine. Feb. No.13. [ePub ahead of print].

Kristiansson, P. et al, (1996). Back Pain During Pregnancy: a Prospective Study. Spine. Mar. Vol.21. No.6. pp.702-9.

Licciardone, J.C. et al. (2010). Osteopathic Manipulative Treatment of Back Pain and Related Symptoms During Pregnancy: A Randomised Controlled Trial. American Journal od Obstetrics and Gynaecology. Jan. Vol.202. No.1. pp.43e1 – 43e8.

Liebetrau, A et al (2012). [Is there a Correlation Between Back Pain and Stability of the Lumbar Spine in Pregnancy? A Model-Based Hypothesis]. Schmerz. Feb. 26. No.1. pp.36-45.

Lisi, A.J. (2006). Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: a Retospectie Case Series. Journal of Midwifery Women’s Health. Jan – Feb. Vol.51. No.1. pp.e7-10.

Majchrzycki, M et al, (2010). Low back Pain in Pregnant Women. Ginekol Pol. Nov. Vol.81. No.11. pp851-5.

Stuber, K.J. & Smith, D.L. (2008). Chiropractic Treatment of Pregnancy-Related Low Back Pain: a Systematic Review of the Evidence. Journal of Manipulative Physiological Therapeutics. July-Aug. Vol.31. No.6. pp.447-54.

Back Pain in Pregnancy? Here’s Why

Amanda Goring — Fri, 23 Mar 2012 22:42:21 +0000

Having lower back pain or sciatica in pregnancy already? Feeling tired and sore in your spine? Wondering about causes of back pain in pregnancy? Brighton chiropractor Amanda Goring explains why.

It is estimated that up to 50% of all pregnant women suffer from some form of lower back pain during their pregnancy. So, as if you didn’t have enough to worry about with information on fluid retention causing things such as carpal tunnel syndrome and muscle cramps some of us will be thrown into the lottery of aching backs, tight hips and even sciatica symptoms. And the irritating truth is that no one has a definitive answer to what, why, who or when.

So let’s look at the ‘What’:

Largely pregnancy related back pain falls into one of three categories:-
1. Lumbar spine pain
2. Pelvic girdle pain (the notorious term which shoots dread into the heart of most pregnant women – previously known as ‘pubic symphysis dysfunction’ – not fooling any of us or being any less intimidating with its new name).
3. Muscle pains.

And the ‘Why’:

Well this is the golden question. The contenders are weight gain, muscle imbalances and hormone changes. Lets look at weight gain and muscle imbalances first.

Weight gain and muscle imbalances causing back pain in pregnancy

It doesn’t take a genius to realise that as your baby(s) grow they place a large amount of stress through your lower body. Considering that your weight gain can be around 1/4 of your total body weight and that the majority of that is distributed at the front, you can imagine how hard your back has to work to anchor you and keep you upright.
As the baby grows you tend to develop an increased curve in your lower back (known as ‘hyperlordosis’) and there is an increase in front to back movements.
In addition, once you are pregnant and galloping through the stages, the muscles in your lower body have to work harder to cope with this weight gain and shift in the centre of gravity and they can become tired faster, leading to all that aching. And if there are imbalances already from tightness in areas, this will only become worse as they are placed under more demand.

Next article: Hormone changes leading to back pain in pregnancy

References

Aldabe, D et al (2012). Pregnancy-Related Pelvic Girdle Paina nd its Relationship with relaxin

Han, I. (2010). Pregnancy and Spinal Problems. Current Opinions in Obstetrics and Gynaecology. Dec. Vol.22. No.6. pp.477-81

Kristiansson, P. et al, (1996). Back Pain During Pregnancy: a Prospective Study. Spine. Mar. Vol.21. No.6. pp.702-9.

Liebetrau, A et al (2012). [Is there a Correlation Between Back Pain and Stability of the Lumbar Spine in Pregnancy? A Model-Based Hypothesis]. Schmerz. Feb. 26. No.1. pp.36-45.

Lisi, A.J. (2006). Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: a Retospectie Case Series. Journal of Midwifery Women’s Health. Jan – Feb. Vol.51. No.1. pp.e7-10.

Majchrzycki, M et al, (2010). Low back Pain in Pregnant Women. Ginekol Pol. Nov. Vol.81. No.11. pp851-5.

Bad Backs in Children

Sundial Clinics — Wed, 14 Mar 2012 13:16:23 +0000

Back pain in children is common. About half of school age children report back aches at some time. Poor school chairs are often to blame. In this video Matthew talks to BBC’s Newsround about the importance of good chairs at school.

http://www.youtube.com/watch?v=plAb9UIcm_E

If you would like your child to have a free spine check-up then please call us to book an appointment.

Can regular chiropractic care prevent back pain here in Brighton?

