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This has to be one of the most comprehensive explanations of simple low back pain. It explains the different types of low back pain, how we chiropractors and health care professionals classify it, what sort of nasties we're ruling out when we assess you, and most importantly, what YOU can be doing to help yourself! Definitely worth watching...
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 Patients are always asking me if their problem is common. Have I seen anything like it before? Why them? Why has their back gone? Why have they been affected? I try to reassure them that they're not alone - low back pain, is unfortunately, a very common problem and, the majority of people will suffer from it at some point during their lives. However, it is difficult to find reliable evidence that answers this question - just how many people suffer with low back pain? It is easy to know how many people we see with back pain in a clinic, or how many people go to their doctor with a sore back, or even how many people take time off work with a back injury, but we don't know just how many people are walking around with low back pain on a daily basis.
Or, at least, we didn't - until recently. A reliable study,* published recently in a well-respected journal, has looked at just this question - what is the prevalence of low back pain in the general population? This study, conducted by the eminent Professor Charlotte Lebeouf-Yde over a one-year period, found an interesting pattern of low back pain in a random population of 50 year olds, revealing three distinct, but virtually equally-sized groups: 1) those who mainly do not have LBP (35%), 2) those who have it at times (30%), and 3) those who have it more or less always (35%). *Chiropractic & Manual Therapies 2013, 21:30 "35% of people have low back pain more or less always" This is one of the few studies that is truly representative of the occurrence of low back pain the general population; participants were randomly selected, not chosen in response to a particular advert or from a particular place of work or a treatment clinic. They came from all walks of life, were from different socioeconomic backgrounds, had different levels of education and did all sorts of different jobs - so truly represented the 'normal, average Joe'. The participants were sent a text message every fortnight, asking them how many days their low back had bothered them, and how many days (if any) they'd had to take off work because of it. These regular text messages meant that the participants didn't have to rely on their memory and recall their pain over a long period, thus further enhancing the reliability of the data. Whilst there was some dropout from the study, the majority participated in the study for the whole year, giving a very valuable pool of data. "3% had low back pain every day for a year!" Further detailed analysis of the data revealed more - a lucky 19% of the sample did not experience any low back pain at all, whilst an unlucky 3% had low back pain every day for the entire year! 9% experienced some low back pain for several days every fortnight (but not every day) but the majority experienced episodes of low back pain lasting anything from a few days to a few weeks. So, what does this study mean? It shows just how common low back pain is within the general population. Whilst a fortunate third of people didn't experience any low back pain at all in an entire year, the remainder experienced some intermittent or constant low back pain. From studies like this which show just how common low back pain is, we can also anticipate the knock-on effect that low back pain has at an individual and societal level - the impact on a person's everyday life with ongoing pain and disability, the number of days off work, the potential loss of income and the resulting cost to society, not to mention the burden on our already stretched NHS. It highlights the necessity to provide a solution to this enormous problem - like chiropractic treatment which hopefully will one day be widely accessible and freely available to all those who are suffering!  With the evenings drawing in and the mornings feeling damp and dewy, there's definitely a sense of autumn in the air. Thankfully we're still getting a few warm sunny days and there are plenty of jobs that need doing, tidying up after the fantastic summer we've had and preparing for the winter ahead. Whether it be mowing the lawn one last time, digging up the last of the potatoes, or reaching up to get that enormous blackberry at the top of the bush just don't overdo it! Otherwise, you'll be calling the clinic, and much as I love to see you, there are a few things that you can be doing to stay away!...
 Many of you are heading to the 50th Royal Welsh Show in Llanelwedd, Builth Wells this week. With over 50,000 people attending each day it's sure to be a bustling affair, showing off the best that Wales has to offer - livestock, food, produce, crafts and entertainment - there's something there for everyone!
However, whilst this glorious sunshine will help to attract people (particularly as there is no danger of cars getting stuck in the quagmire of parking as in previous years!) it can add to the overall exhaustion experienced by some people at this huge event. I'm hoping to get to it myself over the next couple of days and I'm planning a few things to help me enjoy it all the more...
It's sure to be a fantastic event and I'm looking forward to going - who knows, I might even bump into a few of you there (amongst the 49,999 other people!).  It was a pleasure and a privilege to attend the grand opening of the new Peter Maddison Rheumatology Unit at Llandudno General Hospital yesterday afternoon. Opened by the eminent Professor Maddison himself, together with his team of consultant rheumatologists, researchers and healthcare specialists, it was a great opportunity to see around the new unit.
