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.

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.

Now I am not against yoga, far from it, I recommend that my patients go to a yoga class, but they should practice with a teacher who is experienced in working with injuries.  

If a muscle is tight, it is tight for a reason; it may be trying to protect an inflamed joint or it may be protecting itself so that damaged fibres can repair. Excess force on such a muscle may stimulate it to become more tense, shorter and, at worst, cause it to tear away from the bone. 

In the long term, muscles can get into the habit of tension. The original problem may be cured but the muscle’s protective function remains. In fact the tension now becomes a problem in itself, putting pressure on joints it covers. Chronic muscular tension may lead to serious conditions like arthritis of the hip.

So short term muscle tension has a protective function but chronic muscle tension can lead to more serious injuries. We want to leave short term tension alone but we want to get rid of chronic tension. However, forceful stretching can make things worse. So what do we do?

Gentle Stretching with Awareness

I give people a set of simple yoga stretches for their low back and I tell them to stop and rest as soon as they feel their muscles begin to lengthen. There should be no sense of pain or forcing. Resting in the position of minimal stretch, they should start to breathe deeply. As they breathe, the rib cage and abdomen expand and contract. This rhythmical movement imparts a gentle massage to the muscles in the back. Muscles treated like this will relax and lengthen naturally and more easily than muscles forced to stretch.

To improve the quality of this stretch it can be helpful to apply mindfulness. This means exploring the quality of how it feels around the stretching muscle. Be interested! Make micro movements into and out of the stretch; observe how the quality of sensation changes. This Focussing the mind with a gentle interested awareness can improve the healing in your body immensely.

When you try to force a muscle to stretch you are exerting mind over matter and this creates a false mind/body separation. Mindful stretching is working mind in matter or mind with matter. It is a coming together of mind and body and consequently is more likely to result in healing.

In the previous article, we discussed the causes, symptoms, and treatment options for repetitive strain injury. In this article, tips to prevent repetitive strain injury or RSI will be discussed.

Most people nowadays use the computer all day, either for work, school, or to pass time and it is best that you know how to prevent RSI.

1. Keep the wrists in neutral position when typing.

It is important to keep your wrists in a neutral position when you type. Meaning, your wrists should not bend towards the left or the right, or bend upwards towards you. Typing with your wrists bent or placed in the wrong position will cause strain on your sheaths and tendons, and this will increase your risk of having repetitive strain injury. A badly adjusted keyboard is also one of the causes as it will be difficult to keep your wrists in a neutral position if your keyboard is placed in an uncomfortable position.

2. Use the proper technique when using the mouse.

Make sure that you keep your wrist joint in a neutral position when using the mouse, just as when using the keyboard. You can use a gel wrist rest to support your wrist when using the mouse. Most patients develop RSI in the hand that they use to move the mouse; it is best to avoid using it too often as much as possible.

3. Avoid bad posture.

Keeping a good posture when working is important as it prevents many work-related injuries, including RSI. Use a chair that supports your spine and adjust your workstation to lessen the strain in your body. Keep your monitor, keyboard, and mouse in proper position to allow you to work as comfortably as possible.

4. Take a break.

Taking five-minute breaks every half hour or so is helpful in terms of preventing repetitive strain injury. This advice may be difficult to follow, especially for those who have scheduled breaks, but it is best if you find time to stretch or walk.

5. Exercise and eat healthy food.

Obesity is also one of the risk factors for RSI. If you are overweight, your muscles strain in order to support the extra weight. The best way to avoid this is to exercise and keep a healthy diet. Cardiovascular exercises such as swimming, walking, or running would be helpful in keeping a healthy body.

6. Visit a chiropractor.

A chiropractor may be able to point out causes of your symptoms that you may not have thought of, which will calm your fears.Do not just depend on the Internet to understand your symptoms as it may not be accurate. It is always important to see an expert.

7. Do not ignore your symptoms.

The pain caused by repetitive strain injury may sometimes subside if you ignore it, but such is not always the case. Paying no attention to your symptoms will only lead to worsening of your condition; you may develop carpal tunnel syndrome. Adjust your work station as early as possible and modify your work habits to avoid strain on your body. Practice proper typing and avoid using the mouse as much as possible. Try to rest your wrists and elbows when you can and do some appropriate upper body stretching exercises.

You do not have to wait until your symptoms become unbearable before you do something about it. Chiropractic adjustment can help manage and treat your symptoms. Visit us at the Back Doctor Chiropractic Clinic in Chester; we aim to successfully identify the cause of your symptoms and treat your condition with proper joint manipulation and adjustment.

