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...
I enjoyed reading this article written by GB triathlete, Helen Russell. She writes about how chiropractic was available at the London Olympics, the first time that chiropractic was included as part of the mainstream core medical services within the Olympic village. It is estimated that nearly 90% of elite athletes use chiropractic treatment on a regular basis!
You can read the full article here...
I enjoyed the article, particularly the bit when Helen described her own beneficial experience of chiropractic treatment; she was treated by chiropractor, Stuart Herbert, at the Bromsgrove Chiropractic Clinic - I worked with Stuart many years ago when I had just qualified as a chiropractor!
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...!
Taller than average? Wonder if tall people really suffer more with their backs? A recent study, published in the journal Spine* shows that tall people are at far greater risk of being hospitalised due to low back problems affecting the intervertebral discs.
*Wahlstrom et al. Risk factors for hospitalisation due to lumbar disc disease. Spine 2012 July 1;37(15):1334-1339
The study compared the incidence of back pain in over 260,000 construction workers over a period of 20 years. They found that taller people (190-199 cm; 6'3"-6'6") were 1.5 times more likely to be hospitalised due to lumbar disc disease than their shorter colleagues (170-179 cm; 5'7"-5'10").
These results are hardly surprising; tools and equipment are typically designed for those of 'average' height and build. Those at either end of the height spectrum find themselves having to use equipment that is not the ideal size for them which can cause extra strain on the spine.
Ideally, people should take time to find equipment that is the right size for them. Longer handled tools, raised worktops, properly adjusted seats and desks can help to prevent back pain. We chiropractors recognise that 'prevention is better than cure' and much of chiropractic care is about giving advice to help prevent back pain in the first place, as well as treating it.
A debate has been published today in the British Medical Journal (8 June 2012), questioning the safety of neck manipulation. The story has been picked up by a number of national newspapers, and has been discussed on live radio and television programmes. Regrettably, many of these focus on the negative, so often the case with sensationalist journalism. I hope that I will be able to provide a more realistic, accurate and balanced view.
Neck manipulation has been shown to be safe and effective and benefits thousands of people suffering from neck pain and headaches. In fact, the risk of a stroke after treatment is the same whether you see a GP and get a prescription, or see a chiropractor and get your neck adjusted. (http://www.ncbi.nlm.nih.gov/pubmed/18204390)
Manipulation of the neck is at least as effective as other medical treatments and is safer than many of the drugs used to treat similar conditions. (http://www.ncbi.nlm.nih.gov/pubmed/17258728)
The term chiropractic is often mis-used for treatment carried out by non-chiropractors. This leads to over-reporting of incidents blamed on chiropractors, including in the BMJ. In one report of 24 cases attributed to chiropractors, not one was shown to be a chiropractor. (http://chiromt.com/content/14/1/16#B21)
Chiropractors are highly trained in spinal care and manipulation. In one UK study undertaken in 2007, of 50,000 neck treatments reviewed, not one single adverse event was reported. (http://www.ncbi.nlm.nih.gov/pubmed/17906581)
The cherry-picking of poor quality research needlessly raises alarm in patients and does little to help people suffering from neck pain and headaches to choose the most appropriate treatment.
I hope that this has allayed any fears or worries about the safety and efficacy of spinal manipulation when carried out by a trained, professional pair of hands. However, should you have any further concerns or queries - please, just ask!
I'm always being asked 'what is the difference between a chiropractor and an osteopath?' My standard response is 'there are more similarities than differences; the training and teaching is very similar, the problems that we treat are the same, but the actual treatment methods and techniques may differ. It's a different way to skin a cat!' Having said which, there are huge variations within each profession and the technique used often depends on the individual practitioner (out of the myriad that they are taught!). There are some chiropractors who work in a very osteopathic way, and some osteopaths who work in a very chiropractic way!
However, I've had a look at both professions and hopefully will provide a more thorough explanation...
What do we study...?
