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.

I was asked the other day about maintenance care. In fact I was asked if I would recommend it. 

I instantly felt a blog post coming on!

Chiropractors have long held the belief that regular monthly follow up treatments even after you have reached maximum improvement are just as helpful for the spine as the regular services you provide for your car.
 
​Pain
 
In a recent study reported in the Journal of Manipulative and Physiological Therapeutics, after intensive care for one month, thirty long-term back pain patients were randomised to receive either no follow-up care, or maintenance chiropractic treatments at three week intervals for a nine month period.
 
Both groups continued to have significant improvement in their pain scores throughout the follow-up period. However, only the group receiving maintenance care during the follow-up period retained their improvement in disability nine months later.
 
In other words, when patients opt for maintenance care they generally notice their pain and stiffness less often and experience fewer flare-ups.
 
Overall health
 
Can maintenance adjustments really help our overall health and well-being? In case studies, patients report improvement in both mental and physical well being when they continue maintenance care. Also, other chiropractic services, such as advice regarding diet, exercise, posture, and stress management, have a more meaningful impact on overall health and well-being when continued during follow-up visits.
 
In the Journal of Manipulative and Physiological Therapeutics it was reported that based on a seven year period, patients utilising chiropractic maintenance had:

• A 60.2% reduction in hospital admissions
• A 59.0% decrease in hospital days
• A 62.0% drop in outpatient surgeries and procedures
• An 85% decrease in pharmaceutical costs when compared with conventional medicine within the same geography and during the same time frame.

 
Once per month?
 
Do patients have to keep coming monthly to get best results? Well, because chiropractors look at their patients as individuals that respond differently to treatment approaches, it does depend on several factors.
 
There may be some especially older individuals with significant arthritis that get best results when having treatment more often than monthly. On the other hand a younger individual that is fit and has no prior history of problems may be able to return every two or three months for a “tune-up” and still get great results. Still another individual may get great results for a while then get put under a lot of stress, stop exercising and see their problems worsen. They may then need a temporary increase in the frequency of their follow-up care.
 
No two patients are exactly alike. However, for a lot of patients that have a prior history of significant spinal problems, a monthly treatment seems to provide sustained relief and help prevent recurrence. In fact, I go to my chiropractor in Horsham once per month for maintenance and prevention.
 
What if it’s not for me?
 
If you have read through this information and have decided that maintenance care isn’t for you, that’s okay. You can always call us on an ‘as and when’ basis whenever you need us. If you have any questions, please ask.

​MG

It has become apparent that skinny jeans can seriously damage muscles and nerves.

A 35-year-old woman had to be cut out of a pair after her calves ballooned in size, according to the Journal of Neurology, Neurosurgery and Psychiatry.

She had spent hours squatting to empty cupboards for a house move in Australia. By evening, her feet were numb and she found it hard to walk.

Doctors believe the woman developed a condition called compartment syndrome, made worse by her skinny jeans.

Compartment syndrome is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles - in this case, the calves.

The condition caused the woman to trip and fall and, unable to get up, she then spent several hours lying on the ground.

On examination at the Royal Adelaide Hospital, her lower legs were severely swollen.

Although her feet were warm and had enough blood supplying them, her muscles were weak and she had lost some feeling.

As the pressure had built in her lower legs, her muscles and nerves became damaged.

She was put on an intravenous drip and after four days was able to walk unaided.

Other medics have reported a number of cases where patients have developed tingly, numb thighs from wearing the figure-hugging low-cut denim trousers - although the chance of it happening is still slim for most people.

Priya Dasoju, professional adviser at the Chartered Society of Physiotherapy, said: "As with many of these warnings, the very unfortunate case highlighted is an extreme one.

"There's no need to ditch the skinny jeans just yet, simply avoid staying in the same position for too long and keep moving throughout the day. If you do suffer any prolonged pain you should of course seek help, but no-one should be alarmed by this warning or change the cut of their jeans."

I for one agree with Priya. It really is common sense!

MG

Low back pain. Those of us who have experienced it know that when the pain hits, it makes us miserable. Everyone seems to offer friendly advice on how to abstain from pain, but do they really know what they're talking about? Some commonly accepted recommendations may do you more harm than good.

1. Best rest is good for recovery: Recommendations have flipped over recent years between staying in bed or staying active and a 2010 Cochrane review suggested that the margin between these pieces of advice is closer than once thought. 

