Today is World Spine Day and the theme this year is “Love your Spine”. Too often, we hear from our patients “my joints are wearing out”, “I’ve got a bad back”, “I’ve got a weakness there”, “my back’s gone again.”
Right now in the UK, over 190,000 people are suffering from a migraine attack. Despite the number of people affected by migraines, it’s still not know why they occur. It’s thought the genetics and environmental factors play a role. For those who suffer with migraines, you may not know that chiropractic care for migraines can help prevent you from suffering.
Quick facts about migraines:
Migraines are a recurrent type of severe headache which, for some people, will happen throughout their lifetime.
They’re most commonly described as episodes of disabling pain with headache, feeling or being sick, and sensitivity to normal levels of light and sounds.
They can affect people of all ages (even young children).
The head pain is usually one-sided, pulsating, and may worsen with normal physical activity (such as climbing the stairs).
They can last from a few hours to a few days, and on average happen once or twice a month- for some people they have one a year, for others- one a week.
Research has shown that in the USA and the UK, only half of people with a migraine had seen a doctor for this problem in the last twelve months, and only two-thirds of them had been diagnosed correctly. As a result, many migraine sufferers are reliant on over-the-counter medication and have poorly-managed migraine symptoms.
Although migraine attacks affect a significant number of people the triggering processes for the headaches are not fully understood.
At least 60% of people who suffer with migraine never consult their GP because they believe nothing can be done to help them. (Source)
For many people the symptoms of migraine are a mixture of more than one type. This is why many specialists, including chiropractors, now talk about a “headache continuum”, with the less disabling mild tension headache at one end of the scale, and severely disabling migraines at the other.
What causes migraines?
The truth is- no one really knows what causes a migraine. It may be that abnormal brain activity affects the chemicals, nerve signals and blood vessels deep in the brain. The release of inflammatory substances around these structures may be what causes pain.
It’s possible that your genes also make you more likely to suffer. There are several possible triggers that can lead to a migraine attack, including hormonal, emotional, dietary, physical, environmental or chemical/medicinal factors. These can vary from person to person and as such, it’s important to find out what your triggers are and learn how to manage them. This may be by avoiding certain types of foods, keeping to a regular sleep pattern or reducing chemical stressors such as stopping smoking.
Types of migraine
There are seven different classes of migraines- and some of these have further subclasses. We’re going to focus on the main two:
Migraine with aura
This type of migraine accounts for around 10-30% of people with migraines. These type of migraines do not present with an aura. In this case, aura means neurological symptoms, most commonly visual disturbances. These can present up to an hour before or during the migraine, and you may experience:
Seeing sparkles, stars, flashing lights or zig-zags
You might also experience:
Numbness or tingling
Pins and needles
Weakness on one side of the body
Dizziness or a feeling of spinning
Migraine without aura
These generally last for between 4 to 72 hours. Usually, you’ll feel a headache on one side of your head, which may throb or pulsate. They can affect your daily life and generally worsen with everyday exercise (such as walking or climbing stairs). Some people who suffer with these types of migraines also report feeling or being sick, having diarrhoea or being sensitive to light or sound.
This is the most common type of migraine accounting for 70-90% of attacks.
Chiropractic Treatment for Migraines: Prevention is better than cure
Chiropractic treatment has been shown to reduce the severity and frequency of migraine attacks, and is therefore recommended as a treatment for migraine prevention. One study of 127 migraine sufferers in Australia found that those that received chiropractic treatment had fewer attacks and needed to take less medication. More than 80% of the study participants blamed stress for leading to their migraine attacks. The researchers therefore suggest that chiropractic care might physically help reduce the body’s reaction to stress.
Recent research studies suggest that chiropractic treatment for migraines might also be as efficient as amitryptaline, propranolol and topiramate in the prophylactic management of migraine.
