As the clocks go back and the change of seasons are here, we start to feel tired and sluggish. As well has stressed and less motivated.
So here at The Whitchurch Clinic we have develop a some tips and advice to help you through these winter months!
Stress and pain are very closely linked together, but does stress cause pain or does pain cause stress?
Chapman et al, 2008, studied a review of psycho-physiological systems in relation to pain whereby a physical injury or wounding can generate a complex stress response. They concluded that acute pain is an effect of multiple dimensions, and are products of the bodies 'supersystem'. They also proposed that when the 'supersystem' is dysregulated, then health, function, and sense of well being suffer, and can be a result of chronic pain.
Here at The Whitchurch Clinic we have a few tips on how to manage with the seasonal stress:
There are many contributing factors to stress, and it is important to identify the cause. If you are not sure what is causing stress, or if you are unable to control your levels of stress, then it you will need to seek professional help.
One of the most important factors into getting a good night sleep is the mattress in which you are using. We get asked many of times which mattress would you recommend. The following short video by the British Chiropractic Association provides advice on find the right mattress for you:
Your sleeping position is very important as this is where you will spend nearly half of your day. With the darker nights we may find ourselves retreating to bed earlier than in the summer months.
REMEMBER DRINK PLENTY OF WATER! This helps us keep our muscles and joints hydrated and therefore pain to a minimum.
AVOID SLEEPING ON YOUR FRONT! A lot of front sleepers present to us in clinic with chronic problems as it’s difficult to maintain a neutral spine position.
Sleeping on your stomach forces your head and spine into an unnatural position, and staying in this position for hours on end is not good for your back or neck and can result is significant discomfort and restless sleep. Patients have seen great results from trying to change their habits.
As I always say, you can't control what you do in your sleep (especially snoring!), and it is hard to change the habit of a life time, but we can try and set up in a good sleeping position to avoid it.
Vitamin D is necessary in order to protect musculoskeletal health, as it assists with the absorption of calcium. During the summer months our vitamin D levels are maintained by the amount of sun we exposes our bodies to. However in the winter months most of us do not have the luxury of chasing the sun, so our Vitamin D stores maybe depleting. The department of health, as well as a recent publication from the Scientific Advisory Committee of Nutrition (SACN), recommend a daily supplement of 10 micrograms of Vitamin D.
More research is being carried out into the benefits of vitamin D, and recommendations may vary depending on what you read. Therefore the above information should be taken precautionary.
It is important to note that too much sun exposure can increase the risk of skin cancer, and this information should only be taken as advisory.
For further reading on the SACN Vitamin D and Health report please click on the following link:
and the following for an additional press release:
Don't let the cold weather put you off keeping fit and healthy. Not only will exercise and a good diet reduce your risk of major illnesses such as heart disease, diabetes, help you to live longer but it will give you more energy. More energy will mean a happier you!
Here are some tips to keep you moving:
There is always temptation to over indulge in the festive season so here are few tips to keep your diet healthy:
All of the above is advisory and therefore we would recommend that if you have any queries to either contact us here on 02920 617700 or contact your local healthcare practitioner.
The annual Back Care Awareness Week, run by BackCare, the UK’s leading charity for those impacted by back or neck pain, is to take place between 2 and 6 October.
The theme this year is
Back Pain in Education.
Back pain is one of the top common causes of absence from work throughout the country. It costs the UK economy around £15 billion every year, as over four million working days are lost as a result of the condition. Furthermore, about 80% of the UK population will suffer from back pain at some point in their lives.
BackCare decided it was important to run a campaign targeted at children and young people, as many of the back and neck pain problems experienced by adults are due to them not looking after their backs during childhood and teenage years.
Dr Brian Hammond, the Chair of BackCare said: “Early teaching of children and young people of the importance of taking care of their backs is bound to have a positive effect on the health of their backs as adults. He added: “There are simple things children and young people can do, such as sitting properly and not for too long, exercising regularly, stretching and lifting correctly. They also need to know how to carry their school books and equipment in a way that does not harm their back or neck.”
Information has been cited from: http://www.backcare.org.uk/news/back-care-awareness-week-2-6-october-2017/
The Whitchurch Clinic is urging more people to be aware of the benefits of exercise for improving their back health this World Spine Day (16th October).
New research has found that 40% of people in Wales have been prevented from exercising due to back or neck pain, and an unfortunate 24% felt it was exercise itself which triggered their pain:
“We really want as many people as possible to get out there and enjoy sports. Moderate exercise is essential to build and maintain strength and flexibility, improving posture and protecting you from any further pain.
“The spine is naturally strong and stable so it’s worrying to find that so many people are being prevented from staying active due to back pain. While total rest may seem like a good way to recover, often continuing moderate physical activity will help in the long run. Your local chiropractor will be able to advise on what is right for you.”