Repetitive Strain Injury (RSI), is a disorder associated with overuse and repetitive movement of certain body parts.  It generally affects parts of the upper body as well as the neck. Though more common areas can include the shoulders, forearms, elbows, wrists, and hands. It causes pain from the tendons, nerves, and muscles of the upper limbs. As a result, the swelling and stiffness can be extremely painful if left untreated.

RSI is also referred to as work-related upper limb disorder (WRULD).  The cause is mainly attributed to work that involves forceful and repetitive activities. People who work with computers are most likely to be affected by RSI and this can be aggravated in addition to poor posture.

Signs and Symptoms

The symptoms of RSI range from mild to severe and they often develop gradually. These include muscle and joint pain or tenderness; cramping and stiffness; weakness, throbbing, and tingling or numbness.

During the first stage of RSI, you may only notice the symptoms when you are doing a particular repetitive task, such as when you are at work. The symptoms may subside once you finish the task and rest. These early symptoms may be noticeable for a few weeks.

Although the pain may be manageable during the early stages of RSI, the condition is likely to get worse if ignored and left untreated. Some patients experience swelling in the area which can become more severe and take longer to subside. This stage of RSI may last for months. Effectively treating the symptoms in the early stages is vital for rehabilitation to take place.

Treatment

A Chiropractor may suggest that a patient stop doing the task that triggers the symptoms if they are diagnosed with RSI..

However, following this advice is not always that simple, especially when the activity that needs to stop is the task the patient does at work. The patient needs to let their employer know as soon as possible if they have diagnosed with RSI so they can modify work activities to help improve the condition.

Listed below are treatment options for repetitive strain injury:

1. Using a hot or cold pack over the affected area to relieve pain and inflammation.
2. Wearing a splint for support.
3. Taking anti-inflammatory pain medication such as ibuprofen or aspirin.
4. Getting steroid injections to minimise inflammation.
5. Seeking help from a chiropractic doctor to treat the affected areas.

All these options are beneficial in terms of relieving your pain and helping you regain strength and mobility. Many RSI patients come to us at the Back Doctor Chiropractic Clinic in Chester to seek chiropractic adjustment; we not only help relax and strengthen your muscles, but we also give you advice on the proper posture and movement in order to avoid worsening of symptoms.

In the next article we will discuss prevention techniques for Repetitive Strain Injury.

For many years, it has been a belief that pain is a just sensation that the body experiences when exposed to injury, illness, or surgery. It is believed that when the body is exposed to this sensation, signals (or information) are sent to the brain via the nerve pathways. We think of  it as a signal that travels from the periphery to our brain, such as when skin gets in contact with a hot surface. However, chronic back pain is also affected by psychological factors. It can be either relieved or worsened depending on how the patient perceives it. A person goes through different degrees of psychological distress every time he or she experiences pain. It will be more noticeable, even intolerable, if the brain perceives it as important. If the brain sees the discomfort as harmless, it will be less noticeable and less bothersome.

Negative Thinking Makes Chronic Back Pain Worse

Exaggerated orientation to the symptoms or catastrophic thinking is not helpful for many reasons. One is because this only promotes dysfunction and worsening of the symptom. It creates anxiety, stress, and even depression, which worsens the symptom and impairs function. We are likely to become less functional if we keep thinking of pain as a threat to our overall health. Those who consider it as “just a trivial annoyance” are more likely to enjoy their day-to-day activities as they are more confident, have lesser worries, and no pain-related fear. Simply put, if you are injured, you will experience some discomfort. If it is confronted without negative appraisals, it is likely that you will achieve faster recovery.

On the other hand, if you focus on the possible threat that movement might cause, you will hesitate from any kind of muscle activity due to fear of re-injury, which will result to disuse and depression, and possibly a worsening of the condition.

Having chronic back pain or any kind of pain can affect one’s mood and emotions; likewise, mood and emotions can also affect the symptoms profoundly. The more a person focuses on it, the more it will bother him/her, and the more it can ruin his/her mood. Physical discomfort can make one irritable, even anxious. However, a simple diversion, such as watching a feel-good TV show or reading a book, can improve tolerance.

Aside from stress, anxiety, fear, and depression, there are a lot of other things that could affect chronic back pain, including one’s way of understanding of their own health and capacity. If you believe that doing activities can exacerbate or worsen your condition, you may become invalid. A person with more confidence, even with the same medical condition, may be doing their daily activities without any problem.

