Time after time the research shows that chiropractic care should be the first-line intervention for low back pain. “Chiropractors are well placed to provide evidence-based non-pharmacological care for their patients with low back pain, including advice about physical activity, applying judicious manual therapy, education that supports self-management, and a graded return to normal activities and exercise.”
It’s time to move away from surgery, scans and strong painkillers and instead focus on what works.
Did you know that oral health and general health are closely linked?�
Gum disease may increase your risk of all kinds of other health complications, including diabetes, stroke, and heart disease. It has even been linked with problems in pregnancy and dementia.
All the more reason to take good care of those pearly whites!
What to give the person who has everything? How about a voucher for a Thai or Remedial Massage?
£50 for a one hour massage, or £30 for 30 minutes, it’s the perfect pre-Christmas treat.
Pop in to clinic to purchase your voucher.
The health watchdog NICE (National Institute for Health and Care Excellence) is to recommend that vaginal mesh operations should be banned from treating organ prolapse in England.
The documents are currently undergoing consultation prior to publication, and in them NICE said there were “serious but well-recognised safety concerns” and that “evidence of long-term efficacy [for implants treating organ prolapse] is inadequate in quality and quantity”.
Hypopressives is a specific form of training which targets the core and pelvic floor, providing a non-invasive method of treating pelvic organ prolapse. Hypopressives training can negate the need for invasive surgery such as vaginal mesh operations, which are increasingly shown to be unnecessary and ineffective.
Back pain during pregnancy- it might be common, but it isn’t normal!
With top tips on how to avoid back pain during pregnancy, along with information and advice on the causes of lower back pain and how chiropractic can help, this resource is a must-read for all expectant mums!
In this resource, we also discuss the other considerations for expectant mums, including nutritional advice, exercises, and other factors that could affect your pregnancy. Download it here.
Did you know… A growing body of research shows that drugs such as paracetamol, ibuprofen, gabapentin and diclofenac are largely ineffective for back pain.
Opioids (such as oral hydromorphone, oxymorphone, morphine, tramadol, tramdaol with paracetamol, tapentadol, oxycodone, fentanyl and hydrocodone) have also been found to be largely ineffective with high risk of side effects including dependence.
Research recommends manual therapy, exercise, and cognitive behavioural interventions… all of which can be provided by a chiropractor!
What sort of training do Doctors of Chiropractic have?
A chiropractic degree is a four year full-time course, the first two years of which covers topics that are almost identical to those covered in a medical degree, and range from basic sciences such as embryology, physiology and biochemistry, to clinical sciences such as pharmacology and radiology. The key difference between chiropractic and medicine degree programmes is the weighting of the subjects. For example, chiropractic students spend a far greater amount of time on anatomy than medical students, but do not study pharmacology in as much detail as chiropractors opted not to have prescription rights.
A huge focus of training is on practical and clinical work, covering orthopaedic and neurological examination, general diagnosis, clinical nutrition, anatomy and physiology, behavioural sciences, psychology and mental health, clinical imaging, joint biomechanics, functional management, paediatrics, obstetrics, geriatrics and pathology.
As part of their training, chiropractors also engage in prosection and study of cadavers to truly appreciate the structure of human tissues and the anatomy of the body. In addition, our training focuses heavily on perfecting the manual techniques used in practice. Practical classes begin with learning to assess joints, muscles and nerves, introducing methods of treatment alongside. These classes build from a very basic level to the most advanced manual techniques in current medicine.
Finally, after years of academic and practical development, chiropractic students enter into a clinical year. This year is based in a specially designed teaching clinic. Students are supervised throughout this process, and by the end of the year have delivered over three hundred treatments and consultations each.
But it’s not over yet…. After completing their clinical year and graduating, chiropractors then must complete a year of supervised practice before becoming fully-fledged Doctors of Chiropractic!!
Did you know… why Brad Pitt has such a defined jaw? It’s probably due to overdevelopment or hypertrophy of the masseter muscle.