Your chiropractor will provide hands on care and advice across a range of areas. This includes nutritional support, lifestyle management, and exercise. As such, you can work with Philippa to determine a “Migraine Prevention Programme” that works for you. Your treatment programme will address many of the factors that may contribute to migraine. This includes postural issues, muscle tension in the upper back, neck and shoulders, and restriction of movement in the neck and upper spine. Chiropractic care for migraine prevention can include nutritional support, acupuncture or dry needling, manual therapy, soft tissue techniques and more- all your treatment is bespoke to your needs.
If you have any doubts about whether a specific treatment type is suitable for you, please consult your chiropractor or GP.
Ever wondered what it feels like to experience migraine? Watch the video below.
Bryans, R., Descarreaux, M., Duranleau, M., Marcoux, H., Potter, B., Ruegg, R., & White, E. (2011). Evidence-based guidelines for the chiropractic treatment of adults with headache. Journal of Manipulative and Physiological Therapeutics, 34(5), 274-289.
Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011;12:127–133. doi: 10.1007/s10194-011-0296-6.
Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV (1998) The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headaches. Journal of Manipulative and Physiological Therapeutics. 21: 511-519.
Many new patients come to us at this time of year searching for help and advice on sciatica pain relief, how to relieve joint pain, lower back pain, muscle pain and more. Is it the weather that makes it worse? Hard to say!
Numerous studies have shown slim associations between pain factors such as temperature, wind speed, humidity and barometric pressure and their effect on pain. Whilst the research is inconclusive, we know that for many of our patients, being in pain make us sensitive to weather changes and those with conditions such as osteoarthritis or rheumatoid arthritis tend to be amongst the worst affected.
Chronic pain can leave our nerves more sensitive to stimuli, and if you’re feeling chilly, you’re likely to tense up against the cold which in turn can cause muscle pain and joint pain.
So aside from cranking up the thermostat, what can you do to stay warm?
Five secrets to staying warm this winter
Secret 1: Dress warmly and in layers.
You might be tempted to reach for a warm baggy jumper, but don’t forget to wear a close-fitting base layer. This will help keep that body heat close to your skin. Layers will help to trap other pockets of warm air to help insulate your body, which a single thick and heavy layer simply won’t do. This will help keep you warm and cosy, avoiding aches and pains as it gets colder outside.
Secret 2: Chilli Peppers
Capsaicin (the active ingredient in chilli peppers) is safe and effective when applied on the skin in a cream or rub. It can be helpful for soft tissue pain, back pain and more. Using muscle rubs is often easier than a hot water bottle but the warmth from thos will help too!
Note: Ask us about our Hotspot Muscle Rub next time you’re in clinic- it’s completely natural, more effective than comparative products and contains clove and devil’s claw (for reducing pain and inflammation) with capsicum to leave you feeling warm for hours afterwards.
Secret 3: Watch out for hot toddies.
Christmas is the season for mulled wine and hot toddies! Whilst these might make you feel warm and toasty for a brief second, alcohol causes your blood vessels to dilate. This brings that nice warm blood up to the surface of your skin, giving you a temporary warm glow. This” glow” is quickly replaced by a drop in core body heat as the warm blood is diverted away. If you then walk home after an evening in the pub, be aware that you’ll have a lot of warm blood on the surface of your skin, so you’ll lose heat very quickly and easily- which could be dangerous. (More here)
Secret 4: Relieve back pain by lining your shoes.
If you’re standing around in the cold, it’ll quickly creep up into your legs and give you the chills. This can aggravate ankle, knee and lower back pain so make sure you have an extra layer between you and the ground. You can pick up lambswool insoles from high street shoe shops and online.
Secret 5: Ditch the gloves, and opt for mittens instead.
Keep your fingers together in mittents. This means your fingers share their collective heat in an air pocket rather than being isolated as they are in gloves. Makes sense, doesn’t it? This is a great tip for people with arthritis or poor circulation.
How can we help?
Chiropractic care is gentle, safe and effective for a range of conditions and can help alleviate the pain and discomfort associated with a range of conditions including osteoarthritis of the knee and hip, sciatica, lower back and neck pain, and joint pain. We also provide you with specific advice and exercises you can use to help alleviate your condition.
