KEEPING ACTIVE AND WELL

It is important for the patient to stay both physically and mentally healthy while they wait for their surgery as this will help them get the best results from their treatment in the long term.  There are many online tools and resources available to help them keep active and to support their mental health.  Some specific treatments that might help patients include:

Pain Medication and anti-inflammatories          Painkillers and anti-inflammatories can help significantly in terms of allowing people to cope with their daily activities, remain mobile and getting a good night’s sleep. Use of any pain relief medication should be carefully controlled.  Steroid injections can help to ease the pain of osteoarthritis but the likelihood of a steroid injection working can be highly variable depending on the damage to the knee or hip.  Steroids also mask a patient’s symptoms but without addressing the actual underlying cause of the symptoms, thus fooling the patient  into thinking that their knee or hip is better, when it is not resulting in further damage occurring to the joint.

Physiotherapy and Chiropractic            Physiotherapy or chiropractic are recommended by NICE as part of the treatment pathway for knee and hip arthritis.  Appropriate treatment prior to surgery can improve a patient’s mobility and build strength and fitness levels and increasing the likelihood of a successful outcome from the replacement joint surgery.

Non-impact cardio fitness exercise       Exercise programmes can be helpful providing the patient with specific exercises and hands-on supervised guidance.  Cardio fitness exercise is something the patient can do for themselves.  The best exercises for patients with arthritis are those that are light and gentle on the joints such as walking, cycling and swimming.  Performing regular cardio exercise causes the body to produce endorphins helping to raise the patient’s natural pain threshold.

IN SUMMARY

With NHS waiting lists for knee and hip replacement surgery getting longer,  there will be a greater need for patients to consider alternative treatment options in order to delay the need for surgery,  to help them cope while waiting for surgery and to ensure that they are in the best possible shape when they undergo their operation.

USEFUL LINKS

whileyouwait.org       Provides additional information, support and resources to help patients while they are waiting for hospital care.

escape-pain.org  Provides a group rehabilitation programme for people with chronic joint pain that integrates educational self-management and coping strategies with an individualized exercise regimen.

Spinal Stenosis is a problem which builds up over many years. Most people who get spinal stenosis are over 50. In the first part of this article I will discuss the causes and in the second part I talk about symptoms

How Joints Wear: From Muscle Strain to Spinal Stenosis

The short-term episodes of spinal pain or lower back pain that we experience in our everyday life are caused either by strains or injuries to the ligaments and muscles. These may be a result of sports injuries, repetitive stress or sedentary lifestyle. 

People in the middle age are more likely to experience muscle aches and wear and tear of the intervertebral discs.  Aside from these, they also experience degenerative changes or spondylosis particularly in the cervical (neck) and lower lumbar (back) regions.

The discs in our backs naturally have high water content, but as we get older, the discs start to dry out and become weak, which can result in more severe spondylosis. This can cause loss of disc height. As the spine reduces in height the soft tissues and bones to harden and enlarge. These two factors reduce the space that spinal nerves pass through. Spinal stenosis is the narrowing of the space around the spinal nerves.  

Symptoms of Spinal Stenosis

Sciatica

Sciatica refers to a burning sensation that starts from the buttocks and radiates down the back of the leg. Too much pressure or damage to the sciatic nerve is the main cause of this. When the condition worsens, the symptoms will be felt on the sole of the foot.

Numbness and tingling of the buttocks or the legs

Another symptom of spinal stenosis is numbness and tingling of the buttocks and/or legs. When the pressure on the nerve becomes severe, numbness and tingling will be experienced along with the burning sensation; however, not all patients with spinal stenosis will experience both burning pain and sciatica at the same time.

Foot drop

Foot drop refers to weakness of the muscles that allow the ankles and toes to flex. This can occur when the pressure on the nerve reaches a critical level. Foot drop is when an individual has to drag the front of his/her foot and bend the knee in order to help lift the foot higher when walking. Some individuals feel that their foot slaps on the ground when ambulating.