Positive Thinking Can Help To Relieve Chronic Back Pain

Confidence is one of the most important factors for a patient to be able to function normally and comfortably. It is difficult for patients to remove their attention away from their symptoms completely, but focusing on fear and anxiety may cause disability. Frustration and anger caused by pain can also worsen it. It is important to note, however, that even though psychological factors affect your condition, it does not necessarily mean that the it does not exist.

Pain is complex; it is a combination of psychological, emotional, and physical factors, and chiropractic care is one of the best options for patients to get relief. We, at the Back Doctor Chiropractic Clinic in Chester, take into consideration how pain impacts each patient . This way, we are able to choose the best approach for each patient in order to heal them. While chiropractic care is effective, it is even better when you believe that chiropractic therapy can help reduce your symptoms and when you avoid catastrophic thinking.

The BioPsychoSocial Model addresses the problem of back pain (or any kind of health issues) in three ways: Bio (biological) refers to biological, physical, or medical aspects of the pain such as injury; Psycho (psychological) refers to the way you react to it and how it affects your emotions and behaviours; and Social refers to how social pressures affect your symptoms. In this model, Pain is surrounded by Attitudes and Beliefs, Psychological Distress, Illness Behaviour, and Social Environment. These are the things that have to be addressed in order to identify the best approach to treatment as all these aspects have an effect on pain and recovery.

The BioPsychoSocial Model has six basic elements:

1. Sensory – This basically refers to the physical sensation of the pain in four dimensions:

• Location – Which part of the body is the symptom being experienced.
• Intensity -How severe the symptom is, ranging from 1 to 10, or from mild to excruciating.
• Quality – The type of pain, whether it is a dull, achy, stabbing, burning, or sharp kind.
• Time – How long the pain has been present

2. Emotional – This refers to how you respond to the symptom emotionally; whether or not it makes you feel anxious, depressed, worried, discouraged, irritable, angry, or scared.

3. Mental – This refers to how aware you are of the sensation, your expectations regarding the condition, and how you think you can cope with it. This also includes your thoughts about it, your decision-making process, and your attitude towards it.

4. Behavioural – This refers to the things you do in response to your condition. For some, pain affects their physical activities, routine activities, and habits. It sometimes affects social interactions, which can have a great effect, both mentally and emotionally.

5. Environment – This refers to your surroundings or physical environment, which has an effect on your awareness and ability to cope with the symptoms. This includes the weather, house, furniture, and availability of material resources.

6. Social Environment – This refers to your family, friends, physicians, and other people who can affect or be affected by your symptoms.

Interactions:

These elements interact with one another and can directly affect each other in two ways; in positive or negative cycles.

Positive Cycle –  Pain can have an effect on your emotions and physical sensations but you can control its effect through shifting your thoughts and your attitudes towards the pain and your body.

Negative Cycle – These elements can interact in a negative way. For instance, Sensory (or pain sensation) can decrease physical activity (behaviour). With decreased physical activity, depression (emotional) may occur, which can result to decreased self-worth and motivation (mental). This cycle could go in many different ways and can greatly affect your condition.

Chiropractors, physiotherapists and osteopaths are beginning to take into account the biopsychosocial model in their practices, and those that do are more effective. 

In treating back pain, movement therapies can be helpful in many ways. They help improve flexibility and posture, relieve muscle spasms, and relax the mind and body. The following techniques may not have been extensively researched in clinical trials, but these approaches are widely accepted as beneficial for various musculoskeletal conditions.

Yoga

Yoga is an excellent way to relieve stress and backache as it has an influence on both the mind and body. The practice of yoga originated from India many years ago. It involves meditation, proper breathing, and asanas (movements and postures). These aspects help in increasing pain tolerance, minimizing anxiety and depression, and regaining self-control. Regular practice of yoga can enhance strength and flexibility.

There are several types of yoga but the most common are the Iyengar yoga and the Ashtanga yoga. Iyengar yoga focuses on slow and safe movements and postures. The Ashtanga yoga is the more vigorous type; this is not recommended to people with severe back problems as it could worsen their condition.

Although yoga has the potential to relieve back problems, this must be done very carefully and with supervision as it involves a lot of bending and twisting of the spine, which, if not done carefully, can be very harmful.

Pilates

Pilates is a physically demanding exercise developed in the early 1900s by Joseph Pilates. Chiropractors recommend this practice because it is effective in correcting posture. It also strengthens core muscles, promotes flexibility, and increases body awareness. Unlike yoga, all Pilates movements are low-impact but they work deep into the core muscles, which, as a result, flatten the abdomen and strengthen the back. Pilates also helps improve balance and relieves stress.