The masseter is located in your jaw, and based on its size, it’s actually the strongest muscle in the human body. With all muscles of the jaw working together it can close the teeth with a force as great as 55 pounds (25 kilograms) on the incisors or 200 pounds (90.7 kilograms) on the molars.
Think of that as you’re tucking in to your Sunday lunch!
💭KNOWvember💭 ⚽ Mac’s Story ⚽
Mac came to see us in September because he’d had hip pain for over 7 months. As a keen footballer, it had stopped him from playing and was understandably getting him down. He had a severe limp and was struggling to walk and sleep
After a thorough assessment, we diagnosed him with sacroiliac joint dysfunction, a complex issue which is common in footballers, complicated further by an old quadricep muscle tear in his right thigh causing some issues!
We’ve treated him five times with a combination of joint adjustments, soft tissue work, kinesiology taping and rehab exercises. Here he is with Philippa today having popped in for his final appointment- We’re delighted he’s pain free and back on the pitch playing for Widbrook FC.
Chiropractic- it’s not just for back pain!
Your brain cannot feel pain.
When you stub you
r toe or touch a hot stove, your body releases chemicals that trigger signals to go up to the brain, telling the brain about the pressure from the stubbed toe, or the heat from the hot stove. Your brain then interprets that information and decides what to do with it- generally, it’ll tell you it’s painful so you stop touching the stove or rub your toe better!
Although the brain interprets these pain signals, the brain itself does not feel pain, only the structures around it can do that!
As a matter of fact, once inside the brain, surgeons can operate on the brain without anaesthesia. In one technique known as brain mapping, surgeons probe brain tissue while monitoring reactions like muscle movement and speech — all while the patient is awake!
You might have seen this poster on Philippa‘s treatment room wall. This chap wasn’t caught up in an explosion in a paint factory, this image shows a “dermatomal map” of the human body. (The colours are actually just for fun!🌈)
A dermatome is an area of skin supplied by a single spinal nerve. By testing the dermatomes in conjunction with a range of other neurological and orthopaedic tests, your chiropractor can identify not only where a problem might be in your spinal cord, but also what type of problem it is!
This rather fetching looking chap is called a “homunculus” and he’s a little man who lives in your brain. (Sort of!)
The homunculus is a model that shows how your brain sees your body. The cortical homunculus represents the importance of various parts of your body as seen by your brain. Most of us have very sensitive hands and lips, hence why these areas appear larger on the homunculus.
Did you know these “mental maps” can change with experience. People who read Braille (which is done with an index finger) develop large areas that respond to stimulation from the index finger. A homunculus mapped on the motor cortex of a Braille reader would have an absolutely enormous index finger!
The word “muscle” comes from the Latin for “little mouse”, musculus (the diminuitive of mus).
There are two theories behind a mouse becoming a muscle- firstly, that the Romans thought the movement of a contracting muscle resembled a mouse moving under a rug. Or secondly, that in a rather abstract way, a muscle looks a little like a mouse- with a round body (muscle belly) ending in a long thin tail (the tendon).
What do you think, can you see a resemblance? 🐁
Did you know… Kinesiology tape is just one of the many adjuncts that might be used during your chiropractic treatment. You can purchase Sporttape from us in clinic- find out how it works and why we use kinesiology tape for pain and problems. Read more here.
Did you know… Our acupuncturist Gillian is a former midwife and has specialist knowledge in helping couples undergoing fertility treatment.
Acupuncture may help boost fertility by:
– Regulating hormone function
– Increasing blood flow to the ovaries and uterus and helping to relax your muscles which can improve the chance of an embryo implanting.
-Tackling the causes of polycystic ovary syndrome (PCOS) – a common cause of infertility
– Generally helping to relieve stress and make you feel more relaxed
Did you know…. Chiropractic is the third largest primary healthcare profession in the world after medicine and dentistry!
Did you know….
