Advice Blog

Chiropractic - the facts

Chiropractic - the facts

Chiropractic is a profession

Chiropractic, as practised in the UK, is not a treatment but a statutorily-regulated healthcare profession. Chiropractors offer a wide range of interventions including; but not limited to; manual therapy (soft-tissue techniques, mobilisation and spinal manipulation); exercise rehabilitation and self-management advice; and utilise psychologically-informed programmes of care. Chiropractic, like other healthcare professions, is informed by the evidence base and develops accordingly. 

Professional Bodies in Chiropractic

The Royal College of Chiropractors (RCC) is an independent, apolitical body which was incorporated by Royal Charter in 2012 to promote quality, safety and professionalism in terms of postgraduate education, practice and research, in the public interest.

There are also four representative bodies for chiropractors in the UK: the British Chiropractic Association (BCA), the McTimoney Chiropractic Association (MCA), the Scottish Chiropractic Association (SCA) and the United Chiropractic Association (UCA).  


Royal College of Chiropractors webiste:

British Chiropractic Association website:

McTimoney Chiropractic Association website:

Scottish Chiropractic Association webiste:

United Chiropractic Association website:

Chiropractic Regulation in the UK

Chiropractic is regulated by The General Chiropractic Council (GCC), an independent statutory body established by The Chiropractors Act (1994). The title of 'chiropractor' is protected by law and it is a criminal offence for anyone to describe themselves as a chiropractor without being registered with the GCC.

The GCC sets the standards for undergraduate education, and the standards of chiropractic practice and professional conduct for individuals working as chiropractors. It investigates complaints against chiropractors, taking action against them where necessary. The GCC has the power to remove a chiropractor from the Chiropractic Register if they are found to be unfit to practise. 

Chiropractic Education in the UK

Prospective students must apply through UCAS for access to a chiropractic undergraduate programme. Chiropractic undergraduates train for either 4 or 5 years to gain a GCC-accredited, university-validated MChiro or MSc degree, which enables them to apply to join the Chiropractic Register. Many chiropractors further their studies at Masters level in areas of special interest, such as sport and exercise, and some undertake professional doctorate or PhD studies.  

Chiropractic skills and competencies

NHS England’s National Low Back and Radicular Pain Pathway 2017, as endorsed by NICE, helpfully defines the skills and competencies required to manage different parts of the pathway and highlights the likely involvement of chiropractors according to local commissioning arrangements. The RCC has further highlighted the skills and competencies of chiropractors in the context of managing low back and radicular pain. Furthermore, the RCC actively promotes evidence-based care and publishes evidence-based chiropractic quality standards which further highlight what chiropractors do. 

The evidence base for musculoskeletal care

The evidence base for the care chiropractors provide is common to that provided by physiotherapists in respect of musculoskeletal (MSK) conditions. Thus, like physiotherapists and osteopaths, chiropractors can treat a wide range of MSK problems, as determined by the UK Advertising Standards Authority (ASA).

Chiropractors are most closely associated with management of low back pain, and the NICE Low Back Pain and Sciatica Guideline ‘NG59’ provides clear recommendations for managing low back pain with or without sciatica, which always includes exercise and may include manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) as part of a treatment package, with or without psychological therapy. Note that NG59 does not specify chiropractic care, physiotherapy care nor osteopathy care for the non-invasive management of low back pain, but explains that: ‘mobilisation and soft tissue techniques are performed by a wide variety of practitioners; whereas spinal manipulation is usually performed by chiropractors or osteopaths, and by doctors or physiotherapists who have undergone additional training in manipulation’ (See NICE NG59, p806). The Manipulative Association of Chartered Physiotherapists (MACP), recently renamed the Musculoskeletal Association of Chartered Physiotherapists, is recognised as the UK’s specialist manipulative therapy group by the International Federation of Orthopaedic Manipulative Physical Therapists, and has approximately 1100 members. The UK statutory Osteopathic Register lists approximately 5300 osteopaths. Thus, collectively, there are approximately twice as many osteopaths and manipulating physiotherapists as there are chiropractors currently practising spinal manipulation in the UK.  

