Dear patients.

I have essentially pinched this from the BBC website as it is excellent!

The original article, complete with fun pictures is here.

Kind regards

Matt

Millions of people are less physically active than they were before Covid-19. For those working from home, the morning walk to the bus stop has gone. Days on end can be spent hunched over a laptop without ever leaving the house.

For some, that's taking a painful toll.

A survey of people working remotely, by Opinium for the charity Versus Arthritis, found 81% of respondents were experiencing some back, neck or shoulder pain. Almost half (48%) said they were less physically active than before the lockdown. Another study by the Institute for Employment Studies found 35% reporting new back pain while working from home.

Physiotherapists and other back pain experts say those with serious or persistent problems should seek professional help, but there are things that many of us can do to help ourselves.

Don't just sit there

Pretty much all the experts agree that one of the best things you can do is get moving.

Don't sit in the same position for long periods.

"Make sure you take any opportunity you can to move your body," says Ashley James of the Chartered Society of Physiotherapists (CSP). "It doesn't need to be about exercise as such," he says. "It's about building movement into your day." He calls it taking "regular movement snacks".

That could be taking phone calls or joining online meetings standing up, just having a stretch or walking up and down the stairs when you don't really need to, he says. When you're moving, different muscle groups share the work of keeping your head, neck, back and the rest of your body supported, rather than continually overloading the same muscles.

Where lockdowns have restricted outside exercise to once a day, Mr James's advice is to use that daily opportunity for at least a good walk whenever you can.

Movement can help with breathing by opening up your chest, and reducing muscle atrophy. It increases blood flow and lubricates synovial joints - joints that allow free movement - like hips and shoulders.

Set an alarm

Creating a new routine to help keep you moving can be difficult, so experts suggest setting a timer on your phone or laptop to remind you to move. It's a good way to avoid getting stuck in the same position hour after hour, says neck specialist Chris Worsfold.

"We've evolved to move," he says. "We naturally want to move after about 20 or 30 minutes, so that's when you need to go and shake it about."

If you're sitting when it goes off, stand up. If you're standing, have a stretch or walk up and down the stairs.
"The key is to create a routine that works for you," says Leanne Antoine, who treats patients in Hertfordshire. "There's no point in creating a schedule that makes you feel like a failure when you don't keep to it."

So ask yourself honestly what you would be prepared to do, and stick to it. Be careful, but as long as it gets you out of the chair, stretching, walking or Zumba dancing in your living room, it doesn't matter, she says.

Sort out your workspace

"You don't need the perfect set up with a thousand pound chair, but if you're scrunched up on the sofa, it's not going to be good for your back," says Chris Martey.

Your workspace is worth some serious thought, but companies have a big interest in selling expensive equipment, so he says beware of unnecessary costs.

Leanne Antoine agrees: "Just make small tweaks that don't cost the earth."

That could be as simple as using a cushion to raise you up on your chair, or to support your lower back. An inexpensive adjustable office chair can help. A mount for your laptop will raise your screen to eye level so that you're not always looking down, particularly on long online video calls. An external keyboard is also useful.

"Talk to your employer," says Ms Antoine. Many will supply equipment to staff.

If you have to use a sofa, at least make sure your feet are firmly on the floor and you're sitting back with a cushion to support your lower back. Standing desks can be helpful, says Chris Martey. But you need to alternate between standing and sitting - and take regular screen breaks.

If you don't have a standing desk, some experts recommend standing with your laptop on an ironing board for short periods.

Get better sleep

We're in a "perfect storm" for back trouble - according to Ashley James, with Covid-19 restricting physical activity while simultaneously ramping up anxieties about health, job insecurity, children's education and more.

It's impossible to quantify but a lot of back pain is driven by anxiety, he says. In the jargon, back problems are "biopsychosocial". It doesn't help that we're now in winter - when many people experience a dip in mood.

People de-stress in all sorts of ways of course. Pilates and yoga are helpful for some.

One of the best ways is to work on getting better sleep, says Mr James. "Sleep hygiene" is the key.

That means cutting down on caffeine in the afternoon and evening, keeping to a consistent night time routine and trying to wake up at the same time every day.

The NHS advises against using electronic devices for an hour or so before you go to bed, as the light from the screen may make it more difficult for you to sleep. Light suppresses the secretion of melatonin, a hormone which helps to make you sleepy.

