The word ‘mindfulness’ means compassionate and lucid awareness, a sense of knowing what is happening in the external and internal world as it is happening.  In its more common usage in recent clinical literature, it has come to mean intentionally paying attention to moment by moment events as they unfold, noticing habitual reactions to such events, often characterized by aversion or attachment, and cultivating the ability to respond to events with an attitude of open curiosity and compassion.

Mindfulness is traditionally cultivated by the practice of meditation in which people learn to pay attention to each moment with full intentionality and with friendly interest.

There are a number of mindfulness techniques that are utilized as part of MBCT including meditation, body scan exercises, mindfulness practices and yoga.  People might also be taught the ‘three minute breathing space technique’ which focuses on three steps, each one minute in duration.  Firstly, observing your experience (how are you doing right now?).  Secondly, focusing on your breath and thirdly, attending to your body and other physical sensations.

BENEFITS OF MBCT

A primary assumption of cognitive therapy is that thoughts precede moods and false self-beliefs lead to negative emotions such as depression.  MBCT utilizes elements of cognitive therapy to help you recognize and reassess your patterns of stress inducing thoughts and replace them with calming thoughts.  This approach helps people review their thoughts without getting caught up in them.  The combination of mindfulness and cognitive therapy is what makes MBCT so effective.  Mindfulness helps you observe and identify your feelings while cognitive therapy teaches you to interrupt automatic thought processes and work through feelings in a healthy way.

MBCT is also helpful in managing pain, particularly with helping the body to relax and to use calming thoughts as opposed to ones that may increase the subjective experience of pain.

Research has shown that Mindfulness-Based Cognitive Therapy can be effective for helping individuals who have experienced multiple episodes of depression and has also proved to be helpful with a wide range of mental health concerns such as anxiety disorders, low mood, bipolar disorder and depression associated with medical illnesses or trauma.  However, because it is a relatively new treatment modality, the long term benefits of this approach may not yet be fully determinable and further research may provide greater support for its effectiveness when treating bipolar, eating disorders, psychosis and other conditions.

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.

The spine is designed to move. Each vertebra is connected to the next by a disc and 2 facet joints. It is similar to a snake, which is not surprising as we evolved from the same source. For optimum health our backs should be mobile at every joint. Our spines should be as fluid and flexible as a snake. However, they are not. This may, in part, be due to our upright posture which puts more stress on the spinal muscles and joints.

You may have noticed that young people are flexible while older people are more stiff. The older we get the more our backs stiffen up. This is because the fibres that cover our spinal joints get thicker and more brittle over time. These fibres are a kind of scar tissue and those parts of the spine that get more stress on them due to our habitual postures or repetitive work activity, tend to develop more scar tissue. This is called “wear and tear” by some people and may be the first stage of arthritis.

Chiropractic treatment releases the adhesions that form on people’s spines giving them more mobility. When you have a more mobile spine you suffer less pain. Many people think that a chiropractor’s job is about relieving back pain. It is not. It is about restoring mobility.  Reduced pain is a by-product of chiropractic treatment

The first stage in restoring health to your back is to improve mobility. When your back is more mobile it is important to work on your core strength. Core stability exercises, such as taught in a Pilates class, help to strengthen the muscles that support the spine. They also help to develop neurological control over these muscles so that they contract to protect the back at the right time. (It doesn’t matter how strong a muscle is, if it contracts at the wrong time it is useless!)

A mobile spine and strong core are the two essential components of a healthy back. One without the other is insufficient. If you spinal joints are inflexible  your spine is like a solid broom handle. The muscles around it, that move the vertebrae, are ineffective if the joints cannot move. On the other hand a flexible back without a strong core is unstable.

When your back is flexible, strong and stable then all you have to do is to use your back the way it is meant to be used. That is to be active in your daily life; Keep your whole body moving as much as possible. The beauty of being pain-free is that you don’t have to think about your back, you can just get on with the things you want to.

