The COVID-19 situation continues to change rapidly, so I wanted to let you know what we're doing at TWC to protect our colleagues and visitors, while ensuring we continue to provide you with access to the care you need.

We endeavor to stay open as long as it is safe to do so. The safety of our colleagues and visitors is paramount. We are monitoring advice from the Government and the World Health Organisation, and reviewing our plans daily.

We are following the guidelines and advice that is being constantly updated by our governing bodies as well as Public Health England/Wales.

However we do ask that if your or any of your family members are feeling unwell to follow government advice and contact us to rearrange your appointment as soon as possible.

For further Government and NHS advice from on symptoms and self-isolation click on the links below:

NHS Advice: https://www.nhs.uk/conditions/coronavirus-covid-19/

GOV.UK Advice: https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response 

Whilst we are always hygiene conscious at TWC, we are stepping up our measures in clinic to ensure the safety of our patients, staff and the general public.

As always, we are :

• Ensuring to disinfect the bench and change head roll in between every patient.
• Wash our hands and use hand sanitiser between each patient contact or wearing disposable gloves that are changed for each patient.
• Hand sanitiser and tissues are available to use for all our patients in reception and the treatment rooms.

However we will now also be:

• Leaving 15 minutes gaps between appointments to avoid patients having to use the waiting area and giving us plenty of time to clean.
• Regularly disinfecting door handles, surfaces, taps and our payment terminals in between patients.
• Asking patients to touch as little equipment as possible when in clinic.
• No longer shaking hands with you all.
• Asking that you chose to pay with card rather than cash where possible.
• We will not be charging any late cancellation fee's to those who call to us with less than 24 hour notice as they need to self-isolate and recover.
• Taking our patients temperatures to assist with public health screening.
• Spacing chairs in our waiting area to assist social distancing.

Any concerns you may have regarding your appointment you can contact us on 02920 617700 or email info@thewhitchurchclinic.co.uk 

These are a rare type of headache that affects about 1 to 2 people in every 1,000. Onset is normally between 20-40 years of age, and they are 3-4 times more common in men than women. Approximately 1 in 20 people with cluster headache have a family member who also has the condition. Unlike migraine, it is more common in men than women (by five to six times). It is also more common in heavy smokers. As with all forms of headache, cluster headache occurs in children but it is less common than in adults.

The symptoms of cluster headache are characterised by unilateral (one sided) pain, although the affected side may vary each cluster period. The pain is usually centered over one eye, temple or forehead, and can even be a combination of all or spread to other regions making diagnosis difficult. They usually last 15-180 minutes, and can occur from once every other day to up to 8 times a day. Pain is often characterised as excruciating.

Attacks can be associated with one or more of the following, on the same side of the face as the headache:

• conjunctival injection (redness of the white sclera of the eye)
• lacrimation (tears)
• nasal congestion
• rhinorrhoea (runny nose)
• forehead and facial sweating
• miosis (constricted pupil)
• ptosis (drooping eyelid)
• oedema (swelling)

During a bout of cluster headache the pain is often experienced at a similar time each day. The headache often starts at night, waking people one to two hours after they have gone to sleep. The pain usually reaches its full intensity within 5 to 10 minutes, and lasts at this agonising level for between 30 and 60 minutes.

Episodic cluster headache

80% of cluster headache attacks occur in periods lasting 7 days, to 1 year, separated by pain-free periods of 1 month or longer. The bouts (or “clusters”) often occur at the same time of year, and can then disappear for several months or even years. The reason for this seasonal timing is not completely known, although it is one of the key aspects of diagnosis, and may involve a brain area called the hypothalamus.

Chronic cluster headache

The remaining 20% of people do not have these pain free intervals, and are said to have “chronic cluster headaches”. Attacks occur for more than 1 year without remission or with remissions lasting less than 1 month.

There is no special test to diagnose cluster headache, diagnosis is based on your of all your symptoms, and you may be referred for an MRI scan to rule out other causes for the pain starting suddenly.

• Alcohol is one well known trigger of cluster headache, often bringing on the pain within an hour of drinking. Avoid alcohol during a cluster period once the bout is over you will be to drink alcohol again.
• A significant number of people find that strong smelling substances such as petrol, paint fumes, perfume, bleach or solvents can trigger an attack. During an episode of cluster headaches you should try to avoid these things.
• Some people find exercise or becoming over heated will bring on an attack, so again avoiding these is the best advice during a bout.
• Research has showed that heavy smokers are at an increased risk of developing chronic cluster headache so giving up smoking or cutting down is worth considering.

Whilst there is currently no cure for cluster headache, the treatment has become much more effective in the last 10 years.

Acute treatment

Quick treatment is key.  Ordinary painkillers that you can buy over the counter are not usually effective, as they take too long to work. Oxygen is one of the safest ways to treat cluster headache. You need to breathe the oxygen in at a rate of between 7 and 12 litres per minute. The treatment usually starts to work within 15 to 20 minutes. For some people the attack is delayed rather than stopped altogether. Your GP will be able to order oxygen for you.

