With an increase in the number of people working from home we have seen a surge in problems related to our patients home setup.

Many people find themselves using a computer for a large part of the day, and during these difficult times it's happening even more so.

Incorrect 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.

• Consider investing in a variable height desk to allow you to easily vary your posture without having to interrupt your work or meetings.
• Variable height desks allow for bespoke adjustments to suit your height, so can eliminate the need for footstools and ensure optimal positioning for you.
• Make sure you have plenty of space to work with so that you are not cramped (see document holder below).

• 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. 
• Your position 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.

• Position 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.

• Arm position should be such that you are able to have your forearms close to horizontal and your wrists straight when using the keyboard, and your elbows close to your body. 
• Align with the monitor and directly in front of you, so that you don’t have to twist or rotate to use it.

• Consider using an ergonomic mouse to better align you shoulder and reduce strain on your arm and neck.
• Position your elbow close to your body to help with arm and shoulder alignment and reduce strain.
• 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. 

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

Back pain is more common than you’d think, with recent data showing that 80% of the nation will experience back pain at some point in their lifetime¹. This Chiropractic Awareness Week (4-10 April), we’re encouraging Brits to take back their back health.

As people start preparing for competition runs, such as the Cardiff Half Marathon, Sports Therapist and ex professional track runner Gareth Warburton says:

"I cannot emphasize enough the importance of trainers in helping to prevent injury when running. You should be swapping out your running shoes every 400 to 500 miles. This means if you average 25 miles per week, you need a new pair every four to six months. If you push beyond this mileage, you risk discomfort and possibly a long-lasting, debilitating injury."

Spring is here and with it, for many comes the desire to don a pair of trainers and hit the road for a run.

Here’s how not to make it a troublesome one for your joints and muscles… 

Spring brings warmer weather and longer days, which is a great incentive to keep on running for longer than usual and push your body that little bit more. Of course reaching your goal is good, but pushing your body too hard might result in unwanted injuries.

 
You should always listen to your body’ natural resistance and follow these tips for a safe and effective wind down after your run:
 
Don’t Stop Moving
Keep gently mobile right after your run. Try regular walking for 5-10 minutes; it might be the last thing you feel like after running a few miles but remaining static should be avoided at all costs to avoid injuries.
 
Ice
Applying ice to specific injuries such as problems with joints is highly recommended. This is most effective when the ice is applied immediately after a run but still works when applied a few days following.
 
Heat
Taking a hot bath after a long run is ideal for strained muscles. It also helps with overall rejuvenation and relaxation, which is often needed after a strenuous or draining stretch.
 
Food For Thought
What we put in our bodies pre and post run is particularly important. Snack regularly, ideally on something that is high in carbohydrates, low in fat, which contains some protein; for example, a tuna sandwich is ideal. Ensuring you drink lots of fluids is also another very important factor for runners to remember. Water is of course an excellent choice when it comes to keeping well hydrated but there are plenty of other options out there, too, such as sports drinks and gels. Remember: after finishing your run, rehydrate as soon as possible, preferably within the first hour and always refrain from drinking alcohol until fully rehydrated.

With the growing popularity of community-based races and charity half marathons, more and more people are taking up running for fun. While running is associated with a lot of health and general wellness benefits, some athletes experience overuse injuries while running and training. One of these is exercise-related leg pain (ERLP), otherwise known as shin splints, with pain between the knee and ankle during or after exercise.

M Reinking, T Austin, and A Hayes (2013) looked into the prevalence of ERLP in adult runners and how the pain affected their running and daily activities. They also analysed risk factors to determine who is most likely to have leg pain from running. Out of over 200 runners, more than 50% of the runners reported at least one episode in the past year. Of this group, about 40% said that the leg pain interfered with running. They found that the most significant risk factor was previous leg injury or pain and participants who had less than three years experience running were at greater risk than more experienced runners. Those who ran less than 15 miles per week were more likely to suffer leg pain than those running more. The greatest occurrence was among amateur runners who raced at a pace of 9 minutes per mile or greater.

A trigger point is a hypersensitive, nodal point of muscle that can refer pain in specific patterns (Travell and Simon's Myofascial Pain and Dysfunction Vols 1 & 2) depending on if they are active or latent. Trigger points can build up due to an acute overload/injury, or chroinic overload such as repetative strain injuries.

This can be caused by a change in technique, increased training, or faulty mechanics in a joint or muscle (scar tissue etc). Trigger points weaken and shorten the muscle, effecting both strength and endurance. This in turn leads to further dysfunction in the surrounding tissues and joints as they compensate and are over loaded. Further trigger points then form in a snowball effect.

‘Snapping hip’ or coxa saltans/iliopsoas tendinitis/dancer's hip describes an audible snapping or popping noise as the hip moves from flexion (knee toward waist) to extension (knee down and hip joint straightened). After extended exercise pain or discomfort may be present caused by inflammation of the iliopsoas bursae. Pain often decreases with rest and diminished activity.

