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.

What is Active Release Technique?

Active Release Technique (ART) was developed by Dr. P. Michael Leahy and is a soft tissue management technique. Some of his patients presented symptoms relating to changes in their soft tissues. Most of all Dr Leahy observed that he could affect change by using his hands . In addition, he was able to resolve his patients’ problems by noticing how the muscles and ligaments, the nerves and tendons, and fascia all respond to different techniques.

Active Release Technique is a massage technique based on the soft tissues and movement.  Furthermore it can effectively treat the muscles and ligaments, tendons and fascia, including the nerves.

Active Release Technique treats many common problems caused by muscle overuse. These problems include:

• Back pain
• Carpal tunnel syndrome
• Headaches
• Knee problems
• Neck pain
• Plantar fasciitis
• Sciatica
• Shin splints
• Shoulder pain
• Tennis elbow

How does muscle overuse happen?

Muscles that are overused and other soft tissues tend to change in three different ways: such as when acute conditions like pulls and tears occur or when there is a build up of microtrauma (small tears of the muscle tissues). Also when these tissues do not get adequate oxygen supply (tissue hypoxia).

Over a period of time these factors result in scar tissue production in the area affected. This build up of scar tissue will tighten all the other tissues therefore restricting their free movement. The muscles become shorter and weaker and will eventually result in nerve entrapment and tendonitis. This will cause the patient to experience a decreased range of motion, additional pain and reduced muscle strength. So if nerve entrapment occurs, the patient is most likely to experience weakness, numbness, and tingling.

How is ART treatment carried out?

Active Release Therapy is carried out by an ART therapist using their hands to assess the tightness, texture, and movement of the muscles including the ligaments, tendons, fascia, and nerves. The affected tissues can be treated by using a combination of specific muscle movements as well as applying specific and direct pressures. An example of this may be when a chiropractor presses into the muscle at the top of the patients arm whilst gently moving the arm at the same time. 

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

What is a deep tissue massage?

Deep tissue massage which is also called remedial massage, is a type of massage therapy that focuses on the deep layers of the muscles. It is very effective in relieving chronic pain by easing out tense muscles and loosening or untangling knots. Our massage therapist and chiropractors use this technique at our clinics in Chester and North Wales

Muscle Tension and Pain

A deep tissue massage therapist will use focused and intense pressure to penetrate the connective tissues when performing deep tissue massage. This penetrates to the deeper layers of the muscle. They will use both their hands and fingertips when working over the tense muscles. They start the massage gently at first to avoid any muscle spasms and then continue through the session to gradually increase the effort by using a combination of friction and direct pressure.

Deep tissue massage can give long term benefits. Any pain and tension in the muscles a patient has will be relieved. It is not unusual for a patient to feel a bit sore for the first couple of hours after the treatment.

Deep tissue massage can be of great help for people who suffer from injured muscles or chronic muscle tension but you do not need to have a specific problem to benefit from this massage therapy. Deep tissue massage is effective in improving circulation. With improved circulation, your cells will be able to absorb nutrients, gather oxygen, and wash out toxins. This will leave your body feeling refreshed and your mind relaxed. Deep tissue massage does not only promote relaxation, but it also reduces stress and increases your range of motion and flexibility.

Please call us today if you would like to book a massage in Chester or St Asaph.

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

What is Myofascial Release?

Myofascial release is a massage technique that is carried out to treat recurring pain resulting from injuries. It has been used for over a hundred years and is proven to be effective. It is a hands-on therapy that can greatly improve the condition of the fascia. The goals of this massage technique are to re-establish proper posture and to loosen up the myofascia and the muscle. It releases tightness throughout the body and relieves pain.

Myofascial release technique is used to relax the deep tissue of the body and restore the health of the fascia. It is very effective in providing long term relief to the patient.

What is Myofascia?

The myofascia is a dense tissue that covers and enfolds the muscles and bones in the whole body from the head to the toes. The fascia or the outer covering is tough and flexible if it is in a healthy state.  This outer covering presents a web-like appearance when it’s examined under a microscope.  Any damage to an area of the myofascia can greatly affect remote parts of the body even years after the damage has occurred.

The myofascia, if healthy, is relaxed, supple, and flexible. It can stretch and/or move without limitations which also helps to maintain proper posture and good range of motion. It keeps the muscles strong and protects the body from injuries and stress.

When a person experiences inflammation or any physical trauma such as whiplash, the myofascia loses its flexibility and as a result becomes stuck and hardened. It could cause tension and restriction in motion throughout the body. Other factors such as surgery and poor posture can also affect the myofascia over time. Sitting in one position for too long can also result in myofascial pain.

Damage to the myofascia can result in the following problems:

• hronic neck and back pain
• Decreased flexibility
• Difficulty breathing
• Headaches
• Muscle aches
• Muscle spasms
• Numbness
• Pins-and-needles sensation
• Poor posture
• Recurrent injuries
• Sciatica

What can a patient expect from a Myofascial Release treatment?