Many studies have suggested that blue light does this most powerfully, but some research suggests the warmer colours used in "night mode" on many devices may actually have a bigger impact.

Desk exercises

The CSP has designed some simple stretches which, if done regularly, can help ward off aches and pains. They're for people who are working remotely and find themselves sitting for long periods.

• How to exercise at your desk (Chartered Society of Physiotherapy)
• NHS advice on back pain treatment

The chest stretch, the leg stretch, the sit stretch and the wall press, are designed to help different muscle groups. The CSP says there is no "perfect posture" and that the priority is to keep moving.

There's a positive message here, says Chris Martey. For millions of people suffering everyday aches and pains he says: "You can take control. You can self-manage. You don't have to be dependent."
Illustration by Gerry Fletcher.

Dear all

We hope this blog post finds you in good health, both mentally and physically.

Our Worthing & Horsham clinics are now open for face-to-face chiropractic & massage appointments.

​What To Expect At Your Appointment

All these measures are designed to reduce the risk of infection and to protect you, us and our families.

Please book all appointments using our simple online booking system. We have recently integrated online payments as part of the system which reduces your time in the clinic, reduces the amount of items that you need to bring with you (purses & wallets) and eliminates the need for you to touch anything other than the treatment couch. We strongly urge all of our patients to use the online booking system.

​If you prefer not to book and pay online, you can book via telephone and pay by contactless card or Android/Apple Pay after your treatment. 

Before we see you in person, we will ask you to complete an online Coronavirus (COVID-19) Triage & Consent Form. The link for this will be sent to you in your appointment confirmation and reminder e-mails. You should complete this form the night before your treatment. Unfortunately, without this form completed, we will be unable to see you.​

We need to ensure that all patients are symptom free, have not been told to self-isolate by NHS Test & Trace, are not in the “shielding” group and that you understand the risks of face-to-face contact (treatment).

Please use the toilet before travelling to your appointment. The clinic toilet will not be available for patient use for the foreseeable future.

Please arrive for your appointment at your appointment time. Please do not arrive early as waiting in reception will not be possible.

Please come to your appointment on your own to minimise infection risk.

You will be required to wait outside at least two metres from the front door (or ideally in your car) until we come to collect you.

Please wear your own face covering to your appointment. We have a small stock of type IIR surgical masks that you can buy from us if you do not have a face covering of your own.

We will open the door to collect you, give you some hand sanitiser and check your temperature with a non-contact thermometer. You will then be invited inside subject to your temperature being below 37.8°C.

We will be wearing full PPE. We will be using a new set of non-latex disposable gloves and a disposable apron for every patient. We will wear a new face mask and safety glasses for every treatment session. In other words, one set for the morning and one set for the afternoon.

Please do not bring anything with you that is non-essential. If you have not booked online and need to pay after your appointment, please bring your payment card/mobile phone for contactless payment.​ 

New patients should bring their mobile phone as they will need it to give consent to treatment online.

Please try not to touch anything apart from the treatment couch. We will open all doors for you. The less you touch, the lower the risk of infection.

There will be only one chair in the treatment room which will be 2 metres away from our chair and desk.

After your treatment, we will advise you on when/whether you need to book another appointment. If you do, you can do so using our online booking system when you get into your car or when you get home.

​If you prefer, we can book an appointment for you then & there. He will e-mail any advice or exercises to you afterwards.

We will say goodbye and open the treatment room and front doors for you. We will be unable to chat as he will need to clean before the next patient. He will be cleaning all surfaces that may have been touched including the treatment couch, desk, computer, mouse, keyboard and door handles after every appointment.

Appointments are booked at least 15 minutes apart to avoid interaction, to allow airborne droplets to fall, to allow aeration of the premises, and to allow time for extra cleaning measures.

Below is an infographic which summarises the key points.

Please e-mail us if you have any questions.

Kind regards

Matt & Zoe George
Tudor Court Chiropractic

New research reveals that women could be neglecting their back or neck health as they take twice as long, six weeks on average, to seek help for their pain, while men take just three. The consumer research also found that women, on average, develop back or neck pain at the age of 27, six years younger than men and experience it more regularly. Despite this, a quarter of women have never visited a health professional for their pain.

