Sciatica is debilitating condition that will impact around 5% of us. Sciatica is when a nerve root or portion of the sciatic nerve in the buttock is pinched resulting in pain and/or tingling; numbness and weakness in the leg and back. Most cases are the result of a bulging disc, muscle spasm or joint arthritis. Often the sufferer will have to take time off work or their social activities, thus having a major impact on their quality of life. Thankfully, the vast majority of these will respond positively to conservative treatments such as those given by chiropractors or physiotherapists, and pain medication prescribed by a GP. There are a small number however, who will require more invasive treatments such as surgery, which is not only more expensive, it carries a greater risk of complication and should be reserved for the minority of cases.
Researchers in Finland* looked into risk factors relating to sciatica, and in particular those who were more likely to be hospitalised/needed surgery. Here they followed a group of over 35,000 people for up to 30-years and assessed certain lifestyle choices.
Here’s what they found: If you either cycle or walk to work, you are 33% less likely to develop sciatica which requires surgery compared to the normal population. Likewise if you smoked or obese you were 33% more likely. If you were obese with abdominal fat, your risk went unto 41%. Interestingly, former smokers didn’t share the same risk as smokers.
Authors of the study were surprised to see that no effect on hospitalisation was witnessed by other forms of leisure time activities. They believed this may have been due to the fact that regular, moderate activities such as cycling and walking don’t add excessive strain to the back, unlike other higher-intensity exercises that would.
This study emphasises the need to keep mobile and gives us yet another reason to exercise regularly. Using those opportunities such as traveling to and from work can be an easy way to incorporate such healthy habits into our lifestyle.
Furthermore, studies have indicated that sciatica patients noticed a significant improvement when they underwent a number of treatments, including spinal manipulation as performed by chiropractors. As such the UK national guidelines recommends these sorts of treatments. Specific hands on procedures and exercises can be used to reduce nerve irritability, thus reducing pain, muscle spasm, inflammation and weakness.
If you or anyone you know, suffers from sciatica, our practice offers a complimentary 15-minute assessment to provide free advice to any sufferer. Contact clinic reception for further details.
*SHIRI R et al (2017)Lifestyle Risk Factors Increase the Risk of Hospitalization for Sciatica: Findings of Four Prospective Cohort Studies Am J MedDec;130(12):1408-1414.
Scars, also called adhesions when situated deep in our body, are an inevitable fact of life. They are the results of the body’s healing process. The tissue involved in the process of scarring is called the connective tissue. “Connective” because it connects, supports, binds and separates other tissues or organs.
When we injure ourselves, the repair process has to happen quickly. Because of the emergency of the response, the tissue produced is not of the same quality as the original one. Instead of a good, strong “patch” of well-aligned fibres, we end up with a lower quality tissue, looking more like a game of pick-up sticks. The poor quality of this new tissue results in poorer functionality. For example, somebody with a poorly healed ankle sprain or a pulled muscle will be more likely to have a recurrence of the same injury.
As living creatures we are very exposed to traumatic events such as sprains and strains, pulled muscles and torn tendons. These injuries will heal with the inevitable scar tissue. In addition, the healing process resulting from any inflammation and infection will also result in the formation of some scar tissue.
Surgery, particularly abdominal and pelvic surgery, is also a cause of internal scarring, called adhesions. The problem is that these adhesions can squeeze organs, diminish the blood flow, trap nerves and reduce or impede the mobility of organs. The end result usually involves discomfort, pain and reduced mobility.
If we imagine our body as a structure delicately balanced between ‘elasticity’ (the skin, the muscles, the connective tissue) and ‘rigidity’ (the bones), we have a very smart design allowing stress to be distributed equally throughout the structure. The end result is flexibility and stability. As soon as there is scarring or adhesions anywhere in the body, this delicate balance is compromised. This in turn results in us ‘cheating’ and compensating e.g. if we cannot turn our head, we will turn our body.