Myofascial release treatments usually last from 15 minutes to more than an hour. Depending on the patient’s condition, the pressure may range from mild, gentle pressure to deep. This technique is perfectly safe; however, there are instances where the patient may feel a very light, burning sensation on the skin. This is normal and will pass quickly.

Myofascial Release can effectively treat rigid fascial tissue by re-organizing and releasing it, making it more relaxed, flexible, and soft. Myofascial release helps restore and maintain the movement and health of the tissue. It enables the body to move without pain.  

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

What is an MRI Scan?

We sometimes recommend that patients visiting our back pain treatment center in Chester, get an MRI scan. An MRI scan or Magnetic Resonance Imaging is a diagnostic test that helps chiropractors assess a patient’s spine in order to identify the cause of their back pain. MRI scans were developed in the 1980s. They have improved and modified our ability to see abnormalities in the spinal structures and to find out the cause of the backache.

Chiropractors typically already have an idea what they are expecting to see in an MRI scan before it is performed as this study is usually used for pre-surgical planning.

An MRI scan may be able to provide a detailed assessment of the anatomy of the spine; however, it cannot recognize painful and non-painful spinal structures. There are, in fact, instances where an MRI scan shows numerous anatomical problems even when the patient does not have back problem. On the other hand, an MRI scan can also show a normal spinal structure despite the patient’s symptoms. This shows that an MRI scan finding must be consistent with the patient’s symptoms and physical examination to get an accurate diagnosis.

What is the Importance of an MRI Scan?

An MRI scan is ordered when the chiropractor is looking for certain information about the patient’s symptoms. Some information gathered from MRI scan results are the following:

• Alignment of the spine
• Any type of spinal abnormalities that might be the cause of the backache.
• Changes in the spine after surgery – Postoperative infection or scarring can be seen through MRI scanning, as well as disc herniation

• Disc height
• Disc hydration
• Intervertebral disc appearance – MRI scans can identify whether or not the disc is normal, herniated, bulging, degenerated, or dehydrated
• Size of the spinal canal – Whether or not the spinal canal size is enough to accommodate the spinal cord and nerves
• Spinal cord appearance
• The condition of the nerves – Whether they are compressed or inflamed
• Vertebral body configuration

Usually, the chiropractor has an idea on what to expect on the MRI scan result already, based on the medical history and physical exam of the patient. If the patient’s symptoms are consistent with the MRI scan result, the diagnostic study can be beneficial for treatment planning.

In most cases, chiropractic manipulation can resolve back pain within two to twelve weeks of treatment. Thus, an MRI scan is not ordered immediately at the initial onset of the symptoms. It is only necessary when chiropractic treatment does not appear to resolve the pain or when the symptoms call for a more aggressive treatment such as surgery or injections.  We are always ready to discuss whether you need a scan at our back pain treatment center in Chester.

Back Pain: Diagnosis and Imaging
Back Pain: X-ray and CT Scan
Back Pain: MRI Scan

Two of the most commonly used diagnostic imaging procedures are the X-ray and CT scan. Specialists order imaging studies to get an accurate diagnosis and confirm any abnormality that could be the cause of back pain. This article explains the difference between x-ray and CT scan.

X-ray

One of the most common imaging studies used is called an x-ray or Radiograph. A chiropractor orders an x-ray to evaluate the cause of pain and aid with the diagnosis and treatment. It provides detailed images of the spinal bone structures. It can help to rule out back pain caused by certain injuries or fractures including certain deformities and tumours.  So with a condition such as Spondylolisthesis, the frequency of instability may also be detected.

Women who pregnant are not recommended to undergo x-rays.

CT Scan

A computed tomography scan, also known as CT scan, works similar to an x-ray though in a much more sophisticated way. Similarly, a radiation beam is passed through the body. What is especially relevant, is the possibility to visualise problems in the soft tissues as well as the bone. Cross sectional images of the spine are  then generated using computer imaging. This re-formats the images in multiple planes which is repeated at multiple intervals. So a CT scan is extremely useful in diagnosing back conditions such as lumbar spinal stenosis and lumbar disc herniation. Back Pain: Diagnosis and Imaging
Back Pain: X-ray and CT Scan
Back Pain: MRI Scan

Getting an accurate diagnosis for back pain can be very difficult as its causes are complicated, and each diagnosis requires a different treatment technique. The length of time that it takes to make a correct diagnosis is important, as the sooner the diagnosis is made, the faster the patient will get the proper treatment and pain relief. This will help improve his or her ability to perform day-to-day activities, without worrying about worsening of the condition.

Patients face several issues when they get a diagnosis of back problems. This article will provide useful information regarding these issues.

