Back pain treatment needs a rethink
Written by Matthew Bennett Wednesday, 25 September 2013 11:23
Back pain patients in Brighton and Hove might be able to access chiropractic and osteopathy on the NHS next year. The local Clinical Commissioning Group is currently considering this option. This will give local residents access to a wider range of treatments than are available currently.
An article in the British Medical Journal two years ago suggested that back pain treatment needs to be changed. The opinion piece, entitled We Need to Rethink Front-Line Care for Back Pain was authored by a team including Dr Nadine Foster, Professor of Musculo-skeletal Health in Primary Care at the Arthritis Research Centre at Keele University. I saw Dr Foster speak at the recent BCA conference on this topic.
Dr Foster says that patients with back pain are not well managed by GPs who get little training in common muscle and joint problems. We know from other areas such as North East Essex that uses chiropractors and osteopaths alongside physiotherapists to provide back care, that given a choice more than half of back pain patients would prefer to go to a chiropractor or an osteopath rather than to the physiotherapist.
This echoes recommendations from the new Harvard Medical School booklet entitled Low Back Pain: Healing Your Aching Back, which endorses chiropractic care as one good option for back pain treatment. The booklet says chiropractic care ’improved short and medium-term pain more than other treatments including exercise physical therapy and medication’. People who saw chiropractors also reported being less disabled compared to people who received standard medical treatment. The report also states that chiropractic care tends to be satisfying and effective for acute low back pain.
Many patients now demand access to treatment not widely available on the NHS, including chiropractic. As more areas commission chiropractors and osteopaths to provide specialised spine care around the UK is clear that chiropractors and osteopaths can help treat back pain safely, effectively and cost effectively. Hopefully the back pain patients of Brighton and Hove won’t have to wait too much longer to be able to access this care themselves.Learn More
Soreness after chiropractic care
Written by Matthew Bennett Thursday, 5 September 2013 03:50
Mild adverse reactions to chiropractic care are quite common. Sometimes this is normal, in much the same way that soreness after unaccustomed exercise can occur. A new study sheds further light on what might be considered normal in conditions like back and neck pain that tends to come and go anyway.
Researchers at Murdoch University in Australia took a new approach to investigating reactions after chiropractic care. They divided chiropractic patients who were in their 20s all the way up to their 80s into two groups. Both groups had spinal pain but one group received normal chiropractic care and the other group received sham treatment. Neither group knew whether they received the real treatment or not.
12 chiropractic clinics and 180 people took part in the trial. Each patient received two treatment sessions and then filled in a questionnaire some while after each one. In this sort of study you might expect at the group that had received the real treatment would have the usual incidence of soreness and the group that didn’t receive treatment would feel fine. But was this the case?
In fact what happened was the group that had the sham treatment had nearly the same incidence of soreness (33%) afterwards as the group that had received the real treatment (42%). In other words, the temporary soreness that many people put down to chiropractic treatment may in fact be the normal ups and downs that their symptoms go through from week to week anyway.
What do we do to limit soreness after treatment?
Here at Sundial, we always aim to treat you as gently as we possibly can. When you first start treatment we will be using the most gentle techniques we can such as table assisted spinal decompression which gently stretches the discs. Here, light pressure is applied to your spinal vertebra as you lie on your tummy and the lower part of the treatment table rocks up and down.
Another gentle treatment we use here at Sundial Queens Road involves using precision electronic instrument adjusting such as the Impulse iQ. The iQ gently mobilises individual spinal bones and senses when movement has been restored. We are the only clinic in Brighton and Hove to use this leading technology. A similar technique involves using a spring-loaded adjusting instrument called the Activator. Most people who have experienced the Impulse iQ or Activator absolutely love it.
Selecting the right technique for you comes down to several factors. How severe your problem is combined with how long you’ve had it as well as your level of general fitness and overall body size and shape are all important. Sometimes, however, it just boils down to your personal preference. Some people don’t like the clicking type of spinal adjustments and fortunately we have several other options. We will discuss this with you before treatment begins.
