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PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor

The Acorn Health PROMs: A Case Study

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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Why is it we often wait to get help for something until the pain becomes so intense we can’t do what we want to do?

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?

PROMs health chiropractic pregnancy baby childbirth paediatricsAnother 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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s initial responses

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!)

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s outcome at 1 month

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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Patient X’s outcome at discharge

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 PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthyso 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.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Acorn Health Outcome Satisfaction Results

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.

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PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor

5 Ways your foam roller could be more effective

Using your foam roller the right way could improve not only your flexibility, but athletic recovery and relaxation. Utilise the foam roller in the right way with controlled movements, with a neutral spine and normal breathing. Read on to discover 5 ways your foam roller could be more effective.

1. Keep breathing

Breathing activates the sympathetic nervous system. Not breathing at a normal rate sends a message to your brain that there is a threat to your body. Your body reacts by increasing heart rate and blood pressure as well as causing muscles to tighten and constrict — the exact opposite of what we want to happen.

While rolling, breathe in for five seconds and out for five seconds approximately. By focusing on your exhalation, you activate the parasympathetic nervous that activates the body’s healing mechanism.

2. Rolling the IT band firmly but not too aggressively 

The iliotibial band (ITB) is a fibrous tendon that runs up the outside of your thigh. Often it becomes inflamed after walking, running or hiking downhill. It contains many sensitive nerve structures and does not respond well to heavy, prolonged rolling.

The ITB reacts better to a few quick rolls, with body weight partially supported by your arms and other leg. The fleshy, muscular part of the ITB called the tensor fasciae latae (TFL, which runs up to the front of the hip) can often give you better results, along with rolling the quads, hamstrings and calf muscles.

3. Never roll your lower back

The body contains many joints, each of which has a specific job to do. The lower back is generally designed to be a strong core from which other body movements can take place. There is no need to roll the lower back, as true stiffness is rarely the problem. More commonly the hips and upper back are tight, which then leads to compression through the lumbar spine.

4. Neutral Spine

Foam rolling involves lots of different positions. Body awareness and good core stability are important to ensure you don’t injure yourself. In general, try and maintain a neutral spinal zone.

5. Controlled movements

Slow, focused rolling is better for big muscles like the quads, hamstring and calves. Pay attention to your body and if you come across any particularly tight areas you can hold the pressure there for up to 30 seconds, as the muscle slowly releases. If the muscle doesn’t release or you feel any unusual symptoms like pins and needles, it may mean you are compressing a nerve.

Please consult with your health care professional for further advice. If you are interested in purchasing a foam roller, please visit our shop for recommended products. 

Horse and Rider

A good rider knows that they must work in unison with their horse. To create fluid movements it requires symmetry, balance, coordination and stability. This doesn’t come easy, and requires training on both parts as a poor rider can ruin a good horse.Professional horse jumper

At Acorn Health we see patients that are involved in a variety of equestrian activities, including carriage driving, showjumping, cross-country and dressage. In addition to this blog post, we have prepared a brief video to help you reduce the impact of back pain whilst riding (see below), but first please read our hints and tips!

Lower back pain is a common problem in horse riders, due to the static position we adopt when riding – especially in the untrained rider. These problems reveal themselves through dysfunction and altered movement in the hips, pelvis, and lower back from the result of poor core stability, lack of flexibility, and instability in the saddle. There are some simple steps to prevent this.

If you only have a few minutes, scroll down to the bottom to read our top tips to improve these problems.

Restriction in the movement of the hips is a common problem, and this can affect the pelvic movement and motion of the lower back. The pelvis moves in a complex, multidirectional way when riding, if one area is not moving enough, another area will be moving too much to counteract this. Good core stability is vital to allow and support these movements. Insufficient movement through the hips can cause stiffening of the lower back and buttocks so the upper body may become loose (causing head bobbing or bouncing shoulders), or the lower body may become unstable (leading to flapping legs). An example is seen in the video below.

If you feel out of balance in the saddle, this may be because you are tipping forward through the pelvis. This in turn causes your seat bones (the ones you sit on) to angle backwards.  The result here is that the lower back hollows, and the hips are unable to move freely at this angle.  When this happens your body will immediately attempt to compensate for this, usually through recruiting other muscles to stabilise the area- commonly, the inner thighs or hip flexors (the muscles in the front of your thighs) will become involved, and this can lead you susceptible to yet more muscle and joint strain.

