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.
I wasn't surprised by the research findings that the so typically British 'stiff upper lip' may deter patients from seeing their doctor, as they are too embarrassed to disclose their symptoms or fear that they may be 'wasting the doctor's time'. These findings, part of a more lengthy study published in the British Journal of Cancer, may go some way to explain the surprisingly lower than expected cancer survival rates in the UK, when compared with other developed nations, despite access to highly trained medical staff and cutting-edge treatment interventions.
A survey of nearly 20,000 people in the developed countries of UK, Canada, Australia, Denmark, Norway and Sweden revealed that one sixth of British men and women over the age of 50 were embarrassed to share their symptoms with their doctor, and a third were reluctant to visit for fear of being 'time wasters'. This could delay diagnosis and hence commencement of treatment - and early intervention is often the most critical factor in a successful outcome for the treatment of many cancers.
Fortunately, since we chiropractors primarily deal with problems affecting the musculoskeletal system, rarely do people present with cancers, or symptoms that might lead me to suspect anything more sinister. However, I am all too familiar with people's reluctance to disclose potentially important information that might help me to make the correct diagnosis and hence establish an appropriate treatment plan. All too often they might think that something in their history isn't relevant to their particular, current problem, or they might feel a little embarrassed or awkward about discussing things with me. However, I would urge all patients to provide me with as much information as possible - every consultation is totally confidential and we aim to provide you with a comfortable, relaxed, private environment. There isn't much that shocks me, and chances are, I've probably heard or seen similar before!
Whilst we chiropractors mainly treat the joints, muscles, nerves and soft tissues, we spend many years at University studying all the medical sciences, so we are trained to recognise and diagnose all sorts of illnesses and problems, not just those affecting the musculoskeletal system. So, if I were to pick up on something that I thought wasn't within my scope of practice, I would refer you on to your GP, or appropriate healthcare professional for further investigation (obviously with your permission).
Personally, I'm just like everybody else; I still squirm with embarrassment and sit there, on my clammy hands, giggling like a nervous schoolgirl, when having to discuss even the most minor of ailments with my GP. I even worry that I'm wearing 'sensible' clothing when seeing my own chiropractor! I faff around, delay making the appointment, fidget in the waiting room - and then feel so much better once it's done!
So, be brave and grab the bull by the horns. If you're worried about something it is far better to deal with it sooner rather than later, and if it is something serious, the sooner you get help the better! At least you'll have a definite answer to what the problem is - and this has got to be preferable to the sleepless nights, worrying and wondering and imagining the worst...
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!).
Things are hotting up at the London 2012 Olympics. Only a few more days until the Opening Ceremony...
This week, the doors of the Athletes Village will open. Athletes and their support teams from 204 countries will start arriving. And, for the first time, chiropractors will be there!
Within the Athletes Village is the state of the art Polyclinic. Open 24 hours a day this multidisciplinary clinic is kitted out with some of the most sophisticated equipment in the country and staffed by highly skilled specialists - including, for the first time ever, chiropractors. It is expected that a high proportion of the anticipated 200 competitors visiting the polyclinic each day will be suffering from musculoskeletal injuries - sprains, strains, muscle injuries and joint pains - exactly the sort of problems that we chiropractors excel in treating. So, it is expected that the team of chiropractors are going to be kept busy, providing care from 7am - 11pm every day, with 24 hour emergency 'on-call' cover as well!
The state of the art Polyclinic in the Olympic Village
The team of chiropractors will be working alongside other musculoskeletal healthcare specialists - orthopaedic surgeons, neurologists, sports injury physicians - as well as other core services like dentistry, optometry, and physiotherapy. Together, this team of medical specialists will help to ensure that athletes are in their peak condition for this most important time in their sporting careers.
Richard Brown meets Lord Coe
Richard Brown, chiropractor and President of the British Chiropractic Association is one of the chiropractors who has taken time out of his busy practice and professional schedule to be treating the athletes. He had the opportunity to meet Lord Coe, Chairman of LOCOG, who voiced his support at the presence of chiropractors at the Olympics, and who said that his own career would have been far shorter, had it not been chiropractors.
Hopefully, Richard and the other chiropractors in the Polyclinic will be able to keep the competitors in tip top condition; here's hoping that they enable Jessica Ennis and a few of her fellow competitors to bring home some shiny medals...!
Many of my patients spend a long time each day sat at a desk and I see a direct correlation with the amount of neck and back pain they suffer. Prolonged sitting can be detrimental to the health of the spine, and poor posture can exacerbate this. Not only can poor posture lead to back and neck pain, but it can be related to many 'repetitive strain' type injuries of the wrists, elbows, hands and shoulders.