Although chiropractors are known as spinal health care experts, chiropractic care is also effective for:
– Ankle sprain
– Cramp and muscle spasms
– Elbow pain and tennis elbow that has arisen due to an ssociated musculoskeletal condition of the back or neck
– Headache arising from the neck (cervicogenic)
– Inability to relax
– Joint pains including hip and knee pain from osteoarthritis
– General, acute & chronic backache and back pain
– Generalised aches and pains
– Mechanical neck pain
– Migraine prevention
– Minor sports injuries and tensions
– Plantar fasciitis
– Rotator cuff injuries, disease or disorders
– Shoulder complaints (dysfunction, disorders and pain)
– Soft tissue disorders of the shoulder
Did you know… Your spinal cord has an incredible memory for pain. When you experience an instance of intense pain, such as an acute back pain episode, the neurons in your spinal cord will carry signals more easily to the nerves in your back for several days, making your back feel more sensitive during this time. This is the result of a molecule thought to be the precursor to memory, known as PKMzeta. Your spinal cord is especially sensitive to this molecule and “records” instances of pain as a result.
This can make us more susceptible to future episodes of pain when we repeat actions that previously lead to injury, as the spine “remembers” those signals and (much like anything that is practiced over time) gets very good at sending them.
As a gentle, safe, non-invasive way of dealing with back pain, look no further than chiropractic care.
Did you know… We’re often asked where the name “Acorn Health” comes from. It’s from the old English proverb “Mighty oaks from little acorns grow” meaning great things can come from small beginnings!
Our clinic started in 2014 with just Philippa practicing from a single room in Emsworth, and our ‘little acorn’ has grown and flourished into its own premises in the heart of Emsworth with a wonderful multidisciplinary team. This is all thanks to some hard work and the incredible support of our colleagues, friends, family, patients and the local community.
The proverb also conveys to us a sense of growth, health and vitality- and our belief that no matter what, everyone can achieve optimal health… Something we are privileged to see our patients achieve under our care.
The quicker you’re seen by your chiropractor, the faster you’ll get better.
Too often, people suffer in pain for months before seeing a chiropractor as their “last resort”.
Research consistently shows that early intervention and care has a profound effect on both how well and how quickly you’ll recover.
Our ethos is delivering effective, evidence-based healthcare that is uniquely tailored to you.
You deserve the very best healthcare available, and we’re continually reinvesting in ourselves, our knowledge base and our clinic to ensure we provide you with an exceptionally high standard of healthcare.
At our clinic you’ll be treated as an individual, listened to and respected every step of the way.
Did you know… Chiropractors are trained to treat all areas of the body, but specialise in assessing, diagnosing and managing conditions of the spine.
Before starting treatment, your chiropractor will do a full assessment, which will involve taking details about your condition, current health and medical history, and perform a full physical examination (to assess the function of your joints, nerves and muscles) to help make a diagnosis.
If you’ve seen a chiropractor before but it’s your first time seeing Philippa, you might be surprised at just how different her treatment and treatment programmes can be. Philippa often refers to her metaphorical “treatment toolbox”- the skills and treatment modalities she has to choose from which she tailors to your needs based on what’s wrong and what type of treatment you would prefer. This means each and every patient receives an entirely new and individual treatment programme, based on your requirements.
“Slipped discs”- the much-maligned cause of lower back pain. Or are they?
Ah, “slipped discs”. Many of our patients come to see us because they’re worried they’ve got a bulging or slipped disc. To properly explain a disc injury, we need to understand the anatomy of the area and what we’re dealing with. The spine is made up of individual bones called vertebrae. These vertebrae are attached to each other with ligaments which provide additional support and strength. There are also numerous muscles which surround and attach to the spine. In between each vertebra in the spine is a disc which is made up of two parts (rather like a jam doughnut!) There is a tough, rubber-like outer part called the annulus fibrosus, and a softer jelly-like middle part called the nucleus pulposus. These discs sit in between the vertebrae and act as a shock absorber for your spine- a job they ordinarily do very well. Like a doughnut, there’s a certain amount of “squish” to them. This means they can withstand a large degree of force without any issue at all.