Sumatriptan injections have been found to reduce the pain within 10 minutes during an attack. Sumatriptan and zolmitriptan nasal sprays do help some people, although the onset of action maybe slower than the injection.

Preventative treatment

The most common preventative treatments are medication based.  The migraine trust website gives further details of specific medications.  Also avoid triggers as much as possible. The migraine trust gives further details on medications or see your GP.

Information cited from:

https://www.migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/cluster-headache/

http://ihs-classification.org/en/02_klassifikation/02_teil1/03.00.00_cluster.html

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.

These headaches are very common and because they happen regularly, often people refer to them as "just a normal headache". However headaches usually happen for a reason, and for many people chiropractic treatment can be a very effective way of treating these headaches. It is one of the most common types of headache that we see as chiropractors see, and they can be very severe, and often have a profound effect on the lives of sufferers. 

A cervicogenic headache is caused by referred pain from the soft tissues and joints of the neck. When these structures are inflamed often a headache will result. Headaches generated by muscular trigger points are classified as 'regional pain syndrome', and very much overlap with these type of headaches.

The neck has a number of nerves that travel over the skull and if these nerves are irritated they will refer pain to various locations. Pain may radiate to the forehead (frontal region), the eyes (orbital region), the temple, and the ears.

Signs of cervicogenic headache are:

• Pain around neck or base of the skull, may project to other areas of the head
• Pain aggravated by specific neck movements
• Restricted neck movement
• Tenderness of neck muscles
• Abnormal posture

The current theory is that they can be caused by abnormal movements or posture of the neck; osteoarthritis/spondylitis; or even post-whiplash injury.  All can lead to restriction of the joints, particularly the upper neck at the base of the skull. Occasionally the headache can be aggravated by neck movement and muscular trigger points as detailed above.

Chiropractic treatment for cervicogenic headaches is very similar to that of tension type headaches. These headaches can be tough to manage as many of the factors that cause the headaches in the first place are external, i.e. posture or sleeping position. Chiropractors can help through:

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

Other treatments that might help with headaches available at TWC:

• Hypnotherapy for stress management and help reduce tension
• Deep tissue massage to help release trigger points
• Diet advice for food intolerances/allergies i.e. gluten or dairy

This website provides links to multiple recent studies in to the affectiveness of chiropractic and the treatment of cervicogenic headaches:

http://www.chiro.org/LINKS/headache.shtml#Cervicogenic

A 2005 article reviews the diagnosis and treatment of cervicogenic headaches:

http://jaoa.org/article.aspx?articleid=2093083

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.

This is the most common type of primary headache: its lifetime prevalence in the general population ranges in different studies from 30 to 78%. A number of studies have appeared after the first edition of The International Classification of Headache Disorders that strongly suggest a neurobiological basis (coming from the nervous system), at least for the more severe subtypes of tension-type headache (TTH).

The most common triggers of TTH reported are anxiety, emotional stress, depression, poor posture, and lack of sleep, although the evidence for each of these (except stress) is poor. Physical exhaustion is also a common cause of TTH, so make sure you are getting enough sleep! 

If you have TTH, it will produce a mild to moderate pain, whereas the pain of migraine can reach disabling severity. Normal movement during everyday activities shouldn’t aggravate it, unlike a migraine, which can be aggravated by movement. There is an overlap in the triggers of migraine and TTH, as both may be brought on by stress or tiredness. Head and neck movements are important triggers in patients with TTH, whereas hunger and odour were significantly common triggers in migraine.

Tension headaches are divided in to episodic and chronic. Episodic tension-type headache is further categorised into infrequent and frequent subtypes.

Episodic infrequent – They occur less than once per month, so between 10 and 12 times per year.

Episodic frequent - At least 10 episodes occur for 1-15 days per month, for at least 3 months.

Chronic or New Daily Persistent Headache - Last more than 15 days per month on average, for more than 3 months. Can last for hours or may be continuous.

The pain is typically bilateral (right and left), pressing or tightening in quality, and of mild to moderate intensity, and does not worsen with routine physical activity such as walking or climbing stairs. There is no nausea, but photophobia (light) or phonophobia (sound) may be present. 

Over the counter medication, such as Aspirin or paracetamol, does help some sufferers, but long term use is not advised due to the wider problems prolonged taking of these drugs has on your body. Paracetamol overuse can even cause headaches when you stop taking them, due to withdrawal.

