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stretch muscle reflex stretchy injury knee pain relief chiropractic chiropractor education blog physiotherapy physiotherapist health rehabilitation painful sports injury training fitness emsworth chichester hampshire sussex stretching

Stretching won’t make your muscles stretchy

Stretching doesn’t work the way we think it does. At all. If you’ve ever spent your time gritting your teeth, pulling your arms or legs or (eek) neck into weird and wonderful positions to feel that pull, before noticing that a few hours later they’re back to where they were before, you’ll know that stretching doesn’t make your muscles stretchy. To understand why stretching isn’t the key to flexibility, we first have to understand a bit more about how and why our muscles stretch in the first place.

All humans have a reflex in our nervous system called the myotatic reflex. Believe it or not- you’ve probably had this tested without even knowing it. It’s the one we activate when we use a reflex hammer to hit just below your knee which makes your leg jump, or the one just above the elbow which does the same to your arm.

stretch muscle reflex stretchy injury knee pain relief chiropractic chiropractor education blog physiotherapy physiotherapist health rehabilitation painful sports injury training fitness emsworth chichester hampshire sussex
The C6/7 reflex

This reflex is the body’s pre-programmed response to a stretch stimulus in the muscle. When the muscle is stretched (as in when hit by the reflex hammer), an impulse is sent to the spinal cord to contract that muscle (and relax the muscle that works in opposition to it), causing the limb being tested to jump. These reflexes are what are called “monosynaptic” as there is only one junction for any signal to pass through before the body sends a response (the message going in->junction->message coming back happens in the spinal cord, bypassing the brain to make sure the response happens quickly) Think how rapidly your knee jumps when it’s hit by the reflex hammer- it’s usually just 1-2 milliseconds before the body responds.

We use these tests in clinic to check the integrity of your spinal cord and the peripheral nervous system, and they can be vital in helping us identify neuromuscular conditions. But that’s not what we’re talking about today. You might be wondering what purpose these reflexes have? Well, one of their most important functions is to prevent us from tearing our muscles/tendons/ligaments. Let’s look at the patella reflex to demonstrate this:

The patellar tendon is tapped just below the knee, which puts a rapid stretch into the tendon which attaches to your quadriceps muscle (the muscle in the front of your thigh). Muscle spindles (sensory receptors that pick up changes in the length of the muscle) pick up on this rapid increase in the length of the muscle, and very quickly send a message to contract your quadriceps in order to stop the muscle or tendon from over-stretching and causing damage. What happens when your quadricep contracts? Your lower leg comes flying up! If it doesn’t, it could indicate an underlying condition or disease affecting your muscles and nerves (which is why we always test them in clinic!)

What else do reflexes do? Well, they also stop us from falling over all the time. Stand up for a second. Now lean over. As far over to one side as you can go. What happens? The muscles on the opposite side to the lean become stretched, and that reflex is activated again, telling those muscles to contract in order to correct your posture and stop you toppling over. Now, this is a more obvious demonstration of how reflexes maintain our posture, and these postural corrections are generally carried out subconsciously (so we don’t spend all day feeling like we’re going to fall over!) It’s one of those things that we notice more when it stops working.

So what do reflexes have to do with stretching my tight muscles?

When we activate stretch receptors in the muscle, the message the body receives is to contract that muscle to prevent overstretch. So the usual static stretching that we do (for example when we bring our foot up behind us and grab on to it to stretch our quadriceps) puts our conscious and subconscious brain into war against each other. You’re consciously grabbing that foot to pull that muscle into a stretched position, and your stretch reflex (the subconscious brain) is automatically kicking in (as reflexes do) saying “No!” and tries to stop you from over-stretching and causing yourself an injury. What do we tend to do in this situation? Most people say “oooh that’s tight!” and promptly pull harder… Static stretching has actually been shown to decrease strength and athletic performance, while failing to reduce risk of injury to any significant degree.

Why does stretching feel so good then?

There are a few reasons why stretching might make you feel like you’re getting somewhere.

One: If you continually statically stretch your muscles, you can cause that stretch reflex to become less active. This can mean the muscles do lengthen, but only for a little while. Give it an hour or two for that reflex to go back to normal and the muscles will tighten back up again. This can cause problems for athletes- static stretching means the muscle is unable to contract properly because those muscle spindles aren’t functioning right. There’s plenty of research out there to show that static stretching before exercise can reduce your muscle strength, power, performance and joint stability.

