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Chronic Low back Pain.

Recently I found an informative article about the benefits of Myofascial release, specifically the reduction in EMG activity (spasm) of the low back musculature (Erector Spinae) and pain severity. A recent journal article from February 2019 published in the Journal of Clinical Biomechanics studied a group of 36 people with nonspecific chronic low back pain. This randomised control trial investigated whether myofascial release techniques (soft tissue techniques) altered lumbar spine muscle activity with flexion, pain severity, disability and lumbar motion. This research split the patients into 2 groups, one group received 4 Myofascial release treatments and one group received 4 sham treatments. The results at the end of the study indicated that the patients in the Myofascial release group demonstrated a significant reduction of muscle spasm in the low back when the patient bent over. These patients also reported a significant reduction in the amount of pain in their low back and additionally reported less disability than the control group.  This study is very useful for practitioners who treat spinal pain. In our experience we commonly refer patients for soft tissue therapy. Anecdotally we find that by adding Myotherapy to our Chiropractic care it can be helpful in certain cases. This is usually directly to our in-house Myotherapist whose role is to perform a wide range of myofascial release techniques.  If the research findings in this article are to be believed, then it appears as if those improvements that we see clinically may be due to the benefits described about, the reduction in muscle spasm and the decrease in pain and disability. This is particularly important in the case of chronic low back pain as was studied in this article. Chronic low back pain is clinically very difficult to treat as it can be complicated by a large variety of factors. These simple yet revealing research articles help to direct practitioners who treat spinal pain into considering myofascial release techniques as a treatment option.    Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial. Arguisuelas M.D. et al. J. Clin. Biomech. March 2019.Vol 63. Pgs 27-33

Self Manipulating Spine

I click my own neck, what more can a Chiropractor do? Lots of people click their own necks; sometimes for relief, sometimes for dramatic effect, sometime just because they can, often without trying to.  But what is the difference between clicking it yourself and a Chiropractor doing it? The need to click one’s own neck is potentially a sign of an underlying problem.  Often the need to do it is down to poor posture putting excess stress on the joints in the cervical (neck) spine.  Due to the stresses on the spine, the joints become restricted and uncomfortable.  If an on-going problem, it may get to the stage of a trapped nerve!  When you click your own neck (self manipulating) you are mostly ‘clicking’ either the joint above or below the restricted one that needs to move properly.  Chiropractors train over 5 years to adjust the right joint in the right way (see picture below). Is there anything wrong with clicking my own neck? The danger of doing it yourself is you’re clicking the wrong joints.  When you self manipulate it may make the same ‘popping’ noise (air being released from the joint) as a Chiropractic adjustment; it might provide some relief, due to the natural release of a pain-relieving chemical called endorphins.  But it can cause damage. When a joint is restricted, the joints above and below work harder to compensate for the lack of movement in the stiff joint.  So these joints are moving too much already and when you self adjust you are forcing them to move even further (see picture).  This can, over time, cause stretching of the ligaments that support the spine and lead to instability and future problems. So what should I do if I always click my own neck? From what we’ve learnt so far, you potentially have an underlying problem and are causing damage to the ligaments of your spine.  The first thing is to look at your posture to prevent unnecessary stress on your neck and shoulders.  The next thing is to have a full examination with a Chiropractor to assess the movement and function of the individual joints of the spine.  The Chiropractor will then be able to recommend stretches, postural advice, and, if necessary, a course of a Chiropractic adjustments to restore the correct movement to the spine.

