Three gym exercises to avoid with a bad back – Johns’ story

Deadlift can cause back painWhen John came to see me with a recurrence of his back problem he was really fed up. He had been going to the gym and doing the core stability exercises that he had been shown by the instructor. He had been exercising two or three times a week since his bad back had recovered 3 years before and he felt fit and strong. His back felt great too. He didn’t do anything to upset his old problem – it just came on. Unfortunately he had been doing the wrong back exercises. The exercises he had been doing actually contributed to his back pain.

The last time John’s back was bad all he needed was a short course of chiropractic care and he was fine again. He wanted to prevent his back getting bad again so decided to get fit. Usually this is a good idea. People who exercise regularly tend to get a lot less back ache.

John asked the instructors at the gym to put together a program with his back in mind. The program they came up with included a mix of upper and lower body exercises and abdominal exercises to help with core stability. The program relied heavily on machines to provide the weights and resistance – even for the abs. Here is the first problem.

Abs machines, the sort where you sit in them with straps or a bar across your chest, can aggravate back problems. Worst of all they aren’t that good at working your core stability muscles which are important for back strength. There are safer and more effective abdominal exercises that are easy to do – when you know how.

John was doing two other exercises that could also be irritating his low back. The first one was a deadlift. Deadlifts are one of the commonest reasons gym users end up at a chiropractors. Even when done well there is a risk of damaging the low back discs. When done badly they can destroy a healthy back.

The other exercise that concerned us was a leg press. In this exercise you sit in the machine, load up the weight and push a plate away from you with your feet. Because your leg muscles are so strong you can move large weights. Lifting your own body weight is not that unusual. Again this is a disaster for the back, not because of the weight itself but rather that your low back is flexed forward when you load it up.

Normal disc standing upright
Normal disc standing upright
Disc Bulge in forward bending
Disc bulges when spine bends forward

If there is one thing the low back discs hate it is bending forward and then having a load applied as happens when you lift something. The reason has to do with the architecture of the disc itself.  The disc consists of a tough outer wall with a jelly inside. Some have likened it to a doughnut but I prefer thinking of it like a toffee eclair. As you bend forward the toffee like core is forced backwards against the back wall of the disc. If you compress the disc in this position, as you do when you lift a weight or do a leg press, then the core or nucleus, exerts huge forces against the wall. This can cause the wall to crack.

Once that tough outer coat splits or cracks then pain can come on. The pain can last for a very long time and be intense. If the crack is big enough then the toffee can ooze out and press on the nerves causing sciatica. Because the disc is slow to heal the pain can become chronic.

The good news is that other exercises can easily strengthen the low back, allowing the discs to heal and help prevent further pain. In the second part of this article we will show you how to exercise safely at the gym and protect your back from harm.

Update:

Following criticism on Twitter by several physio’s of the piece above I thought it would be useful to provide the reference for the views expressed. Most of the work comes from an excellent book by Prof Stuart McGill Low Back Disorders – Evidenced Based Prevention and Rehabilitation published in 2007.  In a 27 kg deadlift McGill found the compression and shear forces amounted to 7000N – enough to damage some weak spines.

On an anecdotal basis we regularly see people who claim to get back pain associated with certain gym exercises. Deadlifts are the commonest cause amongst these by a long way. In the case above, John was in a 1:1 training session with a gym instructor so can be assumed to be doing the exercise correctly. He still got injured and he felt the moment his back went on the deadlift.

There are other safer ways of exercising the muscles worked in a deadlift and we prefer to recommend these. There are some people who will benefit from deadlift training , especially if their work or play requires conditioning in these movements.

Matthew Bennett

Picture credit: Adrian Valenzuela

 

Bupa and Axa PPP cover our chiropractors and physio’s in Brighton

Bupa accpetedHere at Sundial Clinics, Brighton we often get asked if patients can claim their fees back from their health insurance companies. Most of the time, you can.

At Sundial we have chiropractors and physiotherapists who are recognised by both Bupa and Axa PPP.   Both these private health insurers have a restricted list of recognised practitioners in each speciality.  To become recognised, there are a number of requirements, including being in practice for more than 5 years  and having references from medical consultants. We also have to adhere to strict guidelines on quality assurance, patient satisfaction and probity.

If you are thinking of making a claim on your health insurance for chiropractic or physiotherapy then it’s worth checking your policy to see if there is an excess and to check the limit of the cover. You will then need to call your insurer to get a claim number which you can pass on to us. We can claim your fees back from your insurer directly or you can pay us and can claim back the fees yourself. You may also need to be referred by a GP in order to make a claim. This is usually straightforward and GPs are generally happy to do this.

If you need an MRI scan or an x-ray, this will often be covered as well. Things that aren’t covered include extra services such as massage and products such as nutritional supplements and orthotics.