A disc protrusion occurs when there is damage to the tough outer layer of the disc. In some cases this allows some of the jelly-like nucleus pulpous into the spinal canal, where the spinal cord passes. This type of issue can put pressure on the whole spinal cord, or just one single nerve root (where a nerve leaves the spinal cord).
Whilst the words bulge or protrusion may seem interchangeable, they do have different meanings.
Disc herniation/protrusion= less than 25% of the disc diameter is involved
Disc bulge= more than 25% of the disc diameter is involved (these are often broad and can involved the whole disc)
Disc extrusion= similar to a disc bulge or herniation but one that extends above or below the level of the disc
Disc sequestration= the material of the disc extrusion passes into the spinal canal and may become separate from the rest of the disc material.
How (and why) do disc injuries occur?
It’s not clear. There is an age factor, as we get older our discs have a lower water content and are therefore more likely to become injured.
Some studies have indicated that repetitive loading and compression of the spine (particularly in forward and backward bending) may have an affect. This was performed on porcine spinal segments (pigs!) This is still worth considering when we see someone in clinic who has a job that involves a lot of manual lifting.
Rotation or twisting may also increase the likelihood of a disc injury. Twisting causes micro-injuries to the annulus fibrosus, leaving the discs more open to injury.
Occupational factors are also important as the risk of lumbar disc injuries are higher among both men and women who have strenuous, physically demanding jobs. People who do a lot of driving may also be at risk. (Sitting puts the spine in a sustained position of slight forward bend which may explain this). Poor posture can also affect spinal flexibility and increase the likelihood of a disc injury.
Smoking also plays a role, as it affects the flexibility of the discs. Lack of regular exercise, a poorly balanced diet and being overweight can also contribute to poor disc health.
So why won’t anyone MRI me?
Good question. Guidelines nowadays state that MRI’s for lower back pain should only be taken when considering referring a patient for spinal fusion surgery. In fact, the use of most imaging modalities (such as x-ray or MRI) are strongly discouraged as they show so many false alarms. We know from numerous studies, that a large number of pain free patients will show disc protrusions on imaging. But they’re pain free! Just because an MRI shows a disc injury doesn’t mean that this is why you’re in pain.
An example of this– In 1989, 67 asymptomatic patients with no pain and no history of back pain were given MRI’s. Clinicians wanted to see if they could predict which of these patients would develop back pain. They followed these patients for 7 years to see if they did develop back pain. At their initial scans, 31% of these asymptomatic, pain-free patients had an “identifiable abnormality” of the disc or spinal canal at this time. (12 patients had normal findings, 5 had herniated discs, 3 had spinal stenosis, and 1 had moderate disc degeneration.) 7 years later, these patients were contacted to see if they had developed back pain, and 31 of them were sent for a repeat MRI. Of those who completed the follow-up assessment, only 21 subjects developed back pain within the 7 year period after the initial examination. At follow-up, 58% of them had no back pain at all, yet the repeat MRI showed more disc protrusion, degeneration and spinal stenosis than the original scans. This study basically scuppered the theory that an abnormality on an MRI was a predictor of developing back pain or sciatica!
That’s not the only study, either. We’ll do the rest quickly!
Fraser et al (1995) 56 patients were MRI’d 10 years after treatment for disc herniation. At the 10 year follow-up, 37% of patients still had the disc protrusion, but there was no relationship between the persistent disc herniation and the degree of patient satisfaction. (“The presence or absence of herniation at 10 years had no significant bearing on a successful outcome.”) So patients had a “successful outcome” from treatment, but still had the disc injury.
Jenson et al (1994) 98 asymptomatic (pain-free) patients were MRI’d, and 64% of participants had abnormal findings on the MRI. 52% had a disc bulge, 27% had a disc protrusion. 1% had a full blown disc extrusion- yet they had no pain.
Do you see what we mean? Here’s a few more!