Back Pain with Leg Pain

A recent study has shown sustained chiropractic care and home exercises produced better outcomes for back related leg pain (BRLP) than home exercise alone1. BRLP can be quite disabling, with an estimated 3 million Australians having back problems, including 0.2 million with sciatica2 . The study published in the Annals of Internal Medicine showed that patients who combined chiropractic with home exercises had better results than those who performed home exercises only. In this study, after 12 weeks of care the Chiropractic group had a marked improvement in their BRLP in addition to other secondary benefits measured like patient satisfaction, reduced medication use and an improvement in patient perceived general health state and global improvement. There was one criticism regarding the results which mentioned that after 1 year there was no difference in BRLP between the two groups, this implied that Chiropractic care was in the long run no better than the take home exercise group. So why have Chiropractic when you can do take home exercises and get the same result I hear you ask.  Easy, who wants to wait one whole year for their pain to improve, which logical health practitioner would tell a patient “don’t worry about going to the Chiropractor, do these exercises at home, wait a year and it’ll be gone”. No patient will voluntarily wait a year for low back pain with leg pain to go away when a Chiropractor can make a significant difference over 12 weeks. Do you know what else? The other secondary improvements I mentioned above, they were still there after a year too. So patients were satisfied, experienced a better health state and global improvement and took less medication, what a fantastic result. Australians are increasingly turning toward chiropractic care to manage a range of  musculoskeletal complaints with over 215,000 visits to a chiropractors occurring in Australia each week. Make an appointment with your local CAA Chiropractor today. Gert Bronfort, et al., Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain. Ann Intern Med. 2014. 161(6): p. 381-391. AIHW, Arthritis and other musculoskeletal conditions across the life stages., in Arthritis series no. 18. Cat. no. PHE 173. AIHW 2014: Canberra.

Paracetomal 2014

This month I’d like to focus on an Australian research article recently published in The Lancet1, one of the most highly respected medical journals world-wide. This study compared over 1600 people with low back pain, one third took a regular daily paracetamol dose (3990mg), one third took a paracetamol dose when required to relieve pain (dosage varied) and one third took a sugar pill designed as the placebo. The aim of the study was to reduce the low back pain of the patient to at least a 1 out of 10 on a pain scale. Of the three groups mentioned above the regular dosage group improved in an average in 17 days, the intermittent dose 17 days and the placebo group 16 days. These findings suggest that regular or as-needed dosing with paracetamol does not affect recovery time compared with placebo in low-back pain, and questions the universal endorsement of paracetamol in this patient group. Considering it is still common practice for patients to take paracetamol, this high quality research is particularly important as it now implies that some of our most recognised paracetamol brands are no better than taking a sugar pill for the treatment of low back pain. Fortunately however Chiropractic does work. Chiropractic is a drug free, surgery free approach to low back pain. Chiropractors concentrate on finding the cause of the problem and correcting it with a mixture of treatment and rehabilitation options. Contact your local CAA NT member Chiropractor today for an assessment.

Muscle Balance

The vital component to injury prevention Most people think of the core as a nice six-pack, or strong, toned abs, but the truth is that the abdominal muscles are a very small part of the core. The abdominals have a very limited and specific action, and what experts refer to as the "core" actually consists of many different muscles that stabilise the spine and pelvis. When these muscles contract, they stabilise the spine and pelvis and create a solid base of support. The well-known core muscles are Rectus Abdominus, Erector Spinae, Obliques, Hip Flexors and the Gluteals, in fact it’s imbalances within these muscles that are linked to low back pain. Imbalances within these muscles is commonly called Pelvic Crossed Syndrome (PCS) and is one of the most common underlying causes of lower back pain. Changes in muscle length and strength from PCS creates destructive forces in the lower back, affecting joints, discs, connective tissues and muscles causing rigidity, instability and ultimately pain. Unfortunately it often takes years to develop and initially causes no symptoms. Symptoms become apparent only after PCS has made significant changes to the mechanics of the lower back. Commonly the underlying changes include weak abdominals and gluteal muscles and over-active, tight hip flexors and lower back muscles. PCS is most commonly seen in those who have desk jobs or those who sit for a majority of the day. So when you are aiming to strengthen your core, don’t just focus on the “six pack”. Focus on strengthening your Abdominals, Obliques and Gluteals. And focus on stretching your Erector Spinae, Hamstrings and Hip flexors, if you don’t you are only doing half the job. Chiropractors can be part of your core strengthening team by adjusting (manipulating) the joints in the spine that become very stiff due to these imbalances and by performing muscles releases and trigger point therapy to improve spinal movement. This along with advising our patients about appropriate rehabilitation makes Chiropractic the first choice for the treatment of musculoskeletal pain. So if you’re looking for stronger and most importantly balanced core muscles to help maintain appropriate posture and reduce strain on the spine, see your local CAA chiropractor today.

Do you want more mobility?