Sundial Clinics — Wed, 01 Feb 2012 10:15:39 +0000

If you are one of the four out of five people will go on to develop regular bouts of back pain after an initial attack, this is an important question to answer. For over 100 years chiropractors have claimed that regular treatment can prevent recurrences of back pain. Are we right?

For most of the 20th century, medical treatment, including here in Brighton, consisted of bed rest and painkillers for back pain. Unfortunately, this contributed to an increase in the cases of recurrent back pain. From 1980 until 2000 the number of days off work in the UK due to back pain doubled every decade.

Eventually, GPs stopped treating back pain this way and accepted what chiropractors and others had been saying that active treatment is best. It is also true that chiropractors accepted that painkillers and anti-inflammatory medication are also helpful, whereas up until then old school chiro’s often shunned drugs.

Medical Treatment for Back Pain

Even now, however, back pain treatment from the doctor consists of a brief course of physio or medication which stops as soon as the symptoms stop. If you have had recurrent back pain you will be all too familiar with the trips to the doctor, prescriptions for strong drugs, referral to the physio (after a wait of many weeks) then being given a few exercises. You are probably fed up with your back feeling vulnerable and about to go at any time. You may even find that you’re limiting your activities to avoid the things that bring it on. If so, what can be done to prevent the dreaded back pain from returning?

Well, new medical research, published in 2011, suggests that an initial intensive course of manipulation such as our chiropractors in Brighton do here at Sundial, followed by periodic checkups and treatment may help prevent long-term back pain from re-occurring. Interestingly, those that did not receive the continuing course of care lost their earlier improvements.

Preventative Chiropractic Treatment Works

So the evidence seems to point to an initial course of treatment over a few weeks to get rid of the initial pain and improve function followed by a course of care over the next few months to make sure that those improvements are maintained. Here at Sundial we use the best available evidence to guide our treatment and we generally stick to this sort of plan in helping you get better.

If you would like to know if preventative chiropractic care can help you then give us a call for an initial chat, at no charge.

Reference:

Senna MK, Machaly Sa (2011) Does Maintained Spinal Manipulation Therapy for Chronic Non-Specific Low-Back Pain Result in Better

Long Term Outcome? Spine DOi: 10.1097/BrS.0b013e3181f5dfe0.

Dealing with recurrent back pain

Sundial Clinics — Thu, 17 Nov 2011 11:30:40 +0000

If you are getting recurrent back trouble what can you do to help yourself and sort the problem out? Back pain usually goes away in a week or two at most but for four out of five people, however, it keeps on coming back. In a recent study published in the prestigious medical journal, The Lancet, 70-80% of back sufferers were still having pain a year later in spite of receiving treatment.

Brighton Chiropractors Give Three Tips to Prevent Recurrent Back Pain

1 Stay Active

This is counter-intuitive as the temptation is to take it easy. Most people are afraid of moving about in case they make the problem worse and prolong the agony. This, however, is exactly the wrong thing to do. It is OK to rest for a day two or three days but after that doing gentle exercise is actually helpful even if is sore doing it or for a while afterwards. Walking, swimming, cycling, Pilates or yoga can all be a helpful start. Gradually increasing the intensity of the exercise as your muscles and joints get used the restored function is a helpful way to prevent recurrences. Our Exercise Video Programme is here.

2 Avoid aggravating activities

If your back goes bending over to tie your shoe laces or getting out of the car, the chances are that this activity is not the cause of the pain but rather the trigger factor. It is unlikely that something you have done hundreds of times before would suddenly become a problem without a change in the underlying condition of your back. A gradual weakening of your back muscles due to lack of core muscle strength leads to stress on the spinal joints which gradually stiffen and can eventually sprain.

There are certain activities that can often aggravate your back. These include prolonged sitting, lifting badly with your knees straight or lifting and twisting. Certain specific tasks can cause stresses on back joints and muscles like hoovering or gardening and you probably recognise what these are for you. Sometimes doing the activity for a brief period is okay but doing it for a prolonged period brings the pain on. It is helpful to start the activity gently, gradually increasing the effort you put in to it and then finishing with a few back stretches.

It is also worth noting when the pain comes on. If the back ache is worse in bed it could be an old sagging mattress that is not supporting your spine. If your back is stiff after sitting in low sofa for an evening then perhaps this is the culprit. These are obvious potential causes of back strain but our lifestyle is jammed full of hidden causes of back pain. A car with offset pedals or steering wheel twists the spine on every journey for instance. A computer monitor off to one side has the same effect. Even baby care has its own hazards. Bending over a changing mat or putting a baby in a car seat is a potential back strain in the making. If you do a lot of work at a desk there are tips to set up your desk and chair here.

