As school bags are dusted off in readiness for the 2014 school year, the Chiropractors’ Association of Australia NT (CAANT) would like to take time this month to warn parents and students about the long term impact of poorly fitted or over loaded backpacks and school bags. As our children grow and have to carry more, there is mounting evidence that shows how much stress, heavy school bags can place on growing spines1. This repetitive stress can lead to acute and longer spinal related complaints, and the fact is, lugging an overloaded school bag to and from school can have health implications to our children. According to an international study1, daily backpack carrying is a frequent cause of discomfort for school children. School backpacks were felt to be “heavy” by 79.1% of children, to cause fatigue by 65.7% and to cause back pain by 46.1%. My usual advice to minimise the risk, is that students should limit the weight they carry in a school backpack to no more than 15 per cent of their body weight. In the real world that’s around 6-7.5 kilos for a 40-50kg student. This may seem like a difficult prospect, as the weight of a school bag quickly adds up when you throw in a few text books, a pencil case, a lunch box and a water bottle. However lifting a bag that is too heavy can cause immediate strain on the spine and the longer a child carries that load, the more severe the damage can become. Additionally the problem can also be compounded further by factors outside of parental control, like poor posture and the “fashion factor‟, which dictates the latest trendy way for carrying a bag, which is never in line with the inbuilt ergonomic features. However a little extra parental thought on how to trim some weight in your child’s school bag will go a long way in reducing this impact. Even if you’re considering a wheeled trolley bag, new research comparing backpack and trolley usage amongst six to eight year olds found that the trolley group was characterised by spinal rotation, which could add extra stress to growing backs. Not to mention the fact that students may have to pull the bag over rough ground or grassy areas as well as lift it up stairs and on and off public transport. School is a challenging time for our children, so [...]
This month I’m discussing a topic that creates a lot of controversy between our profession and other health industries. That is the perceived dangers of manipulation (adjustment) to the neck and the corresponding dangers to our neck arteries and blood supply to our brain. Before I adjust a new patient’s neck I explain to them what they should expect to feel. For years now I have said “During the neck adjustment I am going to perform a short quick turn of your neck to the side, the rotation is less than what you can do yourself”. I then show the patient what I mean, by getting them to turn their head as far as they can to the side, we commonly perform this kind of rotation every day, especially when looking over our shoulder. This usually gives the patient a comparison of how far we can naturally turn our head to the side as opposed to during an adjustment. Recently I discovered a journal article from the University of Calgary written by a Professor of Biomechanics. This study measured the amount of strain placed on the neck arteries during normal motion versus the strain on the same arteries during a neck adjustment performed by a Chiropractor. This study found the average strains of the neck arteries were significantly smaller during the adjustment than the strains obtained through normal daily neck movements. This study concluded that Chiropractic adjustments to the Cervical spine do not place undue strain on the neck arteries and is therefore not a predisposing factor in neck artery injuries. Herzog, W. et al. Vertebral artery strains during high speed, low amplitude cervical spinal manipulation. J Electromyog Kinesiol. 2012 Oct. 22 (5) 740-6.
As a follow-up to my September column, this month I will be discussing a further benefit of Chiropractic care, that is, when patients report increased mobility and less stiffness after treatment. Recently I discovered a study performed at the University of Utah by a Professor of Physiotherapy who measured certain changes in the spine after it was manipulated. The authors of this case recruited fifty-one participants with complaints of low back pain. The authors then measured the patient’s spinal stiffness by lying them on their stomachs and utilised a mechanical instrument to apply a downward pressure on the patients spine. After three indents, an average stiffness level was calculated based on how much the patients spine moved with the downward pressure. Following this, small but very important spinal muscles called Multifidi were measured for their thickness under ultrasound. Following both of these measurements, a Physiotherapist or a Chiropractor performed a low back manipulation and following the manipulation, spinal stiffness and Multifidus thickness were measured. The results of this study showed a significant immediate decrease in the stiffness of the patients low back and an immediate increase in Multifidus thickness following spinal manipulation. This study is important for several reasons, as practitioners who work with the spine we all see people every day who report feeling stronger and less stiff after a Chiropractic adjustment This study provided some preliminary evidence to support the notion that manipulation helps improve stiffness as well as increasing the activity of a group of vitally important low back muscles. It also very important due to the fact that often it is hard to explain to people how what you are doing as a Chiropractor actually works. All of us see hundreds of patients every week who report feelings of wellbeing after care, hopefully more evidence like this will assist in improving our understanding of how our amazing body works. Fritz JM, Koppenhaver SL, Nawchuk GN, et al. Preliminary Investigation of the Mechanisms Underlying the Effects of Manipulation. Spine 2011: 36; 1772-1781.
