This spring half term (from Saturday 18th – Saturday 25th February) we are offering free children’s posture checks, please phone 01243 379693 to book to avoid disappointment.
Donations will be gratefully received for Neuroblastoma UK.
Neuroblastoma is an aggressive childhood cancer. At Neuroblastoma UK they save children’s lives by funding crucial research which is carried out by scientific experts in cancer centres and universities all around the UK and it produces results such as new treatments that save children’s lives and are kinder on their young bodies than chemotherapy and other existing therapies.
Their work relies entirely on the generosity of voluntary donors – individuals, companies and trusts – to continually fund new research projects to produce new and better treatments in order to save more children’s lives. They are staffed only by Trustees and volunteers, with no paid staff or offices, meaning that 95% of everything you donate goes directly into funding the best UK-led research.
Your support means they can fund more research and bring closer the day when neuroblastoma will be beaten.
You can make a huge difference to the chances of survival for children with neuroblastoma by donating. Thank you!
Why are we doing this?
– Because children’s cancer research attracts a tiny proportion of the money available from big funders because of its rarity. Yet these so-called “rare” cancers are collectively as common as the “common” ones!
– Research is funded by incidence, so the individual rare cancers are doomed forever to receive just a fraction of the money given to the big four adult cancers.
– Out of total cancer funding of just over £3,000 million, £83 million is relevant to childhood cancer… so just under 3% of all funding.
– In the UK, cancer is the most common cause of death in children aged 1 to 14 years, accounting for around one fifth of deaths in this age group.Read more here.
We wanted to support Neuroblastoma UK in whatever way we could and so we are offering free advice and expertise in relation to posture and healthy spinal habits, in return for a donation to Neuroblastoma UK. Together we can support the vital work these charities do and together change the future of paediatric cancer.
NB. These posture checks are in no way a screening for any form of paediatric cancer.
Chronic shoulder tension. Knots in your upper back. Stiffness, headaches, neck pain. Sounds familiar? Yep- we see chronic shoulder tension a lot in clinic- but allow us to explain why simply treating the shoulder isn’t going to solve the issue.
Firstly, muscles don’t work alone.
Our body moves and functions through a combination of movements in a coordinated group of muscles, ligaments, fascia, tendons and joints. Back pain is our bread-and-butter as chiropractors, and we know from both research and experience that pain in the back doesn’t necessarily mean a problem in the back. That pain could be caused by a problem somewhere completely different- something that often causes a bit of confusion when you come to see us for pain in one area and we end up treating somewhere completely different.
Let us paint you a picture. You work in an office. You’re stuck at a desk all day, sitting on your behind, slouched and worn out by 5PM. Your shoulders are tight and sore, and you can feel the knots building up in your upper traps, giving you a thunderous headache by the end of the day. Now, you know those knots and tense muscles are going to cause problems of their own, so you had an upper back massage two days ago and they should be feeling better… but they’re not. So is the problem the upper traps and shoulders, or is it something else?
Let’s look at the latissimus dorsi.
It’s a muscle that originates from the spinous processes of T7-L5, the iliac crest around the top of the pelvis, the thoracolumbar fascia in the middle of our back, the lower border of the shoulder blade and the lower 3/4 ribs. (Yep, it’s massive!) All those fibres attach to the humerus (the long bone in the top of your arm). Why are we talking about a muscle in the lower back? Surely a muscle in the lower back controls the lower back, right? Wrong. The lat dorsi actually serves to extend, adduct, flex and internally rotate the shoulder, and lends a mere helping fibre or two to extend and laterally flex the spine. (In case you’re interested- it also helps with our lung function and breathing. Safe to say, it’s a pretty important muscle.)
So, back to you sat at your desk.
You’re slouching, your lumbar spine is curved and unsupported, so your latissimus dorsi is stretched beyond the norm and the fibres can’t fire properly. As a result, the muscle can’t complete the role it’s supposed to, the upper trapezius steps in to help and is left to do all the hard work controlling the shoulder itself (Just like that last project your boss asked you and Jane to do together and Jane left it up to you to do all the hard work- thanks Jane….) This leads to imbalance and weakness in both the lats and lower traps not to mention a very grumpy upper trapezius. You’ve tried treating the site of the pain (with that amazing back, neck and shoulder massage) and it feels better for a day or two afterwards but then it comes back.