The mechanism through which manual therapy exerts its effects

Studies have shown various forms of manual therapy to be effective in the treatment of musculoskeletal pain (Clar et al, 2014), but while the mechanisms through which manual therapy exerts its effects are likely to be biomechanical and/or neurophysiological in nature, they are not well understood (Bialosky et al, 2009). Such is the case for many forms of therapy, including numerous examples in medicine and surgery. Note that the audible release sometimes associated with joint manipulation is characterised by rapid separation of joint surfaces with subsequent cavity formation or ‘cavitation’. Any particular therapeutic benefit of audible release is not fully established (Kawchuck et al, 2015).


Experiencing mild or moderate adverse effects after manual therapy, such as soreness or stiffness, is relatively common, affecting up to 50% of patients. However, such ‘benign effects’ are a normal outcome and are not unique to chiropractic care. Cases of serious adverse events, including spinal or neurological problems and strokes caused by damage to arteries in the neck, have been associated with spinal manipulation. Such events are rare with estimates ranging from 1 per 2 million manipulations to 13 per 10,000 patients; furthermore, due to the nature of the underlying evidence in relation to such events (case reports, retrospective surveys and case-control studies), it is very difficult to confirm causation (Swait and Finch, 2017). For example, while an association between stroke caused by vertebral artery damage or ‘dissection’ (VAD) and chiropractor visits has been reported in a few case-control studies, the risk of stoke has been found to be similar after seeing a primary care physician (medical doctor). Because patients with VAD commonly present with neck pain, it is possible they seek therapy for this symptom from a range of practitioners, including chiropractors, and that the VAD has occurred spontaneously, or from some other cause, beforehand (Biller et al, 2014). This highlights the importance of ensuring careful screening for known neck artery stroke risk factors, or signs or symptoms that there is an ongoing problem, is performed prior to manual treatment of patients (Swait and Finch, 2017). Chiropractors are well trained to do this on a routine basis, and to urgently refer patients if necessary. 

The above information has been cited from The Royal College of Chiropractors:

The Royal College of Chiropractors

About the Royal College of Chiropractors Granted a Royal Charter in 2012, The Royal College of Chiropractors or ‘RCC’ (formerly The College of Chiropractors) is an academic membership organisation with the following objectives:

• to promote the art, science and practice of chiropractic;

• to improve and maintain standards in the practice of chiropractic for the benefit of the public;

• to promote awareness and understanding of chiropractic amongst medical practitioners and other healthcare professionals and the public;

• to educate and train practitioners in the art, science and practice of chiropractic;

• to advance the study of and research in chiropractic.

New year, New You?

New Year, New You?

As the festivities are left behind, we begin to make our plans and resolutions for the year ahead.


Through January there is a surge of gym membership with people looking to become fitter and healthier.  


However taking on an exercise regime that your body is not use to can have its toll on the body and thus can lead to injury and pain.


Therefore we advise that you prepare yourself prior to embarking on any new programmes or activities.


According to research by the British Chiropractic Association:


"Exercise is the trigger for 30% of those experiencing back or neck pain.  For people embarking on an exercise regime, especially one that is new, the risk of suffering neck or back pain can be higher so it is important to be well prepared".

Top Tips

•    Seek professional advice to check that there are no medical reasons why you should not exercise, particularly if you are not normally physically active.

•    Remember to warm up and warm down before and after any activity. Start with less strenuous activity like walking or jogging and finish with some light stretches at the end of an exercise session – this may help minimise muscle stiffness and reduce the chance of muscle strain.

•    Keep well hydrated by drinking plenty of fluids before, during and after exercise – this will help your muscles work more efficiently and will reduce aches and pains after exercise.

•    Make sure you wear the right attire for your chosen activity.  Wearing tight clothes when exercising could constrict your movement and lead to injury.

•    Wear appropriate footwear for the type of exercise you are doing – most specialist sportswear retailers will be able to advise you on this.

•    If you are enrolling in a gym, make sure you receive training on any equipment and if you are signing up to a programme, try and make sure you get proper training, advice and ongoing supervision.

Why not chose Chiropractic as your new years resolution?

Chiropractic is a regulated primary healthcare profession.  Chiropractors diagnose, treat, manage and prevent disorders of the musculoskeletal system (bones, joints and muscles), as well as the effects these disorders can have on the nervous system and general health.


Chiropractic uses a range of techniques to reduce pain, improve function and increase mobility.  We offer a package of care which includes treatment as well as advice on self-help, therapeutic exercises, and lifestyle changes.


We can provide advice on how to approach a new exercise routine and tell you what signs to look out for if you overdoing it. 



The above information is for guidance only and is not exclusive.  It is important to ensure you are prepared, and have the right guidance into carrying out a new regime/exercise to avoid any repercussions.