Have a look at the picture below and see how it compares to your sitting position. Get someone to have a look at you when you're sitting and ask them to help you to adjust your seat accordingly. I've listed a few tips on how to sit properly, and hence minimise those aches and pains:
Feet - your feet need to be flat on the floor to provide a firm stable base for your spine and pelvis. If your legs are dangling it can place stress on your back and the legs will pull you forwards into an incorrect position. If you need to raise your chair up to be at the right height for the desk, use a foot rest (a shoebox will do!) to support them.
Legs - your knees need to be bent and ideally a little below the level of your hips. Using a wedge cushion will help you to achieve this posture; not only is it more comfortable but it helps to maintain the 'lumbar lordosis' - the healthy curve in the base of the spine. Make sure that the edge of the seat doesn't dig into the back of your knees. Don't sit with your legs crossed - this hinders the circulation and will distort the position of the pelvis and low back.
Bottom - Relax into the chair with your bottom right back in the seat, up against the seat back. This will allow the back of the chair to support your spine and improve your posture - ultimately reducing the risk of back pain. Don't perch on the edge of your seat, even for a few minutes, sit back in the chair and move the whole chair closer to the desk.
Back - make sure your whole spine is supported; your low back against the backrest of the chair (many have a 'lumbar roll' which will help) and your upper back should be straight, with your shoulder blades gently resting on the back rest. This will help to minimise upper back pain, neck stiffness and achey shoulders. (If you're a 'little' person and find that you can't sit in the seat with your back and bottom touching the back rest, then you might need to place a cushion behind you.)
Arms - your chair needs to be high enough so that your elbows are slightly bent and gently sloping down to your wrists (check that your feet still touch the floor if you've raised your seat up - if not, find that shoebox!). Your hands should relax gently onto the keyboard with a minimal bend at the wrist; don't rest your weight on your wrists. Incorrect hand and arm position can cause all sorts of problems! Make sure that your computer keyboard, mouse and screen are directly in front of you so you are not twisting the upper back or shoulders, and have them close enough to you so you don't have to stretch.
Head and Neck - make sure that your screen is directly in front of you so you don't have to twist. If you are copying from text then place it in front of you (blutak it to the screen and proof read later!). The monitor needs to be roughly an arms' length away and should be at eye level. This will mean that you don't have to move your head about to see the screen. If the monitor is too high or low then you will have to look either up or down for prolonged periods - this can strain the upper back, neck and shoulder muscles and might cause pain and stiffness. If you find yourself peering at the screen, or leaning forwards to read the text, then maybe get your eyes checked, rather than risking neck pain and headaches.
Keyboard and Mouse - make sure that these are close to your body and that you're not reaching out for them. Over-reaching for the mouse can cause prolonged strain on the whole arm and shoulder and seems to be one of the main causes for work-related upper limb pain. Use wireless ones if you can - it minimises the clutter on the desk and makes the mouse easier to move.
Desk - in order for your arms and wrists to be in the correct position on the keyboard and mouse, your desk should be about level with your tummy button. You might need to raise the height of your chair to achieve this, but don't leave your legs dangling... find your shoebox/foot rest!
Wriggle! - it is important to move about and change position regularly to relieve the pressure and strain on the body. Don't sit for more than 30-40 minutes; get up and walk around for a couple of minutes before sitting back down again (make sure you adopt the correct posture!). I suggest that patients stand up to answer the phone - there are whole offices in Anglesey with people bobbing up and down every five minutes (they're much less stiff and achey!). Remember 'face to face' time - go to see people down the corridor rather than using the internal email - make movement your friend (time away from the tedium of your desk has to be a good thing...!).
Phone - use a headset if you are on the phone for any length of time, particularly if you have to be writing or typing at the same time. Holding the phone under your chin will cause your neck to 'crick' and shoulder muscles to tighten up quickly - more neck and upper back pain!
Laptop Computers - the 'portability' of laptops makes them tempting to use in awkward positions. However, using them on your lap, particularly for more than a few minutes, can cause all sorts of problems - particularly with the neck and upper back. Make sure that you place your laptop on a desk or table, and adapt your sitting position accordingly to mimic a 'proper desk'. Place your laptop on a stand (a wedge of paper will do) to ensure the screen is at the right height, then adjust your seating position to match. As the keyboard is generally more compact on a laptop, it is worth using a wireless keyboard and mouse in order to prevent unnecessary hand and wrist strain. If you are using your laptop as a more permanent 'desktop' then plugging it in to a proper monitor and keyboard on a proper desk will help you to prevent the risk of back and neck pain.
It might seem a pain to have to check your chair and desk - but, believe me, it is definitely more of a pain when your back and neck seize up due to an incorrect position! Spend a bit of time to get it right the once, and make sure you check it (and yourself!) on a daily basis...
Ever pulled a sicky? Wonder how many other people do? According to a recent study published by the Office of National Statistics it's quite a lot of us:
Eich Ceiropractydd yng Nghlinig Ceiropracteg Llangefnii