The first thing you should do, if you are experiencing recurring pain, is to get it checked out professionally. If you have nothing seriously wrong, and the problem is mechanical (i.e. bones muscles and joints) a visit to the chiropractor will probably sort it out.

However, many people find that the pain may recur in the future. Why? There can be many reasons. Here are some of them:

1.       Repetitive stress at work.
2.       Poor posture.
3.       The tissues become weakened and prone to re-injury.
4.       Stress or anxiety cause ongoing muscle tension.
5.       Loss of tissue resilience due to ageing.

A combination of these and other factors often lead to tissue damage. It may take a course of treatment and rehabilitation exercises to heal, but it can be difficult to remove all the causes of the problem. For example. You may be putting a lot of stress on your shoulder because of your job as a builder. Or you may be sitting for hours on end over the computer. You cannot just quit your job so the strain on your body is going to continue.

I teach my patients exercises and tricks to help avoid the worst excesses of posture, but with the best will in the world… this might not be enough; For some people, the painful symptoms will return and there is nothing they can do about it.

Well, actually there is; You can reframe pain.

As I have said, if the pain is severe and ongoing, you need to see a professional. Let’s assume you have done this. You have had some treatment the pain has gone away. But now you feel it starting to come back. This can be frustrating and upsetting especially if you thought you had got on top of it.

Firstly, you need to stop the negative thoughts, let go of the frustration and upset, and think about what you can do. You must do this because negative thinking will make the pain feel worse. Remember the pain is not as bad as it was originally; it is just starting to return, don’t catastrophize; it is not going to be as bad as it was before because you are going to take control.

See the pain as a reminder to take special care of yourself. It is like the oil indicator light in your car; There is no need to panic if the light comes on; It comes on long before your engine has run out of oil. You have plenty of time to top it up.

By the time you have been through a course of treatment you will have learnt the main causes of your pain. So you know what to do. Have you been working too hard, are you under a lot of stress, have you been sitting round in poor posture? It is simple, change what you have been doing and the pain will go away. The original injury will not return.

This is the reframe then: Originally pain was your enemy; it ruled your life and it was unbearable. Now the pain is your friend. It is your warning light. You can say “thankyou” to your body for giving you this warning before injury comes. Do what you need to take the strain from your body, and the pain will go away.

Therapeutic ultrasound is a common treatment practice in Physiotherapy and is sometimes confused with diagnostic ultrasound. Chiropractors tend to use spinal therapy as their main method of treatment, however, some do implement therapeutic ultrasound as well.

What is therapeutic ultrasound and how does it help with the treatment?

Therapeutic ultrasound is a method that uses sound waves to relieve and/or treat muscle spasms, inflammation, and pain.

Non-Thermal

Ultrasound brings energy into the body resulting in the microscopic gas bubbles around the tissues to expand and contract. The fast expansion and contraction of gas bubbles improves healing of the affected tissue as it helps improve the speed of the cellular processes.

Deep-Heating

Ultrasound is mainly for deep heating the body’s soft tissue structures. Deep heating the tendons, ligaments, and/or muscles helps to speed up the healing process by increasing the circulation to the soft tissues. Ultrasound increases the tissue temperature and decreases pain. The deep heating helps to loosen tight muscles and tendons. A chiropractor may use ultrasound therapy to improve the extensibility of the affected tissues in your body.

Ultrasound therapy helps treat various kinds of conditions and injuries including muscle tears, muscle strains, sprains and ligament injuries, joint tightness or contracture, bursitis (inflammation of the bursa), tendonitis (inflammation or irritation of a tendon), and frozen shoulder.

Using Therapeutic Ultrasound

Firstly the chiropractor will apply a small amount of ultrasound gel on the body part requiring treatment and this helps to reduce friction. The ultrasound head is placed on the affected area and then slowly rotated in a small, circular direction. The ultrasound equipment uses a variety of settings to control the intensity of the ultrasound. The settings used will depend on the stage of healing.

Ultrasound therapy is a completely painless treatment though some patient’s may feel a slight warming sensation and a little tingling on the treated area.