To help people of all ages and fitness levels protect their backs during their work-out routines this World Spine Day, The Whitchurch Clinic has developed these top tips:
• Know your equipment: When trying a new activity, it’s always best to make sure you ask your instructor how your equipment should be set up, and make sure it’s right for you. For example, if you’re cycling or spinning, you need to set your saddle and handlebar to the correct height so that you are in a comfortable position that isn’t putting tension on your neck or back
• Know your limits: Even professional athletes aren’t born ready, it takes time to build the intensity of your practice. If you try a new sport, or want to intensify your workout, it’s important to take a slow approach and not to push your body’s limits. It is always advisable to visit a professional who can assess your body’s capabilities and advise on a safe way of training based on your body’s limitations
• Warm up and cool down: Before starting any form of physical activity, you should warm up any muscle groups which might be affected whilst you exercise. If you use them without preparing them first, it could cause you pain and injury which could have been prevented
• Reduce the impact: If a previous injury is causing you pain, adapt your exercise to reduce the impact on your joints and muscles. Activities such as swimming, walking or yoga can be less demanding on your body keeping your joints mobile!
• Not all exercise is the same: The fittest of athletes will still find it difficult to adapt to a new sport, as each sport uses some muscle groups more than others. With this in mind, always approach a new activity with care and don’t assume that you can jump in at the deep end!
We recommend that, if you are experiencing pain for more than a few days then you seek professional help, as an undiagnosed problem could lead to longer-term problems if left untreated. The BCA has also created a programme of 3-minute exercises, Straighten Up UK, which can be slotted in to your daily schedule to help improve posture and prevent back pain by promoting balance, strength and flexibility in the spine.
Please visit http://www.worldspineday.org/ for more information.
There are plenty of simple things we can all do to help look after our back health. These are my top tips:
The Whitchurch Village Chiropractor reveals common back pain myths.
To mark BackCare Awareness Week (2nd – 6th October) Sarah Beer, British Chiropractic Association member, and Chiropractor at The Whitchurch Clinic, has revealed the surprising myths chiropractors have heard from their patients about what causes their back pain and the best way to treat it.
Common misconceptions about back pain include thinking a slipped disc means the disc has actually ‘slipped’ out of the spine and that you should always rest a bad back. Hanging off a door frame, and even applying WD40, are some of the strange back pain cures chiropractors across the country have heard from their patients.
According to the BCA at least 81% people in Wales either suffer of have suffered from back or neck pain, with 24% suffering every day.
Sarah further comments: “Whilst these may seem like funny stories, there is a really serious message here. Back pain is very common and if people don’t know enough about what causes it, or how best to treat it, they could delay their recovery or do themselves more damage. For example many people think you should stop being active if you’re suffering from back pain whereas for most people continuing moderate exercise could be beneficial".
Here at The Whitchurch Clinic we are committed to helping you on your road to recovery. Through a detailed case history, with/without an examination, we can advised if we are able to assist with your complaint. If we feel that we are unable to help we will point you in the right direction.
Our Chiropractic team can help through:
To summarise Backcare Awareness Week, and World Spine Day, are focused on getting people conscious and active in their daily life, in order to look after their backs. Andrea and Sarah at The Whitchurch Clinic are here to help you with the diagnosis, treatment, and management of your pain. Please give us a call on 02920 617700 to see if we can help you today.
“Throughout our lives our habits and activities change, impacting on our bodies in a number of ways. This, combined with the natural course of
ageing, means that our spine and back can be heavily affected, which is why it’s just as important to pay attention to your back care needs just as much as other, more visible parts, of your
Dr. Chris Steele
Alternatively read the following information written by the British Chiropractic Association for further information.
Ensure you consult a healthcare professional, chiropractor, or exercise instructor/trainer, before embarking on any new exercise program. They will be able to advise you on the most appropriate and effective type of activity for you, given your previous medical history and current abilities.
When playing sport at school it’s a good idea to take care of your back even at this early age. As with any exercise, you need to warm up first. Don’t go straight into it; start with lighter movements like walking or jogging to lessen the chance of muscle strain.
If you are exercising, why not throw in some stretches and exercises specifically designed to strengthen your back?
Easy to learn and do, the BCA has developed a sequence of precise, slow stretches, each with a specific purpose. To see the exercises, watch them in action on a downloadable vodcast, view an online step by step guide or request free leaflets, follow this link - https://chiropractic-uk.co.uk/active-ageing/
According to a recent research report published in the Archives of Disease in Childhood which looked to investigate whether backpack weight is associated with back pain in children, 50% of children carrying heavy back packs had a higher risk of back pain.
CHECK IT! This makes it really important to check a child’s school bag every day to make sure they are only carrying the things they need for that day. Also, make sure your child is using a backpack and ensure they wear it correctly; both straps on and tightened so the back pack is snug up against the whole of the back.