Pre-existing conditions

Most health insurance companies will not accept a claim for pre-existing conditions. If you have back pain that comes and goes, it can be difficult for an insurer to assess whether or not this is a pre-existing condition or whether the back problem completely resolves and each presentation is in fact a new episode. If you have any doubts as to which sort of back pain you have then please get in touch as we may be able to help in providing the insurer with accurate information.

Sometimes an insurer will suggest another practitioner in your area. If, however, a practitioner is on your insurers approved list, you can choose to see who you like. If you have any queries, please give us a call.

 

Axa PPP

Simply Health WPA

Mind your posture – carers, care for your backs with a free check up

Brighton chiropractor caring for carers with back painThere are currently around 140,000 thousand carers in East and West Sussex with the figure set to rise to 180,000 by 2037[1]. For many carers physical activity such as lifting is a significant part of their daily routine. However, not all carers will be aware of their back health when looking after someone.

Although paid carers may receive training on how to protect their backs during the physical aspects of their work, many unpaid carers, of which there are 5.8 million in England and Wales[2], may not receive any training or information about back care.

To coincide with Back Care Awareness Week (7 – 11 October) Sundial Clinics in Brighton is offering carers a free back check with advice on how to avoid back problems. Sundial Clinics  have developed the following simple tips for all carers to help them whilst they’re helping others.

Golden rules for carers

  • Think ahead – assess each situation and look for the best and easiest way to achieve the desired result, this may mean using any available equipment whether it be for specialist lifting or a simple sack barrow for moving boxes of supplies
  • Follow the weight – always try and face the direction in which you want to carry any weight – your body is strongest when you are square on to the weight
  • Take care when lifting – never lift while twisting from the waist.  Bend your knees, try to have a relaxed, straight back and if possible, brace your abdominal muscles. For added stability make sure that your feet are about a shoulder width or more apart before lifting
  • Ask for training – whether you are caring in a formal setting or helping someone at home, make sure you have been properly trained in how to use any equipment
  • Supportive shoes are essential – wear good, soft-soled shoes that are supportive and have a good grip on the ground
  • Take regular breaks – if doing a repetitive task, take a break every 20 minutes and do some simple stretches to relax your muscles.

Carers – Straighten Up

Matthew Bennett from Sundial comments: “Carers spend long periods of time on their feet and put a lot of strain on their bodies, from lifting and assisting the person they are caring for, to moving equipment. Even though our bodies are very well adapted to a variety of tasks, carers need to be particularly careful not to overload themselves and put their backs at risk.

“Formal care settings should have lifting and moving equipment available and staff should always make sure that they have been trained in the proper use of all equipment. Home carers should make sure they receive home assessments for the person they are caring for as equipment can be loaned out – this will require appropriate training for proper use.”

Matthew Bennett recommends a very simple three minute exercise routine entitled ‘Straighten Up UK’ from the British Chiropractic Association (BCA) has developed which is really easy to incorporate into daily life to help strengthen the spine and improve posture. The exercise routine can be accessed on the BCA website here: http://bit.ly/straightenup.

 


[1] Statistics taken from Carers UK http://www.carersuk.org/newsroom/stats-and-facts

[2] According to data from the Office of National Statistics from the 2011 census

Back pain treatment needs a rethink

photo (1)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.

Soreness after chiropractic care

Chiropractic care -safe and effective
Chiropractic care -safe and effective

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.

Reference

Outcomes of Usual Chiropractic; Harm (OUCH). A randomised controlled trial. Spine 2013 Jun 17.
Walker BF, et al

Back Pain – do lumbar support belts work?

Back supports- Do they work?
Back supports- Do they work?

If you get back pain you may have wondered at some point if a lumbar support belt would help. You may need help with a current bout of back pain or be interested in preventing future episodes of back pain. If so, this should help make your mind up.

Back belts are supposed to work by reducing the load on the spine and by improving posture. The forces going through the lumbar spine when you lift can be considerable. Boffins have measured these forces in powerlifters (1) and they peak at 1.7 tonnes of force! There is controversy around whether hard lumbar support belts that weightlifters wear actually help in the performance of their sport (2). In some studies there is actually an increase in low back muscle work during lifting with one of these belts on.

Weight training in a gym or lifting heavy weights in a competition is not the same as lifting around the house or at work. Most of us are not going to lift such weights but lifting heavy loads, especially if the task is repetitive, builds up huge potential damage to the low back. The sort of lumbar support belts available for domestic or work use are made of neoprene or an elastic or non-elastic webbing type material. This sort of construction is much more comfortable for all day use and can easily be worn under clothing, next to the skin. But does it do any good?

The most recent look at preventing back pain using a lumbar support belt is carried out in 2009. It was published in the prestigious Spine Journal and looked at a variety of back pain prevention measures. Of the four trials comparing the prevalence of back pain in people wearing and not wearing a back belt it conclusively showed that there was no benefit. In fact, the only preventative measure that came out positively was exercise.