Headaches in children part 2 – treatment
Written by Matthew Bennett Monday, 22 April 2013 10:38
Headaches in children are common. What can be done to help? Here at Sundial our first line of treatment is chiropractic care. We often find joints at the top of the neck have become stiff or locked. The nerves around the joints get irritated and can lead to muscle spasm which can cause childhood headaches.
Chiropractic treatment for headaches in children
Headaches in children need a different approach to the treatment in adults. The joint in the neck neck are delicate and this is obviously doubly true in kids too. We usually start with gentle massage or trigger point therapy. Trigger points are localised areas of muscle spasm which refer pain to another area, in this case, to the head. These are sometimes called cervicogenic headaches.
Treating trigger points often reproduces the headache and confirms the diagnosis. This tells us that we have found the true cause of the headaches. The muscle relaxation techniques are combined with gentle mobilisation of the neck joints. We often use a specialist adjusting instrument which is very specific and comfortable and above all – safe.
Headaches in children can often be present for years before effective treatment is carried out so it can take a few visits to correct the underlying problems. A typical treatment program consists of four to six sessions over about six weeks.
Most children with these type of headaches are pain free after that. A periodic check may be needed to make sure it does not come back but usually it is as simple as that.
Advice for children with headaches
- Watch your posture
- Limit screen time
- Get regular exercise
- Watch the artificial additives
An important part of the treatment program is specific advice to prevent recurrence. Poor posture especially on a computer or games console is a key cause of headaches. Slumped, rounded shoulders and the chin poking forwards compresses the joint in the neck and, after a while, strains the muscles which eventually can go into spasm. Hour after hour of this may lead to permanent tissue changes later in life.
Other common causes of poor posture are television watching, doing homework on the bed or the floor or at inadequate tables and reading without proper support. School desks and chairs are often inadequate as Matthew Bennett’s interview with BBC Newsround shows.
Carrying heavy school bags can also strain the shoulder muscles which attach to the neck and aggravate the problem still further.
If kids are exercising and running around then at least they are not at the computer or watching television. Physical activity strengthens the postural support muscles of the back, shoulders and neck and will help with these types of headaches.
Staying active is an important of the Sundial headache program. We can advise on specific exercises to do too. These will relax tight muscles and strengthen other neck support muscles that often have become weak with poor posture.
As ever, advice to limit artificial additives is true here too. There is some evidence that additives excite nerves that could increase pain. Aspartame, especially when combined with other additives has been shown to act as a neurotoxin (more here). So best avoid it just in case. Aspartame is an artificial sweetener found in many fizzy drinks, sweets, pre-prepared food and desserts as well innocent looking stuff like baked beans.
Often we hear people say that dehydration can lead to headaches and whilst it is true in severe dehydration there is not much evidence that being a bit thirsty causes a headache. However it can’t hurt to keep kids drinking plenty of water for a whole host of health reasons. It may even prevent a headache.
Headaches – Which type of headache is it?
Written by Sundial Clinics Tuesday, 22 May 2012 01:33
If you are suffering from regular headaches the chances are that you regularly use painkillers to help alleviate the pain. You may also be taking anti-inflammatory medication or if you’re getting migraine headaches other exotic combinations of drugs. This headache treatment may help with the symptoms but does not address the underlying cause of the headaches. Fortunately there is another approach that research has shown to be effective for certain types of headache relief. Chiropractic can offer significant help to certain types of headache.
The key to getting the right treatment is understanding which type of headache you have. It is not always that easy to know as you may have more than one type of headache going on at different times. There are 3 main types of headaches that may respond to gentle conservative care. They are:-
- Cervicogenic or spinal headache caused by neck problems
- Tension headache caused by tight muscles and/or stress
The other serious types of headache are caused by things like internal bleeds, infections and space occupying lesions which need urgent medical care.
The first step in successful treatment for headaches is to identify which sort you have then a programme of treatment can be suggested which may help.
