Advice Blog

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





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.





“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.”

PAS 1010 

People deal with stress in different ways.

Stress can arise from many of life demands such as work, relationships, money and society.

The most common cause of stress being work related. 

How our body reacts to stress

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.


Effects of stress

The symptoms of stress can effect your body, thoughts, feelings and behaviour.


Below is a list of some of the common effects of stress:

  • Headaches
  • Temporomandibular joint disorder
  • Muscles tension
  • Chest pain
  • Fatigue
  • Stomach upsets
  • Sleep disruption
  • Change in sex drive
  • Lack of motivation
  • Irritable
  • Sad or depressed
  • Overeating or Undereating
  • Drug or alcohol abuse
  • Social  withdrawal 
  • Lack of exercise
  • Plus many more


Stress causes pain or pain causes 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. 


Stress realted Musculoskeletal Pain

Temporomandibular Joint Dysfunction



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:

  • Lateral Ligament
  • Spehnoid-mandibular Ligament
  • Stylo-mandibular ligament

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:

  • Chronic Pain Syndromes which cause an increased sensitivity to pain
  • Muscle over activity - grinding teeth, clenching jaw
  • Dental issues
  • Intra-articular disc degeneration
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Trauma
  • Hypermobility or hypomobility
  • Infection
  • Tumors




Symptoms can vary on individual bases and there maybe other factors that are causing the dysfunction:


  • Pain around joint or referred to head, neck or ear.
  • Restricted jaw movements
  • Jaw noises
  • Ear ache
  • Headache
  • Neck Pain
  • Locking episodes



Treatment is usually non surgical and can consist of manual therapy and lifestyle changes.


Manual Therapy such as Chiropractic therapy, Physiotherapy, Massage Therapy etc/


Lifestyle Changes:

  • Resting joint by eating soft food and avoid chewing gum.
  • Using hot water bottle or ice pack on joint.
  • Stretching jaw and home exercises.
  • Avoid opening jaw wide and clenching teeth.
  • Relaxation techniques to decrease stress.


  • Painkillers such as paracetomol, iburprofen, NSAIDS.
  • Steroid injections to reduce swelling and help with pain.


Surgery is uncommon for TMJ disorder but can consist or Arthrocentesis, open joint surgery or very rarely total joint replacement.  


Can we help?

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
  • Manipulation/mobilisation
  • Home exercises/stretches
  • Ergonomic and postural advice

Other treatments that might help with back pain available at TWC:

  • Hypnotherapy for stress management and help reduce tension
  • Deep tissue massage to help release trigger points
  • Diet advice


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.

How Hypnotherapy can help with Stress

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:


Back & Neck Pain During Pregnancy

Image from; Natural Childbirth Education
Image from; Natural Childbirth Education

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 


  • Talk to your healthcare professional to discuss stretches and exercises that are suitable for you.
  • The fitter you are, and the more muscle tone you have before pregnancy, the more likely you are to be able to cope with the body’s postural changes. 
  • When sleeping on your side putting a pillow between your legs/knees, or supporting your bump can help with lower back or pelvic pain.
  • 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.  Swimming and aqua natal classes are also of benefit, as being in the water takes the pressure off strained joints whilst providing good exercise and relaxation.  
  • Avoid high heels and wear comfortable, supportive shoes.  If you have children already, it can be difficult as they will need lifting and carrying. 
  • Always lift with your spine straight and bend knees to avoid leaning, stretching or bending.  
  • Do not sit for prolonged periods, take regular breaks and, when sitting, let the seat take your weight and, if possible, keep as much of your body in contact with the chair so that your whole body is supported. Knees should be lower than your hips. 
  • Try to keep stretching leg muscles to make sure unnecessary extra pressure is not put on the knees.
  • Elevate legs whenever possible to offset any weight pressure and reduce any swelling - ankle circles will also help. 


Neck and mid back pain is also common during pregnancy due to an increase in breast size:

  • Get measured for bras regularly throughout your pregnancy. This will help make sure you are wearing the right size and, therefore, getting the maximum support possible. 
  • Do neck and shoulder stretches regularly to relieve tension in the muscles.

SPD-Symphysis Pubis Dysfunction

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:

Pregnancy-related pelvic girdle pain: An update

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.