Tai Chi

Tai Chi was originally created in ancient China as a form of martial art or self-defence, but is now considered a healing exercise. It has been gaining popularity recently as it is able to help manage neck and back pain. Tai Chi has three components: Movement, which improves the body’s alignment, balance, strength, posture, stamina, and flexibility; rhythmical and focused breathing, which helps relax the body and improves circulation; and meditation, which helps ease pain caused by emotional and/or psychological factors. Tai Chi not only relieves backache but also promotes prevention of it.

Alexander Technique

The Alexander technique focuses more on increasing physical and mental awareness, and proper use of the body in order to reduce low back pain caused by incorrect movements and stress. Unlike other movement therapies, Alexander technique is taught one to one where the therapist teaches the patient how to sit, stand, walk, and attend to their activities of daily living without straining or tensing the muscles. Patients are also taught how to recognize bad movement habits and postures in order to correct them.

Feldenkrais Method

The Feldenkrais method is considered both therapeutic and preventive. Feldenkrais practitioners teach patients different ways to move with minimal strain and effort. This method helps increase joint flexibility and helps distribute the body’s effort equally throughout the entire neuromuscular system. It is taught in two ways: Individually and in groups. In individual lessons the therapist uses his hands to guide the patient’s ranges of motion. In group exercises, patients are asked to lie on the floor and taught proper movement sequences to improve the body’s flexibility.

In conclusion, the benefits of these movement therapies include improved posture, strength, flexibility, and stability; decreased stress and fatigue; improved balance and function; and decreased pain.

At our chiropractic clinic in Chester, we teach our patients how to move properly. We encourage and motivate them to exercise, using a combination of these techniques, in order to achieve a fast and long lasting recovery.

What are trigger points?

Trigger points are small nodules in the muscle fibres that are hyper-irritable and when stimulated, can cause referred pain.  Injury, poor posture, overuse or overexertion of the muscles, trauma, and even emotional stress are some of the things that can cause trigger points. Anyone can have a trigger point; individuals who have migraines, carpal tunnel syndrome, adhesive capsulitis of the shoulder (frozen shoulder), backache, and/or tennis elbow are prone.  Other components can be osteoarthritis, rheumatoid arthritis, and fibromyalgia.

Our chiropractors at our clinics in Chester and St. Asaph have helped many patients with trigger points.

How do trigger points develop?

When the muscle fibres are overused or stressed they start to tighten. This in turn reduces blood flow to the particular area, causing waste build-up and oxygen deprivation to arise. The muscles will then contract or shorten, and become taut, then trigger points develop.

The taut contracted muscles will pinch an adjacent nerve (called a pinched nerve). This will cause a numb, stabbing, or tingling sensation in the areas served by the affected nerve. For example, when an individual has a pinched nerve in their upper back, they may feel the numbness and tingling sensation in their arms and hands. A widespread chronic pain also develops when satellite trigger points arise.

A person who has a trigger point will feel irritation if the area is pressed which can also send out discomfort signals in other areas away from the original point. This is called a referred pain, which is one of the effects of trigger points. For instance, if a person is suffering from a headache, it may be due to a trigger point in a neck muscle. Or perhaps they are experiencing symptoms in their legs and feet, whic could be from a trigger point in their lower back.

How Does Trigger Point Therapy Help?

Trigger point therapy is a massage therapy or bodywork technique that is specifically designed to help reduce pain in muscles that are stressed or overworked. Since this involves applying pressure to the area affected, this therapy can be quite uncomfortable. Most patients agree however that the pain is tolerable.

Patients need to remember that massaging their own trigger point vigorously will only worsen the symptoms. Doing so can also cause a bruise on the skin, or worse, bruising in the deep tissues. There is a certain pressure required in order to perform trigger point massage correctly. Only experienced, qualified professionals or chiropractors should be consulted as they are able to locate the trigger points easily and have enough knowledge on how to treat them.

If the problem is new or localized, trigger point therapy can help alleviate it in two to three days’ time. However, if a patient’s trigger point symptom has been going on for a while, it will take time. How fast the therapy works depends on how long an individual has had the problem.

What are the benefits of trigger point therapy?

• Helps relax the taut muscles and the constricted areas in it, which, as a result, will alleviate the symptoms
• Relieves neuromuscular pain and tension
• Decreases muscle stiffness
• Improves range of motion and flexibility
• Enhances blood flow and circulation throughout the body
• Improves posture

Introduction
Standard Massage Techniques
Deep Tissue Massage/Remedial Massage
Sports Massage
Trigger Point Therapy
Active Release Technique (ART)
Myofascial Release
Positional Release (Strain Counterstrain)
Visceral Manipulation