The new centre has been specifically designed to meet the needs of the multidisciplinary team and its patients. Housed in a fully-refurbished wing of the Llandudno General Hospital, emphasis is placed on a patient-centred, evidence-based multidisciplinary approach to aid the complex management of rheumatological disorders - lupus, rheumatoid arthritis, scleroderma, Sjogren's syndrome - and many others. The unit has specific purpose-built rooms that can be used by research staff, clinicians, administrative staff and patient-focus groups. The unit will be staffed by a team of healthcare professionals - rheumatologists, specialist nurses, researchers, physiotherapists, occupational therapists - so that rheumatology patients will be able to receive appropriate specialist care for their complaint all in the one location. This centralised hub will receive patients from across North Wales, covering the North Wales coast line, and the area encircled by Holyhead, Bangor, Caernarfon in the west, down the coast to Pwlheli, Portmadog, Barmouth and Dolgellau, inland to Machynlleth and Welshpool, and as far east as Wrexham. This will be ideal as patients will be able to see all the different specialists in one place, rather than having to attend for many different appointments with different people at different locations. It is one of the first multi-disciplinary rheumatology centres in the UK and it is hoped that similar units might be rolled out across the country.  I recently read a fascinating article written by Richard Brown, chiropractor and President of the British Chiropractic Association, extolling the virtue of chiropractic treatment as a drug-free, non-surgical intervention for the management of spinal and musculoskeletal conditions. One of the core philosophical tenets of chiropractic is that it is a drug-free intervention. We chiropractors recognise the body's natural ability to heal and repair itself and the fact that, if looked after with appropriate diet and exercise, it will remain healthy and pain free. This key principal is neatly summarised in the New Zealand Commission of Inquiry's 1979 report:
"As we have seen, much is made by chiropractors of the drugless and non-surgical nature of their therapy. But modern chiropractors do not suggest that there is only one cause of disease; they admit there are limits to their expertise; and they acknowledge the need for medical intervention and medical monitoring. They do, however, place emphasis on the body's natural functioning and its natural recuperative powers. In these matters of emphasis we see some value in the contribution that the chiropractic outlook can make to healthcare generally. There cannot be any fundamental objection to an attitude to healthcare which restricts drugs to cases where they are shown to be a matter of necessity rather than a matter of mere convenience. Nor can it seriously be suggested that anyone is unreasonable to believe that it is better for the body's disorders to be relieved if possible, by natural rather than artificial or chemical means". Whilst more than 30 years old, this statement still holds validity today in our professional methodologies. Obviously, as spinal care experts, working in the modern, scientific world alongside other healthcare professionals, we chiropractors recognise the benefit and necessity for patients to sometimes take drugs and even undergo surgery. I am certainly not suggesting that anyone should stop taking any prescribed medications without appropriate medical advice, and indeed, at times I will refer my own patients to their GP to obtain appropriate pain relieving medication, understanding the fact that my patients' health and wellbeing is of paramount importance. However, I am mindful of the fact that increasingly it seems that patients are turning away from drugs and surgery and are looking for an effective, research-driven form of natural healthcare. Something that gets to the root of the problem, and not just something that eases the pain or masks the symptoms. Added to which, ongoing scientific research and the media seem to increasingly highlight the complications, side-effects and contraindications for a number of commonly prescribed painkillers and anti-inflammatories, often readily doled out for the management of spinal and musculoskeletal pain. It is not surprising then that people seek out a drug-free, but safe and effective alternative - like chiropractic.  With spring approaching, the days lengthening and the wintry sun gradually warming up the air, we're beginning to come out of 'hibernation'. We're generally getting a little more active - out into the garden, spring-cleaning, attacking that DIY project in the house, or taking a bit more exercise than we have during what seems to have been a long winter.
Despite our enthusiasm, it's important to take things gently at first, letting the muscles and joints warm up. Every Monday morning, the phone in the clinic rings non-stop, with people who have 'overdone it' in the house or garden at the weekend. Whilst some gentle exercise is generally good for the back, overexertion can cause problems. Try to ease yourself into it - do some gentle stretches and warm up exercises first (marching on the spot, shrugging the shoulders, circling the arms) to get the blood circulating through the muscles, and pace yourself. Do lots of different jobs, changing your posture and position regularly, rather than concentrating on the one thing for too long. Listen to your body too - if something is niggling or painful, stop and don't be tempted to 'work through the pain' - it is your body telling you something isn't right. If the niggle persists, or worsens, phone the clinic and get advice! A simple, 3-minute stretching exercise routine is Straighten Up that will keep the body supple and loose if practised regularly.  Patients are always asking me what type of bed or mattress is best for their backs. Up until now, I've been reluctant to recommend a particular make or design - they can often be incredibly expensive and people can get 'sucked in' by the sales pitch - and the best bed for one person may not be the ideal one for someone else. However, the British Chiropractic Association and one of the leading bed manufactures, Sealy Posturepedic, have finally got together to provide some advice...