So unfortunately there is no shortcut to preventing episodes of back pain by wearing a lumbar support belt or brace. Back exercises, however, can be very helpful and will make a significant difference to any current episodes of back pain you may be having as well, as future ones. Here are some videos that will help get you started.

Advice on preventing recurrent low back pain.

Why do back problems become long term?
References
1. Lumbar spine loads during the lifting of extremely heavy weights. Med Sci Sports Exerc. 1991 Oct;23(10):1179-86. Cholewicki J, McGill SM, Norman RW.
2. The Effects of Lumbosacral Support Belts and Abdominal Muscles Strength on Functional Lifting Ability in Healthy Women. Spine 1996;21: 356-366. Smith, E.B., et al
3. High-quality trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine Journal 2009; 9: 147-168. Bigos SJ, Holland J, Holland C, et al.

Headaches – a pain in the neck

Headaches sketchHeadaches can sometimes be caused by neck problems in disguise. This type of headache is called a cervicogenic headache. Evidence for the best way to treat this type of headache has been lacking – until now.

Cervicogenic headaches may respond well to manipulation, mobilisation and specific exercises a new study shows. This is good news because this type of headache accounts for one in five of all chronic or long-term headache symptoms.

The new headaches study is a review of lots of other studies. Pooling all the results in a so called meta-analysis is a great way to improve the power of individual studies and get some meaningful results. Although the results were not all clear cut in favour of manual therapy the trend seems to indicate that the sort of treatment used by chiropractors is likely to be effective of cervicogenic headaches.

Cervicogenic headaches are caused by muscle spasms or spinal joint problems in the neck. They affect women four times more than men for some reason. They are made worse by poor posture as well as activities that cause your chin to poke forward such using a laptop or a computer screen that is set too low.

Chiropractic treatment for cervicogenic headaches uses gentle adjustments to unlock the stiff spinal joints as well as deep muscle release techniques to improve the underlying causes of the pain. Our physio’s here at Sundial can also prescribe specific exercises after identifying the weak muscles in your neck and shoulders. Laser therapy or acupuncture needles may be used.

If you would like to know if we may be able to help you, give us a call and make an appointment to see us. If you a not sure whether this approach is for you then make an appointment for a check up at no charge. We will tell you whether your headaches are likely to be caused by neck problems and may respond to chiropractic and physio care.

Reference: Conservative physical therapy management for the treatment of cervicogenic headache: A systematic review. Racicki S, Gerwin S, DiClaudio S et al.
Journal of Manual & Manipulative Therapy 2013; 21(2): 113-24.

Top Tips – neck and shoulder problems in hairdressers

Neck and Shoulder Pain in Hairdressers

Hairdressers get much more neck and shoulder pain and problems in their forearms and wrists than average.  Standing up for long periods, holding your arms up in the air while doing intricate repetitive movements can cause aches and pains. In fact, over half of hairdressers get neck and shoulder pain and nearly 2/3 get back pain. If you’re a hairdresser what can you do about it?

Typically, neck and shoulder pain in hairdressers is caused by muscle tension and locking of the joints of the spine. This may lead to Cervical Facet Joint Syndrome. Here the joints of the neck becomes stiff and inflamed and can lead to nerve irritation. Some nerves coming out of the neck go down the arms to control the muscles in the wrist and hand. Problems in the neck can cause muscle weakness, pins and needles and pain.

The muscles of the shoulders and arms are not designed to contract for long periods. Instead, they’re much better at short periods of intense activity followed by a break. Holding your arms up with the muscles tensed, decreases the blood flow and may lead to tissue damage. It is thought that this is one potential mechanism for repetitive strain injury (RSI).

Top tips for preventing neck, shoulder and arm pain

  1. Get to work early. If you arrive in a rush, puffed out from running up the street, your muscles will be tense before you even start work. If you’re calm and relaxed, your muscles will be too. Also, you will have time to do Tip 2.
  2. Do a few simple stretches before you start work. Go here to download our free sheet – Exercises for Hairdressers.
  3. Take a mini break every few minutes. Every few minutes. Let your hands drop your sides and shake loose to relax the muscles.
  4. In between clients do a couple of the stretching exercises again and massage your neck, shoulder and forearm muscles.
  5. Perch on a high stool when you can. This eases the pressure on your lower back and feet.
  6. Avoid raising your arms up so high by lowering the clients chair or standing on a platform.
  7. Keep your wrists straight. If your wrists are held at odd angles you are straining your forearm muscles.
  8. Breathe deeply. This improves the oxygen supply to your muscles and helps keep them relaxed. If you’re tense and breathing shallowly your muscles are more likely to go into spasm.
  9. Don’t smoke. People who smoke get more aches and pains in their muscles and joints. If you drink, take it easy. Some of the chemicals in alcoholic drinks increase inflammation.
  10. At the end of the work day do the simple stretches again.