This particular patient had a corn in his left foot and he felt that this was causing the referred pain in his back; the fact that he was avoiding walking on the edge of his left foot caused an abnormal pull on the muscles in his legs, affecting his pelvis and low back.

He asked me “ Is that how it goes, from the left foot to the right side of the low back?” I had to answer that I did not know. In fact no-one can know. The body is a very complex moving “machine”. There is a whole science build around complexity, analysing complex systems such as weather patterns or economics. In most cases if you make a small change in some part of the system you cannot predict the outcome. This brings to mind the well known butterfly effect where a butterfly flapping its wings in the Amazon rainforest can cause a storm somewhere else in the world. So a corn on the foot could cause a migraine (but it probably won’t!)

Predicting Outomes

Basically things affect other things and we cannot exactly predict outcomes. However, what we can say is that if you alter your gait due to a problem in your foot, it is likely to have a knock on effect that moves up the body, putting pressure on tissues in different places. We can also say that the points of stress on tissues often swap sides of the body. So, a corn on the left foot might put excess stress on the right knee, the left side of the pelvis, the right side of the mid back and the left side of the neck…. Or you may find that the opposite happens; strain is put on the right side of the pelvis, the left side of the mid back and right side of the neck. Or some other strain pattern may emerge.

We can ascertain the pain/strain pathway by simple observation;  where the strain and pain is experienced, where the muscles are tender and where you can see subtle bends and twists in the body.

A problem in one part of the body can reflect and cause referred pain in other parts via a number of different mechanisms. The chiropractor’s skill lies in diagnosing the root cause(es) of a problem, and working out what effects this has had on the body. When you know the cause and the effect the treatment is straightforward.

How Mindfulness Can Help

Mindfulness is a powerful tool to help address many of the causes of back pain because it puts your mind back in touch with your body. Our modern world tends to make us goal focused, looking out there, while we are unaware of the subtle tensions that arise in our bodies through everyday activity. These tensions can build up to such a degree that the body finally starts to break down, leading to pain. When you are more in touch with your body you will not like the effect of eating unhealthy food, you will feel restless with a sedentary lifestyle, you will be aware of the hormonal changes in your blood chemistry caused by stressful situations. Your habitual postures will start to feel uncomfortable, you will notice the strain that repetitive activities are placing on your body.

When you are more aware of these negative effects, you will feel compelled to make changes. Mindfulness will make you eat a better diet, exercise more, maintain better posture and, most important of all, find creative ways to deal with stress in your life.

History of Mindfulness

Mindfulness is a Buddhist practice that started to filter to the west in the sixties. As more and more people found the practice beneficial, meditation centres sprang up in Europe and the USA. Mindfulness is one aspect of the Buddhist spiritual path known as the Eightfold Noble Path. Many people found the practice hard to stomach, either because it challenged their Christian beliefs. Others found it difficult because people were becoming averse to anything that smacked of religion.

Jon Kabat Zinn, an American writer and ex-Buddhist monk, is recognised as a major proponent in the secularisation of mindfulness. Since the 70’s universities around the world have been studying the effects of mindfulness, based on his work. Researchers have published hundreds of  papers that show remarkable benefits for this practice. Bangor, Exeter and Oxford are the main universities where mindfulness is studied. You can get masters degrees and other post graduate qualifications in mindfulness from these universities.

The universities developed an eight week, one evening a week, course based on thirty years of research into mindfulness practice; Mindfulness Based Stress Reduction.  I include simple mindfulness practices as part of my treatments for people suffering from back pain and stress at my chiropractic clinics in Chester and North Wales, but to really get a taste for mindfulness I would recommend the 8 week MBSR training as a starting point.

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.

To understand facet joint arthritis we need to know what the facet joints are! 24 spinal bones called vertebrae make up the spine. In between each vertebra, there are two sets of facet joints. These work as a hinge that connect the vertebrae together, and allow the lumbar spine to move easily as you bend backward and/or forward. The facet joint is also called zygapophysial joint or apophyseal joint.