Chiropractic may be able to help if your headaches are caused by trigger points in the neck or jaw that refer pain to the head, which can amalgamate to feel like a tight band. A trial treatment period of 3-4 sessions will give you a good indicator of how effective management will be. Treatment can involve:

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

Research looking into the efficacy of chiropractic and the treatment of tension type headaches are available at:

http://www.chiro.org/LINKS/headache.shtml#Chronic_Tension

Information cited from:

https://www.migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/cluster-headache/

http://ihs-classification.org/en/02_klassifikation/02_teil1/03.00.00_cluster.html

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.

Treatment

Chiropractic treatment also has the ability to alleviate some contributory factors, or after effects, including relieve of restriction in movement of the neck; muscle tension in the neck, upper back and shoulders; and helping correct any postural issues that may influence the occurrence of both migraine and tension headaches.

The complex nature of migraine means that the treatments available are varied and differ from person to person. There is currently no cure for migraine, and medication may depend on the triggers.

Chiropractic treatment for migraine is also varied but a trial treatment of 3-4 sessions is normally recommended to give a good indicator of how effective management will be. A lot of our patients have found their migraines become less frequent and less severe with treatment when neck muscle or joint tension and restriction is a contributing trigger. Treatment can involve:

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

Other treatments that might help with headaches available at TWC:

• Hypnotherapy for stress management and to help reduce related tension
• Deep tissue massage to help release trigger points in the muscles
• Diet advice for food intolerances/allergies i.e. gluten or dairy

For those of you interested, here is a link to a website that lists some of the studies looking in to the effectiveness of chiropractic in the treatment of migraines:

http://www.chiro.org/LINKS/headache.shtml#Migraine

[1] http://www.nhs.uk/conditions/migraine/pages/introduction.aspx

The Pain of Tech Neck

 Do you spend most of the day hunched over staring at the screen of your smartphone or tablet? This could be causing damage to your neck and shoulder joints.

Sarah Beer explains, “Tech Neck", as it is known, refers to the strain in your neck and shoulder muscles that develops as a result from excessively craning your neck down when you are looking at a phone or a portable tablet device.”

“Although many of us will use such devices when we are working throughout the day, there are ways to ensure that they don’t cause too much damage to your spine and neck joints. One key way is to make sure you limit the time you spend on such devices; it is advised that for every 15 - 20 minutes you spend on your device you should take a 3 minute break. This is due to the fact that it is easy for a posture to change when we hold a position for a long period of time, so really try to limit yourselves to periods of 15 - 20 minutes where possible.”

“Making sure you’ve got the right posture can also be crucial. Rather than hunching forward to look at your screen, sit up straight and bring your phone or tablet up to eye level. This will help keep your spine aligned rather than curved and should reduce overall strain on your neck and shoulder muscles. This may feel a little odd at first but it will soon become a natural fit. If you are in an office you may want to think about a tablet or phone holder as this will help to raise your electronic up to your eye line instead of you having to hunch over. This also applies to your computer screen. For most people, the computer screen is located below your natural eye line leaving your head and shoulders to naturally hunch downwards. By raising your computer screen to your eye level you will force yourself to keep your head in a more natural position”

Sarah also advises to do some small stretches to relieve the tension in your upper body. “Bend your neck to the right so that your ear moves closer to your shoulder. Relax and hold for 20 seconds. Return to centre, and then repeat the move to the left. Do a repetition of five. A further exercise is to do a simple chin tuck. Tilt your head down and tuck your chin into your neck. Hold for five seconds, and then look back up. Do a repetition of ten. These exercises will help release any tension that might be created due to excessive strain from hunching over”

Make sure to listen to your body. If you have any aches and pains in your neck, shoulders and upper back, it usually means something is not working properly.

People in Wales are encouraged to stay active this Chiropractic Awareness Week

British Chiropractic Association (BCA) discovers half of people in Wales fail to prevent or manage back pain

This Chiropractic Awareness Week (8^th – 14^th April), the BCA is encouraging people in the Wales to keeping moving, after finding that 40% of people in Wales don’t take any steps to look after their back health.

The findings come from a survey conducted by the BCA, which unearthed that 25% of people in Wales don’t take any action when they experience back or neck pain and 10% wouldn’t seek help from a health professional if they were experiencing these issues.

Chiropractic Awareness Week aims to educate people about the easy ways they can avoid or alleviate back pain, which over of the nation suffers with. Regularly changing posture and remaining seated for no longer than 30 minutes at a time are just a couple of the simple ways to prevent or reduce pressure on the back.

According to the BCA’s survey, when it comes to back and neck pain, they found that people in Wales:

• 40% don’t take any steps to look after their back health
• Only 60% have taken preventative steps to protect themselves from developing back or neck pain
• 80% have experienced back or neck pain
• 10% wouldn’t seek help from a health professional for back pain and,39% would wait a month or longer
• Only 14% would make changes to their daily routine if experiencing back or neck pain
• 28% choose their mattresses bases on price, rather than comfort

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The BCA’s top tips for keeping on top of neck and back pain include:

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! 

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.

Other things which people can bear in mind include:

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 three-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.