Two: The more we stretch, the better we’re able to tolerate the sensation of “pulling” in our muscles. Yep, we’ve all said it “Ooooh, that’s a good stretch!” That temporary lengthening and release does feel good, but not for long.

Three: Pull a muscle or tendon enough, and you’ll begin to stretch your ligaments. Ligaments can, over time, then become stretched out to the point where they’re unable to function properly, resulting in joints that move too much, and are unstable. When ligaments get to this point, they might never regain their original length and strength.

stretch muscle reflex stretchy injury knee pain relief chiropractic chiropractor education blog physiotherapy physiotherapist health rehabilitation painful sports injury training fitness emsworth chichester hampshire sussex stretching
Someone tell him to stop…

Stretching- Will it get you out of pain?

In a nutshell, no. The nervous system rules the road. It’s totally in charge of everything that we do. If you’ve had treatment with me, you’ve probably heard me talk about the reasons why the brain can cause our joints to stiffen and feel like they’re “locked up”. It’s your brain’s way of stabilising an area that it perceives to be at risk of injury (whether that perception is founded in fact or fiction!) So on a very fundamental level, if your brain still perceives there’s an issue in that area, no amount of pulling on your muscles is going to change that. Equally,if the muscle is tight and sore because there’s a joint somewhere that’s misbehaving and preventing the muscle from functioning as it should, then stretching isn’t going to do much for that problem.

stretch muscle reflex stretchy injury knee pain relief chiropractic chiropractor education blog physiotherapy physiotherapist health rehabilitation painful sports injury training fitness emsworth chichester hampshire sussex stretching

The process that tells us how tense our muscles should be at rest (known as “resting muscle tone”) is called the alpha-gamma feedback loop and it’s a lot more intelligent than we give it credit for when we’re yanking on our body to get it to stretch. In order to reset an over-enthusiastic resting muscle tone, we need slow, controlled movement which provides vital sensory feedback, allowing this system to reset itself. This makes it fairly clear that pulling our muscles into, or beyond, their stretch capacity does little other than provide a temporary increase in muscle length which then rebounds when those muscle spindles reset, giving you little more than temporary relief from pain and probably serving to prolong your discomfort by making your muscles tighter overall.

So how do we make muscles stretchy without stretching?

First we have to look at what’s causing the muscle tension in the first place. Let’s look at the hip joint as an example. It’s got anywhere between 170 to 200 degrees of flexion and 40-60 degrees of extension, so is well over the 180 degrees needed to do the splits. So aside from structural changes in the hip joint, is mainly restriction in the soft tissues that stops most of us from being able to pop the splits whenever we fancy. No amount of stretching or “bouncing” into the splits is going to get you there- for whatever reason, the muscles you need to do the splits are activating way before their supposed maximum load and your brain is telling those muscle spindles to stop before you hurt yourself.

We have to stop thinking that we can teach our muscles anything. Our muscles don’t call the shots- our brain does. If a muscle gets tight, it’s because the brain is telling it to contract. So if stretching isn’t the answer, what is?

  1. Chiropractic care to correct the cause of the problem- We find, assess, diagnose and treat the underlying reason for the muscle tension. If you don’t know why they’re tight, how can you possibly get them better?
  2. Foam rolling. It’s not just rolling about on the floor (although that helps!) Foam rolling activates a different receptor in the muscle (called the Golgi Tendon Organs) which sit at the junction between your muscles and tendons. When we foam roller correctly, we stimulate these GTO’s which encourage the muscle spindle activity to calm down, helping to decrease muscle tension, reduce pain and improve function.
  3. Functional movement. Simply put, warm up based on movements you actually do in real life. How often do you actually grab your neck and pull it into a weird angle in real life? Not often. If you’re a runner, instead of doing straddle-stretches or the good old foot-behind-your-bum-and-pull stretch for the quads, try lunges, high knees and skipping instead to replicate the movement you’re going to do.

So there you have it. Stretching tight muscle tissue will only make it tighter. Find and correct the reason for the tension and enjoy super-supple muscles instead!

flat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex torticollis

“Flat Head Syndrome”- not just a cosmetic issue

If your child has flat head syndrome, you might be wondering what to do about it and how to help your little one. Let’s find out more about the condition and the various gentle, conservative treatment options available for your baby.