However, overall, studies show that being active has an edge over bed rest and current clinical guidelines favour activity and exercise. One thing's for certain, prolonged bed rest can lead to muscle wasting and de-conditioning, which can make getting back on your feet a greater challenge.

2. Sit up straight to stop the pain: I always tell my patients to listen to their bodies and in certain back conditions, sitting up straight may be even more painful than bending because of added pressure on the lumbar spinal nerve roots. Conversely, a patient may get some relief lying on one side in the foetal position.

There hasn't been much scientific evidence directly linking posture to developing back pain, but it makes sense that posture can put pressure on different parts of your back. If you're always slumped to one side, some muscles may become weaker than others and, therefore, more susceptible to strain or damage. If spinal supporting muscles weaken, it can also affect the position of your spine, contributing to back pain.

3. Your diet won't affect you back: I've seen quite a few overweight patients lose their back pain when they lost weight. Of course, the converse also applies. Carrying extra weight, especially in the abdomen, can strain your back and increase lumbar lordosis, an excessive inward curvature of the spine. Weight gain also causes some pregnant women to develop low back pain. Obesity also speeds up lumbar disc degeneration that often occurs with aging.

A recent study showed that even adolescents who are overweight are susceptible to low back pain and disc degeneration and an elevated body mass index (BMI) was significantly associated with increased severity of disc degeneration.

4. Get the firmest mattress you can find: Several studies suggest that people who suffer from low back pain actually benefit more from a medium-firm mattress. Why? If a mattress is too firm, it won't support the body evenly and may cause discomfort at the heaviest points like hips and shoulders. If the mattress is too soft, a sleeper could sink into the bed and have a harder time moving, which could cause stiffness and pain in the morning.

Having a slightly softer mattress places less compression on your body and may grant you a better night's sleep.

5. You need a back operation: Unless your pain is unrelenting and no form of treatment seems to work, or you develop a serious neurological deficit, such as a foot drop, you shouldn't rush to surgery. Many common back problems, even those that cause severe pain, can be helped with conservative treatment.

Not everyone that undergoes surgery is happy with the end result. A 2009  survey of almost 1000 consumerreports.org subscribers who had undergone surgery for low back pain found only 60 percent said they were completely or very satisfied with the results of their operation. In comparison, 82 percent of the people who had hip or knee replacement surgery in a 2006 survey said they were completely or very satisfied with the results.

6. Painkillers are more effective than hands-on treatment: In a Consumer Reports Health Ratings Centre 2009 survey of more than 14,000 subscribers who experienced low back pain over the previous year but never had back surgery, hands-on treatments were rated very helpful by sufferers. Fifty-eight percent of survey respondents favored chiropractic treatments, while 48 percent liked massage and 46 percent preferred physiotherapy. 

Of those patients who had taken prescription medications in the previous year, 40 percent said they were helped a lot by nonsteroidal anti-inflammatory drugs and 43 percent by muscle relaxants.

7. It matters how you lift: Well, yes and no. While the advice is sound and it's better to: bend at your knees, not at your waist; lift using your leg muscles; tighten your abdominal muscles; and hold the object close to your body, if you have a known back problem, like a herniated disc, it's best to avoid strenuous lifting entirely.

It's fairly common for me to see return patients who get into trouble because they continued to lift heavy weights at the gym, moved furniture, or shoveled snow.

8. Get a scan as soon as possible: Immediate or routine imaging of lumbar spines in patients with low back pain does not improve outcomes, in fact, it may make things worse for you. How? A CT scan increases your exposure to radiation, and a MRI scan may lead to unnecessary surgery. For example, lumbar imaging in America is growing at an alarming rate and some experts believe it correlates with a nearly three-fold increase in surgery rates over the past decade.

When should a scan be ordered? If you are experiencing fever, leg muscle weakness or wasting, a change in bowel or bladder function, have a history of cancer, or pain associated with a recent trauma.

Any questions, please send me an email.

Matt

A 2011 case study suggests that chiropractic adjustments may alleviate chronic dizziness associated with neck pain.

A 29 year old man had been suffering from cervicogenic (coming from the neck) dizziness for 10 years. His dizziness developed in his 20's after a lifetime of neck and back pain as a result of a car accident he’d been in as child. 

The man had tried a multitude (a big word for a Monday) of both medical and alternative treatments but nothing seemed to work. That’s when he began receiving chiropractic adjustments as part of a case study on chiropractic treatment for dizziness. The man immediately felt less dizzy after just one adjustment and continued to improve from there.