In addition, the findings from the British Chiropractic Association reveal that more than a third of women are turning to over the counter medication as a first port of call, 12% more than their male counterparts, ignoring simple fixes such as exercise and stretching which can prevent and improve back or neck pain. In contrast, men are most likely to turn to their GP when initially experiencing pain.

Whilst women are least likely to seek help, the BCA found that overall over a third (34%) of Brits would wait a month or more to seek professional help for back or neck pain. Moreover, one in ten Brits would continue to suffer in silence, not seeking help at all.

​Simple lifestyle changes, such as stretching and incorporating more movement into your daily routine, can be an easy and effective way to keep the back pain at bay, yet only 11% of men and women make these changes to their routine when they start to experience back pain.

This trend for women to ‘keep calm and carry on’ is also reflected in their delay in seeking help for other health conditions, with men seeking professional help for joint pain, strains and headaches more quickly than women.
​
For the majority of back pain sufferers the discomfort of back and neck pain can be eased or prevented by maintaining a strong, active body which is able to cope with the demands made of it, as described in a recent series of paper on back pain in The Lancet.

Top tips for women with back or neck pain:
•    Keep moving: Almost half (47%) of female respondents pointed to sitting still for a long time as a key trigger for their pain. If you are required to sit in one position for extended periods of time, at work or on a long drive for example, try to take breaks to walk around, stretch and move your joints and muscles every 30-60 minutes.
•    Hit the gym: Incorporating moderate exercise into your lifestyle will help you to build a stronger body that is better placed for dealing with the demands you make of it. If pain is preventing you from exercising, try a form of exercise, such as swimming, which will put less pressure on the joints while allowing your body to move.
•    Stretch it out: Stretching can be a beneficial way to keep your joints and muscles active. The BCA’s Straighten Up programme of simple exercises can be incorporated into your daily routine to promote movement, strength and flexibility in the spine.
•    Get a good night’s sleep: After a busy day sleep is essential, so I suggest taking some simple steps to ensure you sleep in a comfortable position. The Sleep Council recommend replacing your mattress every seven years and when you do, pick one that provides the right support for your body type and pillows that suit your sleeping position.
•    Keep it light: Almost a third (32%) of women cite that carrying their bag is a key trigger for their back or neck pain. If you are one of those people, then think about trying a different bag or about what you’re loading it up with! Choosing a bag that can be worn as a backpack or across the body may help to spread the load. Keeping your bag light and emptying it of unnecessary items each day can also help to prevent unnecessary weight.

​Consumer research carried out between 28/02/2018 and 07/03/2018 on a sample of 2,066 UK adults aged 16 + on behalf of the British Chiropractic Association.

I've pinched this from the BBC but I thought it was well enough written that I didn't have to bother! We can't even swim in the sea now!

Matt

Swimming in the sea substantially increases the chance of developing stomach bugs, ear aches and other illnesses, researchers have found.
The University of Exeter Medical School and Centre for Ecology and Hydrology carried out the study.
It concluded, compared to non-sea swimmers, the likelihood of developing an earache increases by 77% and for a gastrointestinal illness rises by 29%.
As well as swimming, the risks also apply to water sports, such as surfing.
Researchers reviewed 19 studies linking sea bathing to illness from the UK, US, Australia, New Zealand, Denmark and Norway. They analysed results from more than 120,000 people.
"In high-income countries like the UK, there is a perception that there is little risk to health of spending time in the sea," said Dr Anne Leonard.
"However, our paper shows that spending time in the sea does increase the probability of developing illnesses, such as ear ailments and problems involving the digestive system, such as stomach ache and diarrhoea.
"We think that this indicates that pollution is still an issue affecting swimmers in some of the world's richest countries."
Research supervisor Dr Will Gaze said: "We don't want to deter people from going into the sea, which has many health benefits such as improving physical fitness, wellbeing and connecting with nature.
"However, it is important people are aware of the risks so they can make informed decisions."
Dr Gaze said most people will recover from infections with no medical treatment but they can prove more serious for vulnerable people, such as the very old or very young.
He added: "We have come a long way in terms of cleaning up our waters, but our evidence shows there is still work to be done.
"We hope this research will contribute to further efforts to clean up our coastal waters."

With the temperatures hitting some icy lows, perfect your ‘ice walk’ this March with top tips from the British Chiropractic Association.