Articular cartilage covers the outer part of the facet joints . This is a smooth material that  causes the ends of the bone to move smoothly against each other with minimal friction.

What Causes Facet Joint Arthritis?

The facet joints are supposed to fit together and smoothly glide against each other with no pressure. If pressure starts, the cartilage that covers the joint surfaces wears away.

Back injury that happened years ago can also cause the facet joints to become arthritic. Torn ligaments, fractures, as well as disc problems can cause irregular movements as well, which causes pressure and stress on the facet joint surfaces.

Facet joint arthritis does not develop immediately, Heavy, incautious twisting, rapid movements, and backward motions can increase the development of symptoms of facet joint arthritis.

What Are the Signs and Symptoms of Facet Joint Arthritis?

Pain from this condition is typically worse after sleeping or resting. Bending your trunk backward or sideways also causes pain on the side of the affected facet joint. Arthritic pain may start at the centre of the lower back and may radiate to one or both buttocks. It can also radiate to the thighs. It does not, however, go below the knee.

Diagnosing Facet Joint Arthritis

Obtaining a full detailed history and physical examination is important when diagnosing Facet Joint Arthritis. The process starts with the doctor asking about a patients symptoms and how the pain is affecting their day-to-day activities. The doctor will also ask a patient to point out which part of their body is in pain and whether or not the patient is  experiencing numbness and/or weakness in their legs. It is also important for the doctor to know what activities or positions worsen or relieve a patients symptoms.

The doctor will then perform a physical examination to find out which back movements or positions cause the symptoms.  This includes testing  the patients muscle strength, skin sensation and reflexes.

The doctor may also refer a patient for an x-ray examination to find out if the bone tissue in and around the facet joints are involved. X-ray images can show if bone spurs have occurred near the facet joints. The images can also show disc degeneration and vertebral collapse.

CT scan and facet joint injection (also known as facet joint block) are also helpful in diagnosing facet joint dysfunction.

Treatment Options For Facet Joint Arthritis

There are a number of non-surgical treatment options for facet joint arthritis. While some of them can only offer short-term relief, there are also some that can give long-lasting help.

Knowing and maintaining the correct posture, changing your daily activities, and taking frequent short breaks can help relieve the symptoms. Hot or cold packs or hot showers can give short-term relief. Taking non-steroidal anti-inflammatory drugs (known as NSAIDs) can also help the symptoms.

For long-term effect, chiropractic adjustment is the best option. Spinal manipulation has proved to be very effective in treating patients who suffer from backache due to facet joint arthritis. Chiropractic treatments can also help reduce pain, inflammation, nerve sensitivity, and irritation. Facet Joint Dysfunction is one of the most commonly treated problems at our chiropractic clinics in Chester and North Wales We can treat it effectively by showing patients how proper posture can help to decrease pain. This in turn improves their mobility function and strength. We teach patients proper movements to protect their spine and prevent the problem from recurring. We use strengthening exercises and soft tissue massage to help minimise inflammation and pain.

Causes and Symptoms of Cervicogenic Headache

A cervicogenic headache comes from the shoulder, neck, and the spine, and the pain is often felt in the head and the neck

Pulled or strained muscles and ligaments in the neck, disc bulges and disc prolapse can result in a cervicogenic headache. In addition conditions such as degenerative disc disease and cervical facet joint arthritis can cause one.

A Cervicogenic headache is typically associated with sharp or aching pains around the neck area and with local tenderness. Movement of the head and neck aggravates the symptoms but rest and heat improve them. Generally, patients experience this type of headache more often than migraine or cluster headache.

Treatment

Although applying heat over the affected area can help, and it can also be treated by carefully manipulating the upper neck. Choosing Chiropractic care as a treatment for can be enormously beneficial to patients. The treatment includes stretching and spinal manipulation.

Headache Introduction
Tension Headaches
Cervicogenic Headaches
Migraine Headaches
Cluster and Secondary Headaches
Headache Self-Help Tips