As I’ve discussed in previous columns, as a population we are becoming more sedentary than ever, particularly children who are exercising less than before. Unfortunately in our modern world we are seeing an increase number of kids spending too much time indoors on computers, in front of the TV or playing video games, coupled with poor eating habits. The adolescent development years are crucial, as the bone mass attained determines lifelong skeletal health. In fact up to 90 per cent of bone mass is developed by 18 in females and 20 in males. To coincide with National Healthy Bone Week (August 4th-10th) my message for this column is if you want strong bones you have to use them, get outdoors and perform weight bearing exercises. The CAANT are reminding Darwin residences that bone health isn’t just about calcium intake, but keeping their skeletal system in tip-top condition. It’s important to remember a healthy bone needs a healthy joint. Chiropractors focus on the health of skeletal joints, but also recommend working with your GP and allied health professionals to ensure a balanced diet and appropriate exercise. Although teenagers would probably associate weak bones and osteoporosis with old age, many are already predetermining their own future health patterns by their activities, in particular their lack of physical activity today. Here’s some tips for everyone Maintain a healthy diet with multiple sources of calcium, magnesium, sodium and trace minerals. Perform weight bearing exercises each day. Run around, play a sport, go to the gym. This allows your bones to adapt to the impact of your weight by building more cells and becoming stronger. Get outdoors in the sun for 15 to 20 minutes three times per week for a healthy dose of vitamin D. Remember a healthy bone needs a healthy joint - consult your CAANT chiropractor for any concerns regarding joint mobility.
One common question that I am asked on a regular basis especially from other health practitioneers, is “what does manipulation (chiropractic adjustments) actually do and how does it work”? There are a few different benefits that occur from an adjustment, one benefit that I would like to discuss today is pain relief and the fact that people will temporarily feel relief almost immediately. Today I’d like to discuss what causes this feeling of immediate improvement, as it is one reason why people chose to see a Chiropractor when in pain. Recently there was a study conducted which investigated the level of pain on two tender spots in the human body, after an adjustment. One was the Gluteus Medius (top of the buttock) and the second point was the Infraspinatus (back of the shoulder joint). This study published in the Journal of Manipulative and Physiological Therapeutics found a significant improvement in the tenderness in both of the above spots, in comparison to a control group where no adjustments were performed. In the body this happens regularly when a joint is moving, this is commonly why people say “I have pain when I get up in the morning but once I’ve moved around for a little while I feel better”. During joint movement receptors that detect movement are activated, this movement stimulates a part of our brain that releases a chemical called Serotonin. Serotonin is found in most animals and is vital for a great deal of our automatic functions, like mood, growth, sleep and general behaviour. In humans Serotonin is commonly referred to as one of our “happy chemicals” and produces a sense of wellbeing. With Chiropractic care people feel better usually after care due to the fact that adjustments stimulate parts of our nervous system involved in producing Serotonin. This also explains why other forms of movement based treatment like mobilisations, massage, acupuncture and exercise create a sense of wellbeing a pain relief. So don’t put up with pain unnecessarily, see a local CAA Chiropractor today, you may get some relief quite quickly, and once the pain level has improved we can work on keeping it at bay. Next month I will discuss another benefit of the adjustment, increased joint movement. Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults. Srbely JZ, Vernon H, Lee D, Polgar M Manipulative Physiol Ther. 2013 [...]
If you had really bad neck pain what animal what you least like to be, if you thought about it for a while, you would probably say giraffe, right? Giraffes and humans have at least 2 things in common, they both have 7 bones (vertebrae) in their neck, and they both benefit from Chiropractic care. Giraffes do get neck pain and commonly for the same reasons humans get neck pain, that is ergonomics. There was an incident reported recently in the Journal of Zoological and Wildlife Medicine that documented the case of a 2 year old male giraffe who presented with severe neck pain and stiffness upon his arrival on an incoming shipment*. Despite initial Veterinary management, the giraffe continued to developed neck pain, muscle spasm, and decreased neck range of motion. With the introduction of a trained Veterinary Chiropractor a series of manually applied Chiropractic treatments were applied to the affected neck vertebrae in an effort to restore normal neck mobility. Laser therapy and neck range of motion exercises were also used to reduce neck muscle spasm. This approach produced a significant improvement and highlighted the benefits of chiropractic care and physical therapy for the management of severe neck pain in a giraffe. Now can you imagine being cramped in a transport container for several hours with a neck that long, that’s what caused the Giraffes neck issue. But that is exactly what happens to us humans when we are sitting in front of a computer or driving a truck or sitting on an aeroplane for many hours every day, we get a postural or ergonomic strain. This constant strain causes microscopic damage to our neck joints, this can cause neck pain, stiffness and headache. So if your neck is in an awkward position for many hours at a time you might also suffer from the same fate as our giraffe friend. So have your spine checked by a CAA Chiropractor today. *Successful management of acute-onset torticollis in a giraffe (Giraffa camelopardalis reticulata). Dadone LI et al. J Zoo Wildl Med. 2013 Mar;44(1):181-5.