It’s fairly obvious by now that the problem with your tight and knotty upper traps isn’t caused by your shoulders- it’s something further afield.
So we have to look elsewhere- we look at your lower back and find that your latissimus dorsi is, surprise surprise, not happy with life. Now we’ve found that we also need to look at the Posterior Oblique Sling.* The POS includes the latissimus dorsi, glut med (in the back of the hip) and the thoracolumbar fascia (in the middle of our back.) *NB When we talk about one of the “slings” in the body, we’re talking about a specific group of muscles, fascia and ligaments which all work together to stabilise and mobilise the body.
Guess what we find when we examine you?
Your lat dorsi isn’t firing properly, which is throwing off the stability in the posterior oblique sling. Your lower back is stiff and restricted, and you can’t laterally flex properly- further compounding the problem with the latissimus dorsi (remember us saying it helps with lateral flexion of the lumbar spine?) So you can see how you’re caught in a vicious circle of dysfunction creating more dysfunction, and, in your case, leading to chronically tight shoulders that just never seem to get better!
The above is just an example of a classic case we often see in clinic.
Now, there are approximately 640 muscles in the human body, all intricately involved with the others in a chain of movement, that can have a chain of consequences if something in that chain misbehaves. To state the obvious again- each person we see is an individual, and the way dysfunction comes about is different for each person, as is the way in which the body adapts to that dysfunction.
As chiropractors, our job is to work out what’s going on and why (and then work with you to get it better) and this often involves looking at areas that might be quite far afield from where the actual pain is felt- but as you can see, there’s a reason for that.
So where to begin? How can you improve your posture and reduce pain and problems? We’d suggest starting with some simple exercises, and downloading your copy of “Understanding Pain” which will help you get to grips with chronic pain, what’s going on in your body and how you can take back control!
Alternatively, and perhaps best- is to seek professional help and get a diagnosis and treatment plan put in place. You can get started by booking your appointment today.
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.
They say money never sleeps, but in reality, it’s healthcare that never sleeps. Constant innovation, new technologies, new treatments, medications, therapies and more, healthcare is changing and developing fast enough to make your head spin.
With a New Year just hours away, we thought we’d take the opportunity to review the latest and greatest developments in healthcare throughout 2015, as well as popular healthcare articles that made headlines and our own most popular content.
One of the most widely-shared articles on the internet in 2015, this article from The Atlantic posed some interesting questions about how doctors interpret (or in fact, underestimate) women’s pain. In America, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing. A harrowing and extreme example perhaps, but it highlights the ultimate need for all healthcare professionals to listen, understand and consider each person as an individual before making a clinical decision. There is no place for assumptions or generalisations in healthcare.
3. When the media gets it wrong
In a classic example of misinterpretation, a report from the American Journal of Cardiology caused quite a stir when it suggested that “strenuous jogging is as bad as no exercise at all.” The claims were quickly clarified by the NHS, as what the media failed to make clear here was the size of the demographic involved in the study- once the 1500 participants had been split into groups based on duration, frequency, and pace, some individual groups – particularly the most active groups – were (by research standards) too small to draw any real clinical significance from, with just 36 runners classified as “strenuous joggers.” As a result, the analyses conducted were less able to detect what, if any differences were present between the two groups. A classic example of needing to know the full picture when drawing a healthcare conclusion like this. (N.B. The biggest concern with exercise is not “overdoing” it. It’s not doing enough! If you’re thinking of taking up a new hobby in 2016, let’s keep you injury free.)
4. Kinesiology tape
Our most popular post of 2015 was “Kinesiotape during Pregnancy”, which to date has had a whopping 22,800 social shares. Kinesiotape is paradoxically gentle, yet strong, and depending on the way it is applied, it creates an effect on skin that improves circulation, relieves pain and supports muscles and joints which can be a huge help for mums to alleviate some of the postural aches and pains associated with a growing bump!
