Are you aware that over half of us regularly suffer with backaches, neck pain or headaches? So why not seek out professional advice sooner rather than later to sort out those pesky niggles before it becomes a serious problem.
Take care of the back you have, because we have never heard of a replacement spine, have you?!
Here are our top 5 tips to help you to spinal health bliss:
Sitting Posture: Support your lower back when sitting down at your desk or at home, try not to curl up on the sofa, as it’ll twist your spine causing back ache and possible problems in the future.
Bedtime: Sleeping on your back (with a pillow behind your knees) is best for your spine. If you really want to sleep on your side, then put a pillow between your knees so you don’t twist into the recovery position.
Keep active! Get into the habit of taking a brisk walk daily. Try to make it fun or work out with a group like class or running group.
Pain is often a warning sign. If something is hurting, don’t ignore it. Particularly important this time of year when we start hitting that gardening again!
Ice. If you’re achy use an ice pack, wrapped up in a tea-towel for 5-10 minutes every half an hour to calm any swelling and promote recovery.
We hope this helps, but if you would like more specialist advice for your particular problem please do not hesitate to contact our principal chiropractor Philippa Oakley.
I saw a lovely lady in clinic today who was suffering with symphysis pubis dysfunction (SPD), which had been bothering her since she was just 16 weeks along in her pregnancy (she’s now nearing her due date). This is quite a common reason for people coming to see me in clinic, so let’s talk about pelvic girdle pain and how a chiropractor can help you.
Pelvic girdle pain (PGP) is common, but not normal, and as anyone will tell you, being in pain can really sap the joy out of your pregnancy. Symphysis pubis dysfunction is now broadly categorised as PGP- an umbrella term for all pain in the pelvic area which could include the lower back, abdomen, hips and thighs. PGP can cause back, hip and groin pain, disrupt your sleeping and affect your walking, amongst other issues. It’s really not fun! Just to complicate matters further, SPD can affect you at any time during your pregnancy, and sometimes even after giving birth (if not managed appropriately). Needless to say, this can cause physical discomfort and emotional distress so it is important to seek help early on- the sooner treatment begins, the sooner you’ll feel better.
What is Pelvic Girdle Pain?
Pelvic girdle pain simply means pain in the joints of the pelvic girdle, including the two sacroiliac joints at the back of your pelvis and the symphysis pubis joint at the front of your pelvis. Dysfunction within the pelvic girdle can affect the pelvic floor (the basket of muscles which hang from the bones of our pelvis), and if the pelvic bones are rotated or dysfunctional, the muscles don’t hang (or function) correctly, affecting spreading of the pelvic floor muscles and symmetrical dilation of the cervix during labour. This can lead to a difficult birth process for both mum and baby, but fortunately if good care has been taken to protect the pelvic girdle from additional strain and trauma, most women with PGP can have a normal vaginal birth. If you are concerned about the birth process, do discuss this with your practitioner, midwife or GP.
SPD can worsen as the baby increases in weight, as a result of postural changes as pregnancy advances, and resultant changes in the body’s centre of gravity. During pregnancy, our body releases a hormone called relaxin which softens our ligaments (which are like strong elastic bands which connect our joints)- this is to allow the baby to pass through the pelvis during birth, and normally lax ligaments in the pelvis during pregnancy do not cause an issue, however uneven movement in the pelvic joints (often termed “misalignment”) or imbalance in the muscles can cause irritation to the joints of the pelvis, resulting in pain.
To a chiropractor there are numerous other issues in the pelvis that can cause PGP without it being SPD (Gosh, that’s a lot of abbreviations!) so it’s important to rule out other possible causes before working on a diagnosis of SPD.
What are the symptoms of PGP?
Pain in the joints of the pelvis
Clicking or grinding in the pelvic area
Pain on weightbearing on one leg (for example when climbing stairs)
Pain when performing straddle movements (for example getting in or out the car or bath)
Difficulty lying in particular positions (often side-lying)
Pain during intercourse
Why do some pregnant ladies develop PGP and others don’t?
It’s hard to say… the research in this area is largely inconclusive when it comes to identifying risk factors for developing pelvic girdle pain, but we do know one of the major reasons for developing back pain in pregnancy and having difficulties during labour is poor musculoskeletal health in the mother. Why? Well, a job that involves a lot of sitting down and little exercise out of work can mean that the tone and activity in the muscles that stabilise the pelvis (such as the abdominals, pelvic floor muscles and the gluteal muscles in the buttocks) is reduced, and they struggle to tolerate additional stress during pregnancy which can lead to ongoing discomfort.