Staying committed to maintaining a healthy back is a life long commitment. 


Here at the Whitchurch Clinic we are there to help with each step by offering a range of therapies:


  • Chiropractic care
  • One to one personal training
  • Hypnotherapy
  • Sports Massage
  • Diet Advice

If you require any further information on any of the above please do not hesitate to contact our clinic on 02920 617700 for an informal discussion.

Happy Holidays

Happy Holidays

During this festive season many of you will be heading away either to visit family, celebrating the new year, skiing, or just escaping. 
So often, when people are on holiday and out of their normal routine, they can end up causing themselves unnecessary discomfort and stress by injuring themselves, so the British Chiropractic Association have put together some top tips to remain fit and healthy when away. 

Suitcase selection – Choose wisely, buy the lightest case possible that has wheels; hard cases tend to weigh quite a lot before you even start to fill them.


Two cases are better than one If possible, take two light suitcases rather than one, so you can distribute the weight more evenly.

Get a good night’s sleep – Travelling when tired increases your chances of injury, so make sure you sleep well the night before a long journey and avoid rushing around.



Make adjustments - Many back problems are caused or aggravated by a poor driving
posture. If you’re driving to your holiday destination, ensure the seat position is
slightly backwards so that it feels natural and that your elbows are at a comfortable and relaxed angle.


Relaxing – Relax at the wheel, as this reduces stress on the spine and allows your seat to take your weight.

Keep an eye on the clock – Stop and stretch your legs (and arms!) at least every two hours.

Clench! – If you are stuck in traffic, exercise in your seat. Try buttock clenches, side bends and shoulder shrugs and circles.

Keep it lose – Don’t wear tight clothing as they will restrict your movement.


Flying high – Avoid alcohol before and during the flight as this will cause you to
dehydrate and, in turn, exaggerate muscle pain. Drink plenty of water instead.


Air-exercise – You will be restricted to your seat for most of the flight, but avoid stiffness by doing shoulder shrugs, buttock clenches and foot circles. Take the opportunity to get up and stretch your legs whenever you can.


Avoid ‘travelators’ – Get your joints moving quickly after a flight and walk to
arrivals rather than the easy option of a moving walkway.


Round and round – Ensure your bags are easily identifiable (e.g. knot a ribbon around the handle) to avoid lifting other people’s heavy cases in error.


Push, don’t pull! – Many wheeled cases encourage you to pull the case handle from behind, but this makes the upper body/back twist. If possible, push the case in front of you or use a trolley making sure you choose one from the stack which does not have ‘wonky wheels’, as keeping it on track will not do your back any good!

At Your Destination

Bed down – When you get to your hotel, if your bed is too hard ask the hotel staff for a spare duvet or blanket to put between you and the mattress. Firm beds are not always best, but it is easier to soften a hard bed than make a soft bed harder.


Lounging around – If you’re heading to the sun loungers in search of the perfect tan, try not to lie on your tummy with your back and neck arched back when reading your book or magazine. Put the reading matter on the floor, so that you can view it over the edge of the sun bed; this should allow you to keep your head and neck in a more neutral position.


Exercise in safety – If keeping in shape is on your holiday agenda, ensure you have a full induction to the hotel gym equipment.


Further information about chiropractic can be obtained by logging
on to
For further information contact the
British Chiropractic Association on 0118 950 5950


Winter Woes

Winter Woes

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 is something that will affect most of us at this time of year, due the demands of the Christmas season.

“Stress manifests itself as a physical, psychological or social dysfunction resulting in individuals feeling unable to bridge the gap with the requirements or expectations placed upon them.” 

People deal with stress in different ways. The symptoms of stress can effect your body, thoughts, feelings and behaviour.

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. 


Helpful tips to manage stress

Here at The Whitchurch Clinic we have a few tips on how to manage with the seasonal stress:

  • Make lists - not only does it help you put your thoughts to paper, but gives you a self of achievement when you tick one off your list.
  • Relax -   find ways to help you relax such as breathing exercises, meditation, yoga, time away from daily stresses.
  • Treat yourself - try to help reduce tension with a massage or reflexology; find new ways to relax with Hypnotherapy; treat those aches and pains with a Chiropractic treatment; or take it all out with a personal trainer session.

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.   

Tiredness or lack of sleep

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: 

Sleeping postions

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.

