Seeing a patient this morning has inspired me to write this blog to illustrate the importance in seeking out other, non-mainstream ways of caring for your back. It also demonstrates the fact that chiropractors do not ALWAYS manipulate the spine to get great results, and also the importance of exercises in strengthening your back for the future.
This female 45yo patient of mine attended the clinic in March with the following history.
In 2011 she had a slipped disc diagnosed with an MRI. She was sent in Feb 2012 for microdiscectomy to reduce the disc problem but gained no relief, in fact it made her worse. 3 months later a surgeon decided to repeat the surgery, but again she got no relief. She was given a nerve root block to numb her pain, but this did not work either.
Following this she began simple core/Pilates exercise which helped a lot, but each session would leave her in pain the following day. Since she has had no succesful treatment.
She came to see me in March with her story, and her symptoms were constant pain in the right lower back, with pins and needles, numbness and pain extending down her posterior thigh to her right knee, and numbness in her right foot. She was on co-codamol and diclofenac. She had limited lower back extension which was painful, and 50% loss of skin sensation in the lateral foot. She had full Lumbar flexion and no neural tension on orthopaedic testing. Her lower back and glutes were extremely tight and full of myofascial trigger points (knots). I believe this was responsible for a large part of her pain and stiffness.
Her treatment has been a simple course of deep tissue massage for the affected lower back and gluteal muscles, Lumbar spine mobilisation, simple gentle ricking side to side with pressure applied to the spinous processes to encourage increased movement. I also used some Dry needling (western Medical acupuncture) on the Multifidus muscles, Piriformis muscles and Gluteus Medius muscles bilaterally. I also used a single needle in the right calf.
Following 5 sessions she reports feeling better than she has in months. She has pain-free weeks (this patient was in constant daily pain), and has now increased her exercises as a result and has been doing 30 mins of Pilates-based core exercises that I have prescribed her every day. She is significantly happier and her goal is to return to cycling to work everyday as she used to before her disc prolapse in 2011. I am confident she will reach this goal.
So this illustrates that spinal manipulation is not always necessary for excellent results, and that chiropractors do not always use this highly effective tool. Many people fear coming to a chiropractor, worrying that they will “crack your bones”. But there are numerous techniques that we can use to gain great results. Exercise is also extremely important for long-term ongoing health, and a good chiropractor will show you how to stretch and strengthen your muscles to make future episodes less likely!
I hope you enjoyed reading, and watch this space for more case studies and similar stories.
What do Chiropractors do?
If you’ve ever had a joint or muscle problem in the past, you will know the choice of practitioner is often overwhelming!
“Do I need a physio? an Osteo? a Chiro? an acupuncturist?”
Sometimes you may think you’re on the right path, until a friend or family member tells you “you don’t need a physio, you need to see my acupuncturist, she’s great!” adding further confusion to the situation.
So this blog aims to make things a LITTLE bit clearer, though is not a definitive guide in itself, and is partly based on my own opinion, as well as the facts.
When you visit a chiropractor, there will be many similarities between us, Physiotherapists and Osteopaths. All of these practitioners will sit you down and take a case history. This means asking a series of questions which allows the practitioner to know what the problem is. Like an interview to give the practitioner a more accurate direction to go in, and to rule out more serious problems.
After this usually comes the physical examination. Again there will be many similarities between each profession. We will all look at your posture, your movement abilities, check your joints, muscles and nerves, as well as make general observations about your physical health. You may have your blood pressure taken, have your abdomen examined, or other general diagnostic tests to rule out problems related to organs, potentially masquerading as joint or muscle pain. For example, gallbladder disease can give rise to shoulder pain. Kidney problems can cause back or groin pain, heart problems can cause radiating pain into the arm or mid back. So it’s important to rule these things out first.
One major difference at this stage between the professions is that Chiropractors are qualified in Radiology and Radiography. We can take an X-ray (if needed), and interpret what we see. Neither Osteopaths or Physiotherapists do this.
After your physical examination is complete, your practitioner will give you a “Report of Findings”. This will be an explanation of what he/she believes is wrong. How the problem most likely came about? how long it will take to fix? how it will be fixed? and also explain any risks associated with the treatment such as soreness, or expected change in symptoms.
Only After this, treatment can begin. And here is where we differ from our Physiotherapy and Osteopathy cousins.
As a chiropractor, personally I see myself as a “body mechanic”. Just as you might take your car into the garage to have it’s parts checked out and repaired. So do we as chiropractors examine the body to look for the moving parts which are not working properly. These parts may be tight muscles, stiff joints, inflamed tendons, injured discs or trapped nerves.
Once the part responsible for the problem is located, it is treated accordingly.