At this time in life we may find we are slaves to fashion. Bags in particular are a must have item and these accessories come in all shapes and sizes.
Cross body bags are good for spreading the load across your back but best are those bags that share the weight over both shoulders and help to prevent any strain on your back muscles.
At this time of life people are contending with long working hours and parenthood which can both be detrimental to back health!
If using a laptop, don’t sit in the same position for long periods as you are looking down onto the screen with your head unsupported. Rest the laptop on a table not on your lap, arms should be flat and your elbows level with the desk or table you are using. Use a seat with arm rests.
Check that your mattress is giving you the support you need. When lying on your side, your spine should be in a straight line. The key thing when buying a new mattress is to TRY TRY TRY out as many as possible to find the right one for you.
It’s time to be aware of the initial signs of ageing. Ensure you keep active, as a sedentary lifestyle is the enemy of a healthy back. It is important to take care of any back problems you develop.
Mild strains can be handled by staying gently mobile and using ice on the painful area. If problems persist, see your doctor or someone like a chiropractor.
Muscles and joints are designed for movement where possible walk and exercise to keep fit. All movement and exercise will improve muscle tone, improve circulation and posture.
At this time of life our fitness levels wane. Try to take up a new sport which will give gentle exercise whilst keeping you moving and flexible.
If you drive around rather than walk or cycle remember that we are all different shapes and sizes and make sure you adjust car seats, head rests and steering wheels to meet your individual requirements. This will not only improve your comfort in the car but also your safety.
Following our topic last month of Arthritis, this month we are going to focus on Rheumatoid Arthritis.
Rheumatoid Arthritis is an autoimmune disease that causes inflammation in multiple joints.
The NHS advises that around 10 million people in the UK suffer with arthritis. The most common types are Osteoarthritis (OA) and Rheumatoid Arthritis (RA), with OA affecting around 8 million of people, and RA affecting 400,000 people.
For more information on how we can help you with treatment, scroll to the end of this article or follow this link to chiropractic treatments available at TWC.
RA is the second most common cause of arthritis in the UK. The symptoms of RA tend to come and go, with episodes of acute flare ups. It commonly presents as joint stiffness, joint pain, swelling and tiredness. The most common areas of the body affected are the wrist, fingers or ball of feet.
The exact cause of Rheumatoid Arthritis is unknown, but it is a result of the autoimmune system attacking itself.
A normal joint is surrounded by a synovial membrane which maintains the synovial fluid. The fluid nourishes the cartilage and lubricates the joint. Within a joint affected by RA the synovium becomes inflamed and produces more fluid, thus resulting in swelling and pain. The joint becomes red due to an increased blood flow, causing it to become warmer than normal.
The pain within the joint is a result of nerve endings becoming irritated by the chemicals produced, and the joint capsule becoming stretched.
When the inflammation decreases the capsule remains stretched and therefore becomes unable to hold the joint in its correct position, leading to the joint being unstable and deformed.
Repetitive flare ups of the joints result in 'wear and tear' of the joint.
Symptoms vary in intensity between individuals. When there is increased activity of the disease, individuals will experience a flare up and then they can go into periods of remissions. Deformities within the joints are usually visible.
The health practitioner will examine for any tenderness, swelling, redness, changes in temperature of skin, and assess the range of motion within the joint. They will also discuss your symptoms, followed by other provocative tests in order to help rule other causes out. Unfortunately there is no specific test to determine Rheumatoid Arthritis, as there are other conditions/causes that can result in stiff and swollen joints.
You may be referred for blood tests. There are no definite blood tests but some of the main tests include the following:
Specific blood tests can be done but are not always accurate:
Imaging can be taken of the affected joint in order to assess the joint damage and level of inflammation. It also assists in determining the type of arthritis present, as well as monitoring the disease progress over time.
The most common types of imaging used are:
Treatment for Rheumatoid arthritis is focused on reducing joint inflammation; relief of pain; preventing or slowing down joint damage; reducing disability and assisting with maintaining an active life.
There is no cure for RA and it is important for early detection in order to provide early treatment and support such as lifestyle changes, medication, supportive treatment and surgery.
If you have RA you will normally be cared for using a multidisciplinary approach where you will see different health professions.
Medications to stop the disease progressing are
Pain relievers are commonly used in order to assist with pain management.
For more information please visit the NHS website:
Supportive treatment is also recommended such as:
Surgery is also used to restore the joint ability and can be used to assist with pain and correct any deformities present.
Suggested further reading:
Chiropractic can help to keep you mobile and help to keep you comfortable.
Chiropractic does not have an impact on disease progression, but will work to mobilize joints, strengthen muscles and provide advice.
During your session the Chiropractor will take a detailed case history, along with a full examination.
Treatment will be on an individual basis, but the overall goal of treatment will be to create mobility into the joints, relax tight muscles, and stimulate weak/inhibited muscles, through specific exercises either in clinic or at home. Your Chiropractor will also provide advice on self management techniques, home care, and ergonomic advice.