Less sun means less Vitamin D

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:

Exercise and Diet

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:

  • Get up, stand up. Inactivity is a leading cause of back pain. If you spend most of your day sitting make sure that you take regular breaks, ideally every 20-30 minutes. Stand up to stretch, change position, and walk around a little.
  • Stretch it out. If you struggle to get away from your seat at work, simple activities such as stretching and shoulder shrugging, and even simply fidgeting in your seat, can all help to keep the joints and muscles in your back moving.
  • Keep moving. Exercise is key to a healthy back, however you don’t need to embark on any extreme fitness regimes. Adding just a few extra minutes of walking a day can have a huge impact on your posture.
  • Straighten Up. Try incorporating some simple exercises into your daily routine. The British Chiropractic Association has developed - - a series of simple exercises designed to improve posture and help prevent back pain by promoting balance, strength and flexibility in the spine.
  • Perfect your posture. Paying close attention to your posture can help you recognise back or neck pain triggers. People who want to improve their posture should try imagining they have a plumb line hanging straight from their ears to ankles - with everything in the middle sitting on the same line. One way to do this is to try standing in a relaxed way and then gently contracting the abdominal muscles. 


There is always temptation to over indulge in the festive season so here are few tips to keep your diet healthy:

  • Remember your 5 a day portions of fruit and veg.  Take advantage of  seasonal vegetables like carrots, parsnips and swede.
  • Avoid comfort eating, keep your meal times regular, and try not to skip meals.
  • Be carb smart.  Carbohydrates are good for us if eaten in the right quantities at the right time.  



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.  

Back Care Awareness Week and World Spine Day

Back Care Awareness week: Back Pain in Education


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:

World Spine Day: Your Back in Action

Monday 16th 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 for more information. 


Simple things to do to look after your back

There are plenty of simple things we can all do to help look after our back health. These are my top tips:


  • Get up, stand up. Inactivity is a leading cause of back pain. If you spend most of your day sitting make sure that you take regular breaks, ideally every 20-30 minutes. Stand up to stretch, change position and walk around a little.
  • Stretch it out. If you struggle to get away from your seat at work, simple activities such as stretching and shoulder shrugging and even simply fidgeting in your seat can all help to keep the joints and muscles in your back moving.
  • Keep moving. Exercise is key to a healthy back, however you don’t need to embark on any extreme fitness regimes. Adding just a few extra minutes of walking a day can have a huge impact on your posture.
  • Straighten Up. Try incorporating some simple exercises into your daily routine. The British Chiropractic Association has developed - - a series of simple exercises designed to improve posture and help prevent back pain by promoting balance, strength and flexibility in the spine.
  • Perfect your posture. Paying close attention to your posture can help you recognise back or neck pain triggers. People who want to improve their posture should try imagining they have a plumb line hanging straight from their ears to ankles - with everything in the middle sitting on the same line. One way to do this is to try standing in a relaxed way and then gently contracting the abdominal muscles. 

Common myths about back pain




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".

Where does Chiropractic come into it?

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:

  • Soft tissue massage
  • Trigger point therapy
  • Acupuncture/dry needling
  • Spinal manipulation/mobilisation
  • Home exercises/stretches
  • Ergonomic and postural advice



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.

Active Ageing


“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 body”
 Dr. Chris Steele

The British Chiropractic Association teamed up with trusted TV doctor, Dr. Chris Steele, to raise awareness of these important issues, and you can hear the audio by going to the following link - 

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 -


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.

Trendy Twenties

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.

Career Climbing Thirties

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.

Slow Down Forties

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.

Get Fit Fifty +

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.

Rheumatoid Arthritis

Rheumatoid Arthritis

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.  



  • Females are more than likely to develop the condition than men.
  • Risk develops with age, usually starting in middle age.  However it can occur in children and young adults.

Risk Factors

Causes of Rheumatoid Arthritis

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.



Symptoms include:

  • Tender, warm, swollen joints.
  • Joint stiffness.  Particularly worse in the morning or periods of inactivity.
  • Fatigue, fever and weight loss.
  • In early stages the smaller joints are usually affected within the fingers and toes.
  • In later stages larger joints can be affected such as wrists, knees, ankles, elbows, hips and shoulder.
  • Most cases the disease presents in the same joint both sides.
  • It can also occur in non joint related structures such as the skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow and blood vessels.