Our profession is always on the lookout for quality evidence based research to help explain how Chiropractic helps people with a variety of symptoms. This month I found an informative article about how spinal manipulation can help to increase the quality and quantity of spinal movement. In essence Chiropractors focus on how we can increase movement in the spine and how this increased mobility helps patients move and feel better. Normally a joint that moves well is a joint that feels good and a joint that seizes over time is usually sore. This not only affects the specific area that has become injured but also tends to affect more distant parts of the body. In Denmark researchers grouped 199 people with low back pain of more than six weeks duration and placed them into 3 groups, one that received spinal manipulation, the second received supervised back exercises and the third was given take home exercises and advice. The researchers found that after 12 weeks of care, when they compared the results of all 3 groups, the group that received spinal manipulation improved significantly in all 6 different types of movement where the exercise groups improved in only 3 of the different movements tested. In addition the spinal manipulation group had a smoother motion pattern than the exercises groups, meaning they were less jerky when they moved into these different directions. These kinds of results help to demonstrate the significant improvements in mobility that can be achieved with spinal manipulation, which is the mainstay of Chiropractic practice. Chiropractors are far more than just good spinal manipulators, however important research such as this helps explain why Chiropractic can help increase the mobility of the general population. Whether you are young or old, sporty or leisurely Chiropractic can help to increase your mobility and reduce spinal pain and associated symptoms. Chiropractors use a variety of different styles of manipulation to improve your mobility, ranging from manual techniques to special instruments or benches to achieve the movement required. Find a Chiropractic Association Chiropractor who suits your needs and works in a style that suits you. Lumbar motion changes in chronic low back pain patients. Mieritz et al. Spine. 2014 March 7. Epub ahead of print.

National Spinal Health Week 2014

Between the 19th and the 25th of May is National Spinal Health WeekTM, an initiative from the Chiropractors' Association of Australia (CAA). The theme for this year's Spinal Health Week is Live Better – We’ve got your back. The idea is for us to Feel Better, Play Better and Live Better. Think back to the 1980’s when Olivia Newton-John was encouraging us to Get Physical. Children born in this decade had a life expectancy of 71 for males and 78 for females. Fast forward to 2014 and our lifespans have extended dramatically. Some might be suprised to learn that a male child born today can expect to live to 79.9 and a female 84.3. Unfortunately though, as our lifespans have increased, the getting physical message failed, sixty-three per cent of Australians are obese and that figure is still on the rise. As the Commonwealth Health Minister, Hon Peter Dutton said in March, “Fully a third of Australia’s burden of disease is due to lifestyle health risks such as poor diet, obesity, physical inactivity, smoking and alcohol misuse”. This is the paradox, we are living longer, but we are not living better. For many of us, a longer life is not enough, we want to be active, healthy and capable of enjoying those extra years. Improving our postural fitness and looking after our spine is an important part of designing a longer, healthier lifespan. Chiropractic offers a drug free, surgery free way to effectively manage back pain. Contact one of our CAA member Chiropractors today for an examination and to discuss ways to improve your postural health and fitness.

Annual Sports Injury Peak About to Hit

After the Christmas and New Year breaks many of us will soon start to begin training for our chosen team sport. No matter what sport you subscribe to, the Chiropractors’ Association of Australia NT (CAANT) is forecasting a surge in sports-related injuries over the coming weeks. Approaching dry season team sports tend to take a toll on players during the pre-season and early rounds, as people start training again after a few months break. In particular, Hamstring injuries are most common in the early part of the year, especially in the faster running sports such as soccer, rugby, and hockey, as ‘weekend warriors’ return to their chosen dry season sport. Back problems are also a major issue and can be interrelated with hamstring injuries, whereby one injury can trigger the other.” A scientific study published in 2009 found footballers (across all codes) in Australia have significantly more severe and frequent low back pain compared with non-athletes, and this escalates with the level of competition*. In fact low back pain is the most common injury reported in elite soccer*, and back injuries have the highest rate of recurrence for all injuries in elite rugby players*. In Aussie Rules the injury toll is also quite high, even amongst the amateurs with 27 per cent reporting long term or recurrent back problems*. To minimise the injury risk, the CAANT recommends a holistic approach to get ready for the game. This includes a Chiropractic check-up and maintenance so that anyone returning to sport after a break can visit their local CAANT chiropractor to tune up their body and make sure it is ready to go for the season. Also of great importance outside of direct Chiropractic care is good nutrition, appropriate warm up and warm down protocols, being prepared with a proper training regime, easing back into exercise gradually after a break, and hydration on the field. It’s also very important to listen carefully to the advice of your personal trainer or gym instructor, their experience will help you immensely. In Australia, CAA member Chiropractors commonly have a great deal of experience in dealing with sporting injuries. Most Chiropractors commonly adopt a range of techniques ranging from adjustments (manipulation), mobilisation, soft tissue therapies, rehabilitation, movement and exercise therapies, nutritional advice, strapping and bracing. Increasingly, professional sporting teams are adding a sports chiropractor to their health care staff to help players maintain their structural health, [...]