Around 20% of pregnant women will develop some form of pelvic girdle pain during pregnancy and we know that other risk factors include a history of pelvic or lower back pain (both during pregnancy and when not pregnant). The good news is that whilst 1-2 % of patients may have persistent pain one year after giving birth, in 93% of cases, the symptoms of PGP settle within the first 3 months post delivery.
What can be done to help pelvic girdle pain and symphysis pubis dysfunction?
Pregnant patients require a gentle, drug-free alternative for treating their discomfort and so seeking chiropractic care is a logical choice as it is a safe and effective treatment option, not only for treatment of pelvic girdle pain but also other musculoskeletal problems that may arise during pregnancy. Not only that, but it can help avoid a difficult labour, may mean you can stay at work longer and can reduce long-term disability.
Chiropractic treatment doesn’t just involve manual adjustments of the spine (chiropractic care is SO much more than that). We use numerous gentle techniques during treatments including soft tissue work, fascial release, acupuncture, exercises, postural advice (including optimal foetal positioning) and perhaps most importantly, we work with you to ensure you understand your condition and know how to manage it. Chiropractic treatment is recommended for pelvic girdle pain by the Pelvic Obstetric and Gynaecological Physiotherapy- you can read their guidance on PGP here.
In the case of our patient, we adjusted the sacroiliac joints and pubic symphysis, but in addition we also adjusted the thoracic and lumbar spine, and released the diaphragm and psoas muscles in the abdomen as we know that these abdominal muscles are key contributors to pelvic pain. Remember- only a fool treats where the pain is, so as chiropractors we have to make sure that all factors contributing to the pain have been addressed! Our patient also went away with some kinesiology tape on her pelvis for support- more about that here.
Is there anything else I can do to help?
Yes- there are some simple exercises that you can do at home to help alleviate discomfort. In addition to giving you exercises we also advise you on ways to move that will help protect your pelvis and avoid aggravating the condition. Always speak to your practitioner to determine if an exercise is appropriate before attempting it. All the exercises we provide our patients are bespoke to them based on the results of their examination.
Sometimes a pelvic belt can offer relief, particularly when you’re up and moving around. We prefer to use kinesiology tape to help our pregnant patients as this provides support to the structures without limiting movement.
Aas-Jacobsen E. and Miller J. (2010) Chiropractic care during pregnancy: survey of 100 patients presented to a private clinic in Oslo, Norway. JCCP. Vol. 11. No.2. 771-774.
Andrew C. and Dorey G. (2008) Pelvic girdle pain in three pregnant women choosing chiropractic management: a pilot study using a respondent generated instrument and chiropractor’s assessment tool. Journal of the Association of chartered physiotherapists in women’s health. 102. p.12-24.
Andrew. C and Pedersen P. (2003) A study into the effectiveness of chiropractic treatment for pre- and post partum women with symphysis pubis dysfunction. European Journal of chiropractic. 48. P. 77-95
Borggren, C.L. (2007) Pregnancy and chiropractic: a narrative review of the literature. Journal of Chiropractic Medicine. 6 (2) 70-74
Daly, J.M., Frame, P.S., Rapoza, P.A. (1991) Sacroiliac subluxation: a common, treatable cause of low-back pain in pregnancy. Fam Pract Res J. 11(2) 149-59.
Elden, Ostgaard, Fagevik-Olsen, Ladfors Hagberg: Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complementary and Alternative Medicine 2008, 8:34doi:10.1186/1472-6882-8-34.
Howell, E.R. (2012) Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: two case reports. The Journal of the Canadian Chiropractic Association. 56(2) 102-111.
Kanakaris, N.K., Roberts, C.S., Giannoudis, P.V. (2011) Pregnancy-related pelvic girdle pain: an update. BMC Medicine 9:15.
Peterson, C.K., Mühlemann, D., Humphreys, B.K. (2014) Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropractic & Manual Therapies. 22:15
Vleeming, A., Albert, H.B., Östgaard, H.C., Sturesson, B., Stuge, B. (2008) European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 17 (6) 794-819
We’re delighted to announce that our St George’s Day Charity Dog Walk has helped raise £398.35 for local charity Hounds for Heroes.
Our principle chiropractor Philippa comments, ‘Coming from a military family, it has always been important for me to give back to the military community. The event was a great success, and we are now planning for next year’s adventures. It was fun for all the family, and we all enjoyed the beautiful scenery of Chichester Harbour accompanied by a slice of cake baked by Emsworth Cookery School and a bottle of refreshing locally sourced water from South Downs Water who both kindly sponsored the event.’