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:

  • Erythrocyte Sedimentation Rate (ESR).
  • C-Reactive Protein (CRP).
  • Full blood count (usually used to rule out anaemia).

 Specific blood tests can be done but are not always accurate:

  • Rheumatoid Factor and Anti-CCP Antibodies.  About 50% of RA suffers will have a positive rheumatoid factor but about 1 in 20 people without RA test positive for the rheumatoid factor also.  An antibody test, Anti-Cyclic Citrullinated Peptide (Anti - CCP) is available.  People who are tested positive for this are very likely to develop RA but not everybody who has RA have this antibody.



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:


  • X Rays - Looking for evidence for soft tissue swelling, osteoporosis, joint space narrowing and marginal erosion of bone.  
  • Ultrasound scans - Looking at the soft tissue presentations such as synovial damage, synovial inflammation, tenosynovitis or bursitis.
  • MRI - Looking for evidence of cartilage thickness, cysts of bone or erosion's, inflammation, bone marrow oedema and joint effusions etc.




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

  • Disease- modifying anti-rheumatic drugs (DMARDs).  These work by blocking the effects of chemicals released when the immune system attacks the joints. The most commonly used is Methotrexate.  Common DMARDs used are: Methotrexate, Leflunomide, Hydroxychloroquine, and Sulfasalazine.


  • Biological treatment is a newer form of treatment which is usually taken in combination with other DMARDs.  They are usually given in injection form and stop particular chemicals in the blood activating your immune system to attack the joints. They include: Etanercept, Infliximab, Adalimumab, Certolizumab, Golimumab, Rituximab, Abatacept, Tocilizumab.


Pain relievers are commonly used in order to assist with pain management.

  • Painkillers.
  • NSAIDS - Ibuprofen, Naproxen, Diclofenac in order to assist with pain and help control inflammation.
  • Corticosteroids - either in tablet form or an injections in the joint or muscle.  

For more information please visit the NHS website: 


Supportive treatment is also recommended such as:

  • Physiotherapy - to increase muscles strength, fitness and joint flexibility. Providing use of heat or ice packs and using a TENS machine.
  • Occupational Therapy - to assist with adaptations required at home or in the workplace, and to provide recommendations for supports such as splints etc.
  • Podiatry - If the feet are affected then recommendations of insoles or further treatment.

Surgery is also used to restore the joint ability and can be used to assist with pain and correct any deformities present.

  • Finger, hand and wrist surgery.
  • Arthroscopy.
  • Joint replacement. 


Suggested further reading:

Can Chiropractic help?

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.  







  • Females are more than likely to develop the condition than men.
  • Risk develops with age.  With estimate age to be around 40's onward

Risk Factors

  • Obesity - people who are overweight are more likely to develop  OA.
  • Occupation - jobs which involve: squatting or kneeling are more likely to develop knee OA: lifting or standing more likely to develop hip OA and manual dexterity (CHIROPRACTORS) more likely to develop hand/wrist OA.
  • Joint abnormalities - such as development abnormalities are at more risk.
  • Genetic Factors.

The above information has been taken from Musculoskeletal Health 2017, Arthritis Research UK.

Causes of Osteoarthritis

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:

  • Hormonal status and bone density as there is a higher incidence of OA in post menopausal women.                                                                                                 
    et al. 
    Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group
    Arch Intern Med
  • Increased prevalence to age related disorders such as OA to those who are continuously exposed to oxidants.                                                                              
    Reactive oxygen species and antioxidant vitamins: mechanisms of action
    Am J Med
  • Genetic causes to OA.                                                                               
Genetic influences on osteoarthritis in women: a twin study


OA symptoms will develop gradually over time.  The most common symptoms are:

  • Pain - during or after movement.
  • Tenderness - over or around affected joint.
  • Stiffness - especially in the morning or after period of inactivity.
  • Noisy joints - grinding or constant clicking of joints.
  • Bone spurs - hard lumps around affected joint. 


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:

  • XRAY - to assess the joint space of the joints, whether there is any bony spurs or sclerosis occurring.
  • MRI - not as common but will allow visualization of the cartilage to assess degree of damage.  

Lab tests can also be requested:

  • Blood tests - there are no specific blood tests for OA so it would be used to rule out other diagnosis such as RA.
  • Joint Fluid Analysis - fluid is drawn from the joint space to assess for inflammation and to determine any other causes such as infection or gout.  


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.



  • Acetaminophen. 
  • NSAIDs - over the counted or higher dosages are supplied.
  • Duloxetine.


