The World Health Organisation defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” So what’s this concept of “wellness” all about? Well, wellness is basically healthiness… It’s the active process of becoming more aware of your health and making positive changes towards leading a healthier, more fulfilling life.
The concept of “wellness” can often be a dirty word in healthcare circles, as it has long been associated with antiscientific or pseudoscientific ideas… But that depends on what wellness means to you. To us, wellness is health. It’s living a healthy and fulfilling life, and taking responsibility for your own health. We’re taking ownership of the word wellness and are going to strive to clean up its reputation!
As an evidence based clinic, we rely heavily on what research tells us is effective for managing conditions or symptoms, and as such the treatment protocols that we utilise can vary quite dramatically depending on what the latest high quality research says is effective. We don’t sell long treatment plans, and you shouldn’t buy into one either- it’s impossible to know that someone will need 12 treatments to get you better when they first start seeing you- instead, a short course of treatment should be proposed and that should definitely include a review appointment where you discuss your progress and determine if you should be discharged from care. We collect patient reported outcome measures to ensure that we do not over or under-treat our patients, and this provides us with an opportunity to identify how effective the treatment is that we’ve provided,
(P.S. We monitor how many treatments our patients receive on average- it’s just 5 appointments over a 3 month period!)
We promise you that as an ethical healthcare clinic we will never offer you ineffective, unnecessary treatment.
If you were lucky enough to be born in the UK, chances are you’ll have encountered the NHS once or twice. The NHS is a fantastic system for taking care of us, but it is overstretched, overburdened and not coping. When it was established in 1948, life expectancy for men was 66 years old, and for women, 71. Today those figures are 77.2 and 81.5. Over the past 60 years, the proportion of all deaths caused by cancer has risen, from 16.9 to 27 per cent. It took 50 years for the UK population to increase from 40 to 50
million between 1898 and 1948, but in just 24 years the population will increase by 10 million – and hit 70 million in 2029, according to the Office for National Statistics. Simply put, there’s more of us, we’re living longer, with more diseases and more complex health needs than ever before. Our poor NHS can’t cut it.
The NHS will always be there for us when we get sick- but how about we work a little harder to stop ourselves needing it in the first place?
More and more people are recognising a need to take responsibility for their own health and are striving to lead a healthier lifestyle. This can be through small steps, such as reducing your alcohol intake, not smoking, regularly exercising or you might take it a little further, with bespoke nutritional programmes, chiropractic care to optimise performance and move well, in addition to regular care to address the stresses and strains we put our body through on a daily basis.
Ahh, “holistic”. Another dirty word. Or is it? Philosophically, holism is described as “the belief that the parts of something are intimately interconnected and explicable only by reference to the whole.” From a medical perspective, it’s characterised by “the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.” Doesn’t sound so bad to me- as humans we do need to consider the person as a whole. Someone with back pain doesn’t just have back pain- they have a problem that’s preventing them from going to work (social issue), that’s causing them anxiety (psychological issue), that’s limiting their ability to walk (physical issue) and no doubt a whole host of other problems. So it would be churlish to only consider the physical issues- that’s probably not going to get them truly better, particularly for those with high anxiety levels as there’s a whole host of research that tells us they need more specific management to help with their back pain. We need to acknowledge their
needs as a whole. We need to ensure we address all these aspects in order for them to recovery.
We also need to consider the why behind their pain. For example, a smoker will report higher levels of pain perception than a non-smoker. That’s an environmental issue. So an holistic approach would aim to tackle the smoking also (not least for the hundreds of health benefits you see from being a non-smoker) and encourage you to take active steps towards leading a healthier lifestyle (there’s that wellness
definition popping up again!)
This is what we aim to provide for our patients- not just addressing the physical symptoms but ensuring that all your health needs are met.
So when we talk about taking an holistic approach to wellness, that suddenly doesn’t sound like such a bad thing, does it?
I saw a lovely lady in clinic today who was suffering with symphysis pubis dysfunction (SPD), which had been bothering her since she was just 16 weeks along in her pregnancy (she’s now nearing her due date). This is quite a common reason for people coming to see me in clinic, so let’s talk about pelvic girdle pain and how a chiropractor can help you.
Pelvic girdle pain (PGP) is common, but not normal, and as anyone will tell you, being in pain can really sap the joy out of your pregnancy. Symphysis pubis dysfunction is now broadly categorised as PGP- an umbrella term for all pain in the pelvic area which could include the lower back, abdomen, hips and thighs. PGP can cause back, hip and groin pain, disrupt your sleeping and affect your walking, amongst other issues. It’s really not fun! Just to complicate matters further, SPD can affect you at any time during your pregnancy, and sometimes even after giving birth (if not managed appropriately). Needless to say, this can cause physical discomfort and emotional distress so it is important to seek help early on- the sooner treatment begins, the sooner you’ll feel better.