Did you find this interesting? You might also want to read our blog on falls prevention, which covers who is at risk, how to avoid falls, and what to do if you do have an accident this winter. Read the blog here.
Plus, six top tips on how to boost your immune system! Read here.
So today, I woke up earlier than usual and have reached a rare moment of having achieved all of my urgent and important tasks on my list I needed to do today by 11:30 AM. This level almost never happens and it got me thinking- what was the difference in motivation levels today?
The truth is, there isn’t one thing, but instead a gradual accumulation of small changes that I’ve made to my lifestyle recently which I thought I’d share four top tips with you, that have helped me master Mondays!
First things first- I swear by my Lumie Bodyclock, and it is my best friend during the winter months. Waking up feeling groggy is horrible- as someone who used to have about 15 alarms on my iPhone to get me up (not even joking) a natural daylight lamp like the Lumie Bodyclock makes mornings slightly more bearable. It helps prevent what’s called sleep inertia– the inability to feel alert and perform when we first wake up. Studies have shown that these lamps help raise cortisol (an important hormone which helps with metabolism, memory and blood sugar), improve our reaction times and make us feel more refreshed. Not only that, but it’s lovely to wake up to daylight in these darker winter months. Step One: Wake up refreshed.
Question for you- did you make your bed this morning? I did- and here’s why you should too. Watch this video (6.01 minutes) for some inspiration that will get you going today. Step two: Make your bed.
I significantly cut down on caffeine recently, and now tend to start my mornings with a few glasses of water with lemon in it- I prepare this the night before and leave it in the fridge so it’s nice and cold to wake me up. Your metabolic rate is boosted by about 30% by drinking two glasses of water and the added lemon gives you around 40% of your daily vitamin C- great for the immune system. It also contains vitamin B6 which supports a healthy nervous system, and flavanoids which support the immune system and have anti-inflammatory benefits. Step Three: Boost your brain.
Then, I ate the frog. Not literally (I actually had a rather nice omelette for breakfast). Eat that frog comes from a saying by Mark Twain- and it refers to doing the thing you dread the most first. So for me, this was catching up on some bookkeeping (*urgh*) BUT it means that I’ve now completed that task and have the rest of the day to fill with things that I enjoy- like taking care of my patients. Reading some new research articles. Enjoying the sunshine at lunch (instead of being stuck at my desk). Step Four: Eat that frog.
So there you have it- four simple steps to help you get going on a Monday, or in fact any day of the week!
It may or may not surprise you to find out there’s a lot of misleading information about back pain out there- more specifically, about what to do when back pain strikes and how to prevent it from recurring. This has not only over-simplified how to treat back pain but also lead to some weird and wonderful rehabilitation strategies.
Let’s bust a few of these back pain misconceptions.
1. Sit-ups will help improve your spinal health
Did you know that the average sit-up causes compression of the lower back that almost exceeds the safe limits set by the National Institute for Occupational Safety and Health (the unified set of manual lifting recommendations based on the convergence of medical, scientific, and engineering points of view which helps determine safe work practices)
Physical fitness does have an impact on our spinal health, but it is more important that we are getting fit in the right way. Studies have shown that increasing abdominal strength through sit-ups causes stress on the discs in our back and compresses the lumbar spine- enough for researchers to conclude that sit-ups may cause problems in almost anyone.
2. “Lift with your knees, not your back”
Have you ever tried to do this? Ever tried to do it all day long? It’s almost impossible to do this every single time we go to lift something. Forget the old squat technique, instead, the way you lift should depend on what you’re lifting, where you’re moving it to, your own build, how many items you have to lift and so on.
For more information on how to lift correctly (and give your knees a break) click here.
3. Strong muscles, strong back
Not so, my friends. Muscle strength doesn’t help us predict who will or won’t get back problems, and focusing too much on strength instead of stability will be sure to cause problems. Instead, focus on muscular endurance (i.e. how long your muscles can sustain an activity for). Remember, muscles have three main properties: flexibility, strength and endurance. Any issues that results in a lack of flexibility, strength or endurance will be enough to stimulate the nerves within your muscles and start telling your brain that something’s wrong. What’s the end result of that? Pain.