Chiropractic is an extremely comprehensive physical therapy. We do not just “Click your bones”. All chiropractors are fully trained in a wide range of massage, stretching and soft tissue techniques, including active/passive release therapy, myofascial trigger point therapy, Post-Isometric Relaxation and Proprioceptive Neuromuscular Facilitation Stretching techniques, remedial and deep tissue massage.
We are trained to use therapeutic Ultrasound and interferential electrotherapies, we use Dry Needling (Western Medical Acupuncture), Joint mobilisation (such as physiotherapists might use), as well as the highly skilled art of joint manipulation, not just for the spine, but for any joint in the body from the fingers to the toes!
We treat every single part of the body, from Headaches to Pelvic pain, Shoulder problems to Knee Problems, Tennis Elbow to Achilles Tendonitis. Muscle problems, Joint problems and Nerve problems alike.
We are also qualified in exercise prescription, so you will always be given stretches, and exercises to strengthen your muscles to make future incidences less likely to occur. Exercises are a very important part of chiropractic practice, and not simply the domain of the physiotherapist. All good “Chiros” should give exercises to their patients.
So I hope this blog helps to explain some of the similarities and differences between the professions. I will be writing another blog soon to further clarify the often confusing world of physical therapy.
Poor posture is a bad habit. Habits can be changed.
Often Pain is intensified by emotional states. Anxiety and stress are often key players that contribute to increased muscle tension.
One way to control the pain of tense muscles is to try this simple relaxation technique.
- Relaxing shouldn’t be an effort. Don’t TRY to relax, just let go and allow it to happen naturally.
- Find somewhere quiet without distractions and sit or lie down in a comfortable position.
- Start to take Deeper and deeper breaths, which are ‘slow and steady’. Once you have breathed in, aim to hold the breath for 15 seconds, then just ‘release’ the breath as you exhale.
- Focus on something calming and repetitive, either a background sound like passing traffic outside your window, or something in the distance.
- Make sure you ‘Let go’ when you exhale. Concentrate on your breathing, and not on trying to relax, this will happen as a natural side effect.
A ‘relaxation response’ can happen quite quickly, but deep relaxation can take around 10-15 minutes.
If you find the exercise too difficult because of extreme stress levels, just leave it for another time. Don’t become too distressed if you don’t succeed immediately. This takes a few attempts to master.
If someone asked you “what kind of things cause pain?” you wouldn’t be wrong to think immediately of that hunchback desk posture you find yourself creeping into after sitting at your PC for twenty minutes. Or perhaps you’d think of overdoing it at the gym, a trip or fall, perhaps a skiing, golf or squash-related injury?
But how many of us think of our diet when we consider the factors that can lead to pain? Did you know that pain is most often due to inflammation in the body?
The process of inflammation and tissue healing is one which requires certain chemicals to be present in order for it to take place. There are some chemicals which are considered ‘anti-inflammatory’, those which lessen the inflammatory response and so reduce pain. There are also chemicals which are ‘pro-inflammatory’ which are chemicals which lead to inflammation and make the response more virulent.
Certain foods in our diets can be considered either pro or anti-inflammatory, and experts believe that they can either help or aggravate the inflammatory response in our tissues and either help or lead to pain.
The list is endless, but most Fruits, nuts and Vegetables are full of vitamins and minerals as well as fiber, phytochemicals and antioxidants which act as anti-inflammatory foods and help your body deal with inflammation.
Fresh Fish, Organic grass/pasture-fed meats are full of proteins which help with inflammation, as well as containing (in oily fish especially) omega-3 fatty acids which aid the inflammatory process. Other sources of Omega-3 fatty acids are omega-3 eggs, organic extra virgin olive oil, avocados, flax and pumpkin seeds, grape-seed oil and walnut oil.
It doesn’t have to be boring either! Moderate consumption (a glass a day) of red wine has also been shown to have an anti-inflammatory effect, as well as the well documented effects of dark (80% cocoa solids) chocolate.
And have you thought of adding some spices to your cooking? Ginger, turmeric, garlic, oregano, marjoram and many other spices have anti-inflammatory properties.
Water is also very important for the healing process as well, so make sure you’re well hydrated.
Foods to avoid
If you find yourself eating a lot of processed foods, Junk Food (This covers most fast food outlets), packaged foods and deep fried foods, then you may be in for a shock. These foods are full of pro-inflammatory chemicals and excessive consumption of them will make any inflammatory reaction in your body go crazy! Think of it as loading your body with petrol, all you need is a spark for a huge inflammatory reaction to explode into action. You may find yourself suffering more than necessary if your diet is packed with these foodstuffs. Unfortunately you may also want to cut down on unhealthy foods like cakes, biscuits and other foods containing refined sugars and Trans fats. These are found in most packaged or processed foods.
If you would like a nutritional assessment of your diet, come and see me and bring me a week-long food diary, noting down everything you consume in a week and at what time. I can give you advice on the content, portion size and frequency, and calorific intake, as well as noting any deficiencies in your diet.