To see what we can offer here at The Whitchurch Clinic take a look at the range of therapies:
Arthritis is inflammation and/or stiffness around a joint, commonly resulting in pain.
The NHS advise around 10 million people in the UK suffer with arthritis. The most common types are Osteoarthritis (OA) and Rheumatoid Arthritis (RA), with OA affecting around 8 million of people and RA affecting 400,000 people.
As this is such a large topic, this month we are focusing on Osteoarthritis, and next month we will take a closer look at Rheumatoid Arthritis.
For more information on how we can help you with treatment, scroll to the end of this article or follow this link to chiropractic treatments available at TWC.
OA is the most common type of arthritis. It can lead to chronic disability. It can also be present without any symptoms. However as it progresses it can lead to pain, stiffness and decrease in range of motion of joints.. The most common areas affected are the spine, knees and hips.
The above information has been taken from Musculoskeletal Health 2017, Arthritis Research UK.
The cause of OA is unknown. OA develops due to a loss of hyaline cartilage within a joint which can result in bony changes, such as bony outgrowths (osteophytes) and increased bone thickness (sclerosis). The soft tissues around the joint can also be affected: Synovium becomes inflamed, ligaments become lax, and muscles become weak. It is unclear as to whether there is a single cause to OA or if there are multiple factors.
Different parts of the body have different risk factors, such as the hip joint will undergo more weight bearing in comparison with the interphalangeal joints of the hands which have more repetitive use.
There can be secondary causes of OA where the cause is known i.e trauma; or primary causes where the cause is unknown.
Research has suggested there are relationships between the following:
OA symptoms will develop gradually over time. The most common symptoms are:
The health practitioner will examine for any tenderness, swelling, redness, changes in temperature of skin, and assess the range of motion within the joint. Followed by other provocative tests.
If required then further imaging can be requested:
Lab tests can also be requested:
OA cannot be reversed, so conservative treatments are aimed at assisting with management of the pain, maximising the range of motion and function within the affected area. Changes in lifestyle, including exercise and health management, are effective in managing OA.
Surgery is not always required and is the last resort if the above has not been beneficial.
Here at The Whitchurch Clinic we see great results with Chiropractic care and the management of OA. We offer a range of therapies:
Strunk RG, Hanses M. Chiropractic care of a 70-year-old female patient with hip osteoarthritis. Journal of Chiropractic Medicine. 2011;10(1):54-59. doi:10.1016/j.jcm.2010.10.001.
Nahin RL, Straus SE. Research into complementary and alternative medicine: problems and potential. BMJ : British Medical Journal. 2001;322(7279):161-164.
Pain is something which is experienced by all and can be very uncomfortable. The International Association for the Study of pain define pain as " An unpleasant sensory and emotional experience association with actual or potential tissue damage, or described in terms of such damage".
Pain is also based on an individual experience and can be categorized as acute and chronic pain.
Acute pain usually has a duration of 12 weeks. It usually has a sudden onset from a known cause. It is an adaptive mechanism of the body to promote healing and recovery. Chronic pain occurs after 12 weeks. It is a long lasting pain and may arise from a particular injury that did not heal or an underlying cause. However there may not be an underlying cause.
Pain can also present as Hyperalgesia (exaggerated response to noxious stimulus), or Alloydina ( pain generated from a normal stimulates that doesn't usually cause pain such as clothes rubbing on skin).
Less than 12 weeks
More than 12 weeks
Causes usually known
Cause usually unknown
Usually self limiting
Long lasting duration
Automatic response: Hyperactivity
Automatic response: Often absent
Flat mood, depressed
Visible changes such as swelling, bruisng etc
Visible changes such as deformity, muscles wasting etc
Firstly we need to understand the pain pathway:
Site of Injury
A noxious event has been recognized as pain by a conscious person. The pain signals are carried thorough different afferent nerve fibers to the central nervous system. The slow unmyelinated C fibers transmit a broad range of stimulus such as mechanical, thermal, or metabolic.
The fast myelinated A-fibers respond to mechanical or thermal stimulus by producing a sharp sense of pain.
Once afferent nerve fibers are stimulated, an action potential is created to transmit pain signals to the dorsal horn of the spinal cord. Here a further synapse occurs and transmits to the thalamus and brain stem.
Nociceptive impulses are relayed to multiple areas of the brain including somatosensory cortex, the insula and the limibic system
Identifying the type of pain will assist with the treatment protocol. The most common types of pain are:
Is a normal response of the nerves being stimulated by injury or damage such as sprain, burns, inflammation etc. The nerves transmit pain to the brain via the peripheral nervous system. The pain is usually localized and is like a constant dull ache. It is usually time limited as pain ceases when the damaged tissue heals. Typically seen in acute pain.