Pelvic girdle pain simply means pain in the joints of the pelvic girdle, including the two sacroiliac joints at the back of your pelvis and the symphysis pubis joint at the front of your pelvis. Dysfunction within the pelvic girdle can affect the pelvic floor (the basket of muscles which hang from the bones of our pelvis), and if the pelvic bones are rotated or dysfunctional, the muscles don’t hang (or function) correctly, affecting spreading of the pelvic floor muscles and symmetrical dilation of the cervix during labour. This can lead to a difficult birth process for both mum and baby, but fortunately if good care has been taken to protect the pelvic girdle from additional strain and trauma, most women with PGP can have a normal vaginal birth. If you are concerned about the birth process, do discuss this with your practitioner, midwife or GP.
SPD can worsen as the baby increases in weight, as a result of postural changes as pregnancy advances, and resultant changes in the body’s centre of gravity. During pregnancy, our body releases a hormone called relaxin which softens our ligaments (which are like strong elastic bands which connect our joints)- this is to allow the baby to pass through the pelvis during birth, and normally lax ligaments in the pelvis during pregnancy do not cause an issue, however uneven movement in the pelvic joints (often termed “misalignment”) or imbalance in the muscles can cause irritation to the joints of the pelvis, resulting in pain.
To a chiropractor there are numerous other issues in the pelvis that can cause PGP without it being SPD (Gosh, that’s a lot of abbreviations!) so it’s important to rule out other possible causes before working on a diagnosis of SPD.
It’s hard to say… the research in this area is largely inconclusive when it comes to identifying risk factors for developing pelvic girdle pain, but we do know one of the major reasons for developing back pain in pregnancy and having difficulties during labour is poor musculoskeletal health in the mother. Why? Well, a job that involves a lot of sitting down and little exercise out of work can mean that the tone and activity in the muscles that stabilise the pelvis (such as the abdominals, pelvic floor muscles and the gluteal muscles in the buttocks) is reduced, and they struggle to tolerate additional stress during pregnancy which can lead to ongoing discomfort.
Around 20% of pregnant women will develop some form of pelvic girdle pain during pregnancy and we know that other risk factors include a history of pelvic or lower back pain (both during pregnancy and when not pregnant). The good news is that whilst 1-2 % of patients may have persistent pain one year after giving birth, in 93% of cases, the symptoms of PGP settle within the first 3 months post delivery.
Pregnant patients require a gentle, drug-free alternative for treating their discomfort and so seeking chiropractic care is a logical choice as it is a safe and effective treatment option, not only for treatment of pelvic girdle pain but also other musculoskeletal problems that may arise during pregnancy. Not only that, but it can help avoid a difficult labour, may mean you can stay at work longer and can reduce long-term disability.
Chiropractic treatment doesn’t just involve manual adjustments of the spine (chiropractic care is SO much more than that). We use numerous gentle techniques during treatments including soft tissue work, fascial release, acupuncture, exercises, postural advice (including optimal foetal positioning) and perhaps most importantly, we work with you to ensure you understand your condition and know how to manage it. Chiropractic treatment is recommended for pelvic girdle pain by the Pelvic Obstetric and Gynaecological Physiotherapy- you can read their guidance on PGP here.
In the case of our patient, we adjusted the sacroiliac joints and pubic symphysis, but in addition we also adjusted the thoracic and lumbar spine, and released the diaphragm and psoas muscles in the abdomen as we know that these abdominal muscles are key contributors to pelvic pain. Remember- only a fool treats where the pain is, so as chiropractors we have to make sure that all factors contributing to the pain have been addressed! Our patient also went away with some kinesiology tape on her pelvis for support- more about that here.
Yes- there are some simple exercises that you can do at home to help alleviate discomfort. In addition to giving you exercises we also advise you on ways to move that will help protect your pelvis and avoid aggravating the condition. Always speak to your practitioner to determine if an exercise is appropriate before attempting it. All the exercises we provide our patients are bespoke to them based on the results of their examination.
Sometimes a pelvic belt can offer relief, particularly when you’re up and moving around. We prefer to use kinesiology tape to help our pregnant patients as this provides support to the structures without limiting movement.
We’ll also be running some kinesiology tape during pregnancy workshops periodically throughout the year, so make sure you subscribe to our newsletter and follow our facebook page to keep up to date with these events.
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.
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.
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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.
This, without doubt, is top of our list of 2015’s successes. Since the 2014 ebola outbreak, over 11,300 lives have been lost but a new vaccine that has been heralded as a “potential game changer” saw a huge drop in the number of new cases. Whilst the disease has not been totally defeated yet with a risk of new outbreaks or long-term side effects still a very real issue, just two days ago, the World Health Organisation declared an end to the ebola outbreak in Guinea.
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.
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.)
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!
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.
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.
Lewisham and Greenwich NHS Choir beat out Justin Bieber for No 1 and the hashtag #NHSWorkingXmas became a Twitter trending sensation in the UK. Yes, 2015 was the year that the NHS fought back! With the start of the year plagued with media coverage of Jeremy Hunt’s intention to impose new contracts affecting junior doctors throughout the NHS, doctors promptly took matters into their own hands and answered back with #ImInWorkJeremy, in response to the health minister’s comments on a “Monday to Friday working culture” within the NHS. With a number 1 single under their belt and a Twitter trend to their name, we felt that the NHS saw the year out on a high note!
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.
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!)
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!
We hosted our injury for runners workshop today
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.
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 email@example.com.