3 Get regular check-ups from a back specialist

If getting a fistful of anti-inflammatory drugs from the GP doesn’t help resolve your back pain quickly then you might choose not to wait for referral to the local physio department. Currently the national average waiting time is twelve weeks by which time, if you are still getting pain, it is becoming chronic. If it does resolve the chances are that it will recur in a few months or a year or two. There are other options for back care though.

The National Institute for Health and Clinical Excellence (NICE), the government body that recommends the best treatments for all sorts of conditions says that manipulation from a chiropractor, osteopath or specialist physiotherapist should be part of effective care for back pain. A short course of treatment will often restore strength and flexibility to the back allowing you to get back to full activity. Once you have the initial problem under control and the pain has resolved there is some evidence that a periodic session of treatment can help prevent back pain from recurring.

Back pain can limit what exercise and activities you are able to do but with the right approach you can get rid of the problem and carry on as normal. These straightforward steps will help you get better.

If you want to find out if we can help you – call for a free check-up.

For more information look at our Treatment and Fees FAQ’s

Back Pain in Children – top tips for prevention

Sundial Clinics — Tue, 18 Oct 2011 10:02:32 +0000

It is incredible to think that even children can get back pain but it’s true. At Sundial we did free half-term kids and teachers chiropractic checks in Brighton. 32 per cent of six and seven year olds get back ache at some time according to research by the British Chiropractic Association. This rises to 45 percent by the age of eleven. To highlight this issue the focus of last year’s BackCare Awareness Week, 17th-23rd October, was school children and their teachers.

One of the main reasons school children are prone to getting back strains is because they are carrying heavy school bags. Now school lockers are no longer available in most schools, children have to carry a bag with the full day’s books as well as all the other stuff that they need. Some kids carry all their books around for the whole week and then games bags as well. An adult wouldn’t put up with it.

Not only are the bags heavy they are often not very well designed. A hand strap sport type bag or book bag means all the weight is carried on one side of the body. A better option is a shoulder strap ideally carried across the body. The option, however, is a rucksack with both shoulder straps used and has been shown to reduce back pain by a third.

School Chairs Cause Back Problems

Schools themselves can also do more to prevent back problems in their students. Budget constraints mean that classroom chairs are often cheap and nasty providing poor support and no adjustability. If an adult was provided with a similar design of chair they would refuse to work in it for more than a few minutes with out screaming for a better one. Indeed, employers have a legal duty to provide a decent chair which is fully adjustable and supportive. Schools have no such duty.

Brighton Chiropractor Interviewed by BBC

The fashion of having children seated in groups around circular tables also adds to back strain some children have their back to the teacher and are constantly twisting round to see what is going on at the front of the class. Chairs that swivel would make this much safer. See an interview with Brighton chiropractor, Matthew Bennett by BBC Newsround on this issue here.

It is not just poor chairs that are associated with more back pain in school kids. The length of lessons themselves is also associated with more back aches. The longer the lesson the more aches and pains children reported in a study at the University of Surrey. Researchers visited classrooms and looked at what children were sitting on and how they perched on chairs as well other factors like length of lessons and how much movement was allowed. They found that if children sat in a flexed posture they had an increased incidence of low back pain. If the children did not move much and sat still they had an increase in upper back and neck pain.

Lifestyle Factors

A recent survey by Ofcom showed that computer game use and watching DVD’s has actually declined in teenagers it has been replaced by other screen based entertainment such as iPads and laptops to browse the internet as well as texting. In fact most teenagers do these things whilst also watching television. It is not just teenagers who are glued to screens, 40 percent of five year olds use an internet enabled computer at home.

But does this digital overload lead to health problems. Previously boffins in Scandinavia found that increasing television watching led to an increase in back ache in children. Certainly sedentary lifestyles have been associated with more back pain in children but does screen time also lead to obesity. The answer is maybe.

Studies are unclear whether gaming and computer use are one cause of obesity. Still, it is probably a good thing if children are running around rather than sitting around. Weak core abdominal and back muscles are more likely in children who get back trouble. It seems however, that you can have too much exercise if you are a child. High level sport and training is associated with more pain.

If a child does get a bout of back pain it will usually disappear in a few days. For a third of kids this doesn’t happen however and they go on to have longer term or recurrent symptoms. It is important to take steps to reduce the postural stresses and other lifestyle factors that can aggravate the spine and if symptoms are not resolving to get a chiropractic check up.

At Sundial we are doing free half-term kids and teachers checks and have reduced our treatment fee to £24, saving £10 per visit. For a video showing treatment of a six year old go here.