5. Back pain and paracetamol
An article published in the British Medical Journal back in March of 2015 confirmed what many of us have known for some time- that paracetamol is ineffective for back pain. With prescription of paracetamol being the most common approach to treatment used by general practitioners for spinal pain and osteoarthritis of the hip or knee, this has highlighted the need for a review and potential reconsideration of current recommendations that support the use of paracetamol for these groups. The current guidelines from the National Institute of Health and Clinical Excellence support the use of manual therapy for low back pain, alongside a structured exercise programme. Good news for Acorn Health patients who will know this is a fundamental part of our treatment programmes.
6. Our big news
2015 was a fantastic year for us as Philippa was accepted into the Royal College of Chiropractor’s specialist Pregnancy and Paediatric Faculty. These specialist faculties recognise chiropractors who have undertaken formal postgraduate studies and have specialist knowledge and expertise in their particular fields and Philippa was delighted to be welcome into the Paediatric Faculty in addition to her already acheiving Licenciate status with the specialist Pain Faculty. Not only that, but 2015 also saw Acorn Health pick up
it’s second national award with the Royal College of Chiropractors, the Clinical Managment Quality Mark, which is awarded to those clinics that demonstrate excellence in terms of operating within a structured and managed clinical environment. The clinics must demonstrate excellence in a range of areas including clinical audit, incident reporting and patient satisfaction.
We were also delighted this year to have been accepted as a Dementia Friendly Business with the Hampshire Dementia Action Alliance, part of the Dementia Friends group.
2015 brought sugar to the small screen in the form of the controversial Jamie’s Sugar Rush. One of our favourite pieces of the year was this article from the Huffington Post, showing what sugar does to your brain. In addition to being a key contributor to rising obesity levels, sugar is also known to impair memory, contribute to depression and anxiety and is linked to cognitive decline and dementia. 2015 was definitely the year that the UK began to combat the hidden sugars in our food, and began to make healthier dietary choices.
9. First Paracetamol, now Nurofen
The UK-based manufacturers of Nurofen, Reckitt-Benckiser were forced to defend their product after Australian courts ordered certain products off the shelves after finding each product, despite being marketed as able to treat specific pains, such as migraine, were identical to one another and contained the same active ingredient, ibuprofen lysine 342mg. Prices for these products also averaged around £3.49 for a box of 16 capsules. Why is it that snazzy packaging and good marketing so often tempts us in? We’ve said it once, we’ll say it again. Save your money and buy generic. (They’ll cost you about 30p instead!)
10. Paraplegic man walks again
An accident 5 years ago left a 26 year old American man paralysed from the waist down, unable to use his legs. This year, scientists successfully rerouted nerve signals from the man’s brain to electrodes on his knees, enabling him to become the first person with paraplegia caused by a spinal injury to walk without relying on robotic limbs that are controlled manually. Yes, our jaws dropped at this one too. Around 50,000 people in the UK live with paralysis, and whilst this treatment surely won’t be appropriate or possible for each of them, it was a truly groundbreaking achievement in science, and a step on the path to giving this young man back his independence.
Gosh- you see what we mean about how much takes place in a year? We know there’s been hundreds of new developments, too many to even mention, but we wanted to highlight a few of our favourites from 2015.
We have an exciting year lined up for us, with a new clinic opening at ActivHealth, Langstone Technology Park, Havant. We also have big plans for the introduction of new and improved online resources, new courses and workshops to be held and a few surprises we have in store for you (but aren’t quite ready to share yet!)
May we wish you all a very happy and healthy New Year!
Here it is, the oh-so-predictable New Year’s Resolution post about a “New Year, New You.” We’re going to bypass that this year in favour of something far more important. Whilst New Year’s Resolutions which centre around going to the gym, getting fitter or putting more of an emphasis on our health are fantastic, we want you to spare a thought for your joints before you start a new exercise regime. Search online for “getting fit quotes” and the words that pop up most frequently are “pain”, “hurt”, “sore”, “skinny” or “burn”. Whilst some pain is normal and to be expected, this has given rise to a worrying influx in the number of sport-related injuries we’ve seen from athletes “training through the pain”.