Hounds for Heroes provide specially trained assistance dogs to injured and disabled men and women of both the UK Armed Forces and UK Emergency Services. Through this provision, Hounds for Heroes aim to provide help and practical support leading to an enhanced quality of life. Allen Parton, founder of Hounds for Heroes, comments, ‘This money will assist us in our aims of placing assistance dogs with injured veterans and emergency service personnel, Acorn Health’s event and support really does send such a positive message to those serving Queen and Country that folk at home really do care about them. Every single penny received makes such a huge impact on and difference to our work. We have a great organisation, staffed by serving members of the armed forces, which in itself is fairly humbling, but we couldn’t do it without others help as well.’
Allen continues, ‘It is a thrilling time for us at the Training Centre as we have just had two new recruits join Squadron 4 so the sound of puppy paws running round the centre re-enforces our aim to improve and enhance the quality of our partner’s lives.’
Emsworth’s St George’s Day weekend of events was supported by The Emsworth Business Association, Havant Borough Council, Acorn Creative Ltd, South Downs Water, and Emsworth Cookery School.
Living and working in Emsworth and Langstone, you’ll know that sailing is an inherent part of our community here (so much so, we’ve included some photos taken by Philippa of our lovely harbour!) As such, it’s not uncommon for us to be treating professional or recreational sailors in clinic, and whether you compete professionally or just enjoy a turn about the Solent, sailing poses as much a risk of injury as with any sport.Sailors often compete in extremely difficult conditions, battling high winds and rough seas, and as such the risk of injury during sailing is 8.6 per 1000 hours sailing when training, and 2.2/1000 otherwise. In a study on the 2003 America’s Cup, researchers found that the upper limb was the most commonly injured body segment (40%), followed by the spine and neck (30%), and the most common injuries were joint/ligament sprains (27%) and tendinopathies (20%). (1)
Who is at risk of injury?
Mastmen are at greatest risk of acute injuries, helmsmen most commonly injury the upper-limb through steering, whilst grinders and bowmen are at the greatest risk of injury from repetitive strains. High repetition activities such as hiking, pumping, grinding and sterring are major causes of overuse injury, even in the most experienced of sailors. Windsurfers are also frequently admitted to hospital suffering from chronic lower back injuries as a result of “pumping” the sail.
It’s not just the professionals who are at risk of injury, as novice and recreational sailors commonly encounter acute injuries such as contusions or abrasions after colliding with the boom or other equipment whilst performing manoeuvres. (1) Not only that, but there are other perils to consider: tripping over ropes, winches and cleats; being swept overboard or falling down open hatches!
How and why do sailing injuries occur?
[clickToTweet tweet=”What are the main contributors to #sailing #injuries? Find out here! #Chiropractic” quote=”The main contributors to sailing injuries are: Heavy weather (23%), tacking (17%), jibing (13%), sail change (12%) and alcohol (7%)”]
Injuries may result from a lack of general fitness, overuse, overtraining, or macrotraumatic accidents.
Lack of warming up, stretching, and cooling down may also increase the risk of injury.
Muscles are placed at high risk when performing explosive, powerful moves, such as those frequently required when sailing.
Shoulder and arm injuries are common through constant handling of the mainsheet, and the sudden, strong movements in hiking may lead to back and knee problems. (Remember Sir Ben Ainslie’s back injury? This was caused by repetitive, high strain hiking out!)
Inadequate leg strength and poor hiking technique are thought to predispose the knee to injury.
Boats can be difficult to navigate around and result in crew members having to adopt awkward positions, often resulting in rotating, hyperextending, locking, or twisting of joints.
Postural problems are common in the majority of the population, and these inherent issues can lend themselves to musculoskeletal problems.
Poor fitness training may exacerbate common muscular imbalances associated with changing forces on opposing muscle groups while sailing.
If ignored, it is easy for these issues to progress into a chronic problem, the possible severity of which could impact on your participation and enjoyment in the sport.
So what can be done about it? Five simple steps to avoiding sailing injuries!
A robust exercise regime is crucial, which should focus on all aspects of physical fitness in order to ensure that your body can cope with the demands of sailing.
– Cardiovascular training
– Strength training (Competitive sailors should undergo regular health screening with specific strengthening of high-risk muscle groups, synergists and stabilizers. )
– Flexibility training
– Core stability training
– For more advice on bespoke rehabilitation plans, please email us at firstname.lastname@example.org or visit our Langstone clinic.