Self Help Tips

  • Do pelvic floor and tummy exercises. Get down onto your hands and knees and level your back so that it is roughly flat. Breathe in and then as you breathe out, squeeze in your pelvic floor muscles and pull your belly button in and up. Hold this contraction for between five and 10 seconds, breathing through it. Relax your muscles slowly at the end of the exercise.
  • Keep your knees together when getting in and out of the car, turning in bed, or getting out of the bath. If you are lying down, pulling your knees up as far as you can stops your pelvis from moving and makes it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs.
  • Don't push through pain. If something hurts, if possible, don't do it. If the pain is allowed to flare up, it can take a long time to settle down again.
  • Little and often, as you may not feel the effects of what you are doing until later in the day or after you have gone to bed.
  • When sitting your hips should be above your knees. Birthing/exercise balls can help to reduce the pressure on the pelvis when sitting, but ensure it is high enough.
  • If you are comfortable enough to do so, you can get down on your hands and knees to take the weight of your baby off your pelvis and back. Hold in a stable position for 10-15 seconds then slowly walk your hands towards your knees to help you upright. Do not do this if you find it painful getting in and out of this position as you risk making the problem worse.
  • Try not to do heavy lifting or pushing. Supermarket trolleys can often make your pain worse, so shop online or ask someone to shop for you.
  • When climbing stairs, take one step at a time. Step up onto one step with your best leg and then bring your other leg to meet it. Repeat with each step.
  • Swimming can be a great way to exercise as it reduces the weight on your joints, but do avoid swimming breaststroke and take care with the other strokes. Beware as you may feel swimming is helping your pain while you are in the water, but it could make you feel worse when you get out.
  • When getting dressed, sit down to do your socks, pull on your knickers or trousers.

For further advice follow this link; 



Lower Back Pain

Lower Back Pain

Back pain is very common. Most people will suffer one or more episodes of back pain during their lives. In many cases, it starts suddenly and gets better quickly, without the need for any treatment.


However, back pain can be painful, debilitating and persistent, and some people suffer repeated episodes. It can also be associated with other symptoms, such as leg pain or sciatica. It may start following a specific incident, such as bending awkwardly or lifting a heavy weight. Or it can develop gradually, perhaps as a result of poor posture, an uncomfortable work position or repetitive strain.

Causes of Low Back Pain

There are many different types of back pain, with different causes. The key to getting the right treatment is to establish which type of back pain you may be suffering from and to seek advice if it is not improving.


Your spine is one of the strongest parts of your body. It is made of solid blocks of bone known as vertebra, joined together by softer pads or discs which act as shock absorbers and maintain flexibility. Your back is reinforced by strong ligaments, surrounded by powerful muscles for support. It is, in fact, surprisingly difficult to damage your spine.

Mechanical Low Back Pain

The majority of people with back pain are suffering from what is known as ‘simple’ or ‘mechanical’ back pain. This means that the pain is not related to any serious underlying condition and there are no trapped or compressed nerves. We do not always know the exact tissues that are involved in simple back pain. Muscles, joints and ligaments can all be involved. Simple back pain can be caused by poor posture, prolonged sitting in an uncomfortable position, and even muscular tension due emotional or work-related stress.

Age  related

As we get older, wear and tear may contribute to back pain. The shock-absorbing pads or discs between the bones of the back can narrow with age and this can cause stiffness, pain and make it difficult to move.

Nerve Irritation

Simple back pain is relatively common. Less frequently, the nerves of the back can sometimes become irritated, compressed or trapped. Again, there can be many reasons why this happens, but slipped discs or wear and tear can lead to pain spreading down the leg, which is commonly referred to as sciatica. This can be accompanied by pins and needles, tingling, numbness and weakness in all or part of the leg and foot.

Sacroiliac Joints

The sacroiliac joint connects the sacrum (triangular bone at the bottom of the spine) with the pelvis (iliac bone that is part of the hip joint) on each side of the lower spine. It transmits all the forces of the upper body to the pelvis and legs. There is not a lot of motion in the joint and it is very strong and stable.

It is not clearly understood why sacroiliac joint dysfunction occurs, although some believe it is due to a limitation in its normal motion patterns and/or misalignment of the joint. Sacroiliac joint (SI joint) pain typically results in pain on one side very low in the back or in the buttocks. Another term for sacroiliac joint pain is sacroiliitis, a term that describes inflammation in the joint. 

Why do people get low back pain?

People experience back pain for all sorts of reasons. It might be the way they sit or stand, or because their work or lifestyle causes stress and strain on their back. Worry or stress can cause tension in the back muscles, or can delay recovery of existing back pain. Sometimes an old injury, or wear and tear over time, might also cause problems.


However, there is often no obvious reason why back pain develops.

Although it can be very painful, back pain rarely has a serious underlying cause. Seeing a qualified health professional, such as a chiropractor, who is experienced in diagnosing conditions of the back and spine, can help treat back pain, and also identify if a referral or specialist investigations are needed.

Coping with back pain

About half of people who have an episode of back pain will have another episode within a couple of years. But that still doesn’t mean that it is necessarily serious. Between episodes most people return to normal activities within two or three weeks, with few remaining symptoms.


Back pain can be very painful due to inflammation and muscle spasm, and you may need to take it easy for a while. But resting for more than a day or two does not usually help, and may actually do more harm than good. It is best to try to keep moving and seek the help of a trained professional, such as a chiropractor, if you are finding it difficult to cope, or to speed up recovery.

Your back is designed for movement. The sooner you get back to normal activity, the sooner your back will feel better. The people who cope best are those who stay active and get on with their life despite the pain.

If your back pain does not improve, it is important to seek help. Early treatment will get you better faster.