Snowy and icy roads and pavements mean potentially hazardous conditions underfoot and a rise in injuries caused by slips and falls. It is quite natural, therefore, for us to be wary when walking outdoors and adopting our ‘ice walk’; the problem is that an unnatural walking posture could cause as many problems as the icy conditions themselves.

Tim Hutchful, from the British Chiropractic Association, offers some top tips to stay safe and adopt a better ‘ice walk’:

Best foot forward
–    It is a good idea to have two pairs of shoes, one for walking in the ice and snow, the other for indoors or whilst driving.
–    Waterproof or other, lined shoes are preferable as are thermal socks, as these items will help keep your feet warm. Cold, numb feet are less able to sense and adapt to changing conditions.
–    Footwear should have a solid and large, raised treads on the sole; essential for maximising your grip on the ice.
–    Shoes with support features are important – walking shoes with a firm ankle support are ideal as they help prevent you ‘going over’ on your ankle and help you feel more stable in slippery conditions.  If shoes have laces, they should be firmly laced to give a close fit without limiting the circulation.
What to avoid…..Wellingtons can be practical, but they often don’t give enough support and can be difficult to take off. Also avoid walking outside in leather or other, smooth soled shoes.

Top Gear
–    Clothing should be warm and allow you to move freely. Anything that impedes you from walking ‘normally’ could make you more prone to falling over or lead to you walking in an unnatural way.

Be Prepared
–    There are things you can do to prepare yourself for better balance. Standing on one leg, as an exercise, is a great way to help improve your balance.
–    When you are out and about, keeping your hands out of your pockets (use gloves) so that you can use your arms for better balance is a great idea too.
–    Watch out for parts of the pavement that may have been in shadow or under trees, where there is more likely be black ice, but make sure you pay attention to what is ahead too!

Falling Gracefully
If you do fall, try and curl up and ‘roll’ with the fall and stay relaxed, this will minimise any jarring to your body. Whilst it may be an automatic reaction, try to avoid putting your hands out to save you – this may cause wrist injuries.

Keep Your Wits
Try to avoid alcohol. Not only will you be more prone to feeling the adverse effects of the cold (because alcohol causes loss of body heat) but it may also cause you to take risks that you wouldn’t normally do and, of course, make you more unsteady on your feet. Keep topped up with warm drinks to keep your temperature up.

I saw this the other day and thought it was brilliant! Give it a try. 

Ten days ago, I went on my annual trip to the Royal College of Chiropractors Winter Conference in London. A lot of it was dull, very dull.

However, at the conference was a speaker named Ann Gates who talked about the importance of exercise for all sorts of health conditions. These were things that I already knew but that I had almost forgotten.

Her main point was that if exercise was a drug that you could get from your GP, if would be hailed as  a miracle. A drug that reduces all causes of death by 30%! 

The other information that I liked was the amount of exercise that different groups of people require. As you can see from the pictures below, 0-5 year old's need 3 hours of moderate intensity exercise per day. 5-18 year old's need 60 minutes per day and everyone over 18 years of age needs 150 minutes per week MINIMUM.

So what is moderate exercise I hear you cry? Well, examples of moderate exercise include: 

• Brisk walking 
• Water aerobics
• Riding a bike on level ground or with few hills
• Doubles tennis
• Pushing a lawn mower
• Hiking
• Skateboarding
• Rollerblading
• Volleyball
• Basketball 

​As the rather excellent NHS website states "Moderate activity will raise your heart rate and make you breathe faster and feel warmer. One way to tell if you're working at a moderate level is if you can still talk, but you can't sing the words to a song."

I would strongly encourage everyone to visit the NHS website I mentioned above by clicking HERE. The page you will be taken to is for adult recommendations but there are links to the children's versions too.

As you will see when you visit the NHS website, their are different ways to get your quota in. You can do 75 minutes of vigorous exercise instead. As a general rule, you can half the amount of time required if the exercise is vigorous. 

Examples of vigorous exercise include:

• Jogging or running
• Swimming fast
• Riding a bike fast or on hills
• Singles tennis
• Football
• Rugby
• Skipping rope
• Hockey
• Aerobics
• Gymnastics
• Martial arts

The recommendations for adults also state that strength training should incorporated into our routines. However, the easiest way to think of it really is to do 30 minutes of some sort of exercise every single day. That way, you've got it covered. 