Research has shown that aerobic training and fitness is directly related to an improved reaction speed to wind shifts, as well as enhanced endurance, decision making, and concentration, particularly in the later stages of races. Mental and physical recovery is faster for those who are physically fit. Suggested types of aerobic exercise that are most appropriate for sailors are rowing, cycling, swimming, stair climbing, or running.(3)/li>
Regular checkups can help ensure joint movement and function is maintained, as well as provide an opportunity for assessment of joint strength and function. Not only will this help reduce the risk of developing injuries, but it can also speed up recovery should you become injured.
Technical skill and expertise is important– if your technique needs improvement, seek out advice and informed coaching to help minimise the risk of developing an injury as a result of poor technique.
Taking frequent breaks and changing positions during long periods of sailing. This will help prevent postural stresses and strains from occurring and is a healthy spinal habit we all should follow.
Whilst we have focused on musculoskeletal injuries, there are a number of other safety measures to take into consideration. Above all, always wear a life jacket when sailing. In the UK, there were 35 sailing or water-sport related deaths at sea in 2014 alone. Safety at sea should always be taken seriously.
1. Neville, V., Folland, J.P. (2009) The epidemiology and aetiology of injuries in sailing. Sports Medicine. 39(2) 129-145.
2. Nathanson, Mello, Baird “Sailing Injuries and Illness – Results of an Internet-based survey” Wild Env Med 2010
3. Allen, J.B., De Jong, M.R. (2006) Sailing and sports medicine: A literature review. British Journal of Sports Medicine. 40(7) 587-593.
We’re not talking about the BBC PROMS, or in fact anything to do with music. We’re talking about Patient Reported Outcome Measures (PROMs), and they’re far more exciting than the BBC version (in our humble opinion).
Patient Reported Outcome Measures are the tools with which healthcare practitioners and clinicians can better understand the impact illnesses or conditions and treatment are having on our patients’ daily lives. At Acorn Health, we utilise Care Response, a system which gathers the data for us and is supported by the Royal College of Chiropractors.
We don’t collect PROMs purely for our own benefit, it’s also for yours. We want to understand how your pain or problem is affecting your daily life- are you able to wash and dress yourself without pain? Is it stopping you from having a social life? Is it preventing you from working? Not only that, but we want to know how you feel about your pain. Are you worried it’s never going to get any better? Perhaps you’re scared about whether being physically active is going to make it better or worse and had to duck out of that golf game you had lined up. These are all very common concerns (so don’t worry if you’re having them- we all do!) and by understanding what your concerns are and how your pain is affecting you, we can provide a more accurate and more appropriate course of treatment for you. The responses to these questions will also indicate to us whether you are at a low, medium, or high risk of the problem becoming chronic (lasting for a long time) and this can mean that we need to provide you with very specific advice and information in order to prevent this happening- and yes, it can be done!
PROMs are starting to sound really good, aren’t they?
Another fantastic thing about PROMs is that they can tell us whether the treatment plan we have together decided upon is having the effect we want or not. Often, when pain decreases it can be difficult to remember just how bad it was (Remember that saying about giving birth? If we remembered how bad childbirth was we’d never have more than one child!) That being said, PROMs give us a way to determine your response to treatment based on your original responses to the questionnaire.
The story of patient X: Utilising PROMs in clinical practice
So how do we put PROMs to use in clinical practice, and how do they help inform our decision making and improve the care we provide our patients? We’ve got a case study here to explain it.
A bit of background- this Patient (let’s call them Patient X… sounds all mysterious and technical doesn’t it!) Anyway, Patient X had sustained a lower back injury in a road traffic accident more than a decade ago and had suffered with recurring episodes of lower back pain which, as seen by the chart below, were having a significant impact on their ADL’s (activities of daily living- things like washing, doing housework and sleeping) as well as their social life (going out to see friends, going to the gym, playing sports), the pain was a 6/10 and it was also making them anxious, depressed, having quite a severe impact on their working day and they had very little ability to cope with, control or reduce the pain themselves. All in all, not a very pleasant situation to find yourself in, but these results are fairly common in the patients we see in clinic. So much so, in fact, that Philippa takes a special clinical interest in chronic pain management– but that’s a story for another time.
The questions on the initial form are part of a validated assessment tool called the Bournemouth Questionnaire, and the answers are scaled on a 0 – 10 linear scale, 0 being “the pain has no interference” and 10 being variations of responses such as “completely unable to carry on” or “extremely anxious/extremely depressed.” As you can see, this patient was also at medium risk of chronicity due to some concerns they had about their back pain and what it meant for them, as they were worrying about it a lot of the time and felt that it was never going to improve.