As we approach Fashion Week I thought I’d discuss a recent CAA NSW media release that I was interviewed about in the NT News. Without putting a downer on certain types of apparel, a new survey by Chiropractors in NSW has revealed that some people are risking physical injuries due to fashion choices. The survey found that on average chiropractors in NSW can see 10 to 15 patients per week with problems caused by fashionable clothing and accessories. From personal experience these numbers are similar in local Darwin clinics as well. By far the most implicated fashion accessory was high heels. Over 65 per cent of Chiropractors in NSW listed them as their number one concern, leading to lower back pain, knee problems, unpleasant bunions and in some cases foot and ankle sprains. In this case high heels throw the centre of gravity forward, causing you to lean backwards to keep from falling face first. This overcompensation often leads to low back pain, while instability through the ankle can put additional strain on the knees and hips. In Darwin, even though plenty of ladies are wearing high heels, they generally don’t walk as far in them when compared to our counterparts in bigger cities. Even if you do wear heels to work, and may walk to the office or to get lunch, local Darwin citizens tend not to have to walk as far and tend not to commute on public transport for as long. This reduces the time spent standing or walking in heels and tends to create less problems. So the problem isn’t just the heels, but the length of time spent in heels. Commonly local Chiropractors tend to see patients with high heel related problems after a special event. This is common after a big night out on the town, especially dancing or if you are attending a function like a wedding or a ball. So if you like high heels, just wear them, they do look good, but if you intend to spend many hours at a time in them don’t be surprised if you suffer from discomfort in your legs or back for a couple of days after. Like always, if your pain persists beyond a few days see a local CAA NT Chiropractor.
In this months column I’d like to focus on a lesser acknowledged reason for why a patient would see a Chiropractor, that is chest pain. Chest pain and epigastric (just below the sternum) pain is a very common symptom that presents to Chiropractic clinics every day. Sometimes it may not be the patient’s main complaint but it may show up as their second or third complaint. Chest pain of non-cardiac origin is commonly a referral from the thoracic spine (the mid back) or can be pain originating from the rib and sternal joints around the breast bone. As well as mimicking cardiac pain, this kind of pain can also mimic indigestion and reflux. Chest pain is common in people who spend a lot of time sitting, like office workers and drivers, in this instance chest pain comes on when the thoracic spine stiffens due to inactivity. Once stiff it is very easy to sprain and strain the thoracic spine or chest and from a patient’s history it’s normally reasonably easy to differentiate whether this pain is from a musculoskeletal or organic origin. A recent study in Denmark published in a well know scientific journal compared the treatment of 115 people who presented to Chiropractic clinics and the local hospital emergency department with sudden chest pain1. 1. Chiropractic treatment vs self-management in patients with acute chest pain: a randomized controlled trial of patients without acute coronary syndrome. J Manipulative Physiol Ther. 2012 Jan. 35(1) pgs 7-17. Stochkendahl, M.J. et al.
This month I’d like to focus on a recent article I found, which discussed the benefits of Chiropractic care during pregnancy*. During pregnancy a woman’s body undergoes a variety of changes as the baby inside her womb starts to develop. It is common for mothers to experience discomfort due to these changes taking place in her body. These changes can cause sprains and strains on the ligaments, muscles and joints in the spine. The article in question was published in the the American Journal of Obstetrics and Gynaecology and compared the response of 169 pregnant women complaining of low back and pelvic pain. The study assessed pain and physical function at 24-28 weeks of gestation and compared them again at the 33 week stage. During this time the ladies were split into 2 groups. Both groups received their normal routine Obstetric care and one group received Chiropractic care. In this instance the care given by the Chiropractor was spinal and pelvic manipulation, stabilisation exercises and patient education. By the 33 week stage the researchers found that the group who received both routine Obstetric care and Chiropractic care demonstrated significant reductions in their pain level and improved function. This is quite an exciting statistic as it demonstrates that a cooperative approach to low back and pelvic pain in mid pregnancy benefits patients more than routine Obstetric care alone. For more information about Chiropractic care and pregnancy contact a CAA NT Chiropractor today. *A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. George JW et al. Am J Obstet Gynecol. 2012 Oct 23. Electronic version ahead of print.
This month I’d like to draw attention to a recent study from the Journal of Spine that compared the treatment of 2 groups of military personal between the ages of 18-35 with low back pain*. This study concluded that patients treated with Chiropractic care in conjugation with Medical care demonstrated a significant decrease in pain and improved physical function when compared to the use of Medical care alone. Within Australia, serving military personal are unable to access Chiropractic services on base and therefore if a patient wants to see a Chiropractor they have to do so on their own accord and pay for the care off base. Some patients over the years have been worried that they are doing the wrong thing by seeking care outside the base and are concerned that if it is found out that they have sought care elsewhere that this would be frowned upon. This has always concerned me, as a health practitioner the goal is always to return the patient to their optimal function as quickly as possible whilst using any means available. To discourage the use of a proven form of treatment that is effective in treating a common issue in young serving men and women is counterproductive. The CAA NT would like to encourage more freedom of choice for people serving in the armed forces and to encourage more cooperation and co-management of spinal pain cases between medical military personal and local CAA Chiropractors. *Adding Chiropractic manipulative therapy to standard medical care for patients with acute low back pain: The results of a pragmatic randomised comparative effectiveness study. SPINE (Phila Pa 1976) 2012 Oct 10 (E-version ahead of print)