What is flat head syndrome?

flat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex
Source: http://www.flatheadsyndrome.org.uk

Flat head syndrome is a name commonly used to refer to brachycephaly and plagiocephaly- both conditions can also be referred to as “positional skull deformity”. Plagiocephaly is where one side of the back of the head becomes flattened, which may result in the front of the head protruding on the opposite side, and the ears positioned asymmetrically. Brachycephaly is symmetric flattening of the back of the head, which can cause the ears to appear prominent and the head appear wide.

There has been a significant increase in the number of babies presenting with flat head syndrome possibly due to the introduction of the “Back to Sleep” (now known as “Safe to Sleep”) positioning recommendations aimed at reducing the risk of Sudden Infant Death Syndrome.  Since the early 1990’s parents have been advised to let babies sleep on their backs, and whilst this has been successful in reducing the number of cot deaths, it has lead to an increase in the number of babies with deformational plagiocephaly and brachycephaly.

What causes flat head syndrome?

It can happen during your pregnancy with uterine constraint (when your baby doesn’t have enough room in the womb- especially common in the case of multiple births such as twins) or as a result of birth injury from forceps or vacuum assisted delivery.  More commonly, it occurs after birth and is associated with congenital torticollis (or ‘wryneck’), abnormalities of the bones in the spine, neurological impairment (problems affecting the nervous system) or forced sleeping position.

The associated torticollis can flat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex torticollisoccur due to strains of the sternocleidomastoid, a muscle in the
front of the neck, which can occur during difficult deliveries. This muscle trauma the baby’s head into an awkward position, thus exacerbating (or in fact causing) the skull deformity. Wryneck may also cause issues with breastfeeding, as the baby is unable to comfortably turn the head to latch properly- if your baby can’t latch to one side or can’t turn their head to one side, they may have torticollis.

Premature babies are at a higher risk of developing skull deformities as the cranial bones become harder and stronger during the last 10 weeks of pregnancy. Premies may also spend longer periods of time in neonatal ICU on a respirator to help develop their lungs, as a result their heads are maintained in a fixed position.

More commonly, babies are born with a normal head shape which gradually becomes flattened or altered as a result of the position they lie in.

What we look for when diagnosing flat head syndrome

We don’t just look for flattening at the back of the head:

  • One ear may be placed slightly further forward than the other
  • One eye may appear larger than the other
  • One cheekbone may be more pronounced than the other
  • There may be a subtle (or not-so-subtle) head tilt
  • The child or baby may have reduced neck movement and are unable to rotate their neck themselves away from the flattened side of the occiput.
  • In older children, they may have delayed motor development or have failed to achieve certain developmental milestones

Why does it matter if my baby has a flat head?

It’s not just about appearance. Most advice seems to be that once baby’s hair grows out, skull deformities will be “hardly noticeable.” There is a growing body of research which suggests that children with plagiocephaly or brachycephaly need to be monitored for developmental delays or deficits. One study states that “Infants with deformational plagiocephaly comprise a high-risk group for developmental difficulties presenting as subtle problems of cerebral dysfunction during the school-age years.” Another study found that children with plagiocephaly were more likely to require special education services in school than their non-affected siblings (34.9% vs. 6.6%, respectively). The services they required included speech therapy, occupational therapy and physical therapy.

flat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex torticollis
Source: Wikimedia commons author Wisewiki

Whilst it is important to note that these findings do not imply that developmental plagiocephaly causes developmental problems, it may instead serve as a marker for developmental risk.

In addition, skull deformities may contribute to headaches, migraines, painful teething, jaw and dental problems. It is therefore recommended that treatment takes place as early as possible, in order to restore normal head shape.

One of the most commonly reported concerns from parents of children with flat head syndrome is their physical appearance and the possibility that he or she will be teased, embarrassed or otherwise stigmatised because of their condition. Parents often first notice the condition through the appearance of uneven bald spots on the back of their little one’s head.

Treatment options

There are numerous treatment options available, and if you are looking for gentle, non-invasive options for your little one there are several to consider. Hands-on treatment and exercises will hflat head syndrome brachycephaly plagiocephaly chiropractic cranial sacral baby osteopathy craniosacral therapy treatment helmet conservative help pillow positioning baby parent babies infant skull parenting help advice sleep tummy chiropractic osteopath Emsworth Hampshire Chichester Sussex torticolliselp to alleviate the strain to the sternocleidomastoid muscle causing the torticollis and encourage normal neck movement in addition to helping to correct the skull deformation. Monitoring for neurodevelopment problems helps to ensure your baby achieves all their developmental milestones.