4. Tight hamstrings and unequal leg lengths cause back problems.
These types of issues are often given as easy diagnoses to simplify the cause of a patients’ complaint. Don’t be fooled. Some studies have shown that in athletes with ‘tight’ hamstrings, these muscles function almost like springs, to help jump higher or run faster. It rather appears that tight hamstrings aren’t the issue, it’s how well these tight hamstrings can cope with stretching that determines whether or not you’ll have back pain. Studies have found that people with chronic back pain tend to use their hamstrings instead of their gluteal muscles to extend the hip, which can increase the amount of force on the spine during squatting- correcting this is going to be a fundamental aspect of care.
Interestingly, back pain also wasn’t found to be definitively linked with leg length discrepancies even in cases where the difference in length was 5cm!
5. Scoliosis= A lifetime of back issues?
Not true! We see so many adults who were abruptly diagnosed with a ‘scoliosis’ after being
asked to bend forwards and touch their toes by the school nurse back in the 1970’s. The difficulty with this is that
the tests for assessing scoliosis have a false positive rate of at least 60%, and the statistical risk of having a scoliosis that requires treatment is only 0.2%. Why are we telling you this? Because once we’re told we have a “condition” it becomes ingrained in us. Part of who we are. So time and time again we see adults who tell us they have a “scoliosis”, and have been plagued by a lifetime of avoiding activities because of their diagnosis, when mild scoliosis (less than 30 degrees deviation) may simply be monitored and treated with exercise.
6. Knees to chest- the ultimate back stretch
Sure, it feels good, lying on the floor pulling your knees into your chest. Depending on your diagnosis, it might even be the right exercise for you, but if you’re one of the many patients I see who doesn’t cope well with forward bending, this exercise isn’t ideal. Why? Because pulling the knees to the chest gives you the perception of relief from your lower back pain (because the stretch receptors in your erector spinae muscles are stimulated) but this type of exercises causes more cumulative damage to the discs, leading to increased pain and stiffness the next day. As practitioners, we know to eliminate these type of exercises and prescribe ones appropriate for your needs- in fact this bespoke rehabilitation plan is one of the main benefits of coming to see a chiropractor.
So where do we go from here?
As you can see, misleading information and advice regarding back pain can lead to us performing the very movements that worsen our back pain in our attempts to get it better. Ensuring you have an accurate diagnosis, treatment plan and rehabilitation strategy is vital to recovery.No treatment plan can be truly successful without incorporating spinal rehabilitation exercises that work to remove the faulty movement patterns that cause back pain problems. We have to work with our clients to ensure that we incorporate exercises that help you build the capacity of the muscles in your back to cope with the tasks you ask of it each day. As you can imagine, each persons’ day is different, and so your treatment plan will be too.
We (as a society) throw huge amounts of money at back pain. There’s new gadgets, research, more effective drugs, better surgeries and dozens more practitioners out there all touting to be the next big thing in curing back pain, yet back pain remains as prevalent as it ever was. In fact, it seems to be getting worse.
So why is it that back pain is still such an issue?
Everyone is different. Gosh, wasn’t that a groundbreaking statement. Yes, well, forgive me for stating the obvious but, it’s true. If we treated your back pain the same way we treat everyone else’s, we’re not going to get very far, as unfortunately everyone’s backs behave differently (and misbehave differently!) That’s why all of these treatment that work for everyone else don’t necessarily work for you- because your back is different to theirs and you need to find the approach that works for you! P.S. This is why whenever someone asks me if I get bored “cracking backs all day” I can answer with a resounding NO! a) Because I don’t “crack backs” and b) because I have to not only work out what’s going on and diagnose it correctly but also work out how best to treat it based on what’s happening and what you want! It’s not quite as simple as handing over a pill and sending you out the door. Blimey, how boring would that be!
We’re treating it far too literally.