When scar tissue is formed it often traps other important structures in the area such as small nerve endings and blood vessels. Trapped pain receptors can cause a scar to remain painful long after the injury has healed. This is often the case with coccyx pain (pain in the tail bone after a fall on the buttocks). During the healing process other receptors may be disturbed by the surrounding scar tissue and this may prevent the brain from receiving the correct feedback allowing it to control properly how we stand and move.
Fortunately, there are ways to mitigate the damage and to redress the balance. The most important thing to remember is that although it is important to give an injury time to heal, it is just as important to start the rehabilitation process as early as possible. We are designed to move and lengthening the period of immobility is not helpful. This is why in the case of a mild whiplash injury, for example, neck collars are only advisable in a very limited number of cases and for as short a period as possible.
Physical therapists, including chiropractors, can help by monitoring any healing process whether of an internal wound, the skin, a muscle, a tendon, or a ligament and will progressively introduce soft tissue work (superficial or deep massage) and gentle passive, active and resisted exercises. This will improve the quality of the scar tissue and restore functionality by increasing mobility, flexibility and strength.
Scarred for life? Not necessarily, if you take the right steps at the right time.
A common response to experiencing back pain is to take it easy and perhaps even go to bed. Whilst this might be appropriate in the very short-term, resting for more than a day or two can in fact be detrimental to recovery. Scientific research has shown that the most effective way of treating lower back pain is a combination of spinal manipulation, as performed by chiropractors, followed by exercise. Your back contains two different types of muscles: ‘movement muscles’, the large muscles which control the movement of the spine, and ‘supporting or core muscles’, the small muscles which provide a support system for the spine.
During a back pain episode, pain signals from the spine cause the supporting or core muscles to become inhibited and stop working. This means that the movement muscles now have two jobs: to move the spine and now also to support the spine as best they can.
Once your back pain has gone, the core muscles remain inhibited and your movement muscles carry on doing two jobs. This is why back pain often recurs when people don’t properly rehabilitate their spinal muscles – the movement muscles are not very good at supporting the spine so the spine becomes more vulnerable to re-injury.
It makes sense then, that to aid recovery from back pain and prevent back pain recurring in the future, back pain sufferers should undertake exercise in order to activate and strengthen their core muscles.
Depending upon your specific complaint, diagnosis and current level of pain the spinal rehabilitation exercises will be very different. This is why it is important to see a trained instructor who can prescribe appropriate exercises.
In general, to start with it will be important to focus on exercises which retain a neutral spinal posture and emphasise activation and strengthening of the core musculature. Once the core muscles are stronger the exercises can become more complex and sport-specific if needed.
At Guildford Chiropractic Centre, our chiropractors and physiotherapist are trained in prescribing exercises to improve your core strength. We are also able to advise you on exercise or a return to regular sport, as we believe that when it comes to back pain, prevention of further episodes is vitally important.
*Suzi Corbett unfortnately no longer practises at Guildford Chiropractic Centre. Further details can be found here
Since I last wrote a column we’ve moved closer to Brexit and as it stands it is still anyone’s guess as to when it will happen. As you read this article the chances are we’ll be out of the world cup (although there is a slim, a very slim chance we will win) long before we’re out of Europe. Results and the timing of events are often uncertain. Life after all is full of uncertainties. We plough through life never knowing what’s around the corner. The news has it that Robbie Williams has just had to leave a burning hotel. I’m sure he didn’t see that coming, although he probably had a good idea his last album was going to bomb.
