Little-known cause of back pain starts in childhood and is entirely preventable

Back pain often comes on apparently without reason. In fact, one possible cause might stretch all the way back to childhood. Hove dentist, Pieter Grobbelaar, tell us how teeth and jaw problems can be behind chronic pain.

The jaw joint (TMJ) and pelvic joints (sacro-iliac joints) both work in conjunction with one another, compensating for one another when either joint becomes misaligned writes Pieter Grobbelaar. With an abnormal bite the TMJ becomes dysfunctional and this creates instability at the weight bearing sacro-iliac joint in the pelvis. This leads to poor body posture which can cause low back pain, neck pain, headaches and other health problems.

The majority of children (75%) now have crooked teeth, incorrect jaw development and other orthodontic problems, which is evident from 3-5years of age, are not caused by big teeth in small jaws or hereditary factors. However, rather than blame genetics for crooked teeth and poor jaw development, modern research has produced evidence that points to other causes.

Concordia dental healthcare has recognised that Soft Tissue Dysfunction or poor myofunctional habits such as mouth breathing, incorrect tongue position, reverse swallowing and thumb sucking are the real causes of malocclusion and poor cranio-facial development.

The restricted development limits the space available for erupting teeth and prevents them from emerging into their natural position.

75% of growing children are affected and most commonly will presents with crooked teeth, undeveloped facial and jaw bones, TMJ (Temporomandibular joint) dysfunction and poor body posture.

Mouth breathing is abnormal and is one of the causes of Sleep Disorder Breathing (SDB) problems.

SDB in children has been recognised as causing widespread health, developmental and behavioural problems, including snoring, gasping, cessation of breathing such as Obstructive Sleep Apnoea (OSA) and interrupted sleep, which can result in drowsiness during the day as well as behavioural problems in children. Additionally, as well as being detrimental to the development of the face, jaws and teeth, if left untreated paediatric SDB can lead to significant and serious health problems causing poor quality of life later in adulthood.

If a child breathes through their mouth during the day or while sleeping at night, the tongue drops to the bottom of the mouth, which results in upper and lower jaw development problems. Allergies, asthma and open mouth posture also cause the jaws to develop incorrectly.

Incorrect dental and facial development can be detected at an early age, but so often no treatment is recommended. It is well known that the majority of our children do not develop their jaws and face correctly. This results in crowded teeth and underdeveloped faces.

Braces and extracting teeth in teenage years does not solve the underlying problems behind the causes of crooked teeth and incorrect facial development.

The balanced cranium provides the anchor points for the tension membranes which support the brain. The rhythmic pulsing of the brain as it expands and contracts, when breathing, provides the basis for the sacro-occipital pump which circulates cerebo-spinal fluid.

One of the most important aspects of normal cranial function is the position of the jaw. When the lower jaw (Mandible) comes in contact with the upper jaw (Maxilla) the movement should be symmetrical, simultaneous and even. This constitutes normal cranio-dental function. When the jaw becomes distorted the entire balance of the cranium is put in jeopardy.

A misaligned jaw will change the bite plane and ultimately the bite, affecting the cranium, TMJ, muscle balance, normal spinal mechanics and pelvic stability.

Good cranial development is needed for optimum neurological development.

The cranium consists of 28 bones, any distortion will affect transmission within the brain, cranial nerves and ultimately the nervous system.

Cranial development is 65% completed at age 8 years and 95% completed at 12 years of age, therefore it’s essential that intervention occurs as early as possible assisting cranial development to its optimum genetic potential.

Pieter-Grobbellar

 

 

Dr Pieter Grobbelaar BChD

Founder and Principal Dentist of Concordia Dental,

51-53 Church Road Hove

 

 

Exercise mistakes that make your back worse

Most back exercises are great for the back and it doesn’t seem to matter much what exercises you do as long as you stay active. But some exercises can be harmful and actually damage your back. So whether you like the gym, Pilates, yoga or a sport it is important to know the good and the bad. Matthew was recently interviewed about just this topic by Stu Girling from Love Yoga Anatomy. Stu trains yoga teachers and practitioners on safe ways to do yoga.