Both chiropractors and osteopaths undergo a 4 or 5 yr degree course at University and study all the basic biomedical sciences (anatomy, physiology, biochemistry, pathology, biomechanics, nutrition, pharmacology etc), together with the hands-on clinical stuff (physical examination, orthopaedics, neurology) and the various different treatment techniques (manipulation, mobilisation, soft tissue work, rehabilitation etc.) Students have to complete 2-3 years in the teaching clinic (real patients with real problems under supervision from clinicians) and complete a clinical research dissertation prior to graduating. On graduating, many of the associations require completion of a year-long Pre-Registration Training Scheme before they can be fully registered.
There are several different Universities and Colleges in the UK that offer chiropractic or osteopathy, as well as those elsewhere in the world. All courses and colleges should be accredited with the appropriate educational and regulatory body.
How are we regulated...?
Both professions are regulated and protected in the UK by the General Chiropractic Council (GCC) or General Osteopathic Council (GOsC) respectively, who set and maintain the Code of Practice and Standards of Proficiency. Both regulatory bodies require all practitioners to register with them, and it is illegal to call yourself an osteopath or chiropractor, or to practise as one, if you are not on the appropriate Register. The GCC and GOsC require renewal of registration on an annual basis, and will check to see that the applicant has met the mandatory Continuing Professional Development (CPD) requirements, is in good health and good character, is in a 'fit state' to practise and has appropriate indemnity insurance. They can and do prosecute bad people, strike them off the register, or put restrictions of practise on them!
In addition to this, individuals may join an association (eg the British Chiropractic Association, British Osteopathic Association). Each different association has its own membership criteria, (some more stringent than others, so may be a useful indicator in the 'quality' of the practitioner). The associations provide a number of different services and support for the practitioner, for instance indemnity insurance, business and clinical advice and legal support.
The College of Chiropractors is another body; subdivided into regional and educational faculties, its primary role is the provision of postgraduate education, courses and seminars. Attendance at these can be used not only to meet the annual CPD requirements, but also to gain further post-graduate qualifications.
So, what do we actually do...?
Both chiropractors and osteopaths specialise in the diagnosis, treatment and management of conditions that affect the neuromusculoskeletal system and the affect that these may have on the overall health and wellbeing of the whole body. Both chiropractors and osteopaths use 'hands on' techniques (including manipulation, adjustment, mobilisation, soft tissue work, fascial release techniques, myofascial dry needling) to mobilise joints, ease muscle tension, reduce pain and restore neurological function. Most chiropractors and osteopaths will advise on rehabilitative exercises and stretches, posture and ergonomics, diet, nutrition and general exercise and lifestyle in order to promote recovery, prevent recurrence and improve overall health and wellbeing of the patient.
Whilst traditionally thought of as just working on the spine (admittedly, we do tend to specialise in this!) both chiropractors and osteopaths treat the whole body. Hence, as well as treating problems affecting the neck, and low back pain we are proficient at treating problems affecting all the joints (including hip and knee pain, shoulder and elbow injuries, sports injuries, repetitive strain and over-use problems).
Does it work and is it safe...?
By taking a thorough medical and case history, and performing an extensive physical assessment, chiropractors and osteopaths are trained to pick up problems or complications that might prevent, or interfere with treatment. If this is the case, they are able to refer you on to the appropriate specialist, usually via your GP. The most appropriate type of treatment will be used for each individual patient, and techniques can be modified and adapted as necessary, so are safe and effective for people of all ages, shapes and sizes.
The efficacy of chiropractic or osteopathy is supported in a number of peer-reviewed research studies, (particularly when assessing manipulation in the management of chronic or acute, low back or neck pain), but as in all areas of medicine we need more research!
And, finally, which one's best...?!
Both chiropractic and osteopathy are safe and effective in the management of problems with the muscles, joints and nerves. Both require a long period of initial and continued training, both are stringently regulated. As in any profession, regrettably there are unscrupulous individuals, and some practitioners may be better or worse than others. When advising whom to see, I always recommend that people should ensure that the practitioner is registered with their regulatory body, and ideally go with a 'word of mouth' recommendation from someone who has been a patient there before. At the end of the day, the appropriate qualified professional, whether chiropractor or osteopath, should be able to provide safe, professional, responsible and ethical care of patients.
Eich Ceiropractydd yng Nghlinig Ceiropracteg Llangefnii