Is result of injury or malfunction of the peripheral or central nervous system. It can be triggered by injury, but may not be due to damage to the nervous system. The pain usually presents as a burning or electric shock type of feeling. It can also cause sensory abnormalities. This type of pain is commonly seen in chronic pain, as pain signals are constantly firing. Examples of this are diabetic neuropathy, entrapment neuropathy (i.e carpal tunnel syndrome), peripheral nervous system (widespread nerve damage).
Mediators within the body are released at the area of tissue inflammation causing the activation of the nocicpetive pain pathway. Therefore taking precautions to reduce the inflammation will effect the pain sensation level. Examples of this are appendicitis, Rheumatoid Arthritis, inflammatory bowel disease etc.
However in many cases there can be a complex mixture of nocicpetive and neuropathic factors such as migraine pain, myofascial pain etc.
An assessment of a patient in pain is multidimensional in order to provide an effective treatment strategy. In order to do this the Chiropractors will carry out the following:
Being in pain can be disabling and prevent daily activities.
Therefore the following information may assist with self management of pain until you consult your GP or Chiropractor:
The above listed are not conclusive to the type of pain, and you may find that you do not fit into a particular area. Therefore it is important to seek professional health if you are experiencing pain.
Chiropractors specialise in assessing, diagnosing and managing conditions of the spine. They are highly trained in finding the cause of pain in the spine. In the UK they undergo a minimum of four years’ full-time training. Importantly, chiropractors are regulated by law and must work within strict professional and ethical boundaries.
Before starting treatment, a chiropractor will do a full assessment. This will involve taking details about your condition, current health and medical history, and performing a physical examination. Sometimes it may be necessary to refer you for other tests, such as X-rays, MRI scans or blood tests. It is important for your chiropractor to gather as much information about your back pain as possible so that the most precise diagnosis can be made.
Your chiropractor will then explain what is wrong, what can be done and what you can expect from chiropractic treatment.
Chiropractors are best known for manual treatments such as spinal manipulation, where they use their hands to free stiff or restricted joints, or mobilisation, which is the gradual moving of joints.
But they may also use other recommended treatments such as certain types of acupuncture, electrotherapy, stretching exercises and rehabilitation, all of which form part of a chiropractor’s package of care. Your chiropractor may also offer lifestyle advice to help recovery and to prevent repeated episodes of back pain.
If your chiropractor does not think you can be helped by chiropractic treatment, you may be referred back to your GP or to another health professional. Chiropractors do not prescribe medication, so if this is needed, you may be referred back to your GP. As chiropractors support a joined-up approach to care, they may ask if they can send a brief report to your GP.
Many people who suffer long-term back pain benefit from regular, supportive chiropractic care to reduce the risk of recurrent episodes.
Other treatments that might help with pain management available at TWC:
As with any new symptoms it is always important to visit your GP or Chiropractor to rule out any other disorders before reaching a diagnosis yourself.
Shoulder pain is very common, and according to Urwin et al. (1) between 16% to 26% of the population will experience it at some time.
Shoulder pain can be disabling and result in compromised shoulder movements due to pain, stiffness or weakness, which has an effect on everyday activities such as getting dressed, eating, work etc.
Urwin et al. state that it is the third most common cause of musculoskeletal consultations in primary care.
The shoulder is a very complex joint surrounded by many ligaments and muscles that work to coordinate its' movement and the surrounding joints. The shoulder is a very mobile joint so relies heavily on the fine coordination of it's muscles to work correctly, and therefore cannot always provide the stability needed for certain movements. Many shoulder injuries result in more than one structure becoming dysfunctional or painful.
Other causes which are less common are:
NB The above lists are not all inclusive and there can be other causes of shoulder pain. If the Chiropractor feels it is necessary they may refer for further investigation such as X-ray, ultrasound imaging, GP etc to reach an accurate diagnosis.
Your chiropractor will carry out a detailed case history and carry out an examination to determine the cause of pain. If required you may be referred for further investigation such as X-rays - to assess the joints; MRI - to assess the soft tissue structures such as ligaments and tendons; ultrasound - to assess joint, ligament and tendons; or blood tests - to test for medical conditions.
Once a diagnosis has been reached, if it is musculoskeletal, your Chiropractor can offer a range of treatment options such as joint manipulation or mobilization, soft tissue treatments such as trigger point therapy or acupuncture. Along with home care/ergonomic advice and rehabilitation programmes.
The shoulder is one of the most mobile joints in the body, it's only bony connection is where the clavicle connects with the sternum (chest bone) so it relies heavily on the surrounding muscles and ligaments for stability. Any damage or dysfunction in any of the stabilizers causes high demands on the other supporting structures to maintain the joint flexibility and movements.
The shoulder provides the arm with a wide range of motion - flexion, extension, abduction, adduction, internal and external rotation. The shoulder also allows for movement of the scapula, such as protraction, retraction, elevation and depression.