One of the exercises that does more harm than good is forward bending despite the fact that lots of people do it to stretch their back. As we bend forward huge pressure builds on the lower discs. As you bend from the waist, if the lumbar spine is held in neutral, with its natural forward curve, the pressure on the disc is reduced. If you round your lower back as you bend forwards then the discs are vulnerable. The jelly inside the disc gets forced backwards and can cause cracking in the outer disc wall. If this carries on it can cause a disc bulge or a “slipped disc”.

 

Forward-bending
Lumbar-loads

 

If you bend, as in a yoga forward fold, over and over again then it can cause injury. It is like repeatedly bending a credit card, a white line appears and ultimately it breaks.

Many people with back pain feel that their back is too stiff and want to stretch it. A better goal for exercises is the right mix of flexibility and stability. If your back is too stiff and this causing pain then the solution is to unlock the spinal joints with chiropractic manipulation or mobilisation. If, however, your problem is too much flexibility then we work to stabilise your spine.

Why an accurate back pain diagnosis is essential

Back pain is not one condition but several conditions causing similar symptoms. A muscle spasm, disc derangement and a spinal joint dysfunction all cause low back problems that can refer pain down to the buttock and leg and a skilled chiropractor or physio can tell which problem it is likely to be. Whilst several conditions can co-exist an accurate diagnosis is important because the treatment is different for all three.

The diagnostic confusion is made worse by the different experts who treat back pain because they often use different terminology to describe the same thing, recommend different treatment based on their area of expertise and frequently ignore the evidence that their approach has been shown to be ineffective and so leave you, the patient, in pain and more confused about what is wrong.

Most back pain is caused by irritation to:

  1. joints,
  2. discs,
  3. muscles or
  4. nerves of the spine.

This irritation happens with repetitive minor trauma such as bending and lifting or, more rarely, by a single traumatic injury such as a fall or accident. It can also be caused by inactivity which causes the joints of the spine to stiffen up and the back support muscles to become weak such as sitting at a desk for long periods.

If the joints of the lower back get stiff they are less able to carry out normal movements and this can lead to further joint irritation, stiffness and pain. This is often called Facet Joint Syndrome. The nerves around the stiff joints get irritated too and fire off alarm signals into the nervous system which can cause further symptoms such as tingling and pain referred down to the hips and legs. This can mimic sciatica.

Occasionally, the nerve irritation can cause muscles in the legs to weaken and this can lead to problems in the hips and knees. How this occurs isn’t clear but anyone with hip or knee problems seeing us here at Sundial will get a thorough muscle and spine check-up.

We treat back pain with an effective step by step programme to rebuild strong and healthy backs so you can lead an active and fulfilling life.

 

Get started today with a free consultation…

Book now

 

 

Bare as you dare – how sunbathing prevents back pain

The sun is shining; it’s warmed up; time to take your clothes off!

If you are suffering from ongoing back pain, then you could be deficient in Vitamin D. This hormone is responsible for a wide range of processes in the body including bone and muscle function. A commonly missed cause of back pain is Vitamin D deficiency, especially over a long winter. At least 50% of people in the UK show signs of vitamin D deficiency and many will have increased back pain as a result.

Common signs of vitamin D deficiency

  • muscle and bone aching
  • pain sensitisation, lower pain threshold
  • fatigue
  • depression
  • weakness
  • muscle soreness after exercise

Vitamin D is essential for bone formation as it helps your body absorb calcium from food. If you don’t have enough Vitamin D you can get a condition called osteomalacia. The dull, aching pain associated with osteomalacia most commonly affects the lower back, pelvis, hips, legs and ribs. This pain can be worse at night, or when you’re weight bearing. Vitamin D deficiency may cause morning back pain in some people too.