Different Spinal Disorder Terminologies

Different chiropractors use various terminologies to describe spinal disorders, and this is often confusing to the patient. For instance, bulging disc, herniated disc, pinched nerve, prolapsed disc, protruding disc, and slipped disc can all be used to describe one spinal abnormality. As there is no specific definition of any of these terminologies, the patient often gets different diagnoses from different chiropractors and gets confused as to what the actual condition is.

Another terminology that can confuse back pain patients is degenerative disc disease, which is not really a disease.  It is a type of degenerative condition that can sometimes cause symptoms from the injured disc.

Different Types of Diagnostic Studies

Diagnostic studies are used to detect the source of the symptoms and to rule out any disease or abnormality. The following are some of the most commonly used diagnostic studies chiropractors recommend:

X-Rays – An x-ray shows the spinal bone structures in great detail. It is commonly used to see if there are any fractures, tumour, or instability such as spondylolisthesis.

CT Scans – A CT (Computed Tomography) scan is a type of x-ray that can take cross-section images of the body. It is capable of providing great bony detail through multiple views. It can be used for imaging certain conditions like spinal stenosis or herniated disc.

MRI Scans – An MRI (Magnetic Resonance Imaging) scan can be used for an accurate detection of the cause of backaches. It provides an excellent detail of the disc and the nerve roots.

In the next articles, the different types of diagnostic studies used in diagnosing the causes of back pain will be elaborated.

Back Pain: Diagnosis and Imaging
Back Pain: X-ray and CT Scan
Back Pain: MRI Scan

As we continue our topic on Iliotibial Band Syndrome, this article includes an additional stretching technique. Several other supplementary treatment options will also be discussed .

Simple stretching exercise 

1. Stand in front of a wall with feet together.
2. Extend one arm and place a hand on the wall.
3. Slowly and carefully stretch the hips toward the wall and hold the position for a few seconds.
4. Return to a standing position.
5. Turn around and place the other hand on the wall and repeat the process.

This stretching exercise can help regain the suppleness of the iliotibial band and is effective if done regularly.

If a patient does these stretches regularly and find they are not getting any relief, there are other ways to relieve iliotibial band syndrome. Using a foam roller will help to stretch out and relieve the tightened iliotibial band. Place the foam roller on the floor and roll the affected area on top of it back and forth.

Additional Treatment Options

Should these techniques still not improve the condition, this could indicate that the patient has extremely tight connective tissue. Incorporating chiropractic manipulation as part of the rehabilitation process can benefit the patient hugely.  A full evaluation by a chiropractor is important in treating iliotibial band syndrome. A patient’s muscle balance must also be assessed in order to better identify all the contributing symptomatic factors. This includes a full biomechanical examination too. 

The chiropractor may recommend the patient to rest and take time off all activities that could aggravate their symptoms, including any sporting activities. Further recommendations may require the patient to ice the area and take anti-inflammatory medications to help relieve the pain. Unless the problems with muscle balance are resolved, rest on its own will not completely heal iliotibial band syndrome. A home exercise program designed specifically for Runner’s Knee may be prescribed.

Trigger point release therapy and soft tissue massage are also helpful in increasing the flexibility of the tightened tissue.

Choosing the correct running shoes is also extremely important and will depend on the patients particular running style. During a running activity, the iliotibial band stretches and contracts when the foot is in the air. Prescription orthotics or arch support for shoes will be helpful to correct the movement of the foot. Because overpronation (flat feet) is a common issue, shoes must be able to support the movement of the feet to prevent further injury.

Runner’s Knee: An Overview
Iliotibial Band Syndrome: Treatment Options

What is Runner’s Knee?

Runner’s knee is a common condition among runners and other athletes who do activities that require repetitive bending of the knee. These include football players, basketball players, ballet dancers, and even walkers. 

Runner’s knee is also known as iliotibial band syndrome and ITB friction syndrome. Iliotibial band syndrome is mainly an irritation to the band that connects the iliac crest (hip) to the tibia (shin). A patient suffering from this condition may feel a sharp pain to the knee or the hip after an intense training session.

The iliotibial bands may get irritated if they are tight. Tight ITBs will cause friction when rubbing against the outer portion of the knee, which will result in pain that may only be troublesome when you are about a couple of miles into your activity. A bony projection on the outer portion of your knee and/or a greater trochanter of the hip may contribute to runner’s knee if your iliotibial bands are tight.

There are a number of factors that could cause iliotibial band syndrome; two of them are biochemical abnormality and training error. Most patients state that the pain started after a sudden increase of activity intensity. Some describe pain after running downhill. Runners and other athletes usually have biomechanical issues (i.e., iliotibial band tightness and/or gluteal weakness). When running downhill, the knee angle at footstrike (when the foot hits the ground) is reduced, thus the symptoms occur. Running on an even terrain is less likely to cause runner’s knee, as the knee flexion when the foot hits the ground is not as limited as compared to when running downhill.