The shoulder joint consists of: the humerus (upper arm), the scapula (shoulder blade) and the clavicle (collar bone).
The clavicle connects with the sternum (chest bone), creating the sternoclavicular joint; and then with the acromion of the scapula laterally creating the acromioclavicular joint.
To the front of the scapula there is a projection of the scapula called the coracoid which is an attachment point for muscles and ligaments.
On the scapula the Glenohumeral Fossa is the socket where the head of the humerus sits, forming the ball and socket joint. It is held in place with the assistance of ligaments, and the rotator cuff muscles.
The glenoid labrum deepens the fossa (socket) providing more stability to the joint.
Extrinsic (superficial) Muscles
Intrinsic (Deep) Muscles
Rotator Cuff Muscles:
Muscles of shoulder and arm
Bursae are fluid filled sacs, found between two moving surfaces to allow the surfaces to move freely and reduce friction between structures. Inflammation of a bursa is called Bursitis.
There are various ligaments around the shoulder joint to provide stability, they include:
Mitchell et all (2,) carried out a study of Shoulder Pain: diagnosis and management in primary care. They concluded the following:
"Shoulder pain is a common and important musculoskeletal problem. Management should be multidisciplinary and include self help advice, analgesics, relative rest, and access to physiotherapy. Steroid injections have a marginal short term effect on pain.
Poorer prognosis is associated with increasing age, female sex, severe or recurrent symptoms at presentation, and associated neck pain. Mild trauma or overuse before onset of pain, early presentation, and acute onset have a more favourable prognosis (3,4). No evidence exists to show that early orthopaedic intervention improves the prognosis for most rotator cuff or glenohumeral disorders. Surgery should be considered when conservative measures fail."
NB Please note that the above is not applicable to everyone. If you have any questions then please contact us to discuss further.
1.Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998;57: 649-55.
2. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ : British Medical Journal. 2005;331(7525):1124-1128.
3. Van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract 1996;46: 519-23.
4.Thomas E, van der Windt DA, Hay EM, Smidt N, Dziedzic K, Bouter LM, et al. Two pragmatic trials of treatment for shoulder disorders in primary care: generalisability, course, and prognostic indicators. Ann Rheum Dis 2005;64: 1056-61.
Many people find themselves using a computer for a large part of the day. Poor workplace design and layout can contribute to work related injuries (such as repetitive strain injuries) whilst correct chair height, adequate equipment spacing, and good desk posture can help you stay comfortable.
Laptop computers and notebooks
Laptops were designed for short term or mobile use; however, this portability means that people often use them at an unsuitable work height and this may result in discomfort over a long period. There are several ways to address these problems such as;
Posture, movement and stretching
It’s a good idea to take short, frequent breaks in which you move around, and to mix up your tasks during the day. This encourages body movement and use of different muscle groups. Stretching your neck, shoulders, wrists, back and ankles is also recommended several times each working day.
Set an alarm on your phone or your computer to remind you to change position and correct posture every half an hour.
Text adapted and Image taken from; http://mydr.com.au/pain/office-ergonomics-workstation-comfort-and-safety cited 11/2/2013
Computers are the top tech back pain trigger for people in Wales. As part of Chiropractic Awareness Week (10 – 16 April) the British Chiropractic Associations is urging people to take a break from their tech.
New consumer research from the British Chiropractic Association (BCA) has revealed that computers are the top tech back pain trigger for people in Wales, with well over a third (38%) of those surveyed having experienced back or neck pain after using their laptop and 30% after using a desktop computer.
Despite these figures, just 16% of people in Wales have either limited or stopped using their laptop due to concerns for their back and neck health or posture and that figure is 13% for desktop computer users.
The BCA says -
“We all know how easy it is to become glued to your tech. Our devices have become an integral part of our lives, with many of us spending our days either looking down at our phones or stuck on laptops. However it’s important to think about the impact this is having on back and neck health, as well as our posture.
“We’re not saying stop using tech altogether, but it’s important to think about limiting the amount of time you spend using it, and start building regular breaks into your day so you can give your back a rest. Particularly when using laptop or desktop computers, if you’re working in an office it’s important that you don’t spend longer than 40 minutes sitting at your desk at one time...”
The BCA has developed these top tips to help people tech proof their back health
Sit up straight - When you are sat at your computer or laptop, it’s easy to forget your posture and lean towards your screen. To avoid developing back pain from sitting at your desk, set up your computer in a back friendly manner. The top of your screen should be at eye level, so use a stand or a ream of paper to elevate the screen to this height. Your bottom should be right to the back of your seat with your back and shoulders in contact with the back rest. Your arms should lie flat at desk level and your chair positioned so that your hips are slightly higher than your knees with your feet flat on the floor.