How much Vitamin D is enough?

There are various ideas about what the minimum blood levels for Vitamin D are required. This is a measure in nanomoles per litre of blood (nmol/L). Severe deficiency is anything below 25nmol/L, but anyone below 50nmol/L is considered deficient. Optimum health is often thought of a being above 85 nmol/L although more than 125nmol/L can be required for some people.

How can you get enough Vitamin D?

Fortunately, it is easy to get enough Vitamin D for free as you make it in your skin. Sunlight contains ultraviolet (UVB) rays that stimulate Vitamin D production. UVB rays also cause sunburn, however, so it is important to avoid over-exposure. If you cover up or use sunscreen, you will not produce Vitamin D so only aim for short exposure.

A sensible approach is to aim for 10-30 minutes exposure on as much bare skin as you dare, depending on how sensitive your skin is, several times a week when the sun is strong enough; in the UK that is from April to September. Full body sun exposure with no sunscreen will produce up to 20,000iu (500 μg) in 30 minutes. More importantly, once you have made enough Vitamin D your skin stops producing it so you can’t get too much.

Vitamin D supplements

Over the winter or for if you are severely deficient then supplements are the only way to go. In your diet oily fish such as salmon, mackerel and sardines provide some vitamin D but you would, for example, need to eat 20 tins of salmon a day to get 5000iu.

Here at Sundial we recommend a liquid Vitamin D supplement which is highly absorbable and inexpensive. The chewable calcium based supplements from ordinary shops are often too low in Vitamin D to help much.

Summary

  • Vitamin D deficiency is common and can cause back pain
  • Safe sun exposure on bare skin from April to September is beneficial
  • Taking a good quality supplement over the winter prevents deficiency

For more information and references:

https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/

https://www.skincancer.org/prevention/uva-and-uvb

https://www.hsph.harvard.edu/nutritionsource/vitamins/vitamin-d/#new-vitamin-d-research

https://www.healthline.com/nutrition/9-foods-high-in-vitamin-d#section2

 

Back pain in pregnancy and chiropractic

freestocks-org-71789-unsplash

During pregnancy your body changes to adapt to your growing baby. These changes happen fast and you can experience pain and discomfort in your pelvic and lower back area.

Hannah’s story

Hannah came to me here at Sundial during her 4th month of pregnancy because she was experiencing pelvic pain for few weeks and the intensity of pain was increasing with time. She was also suffering with pubic pain for the last few days.

She would feel more pain turning in bed, walking and going up or down stairs. Being a nurse Hannah needed to be on her feet most of the day and she desperately needed relief.

After an examination I explained to Hannah that she was experiencing pain because of a sacroiliac dysfunction, a lack of movement in the joint of the pelvis.

These types of pain are very common during pregnancy. In fact 20% of pregnant women suffer with pelvic pain and 50 to 85% with low back pain. This is mainly due to the hormonal changes during pregnancy as your body starts to produce relaxin, the hormone that relaxes your ligaments in order to increase the space for your baby and birth. Also mechanical changes occur as the pregnancy goes along. As your tummy gets bigger the curve of your lower back increases and creates pressure on your back joints and muscles too.

We started working on this sacroiliac dysfunction using very gentle techniques to free up the joints and also working on the ligaments and muscles of the pelvis with gentle pressure. I also gave Hannah stretches and exercises to stabilise her core muscles and pelvis at home.

I saw Hannah regularly throughout her pregnancy in order to maintain the right sort of movement in her pelvis and, fortunately, she didn’t experience pelvic pain anymore!

Can arthritis of the spine cause back pain?

Does arthritis, specifically osteoarthritis, cause low back pain? In this video Brighton chiropractor and back pain expert, Matthew Bennett, reveals the answer and explains what osteoarthritis of the spine actually looks like.