First, a few facts and figures*: On average, we spend a third of our lives in bed. 58% of the population complain that they wake up feeling stiff and achey - anything but refreshed! 25% of people wouldn't consider changing their mattress - even if it is more than 10 years old. (*BCA and Sealy Posturepedic 2012) Time for a change? So, when is the right time to consider changing your mattress? Generally, if it is more than 8-10 years old, uncomfortable, torn, discoloured and a bit 'manky' it could do with an update! If you can feel the springs or you feel it is less supportive than before, or you find yourself rolling into your partner, again it could indicate a need for something new. We should wake feeling rested and refreshed, so another indication is if you find it difficult to get comfy, or you wake up feeling stiff and achey in the morning (although it might be worth having a 'check-up' with the chiropractor too as it might be you, not your bed!). So, what next? Research it - ask your friends, find out the make and model of a comfy bed that you've slept on (I even phoned up and spoke to the manager of a hotel in Berlin to find out the specifications of a particularly comfy bed!), check out internet forums and blogs... Choice - choose a reputable retailer that stocks a wide range of brands and mattress 'types' (foam, sprung, pillow-top etc) and make sure you get an informed opinion from an experienced salesman (Sealy Posturepedic have a wide variety of mattress types and do know what they're talking about!). Try before you buy - Since you're going to be spending a large proportion of your life in bed, it's important to test out each mattress - lie on it for as long as possible, wriggle about, try getting in and out of it, take your other half with you and see how it works for the both of you. If you are a different size and shape from your partner, or you feel them wriggling about during the night, it might be worth getting two separate mattresses, as what suits them might not be right for you. Go large - go for as big a bed as possible. This will allow you the freedom to move and wriggle about - important, as if you stay in any position for too long you'll stiffen up and put pressure on the joints, even if it feels comfortable initially. Don't settle for second best - you don't have to spend a fortune, but a better quality mattress will tend to last longer, so may be a more economical option in the long run. A second-hand bed might be tempting - but remember that the springs and fillings will deteriorate with time, and there is the potential 'yuk-factor' of the previous owners' dust-mites and shedded skin cells... Sleep Easy - make sure you lie in a comfy position, on your side or back, keep moving about, use a mattress 'topper' if you want a softer feel to a firm mattress and stretch gently before you leap out of bed in the morning. For more advice check out my previous blog, or the BCA's website...  A recent study, published in the European Spine Journal, investigated the link between levels of physical activity, physical fitness and the incidence of low back pain.
The study was conducted in the Netherlands and asked a population of police officers about their activity levels and episodes of low back pain over the preceding 12 months. In addition to questioning, their levels of physical fitness were actually measured objectively (hence minimising the problem that often arises with this sort of study where people inaccurately record their activity levels, often tending to over-report). Results were collected from nearly 2000 individuals and the findings were conclusive - moderate levels of physical fitness (both muscular and aerobic) correlated with a lower incidence of low back pain, whereas the occurrence of low back pain increased with lower levels of activity and physical fitness. So, the implications of this are clear - exercise regularly, improve your fitness levels and you should experience fewer episodes of low back pain! However, it is not quite that simple - it may be that people refrained from exercise due to their low back pain, hence their back pain worsened, hence they exercised less - something of a Catch22 situation! Additionally, the findings showed that excessive levels of exercise actually increased the episodes of low back pain - this was particularly true of highly strenuous, vigorous activities such as weight lifting or heavy gardening and was a problem that mainly affected the male cohort of the study. In conclusion, this study showed that physical activity, strenuous enough to improve physical fitness, was strongly associated with lower levels of low back pain. So, the message is clear - get moving, get fit and you should have less low back pain (but take it gently and sensibly as excessive exercise might cause more harm than good!).  Have you ever watched an animal as it prepares to settle down for a nap? Or seen what it does on waking? It stretches. OK, so it might have a bit of a wash too, or circle the ground a few times (apparently dogs do this from their 'wild days' when they would flat down a circle of grass to make a comfy bed), but it will always take time to stretch. This is one of the many things that we humans have forgotten to do as we've evolved, but stretching regularly is really useful - it eases out the joints, loosens the muscles and helps the circulation. One of my favourite stretches is the Cat Stretch; it's quick and easy to do and loosens up the entire back, stretching out all the long muscles that run parallel to the spine and mobilising all the little joints between each vertebra. I encourage most of my patients to do it every day, morning and evening - those that do generally feeler looser and easier with less stiffness and fewer aches and pains.  The Cat Stretch
Start off on all fours, hands below your shoulders, knees below your hips. Make sure you're evenly balanced, keep your arms straight and strong and draw your belly button in towards you spine so your tummy doesn't 'sag' down to the floor. Gently arch your back, pushing your rib cage up to the ceiling, tucking your chin to your chest and your bottom underneath you (think of a dog tucking its tail between its legs!). Hold for a count of three, then gently lower back down to the starting position. Don't be tempted to arch the other way, sagging in the middle and sticking your bottom and head out, as this can over-arch the lower back and jam all the joints together - keep your back flat with your tummy muscles gently supporting your spine. Repeat this whole sequence 10 times or so, and do it every morning when you're getting up and last thing before bed. It only takes a couple of minutes and will really help to keep the spine healthy - a bit like cleaning your teeth twice a day keeps your teeth healthy! Sore knees? You can easily do this kneeling on your bed or on a couple of cushions. If it's still too much for your knees then you can do a 'half cat' - stand facing a wall, place your hands on the wall at shoulder height with your knees slightly bent and gently arch your back. Repeat 10 times, morning and evening. Obviously, if you find this stretch uncomfortable, painful or difficult to do, please be sensible and don't do it! Email me, or give me a call and we can work out what the problem is. |
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