Boos et al (1995) 46 asymptomatic people who were thought to be “high risk” for disc injury (due to the nature of their work which involved frequent bending, twisting, heavy lifting, contact with vibration or sedentary job roles) were MRI’d. 76% of these people who were pain-free but at high-risk of developing a disc injury were found to have at least one disc herniation yet they had no pain! Not only that but 85% had confirmed disc degeneration at at least one spinal level.
Weishaupt et al (1998) 60 people who had never had back pain before were MRI’d (20 aged 20, 20 aged 30, 20 aged 40). 24% of the group had a ‘disc bulge’, 40% had a confirmed disc protrusion, 18% had disc extrusion.
Masui et al (2005) conducted follow-up studies of 21 patients who were treated conservatively (without surgery) for painful disc injuries. They found that there was progressive disc degeneration in all of these patients, but no relationship between MRI findings and continued pain. The authors concluded “clinical outcome did not depend on the size of herniation or the grade of degeneration.”
What can we tell from these studies?
In any group of people, around 60% of them would have some type of either disc protrusion, bulge, herniation, extrusion or sequestration with or without nerve root compression.
This has all been summed up nicely in a recent study by Brinjikji (2014) “Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.”
Now of course there are cases where we do worry. No practitioner in their right mind would ever ignore a red flag, which indicates underlying pathology. When it comes to MRI’s it’s near impossible to get a completely healthy looking scan out of anyone. It just doesn’t happen, and yet most of these “abnormal findings” on MRI’s are clinical red herrings. They’re as unremarkable as that birthmark on your leg, and yet they can scare people silly.
Can’t I have an MRI just in case?
Surely an MRI “just to rule it out or confirm it” isn’t harmful, right? Wrong! MRI’s and x-rays, particularly those that do come back with some form of abnormality can genuinely scare people. These investigations reinforce the idea that something is wrong, broken, damaged. What we all know to be true is that pain is always worse when you believe you are in danger.
To quote the great Lorimer Mosely:
“Any piece of credible evidence that they are in danger should change their pain … And they are all walking into a hospital department with models like this on the desk: what does your brain say when it sees a disc that’s slipped so far out it’s sitting on it’s own? If you’ve ever seen a disc in a cadaver, you can’t slip the suckers — they’re immobile, you can’t slip a disc — but that’s our language, and it messes with your brain. It cannot not mess with your brain.” Watch his talk here.
Your spine is a fundamentally stable structure. Discs don’t slip in and out for no good reason. Nerves don’t get “trapped and untrapped” and your spine is actually well-equipped to cope with most stresses and strains. Stop worrying- worrying about it serves no function other than to ruin your day!
If you’ve read our “Understanding Pain” blog you’ll know that whilst pain isn’t all in your head, the psychological stuff going on in there does affect your pain, and this is why in our chronic pain patients we do recommend CBT or at least doing some research into understanding pain. How you think and feel about your back affects how much pain you perceive. It’d be fairly silly of us as clinicians to ignore that. This is why it’s so important your chiropractor reassures you during treatment. In addition, we also need to help you understand what’s happening and encouraging you to get back to normal activities.
“You’ve got a slipped disc” seems to be said too often and carelessly by healthcare providers. It’s an easy enough thing to say, it’s often in line with what you think is going on yourself. Now whilst it’s easy to give a diagnosis like that, it’s clinically inaccurate and psychologically damaging. Plus, as you can see from all of the above studies, it’s unlikely to be the real reason you’re experiencing low back pain. We’re much more interested in identifying the actual underlying cause for the pain. This could be inflammation in the spinal structures, restricted joint movement, muscular tension or nerve irritation. Addressing this will get help get you better.
Don’t blame discs- They’re not the problem! Let’s find out the real cause of your back pain instead.
Did you like what you’ve just read? Keen to find out more? Download our bestselling resource “Understanding Pain” to find out how your brain adapts to chronic pain, and what you can do to overcome it!
Prefer to listen instead? Here’s Philippa’s recent talk on slipped discs.