Top Ten Tips to Prevent Back Pain In Children

Use a back pack and use both shoulder straps
Ask the school if they have ergonomic chairs
Don’t sit on the floor to play computer games, use a chair
Don’t allow long periods of laptop use in a poor posture
Limit television to 1-2 hours maximum per day
Ideally use a PC rather than a laptop
Set up the computer screen so the top is at eye level
Consider a office swivel chair at a desk for homework
Build in active games and moderate levels of sport
Get a chiropractic check-up if back or neck pain persists

Further information

http://sundialclinics.co.uk/2008/11/

http://www.advms.pl/?q=system/files/53_52SBockowski.pdf

http://www.ft.com/cms/s/0/779f55c2-5110-11dc-8e9d-0000779fd2ac.html#axzz1b7a3nwEv

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=40136

Troussler B et al. Back pain in school children: A study among 1178 pupils. Scandinavian Journal of Rehabilitative Medicine, 1994, Vol 26, 143-146.

Lifting Training Video From the Archive Starring Brighton Chiropractor

Sundial Clinics — Mon, 17 Oct 2011 11:40:53 +0000

Nearly 20 years Matthew took part in a training programme to help a national pub chain reduce injuries due to lifting. He helped put a seminar series and video together to help publicans and their staff prevent back pain on the job. Roy Castle and Geoff Capes were the talent. Matthew says “It was a gruelling 16 hour day of shooting. The director couldn’t make his mind up about how to do it and the shots took ages to set up. Geoff and I were getting tired and cranky by 10pm but Roy was as cheerful at the end as he was at the start of the day.”
Here it is.

Chiropractic does better than medical care for back pain

Sundial Clinics — Wed, 31 Aug 2011 14:34:00 +0000

In a recent study chiropractic care was compared with usual medical care for patients with acute low back pain. The chiropractic patients did much better.

More than 90 patients with back pain lasting from 2-4 weeks were randomly allocated either usual GP type care or a package of care , including 4 weeks of manipulation, delivered by chiropractors. The group treated by the chiropractors had significantly less disability.

This echoes other studies going back to 1990 when the Medical Research Council compared chiropractic care to medical care including physiotherapy. Here too the results favoured chiropractic in the treatment of back pain. In the conclusion of this research the authors suggested that chiropractic should be included on the NHS. 21 years on little has changed.

The Spine Journal Volume 10, Issue 12 , Pages 1055-1064, December 2010

BMJ 300 : 1431 doi: 10.1136/bmj.300.6737.1431

How to get the best from NHS back pain care

Sundial Clinics — Thu, 11 Aug 2011 07:01:57 +0000

The NHS is suffering an ailment of its own. Despite cash being poured into it at unprecedented levels over the last decade or more it is creaking and groaning, showing every one of its 63 years. The talk of cutbacks is becoming deafening and waiting lists are growing. If you are on the end of a long list, putting up with the daily misery of back pain you don’t want to wait at all. As with many facets of modern life mixing and matching different providers may well be the best option, even if that means paying for some treatment yourself.

If you have a bout of back pain the first thing to do is nothing. Many early episodes of pain get better by themselves and are not too disabling anyway. Carry on with your normal life remaining gently active. Consider avoiding things that tend to make the pain worse like bending and lifting and especially long periods of sitting. Break up long tasks or long periods of sitting with other activities.

Medication for back pain

If the pain persists for more than a few days consider taking some over the counter pain relief or anti-inflammatory medication. Your pharmacist should be able to recommend something suitable. If pain persists for a week or more or is severe initially then see your GP for stronger medication. See the course of drugs out and don’t just stop when you feel a bit better as things can get bad again.

Physiotherapy combined with chiropractic

If the back pain carries on for more than two weeks or you keep getting recurrent episodes see a physio or chiropractor privately here at Sundial. You have a window from two weeks to six weeks to get the best response to treatment. If pain persists for more than six weeks the problem is becoming chronic (ie long-term) and is more difficult to treat, so don’t leave it. GP’s are only likely to refer to physiotherapy after six weeks of pain and then there is the wait to actually see one. This is too late for early treatment to have an effect and increases the likelihood of chronicity.

If you do get to see an NHS physio then the four or six sessions can be helpful and can be combined with chiropractic care to get the best outcome if the response is too slow. The clinical guidelines body NICE recommend manipulation as done by chiropractors, osteopaths and specially trained physio’s as well as exercises and drug treatment for back pain. The problem is there are only a few physios who have trained to do manipulation so the chances of seeing one on the NHS is small. In a recent study(1) manipulation got better results than physio care that included exercises, mobilisation and soft-tissue treatment for back pain.

Some physio’s think that mixing two treatments is not a good idea but that is not our experience. Many of our private patients see our physio and one of our chiropractors to get the best from both. By working together in the best interests of the you the patient the best package of care can be given.

If this state of back care persists in the NHS, with long waits for sub-optimal treatment the next 22 year follow up of low back sufferers may not show any improvements over the first one. Make sure you are not one of the statistics.

Further information

Patients Association on how to get the most out of a consultation

http://www.bbc.co.uk/news/health-14390041 waiting times rising

(1) Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one year follow up. F Checchi et al: Clinical Rehabilitation 2010; 24: 26-36