Seeing a Chiropractor for back 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.

Treatment options

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 low back pain available at TWC:

  • Hypnotherapy 
  • Deep tissue massage 
  • 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.

New NICE Guidelines for Low Back Pain and Sciatica 2016

New NICE guidelines for low back pain and sciatica have just been published.  These guidelines recognise the role of manual therapy in the treatment of low back pain and sciatica.

The guidelines state:

“Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.”

Notably the full guideline states manipulation requires special training:
“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 spinal manipulation.”

The full report can be found at 

Our Chiropractic Team


Andrea Howell MChiro, DC, PGCERT, MRCC

Doctor of Chiropractic

Andrea Howell graduated as a chiropractor from the Welsh Institute of Chiropractic, following a four-year undergraduate master's degree (M.Chiro).She was lucky enough to begin her career being mentored by the first chiropractors to establish in Wales 35 years ago.Although she enjoyed her time working at the clinics in Swansea, Andrea was keen to practice closer to home and the community she grew up in, so she established TWC in Whitchurch village, Cardiff in 2012.


Andrea went on to complete her Royal College of Chiropractors post-graduate year (PRT qualification), and a University of Glamorgan post-graduate certificate (PGCert) in 'Clinical Excellence', with Distinction. She has since completed post graduate training in techniques to treat women during pregnancy, western medical acupuncture (or dry needling),  and Sacro-Occipital Technique.


She is passionate about the benefits of chiropractic treatment, and finds great satisfaction in helping people out of pain, and improving the quality of individuals' lives. As a chiropractor Andrea has had experience in helping a wide variety of patients of all ages and levels of fitness.

Sarah Beer BSc (Hons) Chiro, S.A.C Dip

Sarah Beer graduated as a Chiropractor from the Welsh Institute of Chiropractic in 2008, following a 4 year undergraduate Bachelor of Science degree in Chiropractic. 


Sarah is also interested in Complimentary Alternative therapies. Sarah uses this interest and knowledge to reinforce a diversified approach to care.  Sarah has also gained a Diploma in Aromatherapy.


Sarah has a growing interest in treating pregnant ladies and is looking to develop her knowledge and skills to include treatment and care for babies and young children. 





Our Chiropractors are BCA & GCC registered


New blog post

'Tis the season to be jolly'


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


The Centre for Retail Research advises that the average household in 2015 spent approximately £794.39 on Christmas, with 59.6% of this figure being spent on gifts alone.  

According to The Independent only 10% of the UK shoppers said they did all of their shopping in store with as much as 90% of people said they did at least some their shopping online.  


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



Why now?

Here at The Whitchurch Clinic, we do see an increasing amount of patients with back, neck and shoulder pain during the festive period.  


The most common reason for this is due to carry large heavy bags and poor posture when sitting for long periods of time.  These both add extra strain on the joints, ligaments and muscles in your back and shoulder which can lead to an episode of pain.


Top tips to avoid back pain this Christmas

We have put together some tips in order to avoid back and shoulder pain this Christmas:

  • Wear sensible shoes - to avoid any abnormal stresses through the lower back.
  • Avoid carrying heavy bags, including a hand bag - check your hand bag before leaving and only carry the essential items required.  Spread your shopping into different bags to lessen the weight, and try to have an even amount on each side.
  • Park Nearby - try to park as close as possible to the shops, to limit the amount of time that you are carrying bags.  Also try to make regular trips back and for of the car to reduce the amount of bags carried at one time.
  • Take your time and plan your journey - allow your self plenty of time and make a list of the places you need to visit. This will not only reduce the amount of time that you spend shopping, but will help to reduce down your stress levels.
  • Take regular breaks - if shopping on foot, try to take regular breaks on benches etc to give the body a rest and to ease the loads.  If shopping online, take regular breaks every 20-30 minutes away from the computer.  Try to stretch out tired and sore muscles to encourage activation and loosen up the area. 
  • Be conscious of your posture - take time to look at your posture when walking or sitting.  If walking try to maintain a neutral pelvis and stand tall.  If you sitting for long periods ensure that you back is fully supported and you are not leaning to one side.  Make sure that you are not slouching or dropping the shoulders forward.
  • Breaking it up into stages - avoid doing anything in one go such as shopping, putting up the decorations or cleaning the house.  Try to break them up in stages and get help with heavy items.  Carrying these out in one go can cause the muscles to fatigue and taking awkward movements which can result in you straining the muscles, ligaments or joints and hen resulting in pain.  
  • Keep active - Christmas is about of time of relaxing, however keep yourself moving about often.  Try to do 30 minutes of light exercise every day to keep your body supple.

'I have overdone it'

If however the above advice is too late or you are currently in a pain episode, we at The Whitchurch Clinic are here to help.


Our Chiropractors, Andrea and Sarah can help by:


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

Other treatments that may be benefit and are available at TWC:

  • Hypnotherapy for stress management and help reduce tension
  • Deep tissue massage to help release trigger points or provide relaxation
  • Diet advice 

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.