We have long lived in a binary world full of polarised choices. Good and evil, right and wrong, short and tall, Cagey or Lacey, Ant or Dec. The problem of such black and white thinking is that it can inhibit or blinker our thought processes. It begs the question: Why do binaries rule in a relative world? Is someone totally evil and if so can anyone be totally good? And so it is with backs neither are they totally good or totally bad. Your spine (along with the rest of your body) is the result of everything that has happened to you throughout your life, good, bad and indifferent. This intermingling of events leads to high levels of uncertainty and varied outcomes and as chiropractors we’re often trying to read between the lines. When a patient enters the room in pain you could say they they’re the end of the story or the closing credits to a movie. What we have to do is rewind the film to piece together the rest, the what happened before. To try to understand the root of the problem the causal factors, the hidden bit. We then have to frame that in the context of the individuals body and their own individual physiological quirks. Everyone’s similar but different. People can be stressed in many different ways and it’s the effect of those stressors on their body that creates disease. The body’s way of telling you this could be anything from raised blood pressure to back pain or headaches.
Just as a starting point try to reduce your intake of sugar; aim to eat nutrient dense foods (i.e. unprocessed); exercise; don’t smoke and reduce your alcohol consumption. Cutting down rid on the biggest environmental stressors on the body, you’ll be surprised how much better your body performs and feels.
Now a quick quiz question. Name 11 body parts only three letters long . Go!
It never fails to amaze me how much time, energy and money we devote to our earthly possessions whether it is our house, car or garden, and how little attention we pay to our health. Asked by a journalist what the most important thing in life was, a well-known French writer answered: “The silence of our body”. By that he meant that we can only enjoy life if our body remains our most discreet servant. The problem is that to allow our body to perform in this way, we have to keep it in good shape and this is not something we are taught to do.
What happens to most of us is that after years of abuse, something in our body “gives way” and with the help of conventional medicine, we try to fix it. Wouldn’t it be better to slow down the deterioration of our body by treating it with a bit more respect rather than waiting until it breaks down?
It does not make a lot of sense to me to spend vast sums of money on research and treatments of diseases that could be prevented in the first place. Of course, for political leaders, this presents a financial conundrum because if, on the one hand encouraging healthy habits eventually eases the pressure on national health systems, on the other hand it will jeopardise the lucrative financial arrangements between governmental institutions and the food, drug and drink multinationals.
So, what can we do to retain our body as a silent and faithful servant or to lead it back to this desired state when we are ill? For a start we need to provide our body with good “fuel” for a number of reasons including to boost our immune system. This generally means consuming less sugar (especially of the refined kind), fewer meat products, less dairy and possibly alcohol but we are all different and what suits one person may not suit another. It also generally means plenty of vegetables, grains, pulses and water. Nowadays, even if we eat “organic” products we are likely to lack certain vitamins and trace elements. So, here is something that each of us may want to investigate with or without the help of a nutritionist.
Furthermore, to keep our body fit, regular physical activity is a necessity. For that we need our musculoskeletal system to remain in good shape. If we are in pain or overweight, it will be difficult – if not impossible – to run, cycle or swim. So, look after your muscles, joints and bones. Chiropractors, or other physical therapists can help you maintain a healthy musculoskeletal system.
Last but not least, a good functioning body also means a healthy mind. Try to deepen your spiritual connections whatever your beliefs are and find strong reasons for living. Perhaps practising a new hobby such as yoga or mindfulness and meditation might enhance your inner wellbeing.
Nevertheless, in conclusion and above all do not completely entrust your health to others but take control of it yourself – after all, you are the major stakeholder.
If you’ve ever woken up with a ‘crick’ in your neck, you’ll know first-hand just how painful it can be. Moving your head and neck can be extremely painful, often significantly more so to one side, and in severe cases people can end up holding their head at an angle to avoid the pain. The medical term for this, with which to impress your friends, is an acute torticollis. But why does it happen?
Anatomy of your neck
The neck has seven bones, called vertebrae, linked together by joints, called facet joints. There is a row of facet joints on each side of the neck and these allow your neck to move and bend – it’s the most mobile region of the spine. The facet joints are synovial joints, just like your wrist and ankle, and can be sprained in the same way a wrist or ankle can. A ‘cricked neck’, or acute torticollis, often occurs after sleeping in such a way that the facet joints are over-stretched and sprained. When this happens the muscles around the joints spasm to protect the injured joint, and the result is our crick neck.