New study slams medical treatment for back pain

backsA new study on back pain in the prestigious medical journal, the Lancet, roundly criticises medical treat of low back pain. Researchers from all over the world took part and looked at how back pain is treated and they concluded that there is “inappropriately high use of imaging, rest, opioids, spinal injections, and surgery.”  They go on to say that “Doing more of the same will not reduce back-related disability or its long-term consequences.”

Back pain is now the number one cause of disability globally and rates have continued to rise in spite of increased spending on treatment. The authors make a plea for more sense and evidence based treatment. They call for a new direction which encompasses emerging treatments alongside effective solutions that exist already.

Effective treatment for back pain

Guidelines exist for doctors to follow on the most effective sorts of treatment but often these are ignored or not implemented properly. Here in the UK, NICE has issued guidelines and these are mentioned in this study as being helpful and they echo the findings in this paper.  The evidence points to a biopsychosocial model of care which looks at the behavioural, psychological, and social factors as well as the anatomical structures which play a role in the persistence of pain and disability. What does this mean for you if you have back pain?

It means that there is greater emphasis on self-management, physical and psychological therapies, and some forms of complementary medicine, and less emphasis on pharmacological and surgical treatments. So staying active, doing gentle exercises, getting some manual therapy as well dealing with stress, anxiety and depression, especially negative feelings around pain and disability, are very helpful. Some guidelines also recommend massage and acupuncture. One thing the guidelines in the US Denmark and UK agree on is that spinal manipulation is helpful. Which is good news because that’s what we do here at Sundial.

The report goes on to highlight the differences in standards of care throughout the world and it is clear that there is huge variance in practise and approach. For instance in the USA only half of back sufferers are prescribed exercises and in Sweden, USA and Australia electrical modalities like ultrasound are routinely used in spite of being ineffective.

Back pain is not one condition

This review is an excellent summary of the worldwide management of low back pain but has its limitations. Back pain is not one condition but several conditions causing a similar group of symptoms. A muscle spasm, disc derangement and a spinal joint dysfunction all cause low back that can refer pain down to the buttock and leg and a skilled clinician can tell which problem it is likely to be. Whilst several conditions can co-exist it is clear that an accurate diagnosis is important because the treatment is different for all three. Here at Sundial we make sure we make an accurate diagnosis and agree a treatment plan that is the most likely to get the best results.

If you would like a free check up to see if we can help your back pain please give us a call or book online above

 

Reference:

Prevention and treatment of low back pain: evidence, challenges, and promising directions

Foster, Nadine EBuchbinder, Rachelle et al.
The Lancet , Volume 0 , Issue 0 ,

21 March 2018

Free physio exercise routine (worth £42) with free spinal check-up

Low back stretchMost people think that having a healthy back is matter of luck, a matter of avoiding accidental injury and bending a lifting properly. Whilst these things certainly help there are three things that research has shown to be the most effective way of treating and preventing back pain.

Firstly, and most importantly, keeping fit and active has the biggest impact on preventing back problems. Initially, a few days rest may help a bad back but getting active early on is key to a full recovery. Once your back is better it is important to maintain levels of activity and there are certain simple exercises that you can do at home. These exercises can also prevent back pain coming on in the first place.

The second thing that will help keep your back in tip top condition is getting treatment sooner rather than later. If back problems are not clearing up or keep coming and going it may be a sign that that the condition is slowly worsening and this can lead to chronic, ongoing pain.

The third solution to keep your back healthy is regular preventative check-ups. Back problems come on because the spinal joints gradually stiffen over time, causing reduced movement, inflammation and pain. We can check for the early signs of spinal stiffness and our treatment can unlock the stiff joints and prevent the pain from coming on in the first place.