There is evidence to support the use of chiropractic care in managing flat head syndrome, which states “there was both a statistically and clinically significant reduction in plagiocephaly measurement for this cohort of infants after a course of chiropractic care. As this was an observational study, this cannot be interpreted as cause and effect. However, these results encourage further research, particularly an RCT to investigate the effect of chiropractic care on plagiocephaly in infants.”

Products are available which can be helpful , including pillows for the cot (most are not recommended for use when baby is unsupervised) and car seat, beanie caps, slings and wraps to help reduce the amount of time baby spends on their back.

Cranial molding headbands or helmets are what is often recommended. Helmets can be expensive, uncomfortable (they need to be worn 23 out of 24 hours in the day) and can cause excessive sweating and skin problems due to pressure or friction spots. Fortunately the designs for these are being improved to help make them more comfortable for little one.

How can I help my baby at home?

  • Tummy time is of the utmost importance. This helps develop shoulder girdle strength which is important for motor milestones such as crawling and eventually walking. In addition, it reduces the time spent lying on their back.
  • Repositioning: This is best started as early as possible and is most effective with babies under four months of age. Alternating the position your baby lies in at night can also help. Babies tend to prefer to face outward into the room, and being creatures of habit we may be tempted to always place them the same end of the crib. As such, routinely changing this is important.
  • Place cot toys and mobiles on the opposite side to the ‘flat’ side to encourage your baby to spend time on the side that is not flattened.
  • Position your little on the opposite end of the changing table when changing nappies. This helps in the same way altering their position in bed does, by encouraging them to look to the opposite side whilst being changed.
  • Ask your practitioner to show you exercises to help baby at home, such as gentle neck stretches for the sternocleidomastoid for babies with torticollis.

 

References:
Bialocerkowski AE, Vladusic SL, Wei Ng C (2008) Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Dev Med Child Neurol 50(8):577–586

Boere-Boonekamp MM, van der Linden-Kuiper AT (2001) Positional preference: prevalence in infants and follow-up after two years. Pediatrics 107:339–343

Cabrera-Martos I, Valenza MC, Benítez-Feliponi A, Robles-Vizcaíno C, Ruiz-Extremera A, Valenza-Demet G (2013) Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program. Childs Nerv Syst 29(10):1893–1898

Cabrera-Martos et al. (2016) Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study. Child’s Nervous System 32 (11) 2211-2217.

Collett et al (2012) Neurodevelopmental implications of “deformational” plagiocephaly. J Dev Behave Pediatr. 26 (5) 379-389.

Douglas et al (2016) Chiropractic care for the cervical spine as a treatment for plagiocephaly: a prospective cohort study. Journal of Clinical Chiropractic Pediatrics. 15 (3)

Knight, Sarah J., et al. “Early neurodevelopment in infants with deformational plagiocephaly.” Journal of Craniofacial Surgery 24.4 (2013): 1225-1228.

Korpilahti, Pirjo, Pia Saarinen, and Jyri Hukki. “Deficient language acquisition in children with single suture craniosynostosis and deformational posterior plagiocephaly.” Child’s Nervous System 28.3 (2012): 419-425.

Lessard S, Gagnon I, Trottier N (2011) Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complement Ther Clin Pract 17(4):193–198

Miller, R.I., Clarren, S.K. (2000) Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics. 105 (2)

Persing et al (2003) Prevention and management of positional skull deformities in infants. Pediatrics. 112 (1)

Schertz, Mitchell, Luba Zuk, and Dido Green. “Long-term neurodevelopmental follow-up of children with congenital muscular torticollis.” Journal of child neurology 28.10 (2013): 1215-1221.

 

Cover photo source: Wikimedia commons author Gzzz
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.

 

Chronic stress- what does it actually do to us?

Does back pain worsen around Christmas-time? If you asked us, we’ve got enough anecdotal evidence to say yes. But why is that? Clinic gets busier, our patients report symptoms are worse and then blame it on the weather… Now why is this? Well, simply put, as we get towards the festive period and the existing stress in our lives is ramped up yet another notch, we often start to see physical manifestations of underlying stress rear their ugly heads in the form of pain and illness.