Often called cervicogenic headache, in this type the pain is associated with neck pain and pain at the back of the head. Sometimes the muscles in the neck are tender to press. It may cause pain to the forehead, over the eyes or temples too. People often describe a vice like feeling around their head. The pain is often aggravated by certain posture or neck movements. Interestingly it often eases when lying down as the weight of the head does not have to be supported. People with this type of headache often have a history of many years of suffering with it.
Tension headaches are the most commonly diagnosed type of headache with four out of five people being told that this is the cause of their pain. Tension type headaches are characterised by a frequent, steady, dull ache on both sides of the head which can last for long time. People are able to get on with normal life in spite of mild light and sound sensitivity.
Most doctors think that tension headaches are due to tight muscles in the shoulder, neck or scalp. This has not been shown in the research however. It has been tricky to identify tightness in these muscles in spite of looking quite hard. It is more likely that stress plays a bigger role that first thought. Stress, from work, daily-life and relationships has been found to be the most common headache trigger.
When we get stressed our adrenal glands release adrenalin which sensitises the pain receptor nerve endings in the body. In addition our central nervous system can become sensitised to on-going pain messages so that the pain persists even after the injury has gone. This is a plausible potential cause of tension headaches. It may also explain why manual therapy has been less successful at treating it. Traditionally tension headaches have been treated with massage, exercises and manipulation but results have been mixed. It might be that a simple switch to de-stressing type exercises and desensitising manipulation and mobilisation might be more effective.
People often mistake a tension headache for a migraine and there are a lot of similarities in including the mechanisms that are thought to cause them. A good way to determine which type you have is to compare the symptoms.
Migraines are characterised by severe, one-sided, throbbing pain, often around one eye. They are often preceded by visual disturbances. They are relatively short lived but disabling often with extreme light and sound sensitivity as well nausea. Exercise tends to make them worse and lying down doesn’t help much.
Chiropractic care has been shown to help migraines (2.). Massage and acupuncture have also been shown to help.
If you would like a free check up to see which type of headache you have then give us a call to make an appointment.
1. Stress and tension-type headache mechanisms. Cathcart et al. Cephalalgia 2010; 30(10): 1250-1267.
2. Manual therapies for migraine: A systematic review. Chaibi A, Tuchin PJ & Russell MB. Journal of Headache & Pain 2011; 12: 127-133.
3. Effectiveness of manual therapies: the UK evidence report. Gert Bronfort et al Chiropractic & Osteopathy 2010, 18:3Learn More
Runners MOT – New
Written by Sundial Clinics Tuesday, 1 March 2011 05:53
Most runners know that a good warm-up and warm down routine, including stretches, is likely to minimise the risk of injury whilst running. In spite of this, the injury rate in runners is still too high, especially knee injuries. Runners are increasingly us to help prevent injuries as well as treating them once they have occurred.
We are helping out with the Rockinghorse runners again this year. Antony our physio has already been giving training tips and we have all been helping runners get over niggling training injuries. If you are running, whether for Rockinghorse or not, you might like to book an appointment for our Runners MOT. Bring your running shoes along and we will check them out along with your back, hips knees and feet for running problems. Some problems will not cause pain until they build up to a critical point so don’t wait for symptoms to tell you if there is an issue.
The fee for this service is £5 which we will donate to the Rockinghorse charity.Learn More
Acupuncture & Chiropractic recommended on the NHS
Written by Sundial Clinics Wednesday, 27 May 2009 03:55
NICE, an advisory body to the NHS, are actively recommending alternative therapies for the treatment of ongoing back pain:
Patients whose back pain has continued for more than six weeks but less than a year should be offered a choice of 12-weeks of complementary therapy on the NHS, the National Institute for Health and Clinical Excellence has concluded.
Patients should be able to choose between eight exercise classes over 12 weeks in a class or individually, nine sessions of manipulation which could be performed by a chiropractor, osteopath, or specially trained physiotherapists and doctors, or ten sessions of acupuncture over 12 weeks.Learn More
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