On the move - Laptops and tablets are very convenient and flexible to use so it’s tempting to use them in situations where your body may be in an awkward posture position. You are less likely to notice any discomfort developing if you are concentrating on what you are doing.
Head up - Looking down at your mobile phone, tablet or laptop leaves your neck unsupported and the weight of your head will put pressure on your neck and spine. To help keep neck and back pain away, try to hold your phone up in front of you when using it and limit your use of portable technology devices where you can. It is a good idea when using a mobile device to elevate your arms on a table as this will help you. Walking and tech use do not mix so try not to do this at all!
Accessorise - If you are using a portable laptop, plug in a standard mouse and keyboard, which will encourage you to sit in a more ‘back-friendly’ position.
Take control - Ideally, you should sit in a chair when playing video games with your back supported against the backrest and your feet on the floor. If standing, try to position your television screen at eye-level, so that you are not having to strain to look up or down regularly.
Take a break - Our bodies are not designed to stay in one position for long periods of time so, whether working on your computer, scrolling through social media or playing your favourite video game, remember to stand up at least every 40 minutes and move around to keep your muscles active.
Detox - We are becoming much more dependent on technology and taking a break from technology is likely to benefit both your mental and physical health. Use this spare time to get outside and exercise; your back will thank you for it!
For information on setting up your work-station see our blog on ergonomics:
The BCA has created a programme of 3-minute exercises which you can find at
They can be slotted into your daily schedule to help improve posture and prevent back pain by promoting balance, strength and flexibility in the spine.
Our body firstly determines if a situation is stressful or not, by using our sensory and input sensors, and combining with our stored memories.
If the situation is thought to be stressful then the hypothalmus is activated. This will then send a signal to The Pituary Gland and The Adrenal Medulla.
The short term response is to produce 'The Fight and Flight Response' via Sympatho-medullary Pathway (SAM) and the long term response is regulated through Hypothalamic Pituitary-Adrenal (HPA) system.
Short Term Response - Fight or Flight
The Adrenal Medulla secretes Adrenaline with triggers the sympathetic nervous system causing:
- Increased Heart Rate
- Increased Blood Pressure
- Increased Sweating
- Decreased Digestion
Once the stressor has stopped the parasympathetic nervous system takes control and brings back the balance.
Long Term Response
HPA stimulates the release of Coritsol from the Adrenal Cortex, which controls the body's ability to steady the supply of blood sugar. This response allows a person to cope with a prolonged stressor and help the body to return to normal state.
The effects of a long term stressor is a decrease in immune system, making them more prone to illness, disease and injury.
The symptoms of stress can effect your body, thoughts, feelings and behaviour.
Below is a list of some of the common effects of stress:
Stress and pain are very closely linked together. But does stress cause pain or does pain cause stress?
Chapman et al, 2008, studied a review of psycho-physiological systems in relation to pain whereby a physical injury or wounding can generate a complex stress response. They concluded that acute pain is an effect of multiple dimensions and are products of the bodies supersystem. They also proposed that when the supersystem is dysregulated, then health, function and sense of well being suffer and can be a result of chronic pain.
The temporo-mandibular joint (TMJ) is formed from the articulation of the mandible and the temporal bone of cranium. The joint is unique as the surfaces do not touch as they are separated by an articular disc.
The joint is surrounded by three ligaments:
The movement of the joint is produced by the muscles of mastication. These cause the mouth to protrude and retract, as well as opening and closing the mouth.
The TMJ is innervated by the auriculo-temporal and masserteric branches of the mandibular nerve (CN V3).
Factors affecting the joint
There are a range of factors which can effect the joint and result in pain or dysfunction:
Symptoms can vary on individual bases and there maybe other factors that are causing the dysfunction:
Treatment is usually non surgical and can consist of manual therapy and lifestyle changes.
Manual Therapy such as Chiropractic therapy, Physiotherapy, Massage Therapy etc/
Surgery is uncommon for TMJ disorder but can consist or Arthrocentesis, open joint surgery or very rarely total joint replacement.
Here at The Whitchurch Clinic we are committed to helping you on your road to recovery. Through a detailed case history with/without an examination we can advised if we are able to assist with your complaint. If we feel that we are unable to help we will point you in the right direction.
Our Chiropractic team can help through:
Other treatments that might help with back pain available at TWC:
To summarise there are many contributing factors to stress and it is important to identify the cause. If you are not sure what is causing stress or if you are unable to control your levels of stress then it you will need to seek professional help.
As with any new symptoms it is always important to visit your GP or Chiropractor to rule out any other disorders before reaching a diagnosis yourself.
Stress is the feeling of being under too much mental or emotional pressure.
Pressure turns into stress when you feel unable to cope. People have different ways of reacting to stress, so a situation that feels stressful to one person may be motivating to someone else.
Many of life’s demands can cause stress, particularly work, relationships and money problems. When you feel stressed, it can get in the way of sorting out these demands, or can even affect everything you do.
