Tag: Royal College Chiropractors

chiropractor chiropractic Philippa oakley emsworth mckernan Hampshire

Six back pain myths- busted!

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

Feet back pain chiropractic chiropractor osteopath physiotherapy massage back pain neck pain treatment injury recovery Hampshire Emsworth Chichester SussexNot 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?back pain neck chiropractic scoliosis myth chiropractic chiropractor spine health acorn health emsworth chichester hampshire treatment therapy portsmouth southampton

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.

 

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

Healthcare: What made the headlines in 2015?

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.

Happy New Year!

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.

1.  A cure for Ebola

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.

2. Sexism in the ER

One of the most widely-shared articles on the internet in 2015, this article from The Atlantic posed some interesting questions about how doctors interpret (or in fact, underestimate) women’s pain.  In America, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing.  A harrowing and extreme example perhaps, but it highlights the ultimate need for all healthcare professionals to listen, understand and consider each person as an individual before making a clinical decision. There is no place for assumptions or generalisations in healthcare.

3. When the media gets it wrong

In a classic example of misinterpretation, a report from the American Journal of Cardiology caused quite a stir when it suggested that “strenuous jogging is as bad as no exercise at all.” The claims were quickly clarified by the NHS, as what the media failed to make clear here was the size of the demographic involved Acorn Health Mensin the study- once the 1500 participants had been split into groups based on duration, frequency, and pace, some individual groups – particularly the most active groups – were (by research standards) too small to draw any real clinical significance from, with just 36 runners classified as “strenuous joggers.” As a result, the analyses conducted were less able to detect what, if any differences were present between the two groups.  A classic example of needing to know the full picture when drawing a healthcare conclusion like this. (N.B.  The biggest concern with exercise is not “overdoing” it. It’s not doing enough! If you’re thinking of taking up a new hobby in 2016, let’s keep you injury free.)

4. Kinesiology tape

Our most popular post of 2015 was “Kinesiotape during Pregnancy”, which to date has had a whopping 22,800 social shares. Kinesiotape is paradoxically gentle, yet strong, and depending on the way it is applied, it creates an effect on skin that improves circulation, relieves pain and supports muscles and joints which can be a huge help for mums to alleviate some of the postural aches and pains associated with a growing bump!

5. Back pain and paracetamol

An article published in the British Medical Journal back in March of 2015 confirmed what many of us have known for some time- that paracetamol is ineffective for back pain.  With prescription of paracetamol being the most common approach to treatment used by general practitioners for spinal pain and osteoarthritis of the hip or knee, this has highlighted the need for a review and potential reconsideration of current recommendations that support the use of paracetamol for these groups.  The current guidelines from the National Institute of Health and Clinical Excellence support the use of manual therapy for low back pain, alongside a structured exercise programme. Good news for Acorn Health patients who will know this is a fundamental part of our treatment programmes.

6. Our big news

2015 was a fantastic year for us as Philippa was accepted into the Royal College of Chiropractor’s specialist Pregnancy and Paediatric Faculty.  These specialist faculties recognise chiropractors who have undertaken Corporate office business work workstation assessment chiropractic chiropractor back pain health Emsworth Chichester Portsmouth Hampshire Farehamformal 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.

7. #NHSWorkingXmas

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!

8. Sugary Strikeback

red berries acorn health food fruit2015 brought sugar to the small screen in the form of the controversial Jamie’s Sugar Rush. One of our favourite pieces of the year was this article from the Huffington Post, showing what sugar does to your brain. In addition to being a key contributor to rising obesity levels, sugar is also known to impair memory, contribute to depression and anxiety and is linked to cognitive decline and dementia.  2015 was definitely the year that the UK began to combat the hidden sugars in our food, and began to make healthier dietary choices.

9. First Paracetamol, now Nurofen

The UK-based manufacturers of Nurofen, Reckitt-Benckiser were forced to defend their product after Australian courts ordered certain products off the shelves after finding each product, despite being marketed as able to treat specific pains, such as migraine, were identical to one another and contained the same active ingredient, ibuprofen lysine 342mg. Prices for these products also averaged around £3.49 for a box of 16 capsules. Why is it that snazzy packaging and good marketing so often tempts us in? We’ve said it once, we’ll say it again. Save your money and buy generic. (They’ll cost you about 30p instead!)

10. Paraplegic man walks again

An accident 5 years ago left a 26 year old American man paralysed from the waist down, unable to use his legs. This year, scientists successfully rerouted nerve signals from the man’s brain to electrodes on his knees, enabling him to become the first person with paraplegia caused by a spinal injury to walk without relying on robotic limbs that are controlled manually.  Yes, our jaws dropped at this one too.  Around 50,000 people in the UK live with paralysis, and whilst this treatment surely won’t be appropriate or possible for each of them, it was a truly groundbreaking achievement in science, and a step on the path to giving this young man back his independence.

Quick bits:

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!

healthcare health emsworth hampshire chiropractic chiropractor

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Opening Times

Monday 08:30 – 19:00
Tuesday 09:00 – 19:00
Wednesday 09:00 – 19:00
Thursday 09:00 – 19:00
Friday 08:30 – 19:00
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Acorn Health Limited © 2014 - 2019

Website Created by WebHolism