The image in the video demonstrates tipping forward through the pelvis causing hollowing of the lower back. The correct position of the pelvis in the saddle, and rotating backwards through the pelvis causing flattening of the lower back and protruding stomach.Hacking with horses

Importantly, these imbalances in the rider can also affect the way your horse is able to
move. Putting pressure on your horse’s back means that he will find it difficult to use his back and legs in the correct way. This impacts on your horses ability to swing their shoulders through the paces, and can cause them to have back pain too so over time, you will both perpetuate each other’s lower back issues.

Many riders find that their hamstrings (in the back of the thigh) and their quadriceps (in the front of the thigh) become shortened as a result of the position we adopt in the saddle.  Ensure you muscles are functioning at their best by adopting a good stretching routine.

What are the most common postural faults in riders?

  1. The “en avant” position. Leaning forward in the saddle and balancing the majority of the weight in the stirrups.  This is most commonly seen in show jumpers and cross-country eveners. Riding too much in this position also means you will be unable to provide the correct aids to your horse, and are already out-of-balance in the saddle. The pectoral muscles in the front of the chest become tight and sore, further encouraging rounded shoulders. Due to this imbalance, should the horse spook, you may find yourself thrown forward on to his neck or coming off over his shoulder.
  2. Riding too short or too long.  Stirrup length should be measured and adjusted on a regular basis. Why? As you become more flexible, your body will change and as a result subtle changes will adapt the length of the muscle.
  3. Tight hip flexors.  Tension through the front of the thigh will automatically lead to tension in the lower back, causing weakening of the abdominal muscles. A common mistake is to adopt a position in the saddle similar to the position we adopt when using an office chair. When the hip is over-flexed, the lower back hollows as a result which is a key contributor to lower back pain.
  4. Dropping the chin. Constantly dropping the chin to look at the horse causes strain of the muscles in the back of your neck, and weakening of those in the front. This in turn can lead to headaches, neck, and upper back pain. A rider should always be looking up and ahead, not down at the horse.

Top tips for reducing back pain in the saddle:IMG_8878

  1. Stretch. Riders rely on their quadricep muscles to bear the weight of their body, and the calf muscles must work to keep the heels down in the saddle.  This tends to lead to hamstrings becoming tight but weak, calves becoming long, and quadriceps shortening. Maintain suppleness and flexibility through your hips by stretching on a regular basis (not only before you get on the horse!)
  2. Focus on your core stability.  Yoga or pilates exercises will help teach you balance and coordination by encouraging your core muscles to work correctly, allowing you to maintain the correct posture in the saddle.
  3. Ensure your saddle has been fitted correctly.  A poorly fitting saddle can cause discomfort in the horse and affect its movement, often encouraging the horse to move asymmetrically to avoid pressure and pain from the saddle.
  4. Commit to physical fitness.  A lot of riders use riding as their only conditioning activity, but a well-rounded fitness programme (which includes core stability, stretching routines and cardiovascular exercises) will help improve your overall fitness and stamina, and reduce injury while riding.

Please see the full video with guided help here.

Injury for runners workshop

We hosted our injury for runners workshop todayknee acorn health
at The Run Company in Chichester.
We covered kinesiology taping techniques for common injuries for runners, and how the sport tape gives you the confidence to perform at your best.

The uses and benefits of kinesiology tape are overwhelming! At Acorn Health, we have utilised it for issues such as sports injury, post-operative rehabilitation, severe bruising and to help ease postural strains when pregnant.

Whether you’re training for your first marathon, getting ready for your next game, reaching a personal fitness goal, or just trying to get through the day, you already know that nothing slows you down faster than pain and injury.

Sport England has reported the number of people running on a regular basis has risen by more than a third since 2005. In over 10 years, running has become a favourite sport for many people but what should you do when pain and problems strike?  The most common running injuries are the focus of our workshops – join us on 19th August in Emsworth for the next injuries for runners workshop or visit our Facebook page for similar events. Just for fun – find out what type of runner you are by clicking here.Acorn Health leaflets irun

Please visit our resources page for guides on training for running events and more.

If you are unsure how chiropractic can help you please contact us on 01243 379693 or email acorn@acornhealth.org.uk.

Find out how we utilise kinesiology tape for pregnancy.

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Acorn Health Limited © 2014 - 2020

Website Created by WebHolism