Knuckle Cracking and Arthritis

As I’ve focussed on more serious Chiropractic topics over the last few months, in this month’s column I’ve decided to lighten my discussion to something a little less clinical. A question we hear commonly is “Does knuckle cracking cause arthritis and why does my son/daughter do it all the time”? Let’s talk a little bit about arthritis, with the most common form being Osteoarthritcs (OA), unlike other forms of arthritis like Rheumatoid Arthritis (RA), OA is not a disease process but is basically wear and tear. This occurs over many years and is more common in people who have sustained trauma through the affected joints. This trauma can be due to an injury or an accident but is most commonly due to repetitive microscopic trauma through the joint due to a repetitive job or sporting pursuit. So does knuckle cracking cause arthritis? No, a recent study in the Journal of the American Board of Family Medicine compared people that regularly crack their knuckles and the onset of OA in their hands1. Interestingly they found in patients aged 50 to 89 years, “a history of habitual knuckle cracking - including the total duration and cumulative exposure to knuckle cracking - does not seem to be a risk factor for hand OA." The authors also discussed why an individual might develop the knuckle cracking habit in the first place, and suggested that it might offer relief to perceived joint stiffness. It has also been suggested that the tendency to crack the knuckles is due to the close relationship between the hands and the sensory part of the brain. In essence, manipulating the finger joints stimulates the sensory part of the brain and may serve as a 'manual caffeine' jolt to give us a mental lift. Whatever the reason for the habit, it doesn't seem to cause us any problems. 1. Deweber, K. et al. Knuckle cracking and hand osteoarthritis. Journal of the American Board of Family Medicine, 2011 Mar-Apr;24(2):pg 169-74.0156.

School a ‘pain in the back’

The new school year means back to carrying around heavy backpacks Uncorrected postural issues, heavy school bags and poor lifestyle choices can all lead to spinal health problems as a child grows. Spinal health problems related to childhood often go unnoticed, as initial poor posture, back pain and “growing pains” can unfortunately develop into an accepted part of everyday life. Many of the current bags children are using may be fashionable, but unless they allow for even distribution across the back, they can place unhealthy stress on a child’s spine. School can be a challenging time for children, so ensuring they are as comfortable as possible is important to their physical and mental development. According to the Chiropractors Association of Australia (CAA), the peak body representing chiropractors, 90 per cent of school children have bad posture when carrying their bags and could experience unwanted spinal stress and damage as a result. While 75 per cent are not wearing their school backpack’s properly and ignoring the ergonomic features in some backpacks which are designed to provide better support and comfort. What’s more, many Aussie kids are exacerbating the problem by wearing their backpacks too low on their backs (33 per cent) or slinging them over one shoulder (20 per cent). These alarming findings emerged from a CAA ‘under cover’ observational study conducted by chiropractors on high-traffic school commute routes in late 2011. CAA Spokesperson Dr Billy Chow (Chiropractor) said these results are a major concern for the health of our schoolchildren. “Despite the increased use of technology in schools to assist learning, schoolchildren are still overloading their backpacks with textbooks, sports and other gear or simply not wearing them in the correct way,” he said. “Putting too much stress on a child’s back at such an important stage of growth and development will result in serious spinal problems immediately and later on in life.” Some of the problems caused by bad posture at an early age include reduced mobility, possible early degeneration of bones and joints, increased vulnerability to injuries and unhealthy pressures on a child’s nervous system. Chiropractic care has been proven to be effective, and can restore correct function and relieve pain symptoms associated with the carrying of heavy backpacks. The CAA and has provided these tips for carrying backpacks: Backpacks should be ideally no heavier than 10 per cent of a student's weight whenpacked. Put comfort and fit [...]