I think the most important thing to take away from all of this is that most of us could do a little more than we do currently. As the picture at the top of this article shows, the benefits of exercise really are incredible and we can all access those benefits with some fairly small changes.

Thanks for reading,

Matthew George

The second most common question I am asked is: Should I use ice or heat for my pain?

Just to be difficult, the answer is both!

This piece of advice is as helpful as a chocolate teapot. Therefore, I will try to explain when to use ice and when to use heat in the following paragraphs.

The first thing to think about is that cold reduces inflammation which reduces swelling, redness and soreness. Heat increases new blood flow into the area which brings with it nutrients and inflammatory chemicals. This promotes healing and relaxation. So, now that we know what ice and heat do, we can start to understand when to use them.

If you have a sharp, catching pain that almost takes your breath away, you are probably experiencing inflammatory pain. Most commonly this comes from joints and occasionally tendons and ligaments. You would almost certainly need to use ice to reduce the inflammation and thereby reduce the pain. I recommend using an ice pack for around 15 minutes at a time. 20 minutes is okay if you are thick set are using it on your lower back. 5 minutes is enough if you are using ice on your hand or foot as their isn't much padding for the ice to permeate. Remember to wrap the ice pack in a tea towel or pillow case as freezer burn is not nice. When you are finished, pop the ice pack into the freezer for 30-40 minutes and then repeat. If it's easier, just use the ice pack once an hour for 15 minutes until the sharp pain has gone. I do understand that real life means that may not be possible. Just do what you can, the more the merrier. 

If you have an aching, dull pain that seems to be ever present and annoying, you are probably experiencing muscle tightness or over-activity. You would be better served using heat to relax the muscles and flood them with nutrients so that they can heal. I recommend using heat in the same way as ice, except that with heat, it's harder to overdo it. If you left a heat pack on for 30-40 minutes nothing bad would happen. If you left ice on for too long, you can damage the tissues. Use heat in the same way as the ice, once an hour until things have improved. Incidentally, if you have a long-term (chronic) condition such as wear and tear in your joints (osteoarthritis), heat can be used to ease the pain and stiffness associated with this.

So, in summary, the sharper and newer (acute) the pain, the more likely it is that you should use an ice pack. The duller, more achey and longer lasting (chronic) the pain, the more likely it is that a heat pack would be best. 

Acute and sharp = ice.
Chronic and achey = heat.

We have packs that can be frozen or microwaved available in both clinics for £5. They last around five years and can be constantly re-used.

For a bit of fun, the first person who correctly tells me the most common question I am asked wins a brand new ice/heat pack.

Good luck and happy icing. Or heating obviously. 

​MG

We are currently in the midst of a summer of sporting excitement and entertainment with something for everyone: Euro 2016, Rugby test matches, test cricket, Tour de France, US PGA Golf and Wimbledon to name a few and of course, not forgetting the Olympics in Rio de Janeiro. Make sure you are not the injury worry this sporting summer and take care of your posture.

Sitting for long periods can trigger back pain and with endless hours or sporting coverage in the offing, some will be more at risk than ever of becoming couch potatoes!

Our lifestyles are sedentary enough but, during televised sporting events, people spend even more time sitting down. Lack of exercise is our worst enemy and we should avoid sitting for prolonged periods of time, as sitting incorrectly puts almost twice as much pressure on the back than when standing.

Prolonged sitting isn't the only health hazard. Sport fans will argue that jumping up to celebrate a gold medal win or berate a referee is an involuntary action but, doing it too quickly may be more harmful than sitting down for prolonged periods. Going from a fixed posture when sitting down to quickly jumping up on your feet in excitement could be potentially damaging.

Follow this simple advice from the British Chiropractic Association (BCA) to have a pain free summer of sport:
• Try to ensure that you change position every twenty minutes; stand up and move around (An excuse to grab a refreshing beverage)!
• Make sure you are active during half time; there is plenty of light exercise you can do during the 15 minute break.
• Don't slump, sit right back into the seat, so your back is fully against the back of the chair/sofa.
• Drink Up! - As much as possible, try drinking water instead of beer, tea and coffee; it will keep you hydrated and help you concentrate on what is happening.
•  All this variety of sport may inspire you to get out and try it yourself, which is the perfect way to keep active over the long summer evenings.