  • CHIROPRACTIC can help through both hands on treatment and exercises to help support and strengthen the affected areas. To find out what types of treatments our chiropractors can provide at TWC follow this link
  • Physical therapy and exercise.
  • Occupational Therapy.
  • Acupuncture/dry needling.
  • Nutritional supplements such as Glucosamine and Chondroitin.


Surgery is not always required and is the last resort if the above has not been beneficial.

  • Cortisone Injections - assist with relieving pain but are usually limited to 3 or 4 a year due to the long term effects it can have to the joint.
  • Lubrication Injections - injections of Hyaluronic Acid can assist with pain relief and contribute to the cushioning of the joint particularly the knee. However research is limited in this area.
  • Realigning the bones - through an Osteotomy.
  • Joint replacement

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. 



Acute Pain Vs Chronic Pain

Acute Pain Vs Chronic Pain

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).


Acute Pain

Chronic Pain

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

Anxious, restfulness

Flat mood, depressed

Visible changes such as swelling, bruisng etc

Visible changes such as deformity, muscles wasting etc



Pain Pathway

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.

Spinal Cord

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


Classification of pain

Identifying the type of pain will assist with the treatment protocol.  The most common types of pain are:


Nociceptive Pain

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.


Neuropathic 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).


Inflammatory Pain

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:


  • Taking a full history, including physical and neurological screening.
  • If the clinician feels necessary, referral for further imaging such as xrays, MRI, blood tests etc.
  • Psychosocial assessment to assess any psychological factors contributing to pain management.
  • Patient explanation of findings, diagnosis, treatment options and prognosis.
  • Advice on activity, lifestyle, rehabilitation, self-management etc.
  • Monitoring and re-assessing when required.

Self-management tips

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:


Acute Pain

  • PRICE (protection, rest, ice, compress and elevate).
  • Find your pain free movements and try to avoid any painful movements.
  • NSAIDS, over counter pain killers (always read label).
  • Use support aids.

Chronic Pain


  • Heat is generally more effective for Chronic pain.
  • Relaxation techniques using deep breathing.
  • Exercise.
  • Behavioral changes.
  • Muscle relaxants

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. 

Seeing a Chiropractor for 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:

  • Hypnotherapy 
  • Sports massage
  • Personal training
  • Diet advice for food intolerances/allergies i.e. gluten or dairy

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 and Chiropractic

Shoulder Pain and Chiropractic

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. 

Common causes of shoulder pain

  • Instability (traumatic or non traumatic)
  • Impingement syndrome
  • Tendonitis or bursitis
  • Osteoarthritis
  • Adhesive Capsulitis (Frozen Shoulder)
  • Acromioclavicular joint separation
  • Referred pain from Cervical Spine
  • Partial or full tears of tendons/muscles
  • Fracture following trauma
  • Muscles strains or ligament sprains
  • Poor posture 
  • Overuse

Other causes which are less common are:

  • Visceral (organ) referral pain
  • Tumour
  • Infection
  • Calcification of bursae or tendons

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. 

How can Chiropractic help?

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.

Shoulder Anatomy


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.


Bone Structures


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


Anterior muscle:

  • Pectoralis Major - The pectoralis major has four actions. The first is flexion of the humerus, it also adducts the humerus, rotates the humerus medially, and keeps the arm attached to the trunk of the body.

Posterior muscles:

  • Trapezius - elevates shoulder and rotates scapula to extend upwards.
  • Latissimus Dorsi - Extends, adducts and internally rotates arm; draws shoulder inferiorly and posteriorly; keeps inferior angle of scapula against chest wall


Lateral Muscles:

  • Deltoid muscles are in 3 compartments:  Anterior - flexes and internally rotates arm; middle - abducts arm and posterior - extends and externally rotates arm. The deltoids take over when the arm is lifted away from the body.


Intrinsic (Deep) Muscles


Anterior muscles:

  • Pectoralis Minor - draws scapular anteriorly and internally, raises rib in forced inspiration.
  • Subclavius - depresses clavicle, draws shoulder anteriorly and inferiorly, steadies clavicle during movements of shoulder girdle.


Posterior Muscles:

  • Levator Scapula - Elevates scapula, and rotates or extends the neck when the scapular is fixed in position.
  • Rhomboid major and minor - retract and elevate scapula.
  • Teres major - extends and internally rotates humerus.