What to do
If you wake with a crick neck, remember to start the day slowly, within your pain-free limits of movement. Massaging the muscles around your neck, especially with a hot shower, or lying on the bed and gently turning your head may help improve your movement. Keeping your neck warm with a scarf is often helpful but using cold packs over the area to reduce inflammation can also be soothing. Keeping active is important, as long as the pain isn’t too acute. Most crick necks resolve within a week. However, seeing a chiropractor can help speed your recovery and you will receive specific advice to help prevent future occurrences.
Preventing it from happening again
Exercise regularly. We often strain the muscles we exercise the least, so if you’ve had a crick neck in the past, consider doing some exercises to strengthen your neck.
Check your posture – keeping your posture good will reduce strain on the joints and muscles. If your work is desk-based try to keep your computer screen at eye level and keep your shoulders relaxed. Avoid using too many pillows, or overly soft pillows that don’t provide enough support for your neck at night.
*Suzi Corbett DC unfortunately no longer practises at the Guildford Chiropractic Centre. Her contact details can be found here
Turn your head all the way to the right and then all the way to the left. Do have any idea of what the ideal range of movement should be?
Between 160 to 180 degrees; i.e. you should be able to rotate your neck to the right and to the left, so that your nose is in line with your shoulder (or near enough).
The neck moves a heavy 4 to 5kg weight, around several axes of movement. It also has the big job of aiding in the position of the eyes which helps us see the world around us. The nervous system supplies our neck muscles and joints so that we can accurately position our eyes and visual specific objects, whether moving or static. This incredibly complicated system gives us the opportunity to act fast if we spot signs of danger or require an immediate action.
For instance, imagine you decided to go for a cooling swim in the river Nile. Suddenly you catch a glimpse of a crocodile’s snout poking out of the water. Your brain would need to identify exactly where the predator is, so it can then decide which direction you should swim and run before you become this croc’s next meal!
The same system allows us to calculate the position of an incoming tennis ball so the brain can activate certain muscles in our arms and legs to strike the ball accurately.
Signs of the system under strain can be a simple as reduction in the range of movement i.e less than 160 degrees. Dysfunction to the joints and muscles of your neck can wreak havoc on the complex pathways our neck has with our brain. An array of conditions can result as a consequence of this. Such conditions include certain types of headache, jaw pain, “mental fog” and dizziness.
Although whiplash, trauma and wear and tear maybe common sources, research is showing that poor posture and the increasingly sedentary lifestyles we are living maybe the biggest cause.
If you’re not getting your 160-180 degrees; if you’re struggling to turn your head when driving out of a junction, or if you’re fed up of relying on pain killers for your headaches,consider coming to see us and getting your neck get checked.
May is Lyme Disease Awareness Month. Lyme disease is bacterial infection spread by infected deer ticks. It is the most common tick-borne infectious disease with 2000- 3000 new cases in the UK every year, and is particularly prevalent in the Southern Counties, Yorkshire Moors, Lake District and the Scottish Highlands, probably due to increasing numbers of wild deer in these areas.
Ticks are tiny spider-like creatures found on foliage and long grass in parks, woodlands, heathland and gardens. Ticks cannot jump or fly but climb on to humans and animals as they pass by. They then attach themselves by burrowing their head under the skin, where they can remain for up to 72 hours, swelling up considerably as they suck blood. Because they are so small, and their bite is not painful, it is very easy to have a tick bite without noticing. Most tick bites are not a problem, but a bite from an infected tick can cause Lyme disease.
Infected ticks only release the bacterium into the bloodstream 24-48 hours after the tick bite, so the longer an infected tick remains attached, the greater the risk of contracting Lyme disease. Initial symptoms can include a circular red rash, which is not itchy or painful, within 3-30 days of being bitten. The rash may spread outwards slowly until it resembles the bullseye on a dartboard, before gradually fading. There may also be mild flu-like symptoms such as headaches, high temperature, tiredness, neck stiffness, and arm and leg pains, which usually resolve after a few days.