We normally complete an outcome questionnaire after 2 weeks but in this particular case it was after 4, and Patient X completed this questionnaire which asked how their pain has changed, and also assesses the impact this pain is having on their lives at that time. This is where we get a bit geeky and excited- bear with us while we explain why.
Yes, as you can see below, Patient X’s pain level had increased at the time they completed the outcome questionnaire because (by their own report) the “Sciatic nerve in left leg has been irritated since last weekend” after spending a weekend doing a lot of heavy work in the garden…. they knew it wasn’t the best idea (!) However, despite the fact that they’d been doing quite hard physical work and had a slight flare-up as a result, they still reported they were “much improved” as a result of treatment, and their Bournemouth Questionnaire (the one that tells us how the pain is impacting on your day-to-day life) had reduced from 52/100 to 34/100 (which is computed as a 34.62% improvement!)
How is it possible that the pain could actually have increased, but Patient X felt better? Well, as we do with all our patients, we had a lengthy chat with Patient X about their pain, and how it was impacting them, and how they could manage it more effectively, as well as what we could do to help. Studies have shown that in some specific cases, a pain management course is actually more helpful than physical treatment, so we always include pain management as part of our treatment programmes. The more control you have over your pain, the less pain you feel. So through understanding pain and knowing what’s going on, what the cause was (in this case a mechanical issue with how a joint in the lower back was moving) what it isn’t (lower back pain is very rarely serious) and what to do about it (treatment and active self-management), Patient X felt less pain as they were less threatened by it, understood what was going on, were less concerned by the pain and able to move more normally without fear of pain.
After speaking to Patient X to establish what they felt had changed, the overall message was “I know what’s happening now, and I know what to do about it.” Woohoo! This is why it’s absolutely critical that we convey the right messages to you and help you to understand your pain. As practitioners, we also know that pain in itself is a really unreliable indicator of the severity of the underlying issue. To use our favourite analogy- think how painful a papercut can be despite the fact it’s a fairly minor injury. Pain in itself is just a symptom and studies have shown it does not relate to the severity of the underlying problem- in fact, some studies show that pain related fear is more disabling than the pain itself!
To understand more about pain and what causes pain, this should be your next bit of reading: Understanding Pain.
Let’s get back to Patient X, who today completed their final outcome assessment.
As you can see, the pain has dropped now to a 3/10. Those sections where Patient X reported were a 9/10 (ability to complete ADL’s and impact on social life) have dropped to a 3/10 and 2/10 respectively, impact on work was initially 7/10 and is now 0/10, anxiety and depression are both down from 7/10 to 1/10, and ability to cope with, control and reduce the pain was initially a 7/10 and is now a mere 2/10!
Whilst plenty of naysayers might say “Sure, but they’re not pain free and their Bournemouth Questionnaire isn’t zero.” If you had an illness or disease that lasted several years, would you take a few pills and expect it to be cured? No. Realistically, you’d hope that it would be better, as it is for this patient. Recovery takes time and is something that cannot be rushed. If you recall, Patient X’s problem had started over a decade ago, so we’re delighted that two months later the pain has improved this significantly. Not only that, but Patient X reports feeling “much improved” as well so we know they’re happy with how they’ve progressed- which gives us all sorts of warm fuzzy feelings. Hooray for job satisfaction!
So what happens now? At this stage, we’ll see a lot less of Patient X as they are formally discharged from care. The pain is now so minimal and intermittent that after discussing it with them, they’re happy to manage it themselves at home with stretches, exercises and lifestyle modifications (such as taking regular breaks from sitting whilst at work). We’ll check up on them in a few months to review their exercises, identify if there are any issues that have crept back on and this also gives us an opportunity to discuss their progress with them and if they have any further concerns. Of course, we’re always at the end of a phone or email, Facebook, Google+ or Twitter if they (or you) want to get in touch in the meantime!
We never guarantee 100% cure as nothing in medicine can. No pill, no operation, no treatment. There are no guarantees. What we do say at Acorn Health is that we will always give you the very best treatment and care, in accordance with the latest research guidelines and current evidence base. We can also say (thanks to another fancy PROMs questionnaire) that we have 100% satisfaction rates from every patient we’ve seen since we opened back in 2014, and that makes us very happy indeed.
So there’s a little overview and case study into how PROMs are put into use in clinical practice, and why we utilise them! If you’d like to know more, or would like to get in touch to book your own appointment, you can contact us using the form below.