Lateral Muscles:

  •  Serratus Anterior- pulls scapula anterior of the thoracic wall and rotates scapula for abduction and flexion of the arm

Rotator Cuff  Muscles:

  • Supraspinatus - flexes arm, aids deltoid abduction, draws humerus towards glenoid fossa, prevents deltoid forcing humerus up against acromion.
  • Infraspinatus - draws humerus towards Glenoid Fossa, resisting posterior dislocation of arm, externally rotating and abducting arm.
  • Teres Minor - externally rotating arm and assists with minimal adduction of arm.
  • Subscapularis - internally rotates arm and stabilizes glenohumeral (shoulder) joint.

Muscles of shoulder and arm 

  • Biceps Brachii - consists of two heads: long head and short head.  Primary flexor of forearm, supinates forearm and weakly flexes the arms at shoulder.
  • Coracobrachialis - weakly adducts arm and aids with stabilizing the humerus
  • Triceps brachii - consists of three heads.  Primary extensor of forearm at elbow joint, long head crosses glenohumeral joint so it can also extend and adduct humerus.

Shoulder Bursae



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. 


Shoulder Ligaments


There are various ligaments around the shoulder joint to provide stability, they include:

  • Glenohumeral Ligament 
  • Coraco-acromial ligament 
  • Coraco-clavicular ligament  
  • Transverse Humeral Ligament 



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.


Work Station Ergonomics

Ergonomics : British Chiropractic Association Advisory Video

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.






  • Ideally, use a swivel chair with wheels or glides to allow easy chair movement.
  • Adjust the height of your chair so that your feet rest comfortably on the floor or, if this makes your chair too low in relation to the desk, use a footrest. 
  • When sitting, your knees should be about level with your hips, and the seat of your chair should not press into the back of your knees. Your spine should be against the back of the chair and your shoulders relaxed back and down.
  • If your chair can’t be adjusted so that your back is straight, place a cushion between the curve of your lower back and the back of the chair.



  • The monitor should be roughly an arm’s length away. 
  • The top of the screen should be at eye level or just below so that you look down at a slight angle to your work.
  • If you wear bifocals, position the monitor lower than normal to compensate for needing to look through the bottom of your lenses. Raise your chair until you can view the monitor without tilting your head back. This may mean that you have to raise the keyboard and use a footrest. Alternatively when working at the computer, use a pair of single-vision lenses with a focal length designed for computer work.
  • Reduce glare and reflections, by ensuring neither you or the monitor face the window. Tilting the monitor slightly downwards can help with glare, and adjust the monitor’s brightness to a comfortable level.
  • Remember to rest your eyes every 30 minutes or so, by looking away into the distance.



  • You should be able to have your forearms close to horizontal and your wrists straight when using the keyboard. 
  • Your elbows should be close to your body. 
  • The keyboard should be aligned with the monitor and directly in front of you, so that you don’t have to twist or rotate to use it.
  • Put reference documents either between the monitor and the keyboard or directly alongside the screen in a document holder. Putting such documents between the keyboard and the front of the desk pushes the keyboard too far back on the desk, disrupting your posture.
  • The keyboard should not be so close to you that your wrists rest on the sharp edge of the desk.
  • If your workstation has been set up properly, a wrist rest should not be needed. If you do use one, make sure that you only use it when pausing between typing rather when actually keying, to avoid strain on the wrists.



  • The mouse should fit the size of your hand so that it is comfortable to work with. 
  • Your wrist should be in a neutral position (minimal bend in any direction at the wrist) when you use the mouse, and your fingers should be able to rest on the push buttons between actions. 
  • If possible position the mouse on the desk so that the weight of your arm is supported by the desk.
  • Ensure your elbow remains close to your body so your arm and shoulder arer not under strain while you use the mouse.



  • Position the phone so that you can perform simple tasks such as taking notes without twisting or cradling the phone on your shoulder, and ensure the cord is long enough.
  • If you are using the phone frequently in your work, or if you need to do other tasks such as keying information at the same time as using the phone, use a headset.


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;

  • Docking the laptop into a desktop computer at a suitable workstation.
  • Connecting the laptop to stand-alone equipment such as a separate screen, keyboard and mouse. 
  • Transfering your information onto a desktop computer if working for long periods. 
  • Use a desk as opposed to your lap, or use a tray over a cushion to elevate the laptop, and the tray will insure the fans aren’t blocked.


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; cited 11/2/2013