Here are the instructions for the simple stretching to alleviate the pain caused by runners knee.

1. Lie flat on your back.
2. Raise your left knee up to your left shoulder and push it over to your right shoulder using your palm.
3. Hold position for about twenty seconds.
4. Repeat five times.
5. Follow the same instruction for your right knee.

You can do this stretching three times a day or more. This can also be a part of your pre-exercise routine. You will see improvement in your condition in a week’s time with regular stretching. Whether you naturally have abnormally tight iliotibial bands or they got stiffened by running, regular stretching is recommended for faster improvement of your condition. The more you do this, the better.

Taking an oral anti-inflammatory and placing ice on the affected area can also help alleviate the pain. 

We regularly treat people with runner’s knee at our chiropractic clinics in Chester and in North Wales.

For more stretches and treatment options, if you do not get better, see part 2 of this article.

Runner’s Knee: An Overview
Iliotibial Band Syndrome: Treatment Options

This article will discuss the causes, symptoms and available treatment.

What is plantar fascia?

The plantar fascia is a ligament that extends from the bottom of the heel to the front of the foot. Its function is to support and maintain the arch of the foot. The plantar fascia plays a very important role in movement. Thus, any injury associated with it can result in difficulty walking and severe discomfort.

Plantar fasciitis was initially classified as inflammation. However, since no inflammatory cells presented within the fascia when examined, this information is now considered incorrect. In some circles they believe this can be attributed to heel overuse which then causes the collagen fibres near the heel bone (calcaneus) to degenerate.

Plantar fasciitis is often compared with heel spur; however, these two conditions are not exactly the same as a heel spur is a bony growth at the calcaneus.

What are the causes of plantar fasciitis?

Plantar fasciitis is common in people with overpronated feet (flat feet or feet that roll inwards). They are the most at risk for this condition as overpronation of the foot results to added stretching of the fascia.

When the calf muscles are too tight, they tend to cause high velocity foot pronation. This leads to repetitive overstretching of the fascia, causing the tendon to thicken. This thickening then causes the plantar fascia to lose its strength and flexibility.

Using footwear that does not provide sufficient arch support is also a cause of plantar fasciitis. Wearing shoes with cushioning and adequate arch support e.g. flat, lace-up shoes is ideal.

People who engage in sports activities that cause great impact to the foot (e.g. dancing, jumping, or running) are also at risk. Excessive and repetitive foot activity, such as running or walking on hard, uneven terrains, can also result in symptoms.

Overweight people are also at risk as the excess weight causes high impact to the foot. Sudden weight gain is another cause.

What are the symptoms of plantar fasciitis?

Plantar fasciitis is usually felt on the inside of the heel, where the attachment of the fascia is located. The symptoms present when the inside of the heel or the arch is pressed. As the fascia tightens up overnight, the symptoms may be worse in the morning when you take your first few steps. The pain, however, gradually alleviates as the foot warms up. The symptoms may worsen throughout the day, especially after intense activity. Tenderness, tightness, or stiffness on the bottom of the foot may also be present.

Treatment

There are numerous treatments available to ease the pain caused by plantar fasciitis, but there is no cure. In order to get long term relief, it is best to know and correct the cause of the condition.

What can you do?

1. Using a cold or hot pack on the affected foot can lessen the inflammation. Cold therapy is recommended to be applied regularly until the pain is relieved.
2. Resting until the feet are not painful is recommended. Doing so would be difficult as many people’s work involves being on their feet the entire day; however, forcing the affected foot to walk will aggravate the condition and worsen the inflammation.
3. Reducing the inflammation may be helpful but it does not provide a long term solution. The fascia may tighten up more, causing the heel to become more prone to stress. Doing plantar fasciitis exercises, like stretching the plantar fascia, is a significant part of the treatment and therefore should be done.

What can your chiropractor do?

1. Your chiropractor can prescribe anti-inflammatory medication (e.g. ibuprofen) to relieve the pain and inflammation.
2. Gait analysis can also be performed for the chiropractor to know whether you overpronate or oversupinate, so the proper insoles or orthotics can be prescribed. If overpronation is the cause of the problem, an insole will be helpful in restoring the normal biomechanics of the foot.
3. Your chiropractor can also reduce the stress and tension on your foot by applying sports massage techniques and calf muscle stretching.
4. He can also prescribe and teach you the proper exercises to help stretch the plantar fascia. These exercises can also help strengthen the fascia.
5. Your chiropractor will perform a biomechanical assessment of the foot ankle, knee, hip and low back as dysfunction in any of these areas can put excess stress on the foot. He will treat the joints with mobilisation where necessary.

We regularly treat plantar fasciitis in our chiropractic clinics in Chester and near Llandudno in North Wales.