If you’re still getting aches and pains come and see us at Sundial. Our chiropractors, physio’s and massage therapists can help you.

 

Reference:

Neck and Shoulder Pain in Hairdressers, Brighton

Self-reported work-related symptoms in hairdressers. L. Bradshaw, J. Harris-Roberts, J. Bowen, S. Rahman and D. Fishwick. Occup Med (Lond) (2011) 61 (5):328-334.

 

5 Top Tips To Avoid Injury When Training

If you want the best advice about how to avoid injury when you are training then ask an expert. In this guest post, Lucy Howlett of LIFT Personal Training, Brighton, gives some great tips to stay fit and active without pain.

Warm Up Safely
Warming up is vital to keeping the body flexible and adaptable for what we require it to do. Before you run, jump (or fly!) ensure that you spend 5-10 minutes warming up and mobilizing all the joints. You can do this with things like leg swings (forwards and sideways), arms swings, twisting the torso from left to right, shoulder rolls and gently turning the head from left to right to look over each shoulder.

Posture & Technique
Do you know why lifting technique is taught in most workplaces? E.g. bend the legs, back straight and chest up … because technique matters and can be the difference between healthy exercise and injuring your back. So the same applies to when you’re purposefully training, whether with weights or bodyweight exercises. Training with good technique transfers into everyday life, such as having better posture, holding less tension in the body and moving with greater ease.

Core Strength
The importance of having a good level of core strength can sometimes only hit home when you’ve hurt your back or sustained another type injury caused by a lack of core strength. The layers of core musculature are like a corset that protects your internal organs and keeps the rest of your body stable and supported. Learning to recruit these muscles effectively can help you to look slimmer, support your overall posture and reduce back pain. Ask me for more advice on how to improve your core strength and stability.

Leave Your Ego Behind
I know someone who did his back in while training recently and admitted that his ego was the cause of it. Appreciate where you are, know that we all start somewhere and progress is still PROGRESS. With good foundations you can build a skyscraper but not before. The body (and life) is much the same; one must progress in stages. Too early and the supporting structure may fail us.

Stretch Out
After exercise, you will need to stretch out to allow the muscles to return to their normal length. If you don’t, you could possibly land yourself an injury. Without flexibility, your muscles could pull or tear during fast paced, or explosive movements. Yoga is fantastic for realigning the body, correcting imbalances and built up tension, as well as reducing stress.

Lucy Howlett
www.liftpersonal-training.co.uk
Mobile: 07879 490373

How to treat Shin Splints

Shin splinPhysiotherapy leg examts or Medial Tibial Stress Syndrome (MTSS) is easy to treat if the problem is caught early. If symptoms of pain along the inner border of the shin bone (tibia) goes on for too long then significant damage can occur to the muscle and bone bone coverings and the condition becomes chronic. Brighton physio, here at Sundial, James Masterson explains.

What can I do to help myself?

Rest and ice – Ice can be an extremely effective pain relief for shin splints as it acts as a local anesthetic by numbing sore muscle tissue. It also helps to slow down the inflammation and swelling process which occurs with injury.

Take down inflammation – Anti inflammatory medication may help to reduce any swelling and speed up your recovery time. Please consult your doctor before taking any medication.

Wear appropriate footwear!! – It may be beneficial to visit a specialist running shop where you can be advised about what might suit your needs. On average running shoes should be replaced when worn for between 300 and 600 miles, depending on factors such as body weight, running style and training surface. In some cases orthotics (inner soles) may be used to help abnormal loading throughout your lower limb and correct issues such as over-pronation and supination. More information on orthotics here.

 

What can the physio’s at Sundial do to help?

The first stages of rehabilitation may include advice to rest from aggravating activity for a while. We can give you ice packs to use of the first 2 day after the pain starts or is aggravated by the offending activity. We will help you switch to low impact exercise such as swimming and cycling and advise on how best to incorporate changes to maintain strength and fitness. Only in extreme cases is protected weight bearing necessary.

Foot alignment

An important part of the recovery process is assessment of foot alignment and walking/running analysis to highlight any potential problems. Advice on appropriate footwear and the
In more severe cases our physio care involves laser therapy which improves healing, reduces pain and takes down inflammation. Soft tissue techniques such as massage may also help to ease tight muscles associated with shin splints or MTSS. application of inner soles may also be of benefit. We are experts in this sort of advice and work with local running shops to get the best footwear for you.

We will also advise on a home exercise plan consisting of stretching, balance and strength exercises to help too. This is an important part of your recovery along with a graded return to activity with symptom free progression.

 

Causes of Shin Splints -more here