“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.

“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

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

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. 

• "In 2015/16 stress accounted for 37% of all work related ill health cases and 45% of all working days lost due to ill health".
• http://www.hse.gov.uk/statistics/causdis/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.

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 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.

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:

http://www.karen-thomas.co.uk/

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.

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.

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.

• 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;

http://www.babycentre.co.uk/a546492/pelvic-pain-spd#ixzz2QM1R7Wir 

cited-13/04/2013

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.

http://www.spine-health.com/conditions/spine-anatomy/sacroiliac-joint-anatomy 

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.

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.

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 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 https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#non-invasive-treatments-for-low-back-pain-and-sciatica 

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.

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.

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.