This is the big one! So many treatments out there focus on treating the area of pain as though that’s the cause of the pain. Pain in the lower back, treat the lower back. Monkey see, monkey do. Do you follow? Well, there’s two problems there. Firstly, if it was that simple to treat back pain, it wouldn’t be such a massive problem. Secondly, if we isolate our treatment and just focus on the spine, we are ignoring everything the spine connects to (and you don’t need a genius to tell you that the spine connects to everything!) As such, treating just one thing in the giant jigsaw that is your back pain is going to end up in tears and a lot of wasted time (and money). Of course we need to treat the site of pain (duh, that’s where it hurts!) but pain in itself only tells us there’s a problem, not where the problem is or what it is. Treating the site of the pain is lazy- we need to look at everything inside your body that impacts on the area of pain and could, as a result, be affecting it. Then, we need to look at everything outside your body (like your job, hobbies, environment) and see if that’s having an impact too!
As a really simple demonstration of this, do me a favour- Google “Cervicogenic headache.” Done it? What does it say? That it’s pain referred to the head from structures (i.e. soft tissues and joints) in the neck. So as you see, you could take a paracetamol or sit with an icepack on your forehead but as this isn’t the source of the pain, it’s not going to do much good in the long term. A good clinician needs to look further afield to find out what’s actually causing that pain.
Have a look at the image below- see how forward head carriage can cause dysfunction in your back and thoracic extensors?! What a waste of time it would be just treating the back and not addressing the forward head carriage (i.e. the issue that’s actually causing the pain!)
So if back pain is really so tricky to treat, what can we really do about it? Here’s two super simple tips.
1) Get in touch with mother nature. No, we don’t mean making skirts out of hemp and running naked through the wilderness (although feel free, if that’s your thing). We mean take your shoes and socks off and feel the ground.
The nerves in your lower back run all the way down to your feet for a reason! Your feet provide feedback to your brain that not only tells your brain where you are in space, but they also provide invaluable feedback to help stabilise your body. Stick some bulky trainers on to stop your feet from being able to feel the ground and those feedback signals sent to your brain get confused, which leads to instability. When the brain feels unsafe, or unstable, it’s going to make things hurt and reduce the amount of movement in the area.
(While we’re on the subject, where most people go wrong is that at this point, right when they have less movement, they strain against it to push the body beyond that threshold. As soon as you go beyond where your body is happy to go, the body has a habit of going into shutdown- it tenses up and produces pain to stop you from doing it again!)
Simply put- the more skin in touch with the ground, the more sensory input your brain gets, which it in turn feeds forward to your spine, giving you more stability and in turn reducing pain.
You’d think, given it’s something you’ve been doing your whole life, that you’d know how to breathe by now. But I bet you don’t! Do yourself a favour- for the next 24 hours, try and pay attention to how you’re breathing when you’re moving. My bet is that you hold your breath when you’re performing dynamic movements. Why? Read on, dear friends and all shall be made clear.
Breathing is closely related to spinal stability. If you think of your body as a barrel, the diaphragm is the top, and the pelvic floor the bottom. The diaphragm regulates our intra-abdominal pressure and contributes massively to our spinal stability. So when our spine is unstable and weak, we hold our breath to perform movements. This is an ill-informed attempt by our brain to increase our intra-adnominal pressure and maintain spinal stability because it’s worried that if we don’t, we’ll become unstable and get injured. Pull that belly button in towards your spine and breathe OUT as you perform dynamic movements- this will engage the good ol’ core musculature and take the pressure of your diaphragm and stop relying on the diaphragm alone to provide spinal stability. 24 hours, focusing on your breathing, that’s all I ask. Being mindful and aware is key to changing your habits.
In a nutshell, part of your treatment programme is going to involve teaching you how to breathe!
So there you have it!
Now you understand why back pain can be such a nuisance to treat. Fortunately, you’ve got those two simple steps to reducing your back pain. Doesn’t that sound like a great catchphrase?! Honestly though, if I could give one (okay, two) pieces of advice to every person I see in clinic, it would be those. Create some healthy habits to help your spine and I guarantee you’ll see an improvement.