After a short course of treatment, the young man had substantially less dizziness and pain, better neck range of motion and an improved quality of life. Since there were no serious side effects, researchers concluded that chiropractic adjustments were a safe, effective treatment for this patient’s pain.

Although this was just a case study, it verifies research from another study in which chiropractic care combined with other approaches reduced dizziness in 80% of patients. However, it must be said that chiropractic adjustments will only be effective for cervicogenic dizziness.

For Benign paroxysmal positional vertigo (BPPV), the Epley manoeuvre would be more appropriate but happily, equally as effective.

Have a great day (in the pouring rain).

Matthew

The December 2009 issue of the Journal of Chiropractic Medicine included a study that focused on golfers at two different clubs in São Paulo, Brazil. A group of 43 golfers were divided into two random groups: One group received only a stretch program while the second group received the same stretch program in addition to chiropractic care.

All study participants were initially asked to perform three full swing maneuvers, and measurements were made of the average distance they were able to hit the ball for the three swings. Then, depending on which test group they were part of, the golfers went through just the stretching program, or the stretching plus chiropractic.

After participating in just the stretching or chiropractic plus stretching, the participants were asked to repeat the same three swing maneuvers and measurements were taken. This entire process was repeated for a period of four weeks over the course of the study. To maintain consistency, the study noted that the average age, handicap, and initial swing were comparable among all 43 golfers in the study.

The results were clear: After four weeks, there was no improvement in the “full swing performance” (defined in the study as the average distance the golfers were able to hit the ball), among those in the group that only did the stretching program prior to hitting the golf balls. But among those who received four sessions of stretching and chiropractic care, golfers showed a statistically significant improvement in their “full swing performance,” meaning that they hit the ball farther than the stretching-only group.

If you are hoping to improve your rounds of golf, please give us a call.

Tennis and golfers elbow, two of my favourite injuries. Is it strange that I have my favourite injuries, well yes it probably is.

Anyway, most of us have either had tennis or golfers elbow or know somebody who has. So what are they? Simply put, they are a tendon strain/pull/tear. N.B [The terms strain, pull and tear can be used interchangeably for any muscle or tendon injury].

Tennis Elbow

This occurs on the outside of the forearm and is shown on the above picture on the left hand side. Most people who suffer from tennis elbow don't play tennis. It's more likely that they have been typing or using a screwdriver too much. 

Over time the tendon gets irritated, tears slightly and becomes inflamed which hurts, a lot. If tennis elbow is actually caused by tennis, it happens we we over-reach to play a backhand shot. The ball hits the racket and forces the wrist to flex unexpectedly. This pulls the muscles on the outside of the forearm which in turn pulls the tendon resulting in a tear. Hopefully the picture below will help to explain a little better.

Golfers Elbow

This is essentially the exact opposite of tennis elbow. It is shown on the picture at the top of the page on the right hand side. Again, this is rarely caused by golf and is more commonly a problem for people who work with their hands, especially tradesman, gardeners etc.

As with the tennis elbow, the tendon on the inside of the forearm tears slightly and hurts, a lot. If golf has caused golfers elbow, it happens as you swing the club down to hit the ball, especially if the club gets caught in the turf/sand. The arm furthest from the ball is the one that is affected as the wrist is forcibly extended. This pulls the muscles on the inside of the forearm which in turn pulls the tendon resulting in a tear. The picture below should help explain.

Treatment

If you are unfortunate enough to suffer from tennis or golfers elbow fear not as it can be treated successfully with chiropractic treatment without the need for surgery or cortisone (steroid) injections. 

However, it can take several months to get back to normality, especially if your work/hobbies irritate it. The treatment involves fairly painful muscle and tendon massage with home exercises to keep the muscles and tendons flexible and strong.

Prevention

Whoever said prevention is better than cure probably suffered from tennis or golfers elbow. These problems are so easy to prevent with some simple stretches.

The following stretches should be performed by all tennis players and golfers before they play and anyone who works with their hands. Zoe and I always do these stretches before we start seeing patients, every day.

Hold them for 30-40 seconds and do two of each on each arm.

Summary

• Tennis and golfers elbow are horrible, painful injuries that anyone can get, not just tennis players and golfers.
  

• Chiropractic treatment can fix these issues but treatment hurts and it can take a while.
  

• It's much easier, cheaper and less painful to prevent these problems with simple stretching than to treat them.
  

Any questions please email me: [email protected]

Happy stretching!

Matthew