If diagnosed early, Lyme disease can easily be treated with a 2-4 week course of antibiotics. Failure to diagnose and treat early can cause more serious symptoms to develop weeks, months, or even years after the original bite. These include painful and swollen joints (inflammatory arthritis), limb pain and numbness, facial muscle paralysis, memory or concentration problems, heart problems (myocarditis or pericarditis), and disorders of the nervous system such as meningitis or encephalitis. These may require a prolonged course of antibiotics, often given intravenously, but some symptoms may persist for a long time. A few people develop “post-infectious Lyme disease” with long-term symptoms similar to those of Chronic Fatigue Syndrome or Fibromyalgia, but it is not know why this happens, or how best to treat it.
You can reduce your risk of getting Lyme disease by using an insect repellent on exposed skin, wearing long-sleeved tops and tucking trousers into your socks, and keeping to footpaths and avoiding long grass or dense vegetation in tick-infested areas. If you go out into the countryside check for ticks on your clothes or exposed skin, and in particular check the head, neck and scalp of your children, before returning home to avoid taking ticks home with you. You should also regularly check your pet cats and dogs for ticks, and consider using a tick preventative medication.
If you find a tick on your skin, remove it as soon as possible using either fine-tipped tweezers or a tick removal tool as close to the head of the tick as possible, and pull upwards slowly and firmly to avoid leaving the mouthparts in the skin, where they can cause a localised infection. Wash the area thoroughly and apply an antiseptic. Monitor the area for any changes for several weeks. If you develop symptoms, visit your GP and tell them you have been bitten by a tick. NEVER try to burn the tick off, squeeze the tick or apply any other substances like petroleum jelly to the tick as these may cause the tick to regurgitate infected material into the skin, increasing the risk of getting Lyme disease.
Enjoy yourself in the British countryside, but be tick aware.
One common question we are asked time and time again does not relate to medical matters. It usually starts by: “Can you tell me the difference between …” and at that stage we can usually finish the sentence: “…a chiropractor, an osteopath and a physiotherapist?”
We practitioners, have a tendency to forget that, if the answer to such a question is evident for us, this is not the case for members of the general public. Here is what I usually say:
Although chiropractic and osteopathy have distinct professional identities and philosophies, they are both founded on the two pillars of science and vitalism. Vitalism recognizes the patient’s own capacity for self-healing. Both professions have a holistic approach to health, integrating body, mind and spirit and use a hands-on approach. However, despite these basic similarities, there are some significant contrasts between and even within the two professions. This results in very different styles of practitioners leading to situations where one chiropractor and one osteopath will practise in a very similar way and two chiropractors or two osteopaths may be practising very differently.
In any case, practice tends to concentrate on treating the patient’s condition and leaves philosophy some way behind. Both professions treat similar conditions in a generally similar way and get similar results. The success of any treatment is therefore dependent on a wide variety of factors such as the condition, the patient, the practitioner etc. So, there is no simple answer to the “what’s the difference” question!
Physiotherapy emphasises the use of physical approaches to the prevention and treatment of disease and disability. In the face of growing competition from chiropractic and osteopathy, some physiotherapists have taken a greater interest in the use of mobilization and manipulation. As a result, there is now wider competition between the three professions with regard to the treatment of neuro-musculoskeletal conditions (a very long word referring to the aches and pains and disabilities caused by the dysfunction of the framework of the human body).
As a member of both the physiotherapy and the chiropractic professions I can only emphasize the importance of touch and physical contact between practitioner and patient. In addition, chiropractic and osteopathy are both wellness-orientated rather than sickness-orientated. They are concerned with the patient rather than the illness. My advice is, whatever professional you decide to consult for your aches and pains and/or your disability, make sure he uses a hands-on approach.
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