Stress can affect how you feel, think, behave and how your body works. Common signs of stress include sleeping problems, sweating, loss of appetite and difficulty concentrating.
You may feel anxious, irritable or low, and you may have racing thoughts, worry constantly or go over things in your head. You may notice that you lose your temper more easily, drink more or act unreasonably. You may also experience headaches, muscle tension or pain, or dizziness.
Stress causes a surge of hormones in your body. These stress hormones are released to enable you to deal with pressures or threats – the so-called "fight or flight" response. Once the pressure or threat has passed, your stress hormone levels will usually return to normal.
However, if you're constantly under stress, these hormones will remain in your body, leading to the symptoms of stress, which can cause other illnesses.
Hypnotherapy is a positively great way to help alleviate and manage stress on a daily basis, as it works with our minds and bodies.
For more information on hypnotherapy visit:
Unless you have suffered back problems prior to being pregnant, or during previous pregnancies, it is uncommon to have any in the early stages. In the mid to later stages, women develop an
increase in their lumbar curvature as their centre of gravity changes with their increasing bump. The other curves of the back and neck also increase due to compensation, and this puts more
pressure on some of the joints of the spine causing discomfort, and for some women pain.
A hormone called relaxin is released during pregnancy which softens the muscles, ligaments and tendons in order to prepare for birth. As pregnancy progresses into the final stages the increasing size of your bump combined with looser ligaments make it easy to overstretch, or to find that lifting something is more of a problem than normal.
Some chiropractors undertake postgraduate studies to obtain the necessary specialist training to enable them to work with women who are pregnant, and there are many adaptations that can be made to our treatment methods, and benches, to ensure the comfort of our pregnant patients.
Evidence suggests it is very beneficial to both mother and baby if the pelvis and lower back functions biomechanically at its best during pregnancy, and especially during the birth. The three joints of the pelvis need to work and expand equally during pregnancy and birth to reduce the risk of overstretching, which can lead to postnatal pain in that joint. There are also some research articles that suggest chiropractic can reduce labour times, and the need for pain relief, due to decreased pressure on the back.
For further details of the benefits and research follow this link to the International Chiropractic Pediatric Assiociation
For a personal account of an experience of chiropractic during pregnancy follow this link to Natural childbirth Education
Neck and mid back pain is also common during pregnancy due to an increase in breast size:
Symphysis pubis dysfunction (SPD), or now referred to as Pregnancy-related Pelvic Girdle Pain (PPGP), is very common. It is pain, caused by either too much or too little mobility in any of the three pelvic joints, the Sacroiliac joints (right and left) or the symphysis pubis.
A 2011 review of the research found that between 16% and 25% of women report suffering from SPD/PPGP during pregnancy. Over the same large samples of pregnant women, they also found that clinically persistent SPD/PPGP symptoms were present from the post-partum stage to 2 years after childbirth, in 5% to 8.5% of women.
Even now I still have patients coming to me who have been told it is normal to experience these types of problems and that they will go away after the baby is born but as you can see that is not always the case.
Follow this link for the full article:
In a perfect world, it is ideal if you can be fit with good muscle tone before pregnancy without any back problems, but we are not always in that perfect world! However, It is never too late to start. Core exercises are very useful and you can talk to a chiropractor, GP, midwife or other healthcare professional for advice on this. During pregnancy specialist yoga classes, taken from 12 weeks onwards, can be very beneficial.
If you haven't done much exercise previously do not embark on a high end fitness regime. This is important pregnant or not, as you are always at risk of damaging your body if you push too far before your body's ready. Seek professional advice on how to build up slowly and achieve your goals.
Specially designed supports and braces can be really useful in the later stages of pregnancy. They help to stabilise and reduce pressure on the joints, reducing pain.
Long term use of these types of supports is not recommended, as one of the ways they work is to reduce the work the muscles have to do so weakening them and in the long run this can lessen the body's ability to support itself and recover.
For further advice on the type of support that's best for you and when to use it talk to your chiropractor, midwife, or physiotherapist.
Manual therapists can help patients with back and PPGP by mobilising and loosening tight ligaments and muscles, allowing stiff joints to move more freely thereby reducing pain. Each person's case is a little bit different, so treatment varies depending on what the patient needs, and more importantly, what is comfortable for them!
There is no evidence to suggest manual therapy is contraindicated in pregnancy, and in fact there is good evidence to support its role in both pre and post-natal care of PPGP. In combination with exercise, function can be improved and even reduce back pain during the birthing process.
For further advice follow this link;
We are located above the Hearing and Mobility Centre, Whitchurch, our clinic entrance is on Church Road.
For those who may have difficulty getting up our steps to the first floor, home visits are available.
The Whitchurch Clinic
2 Merthyr Road
Tel: (029) 20617700
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