Worsening symptoms with standing and walking

Pain caused by spinal stenosis may be worsened with standing and walking. Studies, however, show that patients experience less pain with sitting or leaning forward as this increases the spaces for the nerves to pass through. Some patients state that walking more than one block can exacerbate the pain and weakness. Walking while leaning on something or even riding a bicycle, however, does not worsen the pain.

With these symptoms, consulting a chiropractor is still the best option. Visit us at our chiropractic clinics in Chester or North Wales. We can help determine the cause of your pain and give appropriate treatment. Spinal stenosis is  not curable but a lot can be done to reduce the symptoms once the correct diagnosis is made.

Spondylosis is a degenerative condition of the spine. It is also known as spinal osteoarthritis. There are two common types of spondylosis: Cervical, which affects the neck, and lumbar, which affects the lower back.

Causes

According to experts, spondylosis is mainly caused by aging. When a person gets older, they tend to exert their bones and cartilages more with every movement, and this causes wear and tear. When this happens, the cushioning in the spinal discs decreases and the bones develop spurs. This results in pain.

Risk Factors

There are a lot of factors that could put someone at risk for this degenerative disease and these include the following:

• Diet
• History of injury
• History of spinal surgery
• Mental health problems
• Smoking
• Sedentary work

Symptoms

Pain in the affected part is one of the most common symptoms of both cervical and lumbar spondylosis. However, the symptom could extend to other areas of the body. It tends to be more severe at the beginning and the end of the day. Other symptoms include numbness, tenderness in the area, tingling, and feelings of weakness.

Spondylosis symptoms develop over time. In some cases, however, symptoms occur all of a sudden. It is recommended to have this condition treated as early as possible because if these symptoms remain untreated, it could result in certain complications such as chronic pain and muscle function loss.

Treatment

While some patients prefer to treat spondylosis with conventional medicine, others prefer chiropractic treatment as this option does not need medications or surgery. Chiropractic treatment restores spinal joint mobility which helps reduce pain as well as improving your overall health.

Chiropractic treatment has a range of methods including spinal adjustment, heat or cold therapy, lifestyle modification, and ultrasound. Most people, as they get older, suffer from spondylosis and this is one of the main conditions we treat at our chiropractic clinics in Chester and North Wales.

The most common symptoms of hip arthritis are stiffness and pain which become worse over time. The pain will start off as mild but will worsen and become more persistent if not treated.

Movement will usually relieve stiffness in the hip joints though they can get worse during periods of rest. Cold weather usually exacerbates the pain. Patients may also suffer from morning stiffness, which may typically last for 30 minutes. Some patients will experience localised pain to the groin area as well as the thigh. The hip can also have limited range of motion and pain with weight-bearing. If the condition worsens the symptoms may become more persistent and painful.

How to Diagnose Hip Arthritis?

Pain in the hip region may refer from the low back, the pelvis or the knee. The first thing a Chiropractor does is take a full medical history.  They will identify the exact location of the pain and find out what makes it worse and what relieves it.  They will also investigate the possible causes. The Chiropractor will complete a physical examination of the patient and perform several tests, including orthopaedic and neurological assessments, muscle strength/tone and postural analysis.  Of course the best way to diagnose hip arthritis is with an x-ray.

Options for Hip Arthritis Treatment

In treating hip arthritis, it is best to first consider  non-surgical and non-drug treatments. Physical therapy is recommended for strengthening and stretching the muscles.  Some aerobic exercise will further benefit rehabilitation.

Treatment for hip osteoarthritis has two main goals – to reduce pain and inflammation and rehabilitation. Once pain and inflammation are under control the chiropractor and patient work together to prevent the problem from reoccurring. This rehabilitation process may include:

• Adjustment and mobilisation of the hip and other involved areas.
• Active soft tissue therapy.
• Education on home exercises, which includes stretching and strengthening exercises.
• Lifestyle changes to prevent aggravation of the injury.
• Orthotics or shoe inserts

A course of Chiropractic treatment can improve hip mobility. By using hands-on treatment techniques and combining these with home exercise, it is possible to restore hip function if the arthritis is not severe.