The more common lateral extra-articular type of snapping hip syndrome occurs when the iliotibial band, tensor fascia lata, or gluteus medius tendon slides back and forth across the greater trochanter.

Less commonly seen medial extra-articular type is caused by the iliopsoas tendon catching on the anterior inferior iliac spine(AIIS), the lesser trochanter, or the iliopectineal ridge during hip extension, as the tendon moves from an anterior lateral (front, side) to a posterior medial (back, middle) position.

‘Snapping Hip’ syndrome is commonly associated with a leg length difference (usually the long side is symptomatic), tightness in the iliotibial band(ITB) on the involved side, weakness in hip abductors and external rotators, poor lumbopelvic stability and abnormal foot mechanics (Overpronation). Intra-articular can also be indicative of injury such as a torn acetabular labrum, recurrent hip subluxation, ligamentum teres tears, loose bodies, articular cartilage damage, or synovial chondromatosis (cartilage formations in the synovial membrane of the joint).

A compartment syndrome is characterised by having too much pressure in the muscle compartments in our leg.  Our muscles are surrounded by very tough tissue we call fascia, it is not very flexible and some runners or athletes experience muscle swelling during activities.  If this swelling is significant enough, the fascia will squeeze or put pressure on the muscle.  This reduces blood flow to the muscle and the muscle will fatigue rapidly and start to hurt. People with compartment syndromes typically have no pain at the start of their run/game, but at some point during the run/game pain will start and steadily build. You will typically need to stop your activity to relieve the pain.  Sometimes compartment syndrome can become so chronic and severe that it requires surgery to reduce the pressure, so best to get it looked at by chiropractor as soon as possible for prevention.

Tendonitis (tendon inflammation), or Tendinosis (degeneration of the tendon) is a very common issue sports medicine specialists see in sports and runners.  One of the most commonly affected tendons is the achilles. If the tendon, a few inches above your ankle joint is tender, but you do not feel or see any nodules you are most likely suffering from a form of tendonitis or peri-tendonitis where the tendon itself, or the tissue around it is inflamed from chronic use. Achilles tendinosis is caused by a chronic tendonitis, causing nodules or enlargement of your tendon that is tender to touch, diagnostic ultrasound can confirm the diagnosis.  Chronic achilles tendinosis causes scar tissue and weakening of the tendon, which can potentially lead to rupture.

2:  For Improving Memory – Dancing

A study from 2017 found that all exercise can help reverse the signs of ageing in the brain, but dancing more than any other sport.[1] The study, which focused on adults in their late 60s who took part in a weekly dance class, found that all participants showed an increase in the hippocampus region of the brain, which can be affected by diseases such as Alzheimer’s and dementia, as well as more general age-related decline.
https://www.newswise.com/articles/new-study-jogging-keeps-you-young

3. For Back Pain – Active Therapies

Many GP appointments are connected to muscle and nerve problems- and these are often based in the back. If you suffer with back pain, you will know that it can affect your movement and sleep and leave you feeling quite low. Luckily, help is at hand in the form of gentle stretching.  Also, research shows that active therapies, such as chiropractic treatment, are a great option for managing back pain and to create optimal alignment, balance and symmetry. 

4. For Depression and Anxiety - Walking

Science agrees - walking outdoors has been linked to a reduction in stress and a boost in mood, particularly for those who have just been through a negative life event such as a serious illness or the loss of a loved one. Brisk walks have also been shown to help women deal with anxiety and stress that's sometimes associated with menopause. Movement helps your brain to release endorphins, the feel-good hormones that can reduce the perception of [pain as well as depression and anxiety. 

5. For Bone and Muscle Health – Weight Training

Experts are increasingly suggesting a bit of strength training goes a long way when it comes to better bone and muscle health. As we get older, we start to lose muscle mass, which can leave us prone to falls, as well as making it easier to gain weight. So think of strength training as insurance for your later life. While this could mean leading to lift lightweights, it can also mean strength exercises using your own body weight – such as sit-ups or squats. It’s really never too late to start. A study of 90-year-olds found that 12 weeks of strength training improved their muscle tone, ability to balance, general power and walking speed.

Don’t forget 150 minutes (just over 21 mins daily) is the minimum moderate exercise the NHS recommends for adults to stay healthy! And the best part is, it’s freely available to most of us, small things make a big difference. Movement is the new medicine!

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.

This image shows how the spine and pelvis position can be distorted without the appropriate support or positioning.

This gives an idea of optimal positioning for whole body, with a pillow used between or under the legs for support

*Some patients tell me they find it hard to keep a pillow in place so suggest trying a longer body pillow or small folded quilt. This is especially good for front sleepers who want to avoid rolling.

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!

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 www.chiropractic-uk.co.uk
For further information contact the
British Chiropractic Association on 0118 950 5950

As Christmas day is fast approaching, we are all hitting the shops to buy special gifts for our loved ones.

However all this shopping can be both physically and emotionally stressful, resulting in head, neck and back pain. 

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.

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 - bit.ly/straightenupuk - 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.