Now, it’s not news that stress plays a part in pain and disease. What we’re interested in is chronic stress, and how this can make us ill. I wanted to find out more about the role of chronic stress, so I’ve been working my way through a reading list, including  “Why Zebra’s Don’t Get Ulcers” by Robert Sapolsky. Now, this blog isn’t really about the inner workings of a zebra’s digestive system, it’s a book which focuses on why we as humans have developed a whole range of accumulative diseases as a result of living our lives chronically stressed. It explains how our body adapts to stress and details what the healthcare profession have had to learn in order to manage our patient’s stress.

Where we used to be killed off by cholera, influenza and leprosy (which did the job fairly quickly, it has to be said), we now suffer long, slow diseases that come about as the result of gradually accumulating a number of healthcare issues. Cancer. Heart disease. Strokes.

In the words of Mr Sapolsky, “Chronic stress can make you sick.”

So why don’t zebras get ulcers? Simply put, zebras don’t get ulcers because they don’t spend hours, days, or weeks stressing about making the mortgage repayment. Or worrying about your big project which needs completing by the end of the month. They worry about if a lion is going to eat them in the next 10 minutes. Their stress is short and to-the-point. It’s only we humans who have geared ourselves up physiologically to have all sorts of physical manifestations to stressful events generated entirely in our heads. If you’ve ever experienced sweaty palms or a racing heartbeat whilst thinking about what might go wrong then you know what I mean. Zebras just don’t do that.

Stress health wellness function disease illness chiropractic chiropractor lifestyle coping mechanism stressors immune sleep function cognitive memory work office job
Look at him. Isn’t he majestic? Not a care in the world and no ulcers in sight!

It’s safe to say most of us nowadays live our lives in a state of chronic stress. We don’t take time to look after ourselves and truly de-stress (a soak in a bath doesn’t count!)

What does chronic stress do to our bodies?

In short- chronic stress wreaks havoc. Your body’s response to an acute stressor is perfectly suited for its job. Stress health wellness function disease illness chiropractic chiropractor lifestyle coping mechanism stressors immune sleep function cognitive memory work office jobYou’re home alone and hear footsteps upstairs- your heart starts racing, blood pressure and breathing rate increase as your body prepares to transport nutrients and oxygen to your muscles STAT. Why?

Because your muscles are going to need that energy as you hot-foot it out the door faster than Usain Bolt! Your body also shuts down digestion (because absorbing dinner suddenly isn’t so important) growth and tissue repair stop, senses are sharpened, sexual drive decreases, and the immune system becomes inhibited (there’s plenty of time to hunt for tumours in a week or so- right now, all your body cares about is getting out of the house and out of danger pronto). Oh, and another neat feature: To stop your body going into shock from extreme pain, your pain perception is decreased. Handy!

So- all good responses from the body and we’re out of danger now thankyouverymuch. But what happens if that stressor doesn’t go away? If your stressor is a busy desk job in a Fortune 500 company, you’ll never be able to switch off the stress response. You might find your heart rate stays at about 180/100 and steers you towards an early heart attack. Your digestion is going haywire, tissue healing and recovery is halted so nothing is ever repaired (hello ulcers!). Not only that, but you’ll never store any surplus energy because your body is mobilised to use it all straight away, and you’ll fatigue quickly.

Sounds bad, doesn’t it? It doesn’t stop there though. Illnesses and viruses will be easier to pick up and harder to recover from if your immune system is permanently compromised. This becomes particularly noticeable at this time of year when germs and viruses are floating around. You’ll be shaping up for a very snotty Christmas indeed if you’re stressed!Stress health wellness function disease illness chiropractic chiropractor lifestyle coping mechanism stressors immune sleep function cognitive memory work office job

Stress disrupts our lives. It can make us very ill.  As a chiropractor, my chronically stressed patients have widespread muscular tension and sometimes heightened sensitivity to pain. They suffer from headaches or jaw pain, visual disturbances, lower back pain, tummy upsets… Stress causes changes in our nervous system and can result in muscle tension, spasm, and pain. Now, I can adjust their neck to alleviate the headache, but that won’t help if the headache is a result of chronic stress. We need to manage their stress and anxiety or the headaches will just keep coming back (as any of my patients will tell you- I’m focussed on the long-term resolution.)

So what are we going to do about stress?

There are various management techniques and these all work for different people- you’ll have to find what works for you.

Exercise: A simple place to start is with exercise- being physically fit can lower blood pressure, resting heart rate and increase your lung capacity (yes- directly counteracting the effects of stress). Simply put, exercise releases endorphins and endorphins make you happy PLUS it increases your feeling of self-efficacy and achievement. Instead of sitting at a desk getting tense, you’ll be using your stress response for what it’s meant to do- explosive activity! That’s how exercise can be a powerful way of reducing stress.

