The research, which was carried out by the British Chiropractic Association, found that for sufferers in Wales, the top triggers for this pain were;

• Lifting or carrying heavy objects (53%)

• Sitting for long periods of time (46%)

• Sleeping/mattress/pillow (37%)

Notably, incidences of neck and back pain among younger people are also on the rise with 28% of people in Wales experiencing neck or back pain by the age of 20.

Sarah’s top tips to help local residents to prevent and manage neck and back pain are:

·       Take a break: When sitting for long periods of time, ensure you stand up and move around every 30 minutes. When at work, also make sure your desk is set up to support a comfortable position. This is different for everyone so if you don’t feel comfortable in your current set up, try altering the height of your chair or screen.

•  Keep on moving: Physical activity can be beneficial for managing back pain, however it’s important that if this is of a moderate to high intensity that you warm up and down properly to get your body ready to move! If a previous injury is causing you pain, adapt your exercise or seek some advice. Activities such as swimming, walking or yoga can be less demanding on your body while keeping you mobile! 

Other things which you can bear in mind are:

•  Lifting and carrying: Remember to bend from the knees, not the waist when lifting heavy items. Face in the direction of movement, and take your time. Hold the object as close to your body as possible, and where you can avoid carrying objects which are too heavy to manage alone, ask for help or use the necessary equipment.

• Sleep comfortably: The Sleep Council recommends buying a new mattress at least every 7 years. Mattresses lose their support over time, so if you can feel the springs through your mattress, or the mattress is no longer level, your mattress is no longer providing the support you need. Everyone has different support requirements, so when purchasing your mattress ensure it is supportive for you. If you share a bed and require different mattress types, consider two single mattresses which are designed to be joined together, to ensure you both get the support you need.

• Straighten Up!: The BCA has created a programme of 3-minute exercises, Straighten Up UK, which can be slotted in to your daily schedule to help prevent back pain by promoting movement, balance, strength and flexibility in the spine

We recommend that, if you are experiencing pain for more than a few days you should seek professional help, for example from a chiropractor, who can assess you and help you to get moving again without pain. You can book an appointment with any of our Chiropractors by calling 02920 617700

Notes to editors:

1)     This consumer research in 2018 was carried out on behalf of the British Chiropractic Association on between 28/02/18 and 07/03/18 on a sample of 101 adults in Wales.

2)     Chiropractors are specialists in spine care and chiropractic is a primary contact health profession that specialises in the diagnosis, treatment, prevention and management of many conditions that are due to problems with bones, joints, muscles and nerves, particularly those of the spine.

3)     The BCA is the largest and longest established association for chiropractors in the UK. Chiropractic is a statutorily regulated healthcare profession, regulated by the General Chiropractic Council (GCC). Members of the BCA must abide by the GCC’s Code of Conduct and Standard of Proficiency. The association only accepts from an internationally recognised college of chiropractic education.  Chiropractic care offers hands on pain management and focuses on muscles, joints and nerves.  Chiropractic is suitable for all ages and can help with a wide range of problems

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

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

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

Royal College of Chiropractors webiste: www.rcc-uk.org

British Chiropractic Association website: www.chiropractic-uk.co.uk

McTimoney Chiropractic Association website: www.mctimoney-chiropractic.org/home.aspx

Scottish Chiropractic Association webiste: www.sca-chiropractic.org

United Chiropractic Association website: www.united-chiropractic.org/

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

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

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

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

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

The above information has been cited from The Royal College of Chiropractors: https://rcc-uk.org/wp-content/uploads/2017/12/Chiropractic_the-facts_071217.pdf

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

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

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

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

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

• to advance the study of and research in chiropractic.

www.rcc-uk.org

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

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

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

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

According to research by the British Chiropractic Association:

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

https://chiropractic-uk.co.uk/new-years-resolutions/

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

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

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

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

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

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

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

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

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

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

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

As the clocks go back and the change of seasons are here, we start to feel tired and sluggish.  As well has stressed and less motivated.

So here at The Whitchurch Clinic we have develop a some tips and advice to help you through these winter months!

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

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

http://isma.org.uk/about-stress/facts-about-stress 

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

Stress and pain are very closely linked together, but does stress cause pain or does pain cause stress?

Chapman et al, 2008, studied a review of psycho-physiological systems in relation to pain whereby a  physical injury or wounding can generate a complex stress response. They concluded that acute pain is an effect of multiple dimensions, and are products of the bodies 'supersystem'.  They also proposed that when the 'supersystem' is dysregulated, then health, function, and sense of well being suffer, and can be a result of chronic pain. 

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

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

There are many contributing factors to stress, and it is important to identify the cause. If you are not sure what is causing stress, or if you are unable to control your levels of stress, then it you will need to seek professional help.   

One of the most important factors into getting a good night sleep is the mattress in which you are using.  We get asked many of times which mattress would you recommend. The following short video by the British Chiropractic Association provides advice on find the right mattress for you: 

Vitamin D is necessary in order to protect musculoskeletal health, as it assists with the absorption of calcium.  During the summer months our vitamin D levels are maintained by the amount of sun we exposes our bodies to.  However in the winter months most of us do not have the luxury of chasing the sun, so our Vitamin D stores maybe depleting.  The department of health, as well as a recent publication from the Scientific Advisory Committee of Nutrition (SACN), recommend a daily supplement of 10 micrograms of Vitamin D.