For January, we are offering a free spinal check-up with a chiropractor combined with free 30-minute physio assessment and personalised exercise routine (worth £42) for everyone seeing a Sundial chiropractor. To book in online – www.sundialclinics.co.uk or call Sundial Queens Road, 01273 774114

 

Terms and conditions: One free spinal check up and one free physiotherapy exercise session is available on request. To be eligible to claim you must receive a session with a Sundial chiropractor between 2nd – 3rd February 2018. Only one free chiropractic check-up and one free physiotherapy session is allowed per person and it must be taken by 31st March 2018. The free sessions are not transferable and cannot be exchanged for the cash equivalent. 

Preventing low back pain

low back treatment, chiropractor BrightonRecent research shows that low back pain can be prevented with regular chiropractic care. Researchers from the Karolinska Institute in Sweden reported that early results from their randomised control trial showed significant improvements in the recurrence of back pain. These results, as yet unpublished, were reported at the latest European Chiropractic Union Conference in Cyprus, May 2017.

In the trial, people with recurrent low back pain were divided into two groups. Both groups were treated with an initial course of usual chiropractic care which consisted of spinal manipulation, mobilisation, exercises and advice. One group was then told to come back every few months and the other group was told to come back only if and when the pain recurred.

The group that were told to come back every few months experienced nearly 20 fewer pain days over the year.  On average they had two more treatment visits than the other group.

This result confirms for the first time that regular chiropractic care can have a significant influence on the course of low back pain. People with recurrent episodes of back pain should consider regular preventative check ups to reduce the impact of their back pain.

Here at Sundial we recommend periodic check ups every few months based on your history and the severity of the problem. We monitor progress through regular reassessments and online questionnaires to help us improve our care.

Latest research show what works for sciatica

Back manipulation - Brighton chiropractorEffective treatment for sciatica has been hard to prove. There may be many reasons for this but recent research has attempted to analyse all the best studies and combine the results in a so-called meta-analysis. The research team from Bangor University looked at more than 120 studies comparing 21 different treatment strategies. What they found will surprise many doctors and patients alike.

Previous studies have often found little or no significant improvements between various treatment strategies. This understanding combined with the fact that most sciatica gets better over a few months all by itself has meant that usual medical treatment has been to reassure the patient, prescribe pain-killers, and send them on their way. This new study should change that approach.

The researchers from the North Wales Centre for Primary Care Research concluded that for the best overall outcome significant improvements followed disc surgery, epidural injections, nonopioid analgesia, manipulation and acupuncture although disc surgery and epidural injections were associated with some adverse effects. If the only consideration was pain relief then epidural injections helped as did certain anti-inflammatory drugs. The interventions that were shown not be effective were bed rest, certain strong pain killers (opioids like codeine), traction and some surgical procedures like discectomy. Lead researcher Ruth Lewis said  ‘The most interesting finding was that opioids are not effective. The lack of effect is probably due to the type of pain you’re dealing with.’

What sciatica treatment should you try first?

Back examination - Brighton chiropractorThe NHS Pathfinder helps identify what treatment is best and when to seek it out. First of all you need a thorough assessment and examination by a competent health care professional such as a GP, of course, but also a chiropractor, physiotherapist or osteopath. This first assessment is important to rule out serious diseases and nasty nerve problems that need more invasive treatment like surgery. Fortunately most sciatica problems respond well without surgery. Manual therapy, like manipulation, as well as acupuncture feature have been shown to be effective.

How you choose to be treated for sciatica will often depend on your personal preferences. Some people hate the idea of acupuncture needles. For others manipulation or drug treatments are not appealing. Fortunately there are many treatment options and usually a combination of the most effective ones should be tried first. This means consulting a practitioner who is happy to work as part of a team to get the best outcome. Here at Sundial we have chiropractors, physiotherapists and acupuncturists who work with the recommendations from your GP. For more information on back and leg pain go here.

Surgery for sciatica is usually only contemplated for patients with severe nerve compression, if symptoms don’t respond to conservative care or carry on getting worse in spite of treatment.

Reference

Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses.
Lewis RA et al. Spine J. 2015 Jun 1;15(6):1461-77.