Most sporting injuries occur from what we call the Terrible Toos- doing too much, too soon. After not working out for months or years, people come in and try to run 5 miles or lift 200 lbs at their first session. Their deconditioned, unprepared muscles can’t cope with the action and so injury occurs. We then have to recover from the injury by which point our motivation for our New Year’s resolution is gone. You won’t become Batman (or Catwoman) in one workout session, so please please please train properly and spare a thought for injury prevention this year.
So how does injury occur?
Injury, particularly sports injury, occurs through direct or indirect trauma to muscles, ligaments, and joint capsules. Injury takes two forms- direct and indirect. Direct trauma or injury occurs through blunt trauma or a sudden overload- so dropping a weight on your foot would be a direct trauma (HINT: Don’t do it!)
Indirect trauma or injury occurs from repeated submaximal loading. (When we refer to joint loading, what we mean is the force that is put on a load-bearing or weight-bearing joint during exercise.) This could be therefore be repetitive injury to your elbows when lifting, or your knee when running. Indirect trauma can therefore occur through repetitive lifting of weights, running, or any activity that “loads” a joint.
Regardless of direct or indirect trauma, the end result is still the same- tissue dysfunction that is characterised through pain, inflammation, and internal tissue stress. This can lead to what is known as “functional disability”, where you’re able to go about your day-to-day life largely without issue, but your training or exercise regime is impaired. Not what you want when you’re motivated to get to the gym!
Why does injury occur?
Whilst some sports injury occurs through direct trauma- such as a rugby tackle, overuse injuries are more common in sports than acute injuries. These are subtle and occur over time, hence why early detection and diagnosis is key. Faulty movement patterns, joint restriction or muscle dysfunction can be detected by your chiropractor which can help to identify those who are at risk of an overuse injury and provide advice on injury prevention, modification of exercises, adaptations to technique or treatment if appropriate.
Researchers have reported that impact forces of up to 550% the normal force load are transmitted to our joints when running, with impact forces between 4 to 8 times higher than those during normal walking. Much as you wouldn’t lift a heavy weight without putting some thought into it first (if you even decided to lift it at all!) we need to put some thought into how well equipped our bodies are to cope with these additional stresses and strains before we hit the gym. This is why launching into a fitness regime without putting some thought into how you’re going to do it and how you’re going to protect yourself whilst doing it can be crucial.
Coping with this degree of stress can be challenging enough even for joints that are well-adapted to this degree of stress, but if you are starting a new exercise regime or perhaps picking up a new activity, your joints need some time to adapt to the new activity. They also need to be ready and able to cope with this degree of stress. This is where chiropractic comes in.
How does chiropractic help?
Chiropractors are primary healthcare professionals who are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system (bones, joints and muscles), as well as the effects these can have on the nervous system and general health.
Chiropractors are often thought to only “crack backs” and only treat back pain. Much like your GP wouldn’t prescribe the same pill for an ear infection as they would for high blood pressure, so a chiropractor doesn’t just perform spinal manipulation for a bad back. It entirely depends on the nature of the injury, the level of pain, and most importantly, your personal preferences (it all comes down to teamwork!) Chiropractors have a vast array of treatment options they can offer and chiropractic care can be crucial in injury prevention because chiropractic emphasises the correct functioning of all joints, muscles, tendons and ligaments in your body to ensure you are performing at your very best. Whether you are an elite athlete, a gym newbie, or perhaps a keen sportsperson returning from injury, chiropractic can be crucial in identifying dysfunction prior to an injury occurring.
A crucial part of treatment at Acorn Health is helping you to develop a firm understanding of how your body works, how pain and problems can occur and how to prevent it. We work with you to develop a new fitness routine and training programme with appropriate exercises that will enable you to strengthen and stabilise your joints whilst reducing your risk of picking up an injury.
So whilst you’re dusting off your trainers and wrangling your way into your sports kit, spare a thought for your joints, and spare a thought for injury prevention.
If you would like to receive our “Injury for Runners” resource, detailing the most common types of running injuries, the mechanism of injury, preventative measures and more useful information, please complete your details below.