Lumbar spinal stenosis is often associated with ageing. It is caused by a narrowing of the spinal canal in the lumbar area (lower back). The spine changes as we age and this leads to the degeneration of the intervertebral discs and facet joints. The ligaments also become thicker with age, which also contributes to the narrowing of the spinal canal. [1]

Symptoms of lumbar spinal stenosis include low back pain, increased pain with walking, as well as stiffness of the legs and thighs, pain, numbness, weakness or cramping of the legs, feet or buttocks. Patients usually achieve pain relief when they sit down.

Epidural Steroid Injections

Before surgical treatment is suggested, most clinicians start with conservative measures, such as epidural steroid injections, in treating lumbar spinal stenosis.[2] The use of these injections has increased over the years. However, a recent clinical trial showed evidence that epidural steroid injections are not effective, as published in the New England Journal of Medicine.

The study was conducted by Friedly JL et al. (A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014 Jul 3; 371:11.).

A total of 400 patients with lumbar spinal stenosis were enrolled in a double-blind randomised controlled trial. These patients were randomised to injections with lidocaine plus corticosteroid or lidocaine alone for six weeks.

According to the study, no significant difference was found in between the two groups after a six-week period. No difference was also found after a secondary analysis, comparing interlaminar and transforaminal injections.

Lumbar Spinal Stenosis and Chiropractic Care

Symptoms of lumbar spinal stenosis can be improved with chiropractic care. Patients can achieve long-term pain relief and better quality of life with proper spinal adjustments as well as exercise and self-care techniques.

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[1]
[2] http://www.medscape.com/viewarticle/830500

Spondylolisthesis is a back condition that occurs in both children and adults. In this article we will discuss the different types of Spondylolisthesis together with its causes and symptoms. We then offer the recommended exercises and treatment options available.

What is Spondylolisthesis?

Spondylolisthesis is a medical term for slipped vertebra. This occurs when one vertebral body slips forward over the bone below it. It often affects the lower vertebral bodies. Spondylolisthesis causes back pain, numbness, and/or weakness in one or both legs.

What Are The Symptoms of Spondylolisthesis?

One of the most common symptoms of Spondylolisthesis is an achy-type sensation, however, there are two additional types of pain associated with this condition.

1. Sciatic – Sciatic pain involves tingling, numbness and weakness that starts from the lower back and radiates to the buttocks, down to the back of the thigh and calf. 
2. Claudication – Claudication generally means limping and difficulty in walking.  The numbness and weakness in the legs is related to prolonged activity such as walking and standing. The symptoms are normally felt in the back, buttocks, thighs, or calves.

The Five Types of Spondylolisthesis

1. Isthmic

Usually caused by a fatigue fracture and people who play sports that involve repetitive stress to the lumbar vertebrae are most at risk.

2. Congenital or Dysplastic

This is caused by inadequate bone formation in the spine. Misalignment of the spine puts the vertebrae at risk of slippage. This occurs during a childhood growth spurt in about 14{b67a0f01f7b147b7e978da5adbadca47e09d0d78364efaa0732b6ae8d4f320dc} to 21{b67a0f01f7b147b7e978da5adbadca47e09d0d78364efaa0732b6ae8d4f320dc} cases.

3. Degenerative

This type is most commonly seen in older patients  and is caused by erosion. This results in breakage to the pars interarticularis. Longstanding instability as a result of disc and facet joint degeneration is usually the cause.

4. Traumatic

This is a fracture in the neutral arch as a result of direct injury or trauma.

5. Pathologic

This is the least common form which is brought on by destructive lesion to the pars interarticularis due to severe osteoporosis, carcinoma, or metastasis.

Exercise Recommendations

Doing some knee-to-chest stretch exercises of the tight iliopsoas muscles and hamstrings may help relieve the symptoms temporarily. Core strengthening exercises can also be particularly helpful.  However, it is not recommended to attempt any new exercises or stretches as some of these can cause or exacerbate symptoms.

Chiropractic Treatment

Treatment of Spondylolisthesis depends on the signs and symptoms a patient has. At the Back Doctor Chiropractic Clinic in Chester, we have helped patients with this problem.

If conservative treatment does not relieve the symptoms, the condition has most likely become sever and surgical consultation may be required.