There are a few caveats to this though:

  1. Exercise only works to reduce stress if you want to exercise. Your friends forcing you into a spin class isn’t going to help!
  2. It’s effects are short-lived, lasting only for 24-48 hours. So you have to do it regularly to see the benefit.
  3. Too much exercise or overtraining can produce a stress response.

Psychotherapy: For natural stress-heads (or, to use the correct term- type A personality), psychotherapy can change your behaviour, lower cholesterol levels and reduce your risk of a heart attack. Stress often depends on how we view problems, and some studies have found that in the face of terrible news, denial and hope are strong coping mechanisms. Don’t accept a poor prognosis and hope for the best- miracles can’t happen.

Ommm… Zen: Meditation is another interesting one. It can decrease glucocorticoid levels and decrease muscle tone/tension. But again, studies show that it works while meditating, but doesn’t necessarily have a long-term effect.

Social Support: In the immortal words of the Beatles, “I get by with a little help from my friends.” Giving and receiving support from the right friends is going to help, as will the support of a partner or spouse. A problem shared is a problem halved!

What about control?

Understanding PainIf you’ve downloaded our resource “Understanding Pain” you’ll already know all about this. If you haven’t downloaded it, we’d suggest you do!  Control and belief in your own self-efficacy is a powerful thing. Whilst you can’t have full control over the fact that you have stressful projects to complete, you can gather information about how long the project is going to take for you to complete, what the goals are and who you’ll be working with. This predictive information about impending stressors can help to reduce your stress levels by giving you some control over the situation. This is in much the same way that learning about chronic pain can help you control, cope with and reduce your pain.

The caveat to this is that control isn’t always such a good thing psychologically. If, for example, you have control over a situation that ends up disastrously, that’s going to be completely detrimental to your psychological health. Believing that everything challenge in life can be overcome “provided we work hard for it”, can leave you in a stressed heap in the corner.

How do you cope?

We also need to talk about cognitive flexibility. This is the ultimate ability to “cope”. Try problem-solving the issue and working out if it’s the stressor that needs altering, or your perception of it that does. This can be hugely stress-reducing. Admit that you’re finding something stressful and rely on social support from friends and loved ones- they’ll want to help. You’ll need a selection of coping strategies to effectively deal with stress. You might have a Stress health wellness function disease illness chiropractic chiropractor lifestyle coping mechanism stressors immune sleep function cognitive memory work office jobtendency to try to cope with an event, fail, and then go back in and try to cope even harder with the same strategies. If a cup of tea and a chat with friends hasn’t worked, try something different. A meditation class. The gym. Yoga. Speak to a psychotherapist. During times of stress, finding the right coping mechanism for you is critical.

 

Here’s our ultimate stress-busting check list:

  • Find ways to view even the most stressful situation as holding the promise of hope and improvement. But don’t deny the possibility that things will not improve.  As they say, “hope for the best, but prepare for the worst.”
  • Take the time to look after yourself, using coping mechanisms that work for you. However, don’t give ulcers to others to avoid getting them yourself. You might find that a midnight drumming session is just the trick to soothe your nerves, but it’s going to make your neighbour’s life awful!
  • What can you predict about the upcoming stressful events in your life? Is your toddler likely to have an over-stimulation meltdown in the middle of Christmas lunch? If so, plan for a quiet hour beforehand to allow them to settle and calm. Guests coming for Christmas dinner and worried about cooking? Gather as much information as you can about them before you turn on the oven! Are there any food allergies, what can you prepare instead? Gather as much information about the upcoming stressors as you can, and then implement a plan to help you cope.

Accept the things we cannot change

In this blog we’ve learnt about just how stress can impact on our lives and wreak havoc in our bodies. There’s no one way to avoid stress- moving to a remote desert island is going to give you all sorts of acute stresses like our poor zebras. (Just think about all the poisonous critters who might see you as a tasty treat!) Fortunately there are numerous ways in which we can cope with and reduce the stress we experience.

The real world is full of stress yet many of these issues aren’t real, we’re worrying over what might happen. Imagined stressors can take over our lives with worry in anticipation of a horrible event happening. It may happen, it may not- worrying about it isn’t going to make it any easier to cope with!

Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference.

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
Saturday 09:00 – 12:00

Acorn Health Limited © 2014 - 2019

Website Created by WebHolism