More research is being carried out into the benefits of vitamin D, and recommendations may vary depending on what you read.  Therefore the above information should be taken precautionary.

It is important to note that too much sun exposure can increase the risk of skin cancer, and this information should only be taken as advisory.

For further reading on the SACN Vitamin D and Health report please click on the following link:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf

and the following for an additional press release:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/539596/SACN_Vitamin_D_Press_Release_July_2016.pdf

DISCLAIMER

All of the above is advisory and therefore we would recommend that if you have any queries to either contact us here on 02920 617700 or contact your local healthcare practitioner.  

The Whitchurch Clinic is urging more people to be aware of the benefits of exercise for improving their back health this World Spine Day (16^th October).

New research has found that 40% of people in Wales have been prevented from exercising due to back or neck pain, and an unfortunate 24% felt it was exercise itself which triggered their pain:

 “We really want as many people as possible to get out there and enjoy sports. Moderate exercise is essential to build and maintain strength and flexibility, improving posture and protecting you from any further pain.

“The spine is naturally strong and stable so it’s worrying to find that so many people are being prevented from staying active due to back pain. While total rest may seem like a good way to recover, often continuing moderate physical activity will help in the long run. Your local chiropractor will be able to advise on what is right for you.”

To help people of all ages and fitness levels protect their backs during their work-out routines this World Spine Day, The Whitchurch Clinic has developed these top tips:

•       Know your equipment: When trying a new activity, it’s always best to make sure you ask your instructor how your equipment should be set up, and make sure it’s right for you. For example, if you’re cycling or spinning, you need to set your saddle and handlebar to the correct height so that you are in a comfortable position that isn’t putting tension on your neck or back

•       Know your limits: Even professional athletes aren’t born ready, it takes time to build the intensity of your practice. If you try a new sport, or want to intensify your workout, it’s important to take a slow approach and not to push your body’s limits. It is always advisable to visit a professional who can assess your body’s capabilities and advise on a safe way of training based on your body’s limitations

•       Warm up and cool down: Before starting any form of physical activity, you should warm up any muscle groups which might be affected whilst you exercise. If you use them without preparing them first, it could cause you pain and injury which could have been prevented

•       Reduce the impact: If a previous injury is causing you pain, adapt your exercise to reduce the impact on your joints and muscles. Activities such as swimming, walking or yoga can be less demanding on your body keeping your joints mobile! 

•       Not all exercise is the same: The fittest of athletes will still find it difficult to adapt to a new sport, as each sport uses some muscle groups more than others. With this in mind, always approach a new activity with care and don’t assume that you can jump in at the deep end!

We recommend that, if you are experiencing pain for more than a few days then you seek professional help, as an undiagnosed problem could lead to longer-term problems if left untreated. The BCA has also created a programme of 3-minute exercises, Straighten Up UK, which can be slotted in to your daily schedule to help improve posture and prevent back pain by promoting balance, strength and flexibility in the spine.  

Please visit http://www.worldspineday.org/ for more information. 

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

• 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. 

Here at The Whitchurch Clinic we are committed to helping you on your road to recovery. Through a detailed case history, with/without an examination, we can advised if we are able to assist with your complaint.  If we feel that we are unable to help we will point you in the right direction.

Our Chiropractic team can help through:

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

To summarise Backcare Awareness Week, and World Spine Day, are focused on getting people conscious and active in their daily life, in order to look after their backs.  Andrea and Sarah at The Whitchurch Clinic are here to help you with the diagnosis, treatment, and management of your pain.  Please give us a call on 02920 617700 to see if we can help you today.

“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

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.

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.

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.

http://www.nhs.uk/Conditions/Rheumatoid-arthritis/Pages/Diagnosis.aspx

Imaging

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: 

http://www.nhs.uk/Conditions/Rheumatoid-arthritis/Pages/Treatment.aspx 

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:

https://www.nice.org.uk/guidance/cg79/chapter/Recommendations#diet-and-complementary-therapies

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.                                                                                                 
  Nevitt
  MC, 
  Cummings
  SR, 
  Lane
  NE, 
  Hochberg
  MC, 
  Scott
  JC, 
  Pressman
  AR, 
  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
  1996
  156
  2073
  80
• Increased prevalence to age related disorders such as OA to those who are continuously exposed to oxidants.                                                                              
  Frei
  B. 
  Reactive oxygen species and antioxidant vitamins: mechanisms of action
  Am J Med
  1994
  97
  5S
  13S
• Genetic causes to OA.                                                                               

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.

Medications

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

Therapies

• 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

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:

https://www.thewhitchurchclinic.co.uk/twc-chiropractic/treatments/

References

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.

http://www.arthritisresearchuk.org 

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.

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.

• 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. 

Once a diagnosis has been reached, if it is musculoskeletal, your Chiropractor can offer a range of treatment options such as joint manipulation or mobilization, soft tissue treatments such as trigger point therapy or acupuncture.  Along with home care/ergonomic advice and rehabilitation programmes.

The shoulder is one of the most mobile joints in the body, it's only bony connection is where the clavicle connects with the sternum (chest bone) so it relies heavily on the surrounding muscles and ligaments for stability. Any damage or dysfunction in any of the stabilizers causes high demands on the other supporting structures to maintain the joint flexibility and movements.

The shoulder provides the arm with a wide range of motion -  flexion, extension, abduction, adduction, internal and external rotation.  The shoulder also allows for movement of the scapula, such as protraction, retraction, elevation and depression.

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.