No Quck Fix!

Back pain is a common condition which often settles spontaneously, thus justifying a conservative approach to management by both practitioner and patient.

Patients benefit from a confident and knowledgeable practitioner who can dispel doubts and myths, provide appropriate back education and reassurance, outline a logical management plan and refer to other therapists if necessary.

The great variety of treatments available indicates the lack of a `quick fix' cure.

All treatments have some, albeit limited, benefit. The most beneficial treatments are rest for 2-3 days, exercises and appropriate physical therapy.

Key words: Limited rest, education, exercises, physical therapy.

The Pain of it all!

Lower back pain is one of the most common ailments people suffer from and approximately 8 out of 10 people will deal with back pain at some point in their life. That's a lot of people… are you one of them? I am.


I have bulging, herniated discs and have had low back spasms (that knock me to my knees) and sciatica. I have been on all kinds of pain killers, including narcotics which only mask the problem and is by no means a permanent solution.

I have avoided back surgery like the plague as there are so many with horror stories.

The only relief I have found is with the proper exercise and stretching. I can assure you will find back pain relief if you do this regimen the correct way, do it the wrong way and you might up under the knife! Out of all of the various forms of back pain, lower back pain is by far the most common and there's a good explanation for this.


Any idea why? It's not car accidents, it's not work-related injuries, and it's not a lack of prescription medications either. Lack of movement and use is the number one cause of lower back pain! It's the lack of movement in various muscles over years that leads to muscle imbalances and uneven wear and tear on your body, especially the spine. For example, how many times a day are you bending, leaning, or twisting?

Here's what the typical person's day is like:

Wake up - Eat breakfast (hopefully) - Drive or ride to work - Sit at desk - Eat lunch - Sit at desk some more - Drive or ride home - Eat dinner - Sit on couch and watch television - Go to bed
Notice the trend here?

That's an awful lot of sitting and not moving. Well, this is what leads to serious muscle imbalances and so what do we do, we go to the gym and perform exercises that only make the imbalances worse! The key to eliminating lower back pain (nearly any ache, pain, or injury for that matter) is to identify the muscle imbalances that are pulling the spine, bones, and joints out of place and then stretch the tight muscles while strengthening the weak muscles.


Many people who seek professional help are often mis-diagnosed and end up following a treatment plan that fails to eliminate the cause of their back pain. ( Seek out Physical Therapy)
Nearly all of the individuals I worked with were able to eliminate their back pain, or significantly improve their condition even though all of the traditional treatments failed them , cortisone injections, anti-inflammatory medications, back surgery, etc). Even more amasing is the fact that most of these individuals were able to eliminate their back pain in a matter or days or weeks simply by performing a handful of exercises and stretches!

These weren't your basic exercises or the standard back stretches and stomach exercises most "experts" recommend - these were specific exercises and stretches prescribed based on the individual. Many of these people had suffered for years and years with aches, pains, and stiffness and lived inactive lives because of their back pain.


Most back pain treatments offered for lower back pain only address the symptoms and don't address the cause, which usually delivers just temporary relief for the individual. In addition to helping hundreds of others eliminate lower back pain, I also have had personal experiences with back pain and other various conditions such as sciatic pain, tendonitis, muscle strains and sprains, and more.

In every single situation the traditional treatments did nothing but treat the symptoms (often times not successfully) and the only approach that gave lasting improvements and relief was targeted stretches and exercises.


Have you tried traditional treatments and found little relief? I am not saying these treatments are not effective at temporarily reducing the pain or inflammation, but I am saying nearly all fail to get rid of the underlying cause of the problem.
I wish you the best and remember, the key to a healthy back is movement!


About the Author:

Terry O’Brien served 15 years in the Army (Medicine) (Airborne Forces).
He then embarked on Air Crew Emergency Medical Training for Global Airlines and has been actively involved in Sports Medicine, Rehabilitation and Community Care.
www.backtrouble.co.uk/

Sex

Back pain can be an intruder into your sex life and even ruin your relationship, if you are not careful. This article presents six things you can do to keep the love in your life when you suffer from back pain. The tips and insights here are provided by Terry O'Brien. Back Trouble (UK)

1. Try to Talk to Your Doctor About Your Sexual Functioning - or Turn Elsewhere
Patients tend to be uncomfortable about discussing sex and sexual positions with their doctors. According to Terry , a big part of the responsibility for the lack of communication between doctor and patient lies with the medical professionals. "Health care providers should be actively seeking the subject," he says. Sex is on par with returning to work and daily activities in diagnosing and treating back pain.

If your health care provider will not address your questions about sex, Terry suggests researching the information on the internet.

2. Address Your Attitude

Address your attitude about your condition and the effect it will have on your relationship. Terry says that quite often relationships break up when one partner experiences back pain. This is because, he says, reaction to pain is a learned behavior. "As you decide to be, that's how you are." Often people in pain will exaggerate it by avoiding sex. "This is what ruins the relationship," he says.

3. Accept that you may not be able to be as vigorous as you were prior to the onset of your pain. You can turn to your creativity and sense of discovery to help you adapt your sex life to the level your back can handle.

4. Know your condition and which positions bring on symptoms, as well as which alleviate them. Back injuries and conditions can be categorized by what kinds of movements make symptoms worse, and this information can be used to guide the selection of sexual positions.

5. With your partner, plan out which positions to try. Often you can modify your favorite positions with just a pillow or towel. Other times, you need to communicate and work it out with your partner. Talk about it up front, then expect, at times, that you will need to modify the plan. Planning your positions is a valuable strategy, Terry says, because relationships which accommodate back pain with a "we can adapt" attitude fare better than those in which the problem belongs only to the partner with the pain.

6. Get your pelvic floor muscles in shape. Strong flexible pelvic floor muscles can greatly enhance sexual function. The good news is that they can also do wonders for your back. The reason for this is that they are a part of the core support system that balances out muscle usage and stabilizes body posture. Terry says that along with their role in sex, the pelvic floor muscles are as important as the abdominals and low back muscles in back health.

Our incredible body!

"The human body is an incredible machine that adapts to the stresses we give it every day. Stresses such as poor posture, unusual movement or activities, or even a sedentary lifestyle can lead to poor mechanics and pain. Disability from back pain is second only to the common cold as a cause of lost work time.” Says Terry O’Brien (Back Trouble UK)

Back pain affects 80 percent of adults at some point in their lives, according to the Arthritis Foundation.

Here are 11 things you can do to prevent and reduce back pain:

1. Identify and correct body stresses such as poor posture, improper lifting techniques, or weak or tight muscles.

2. Strengthen your back, learn proper lifting methods, carry lighter loads, and use luggage carts for heavy packages and suitcases.

3. Increase your muscle mobility by stretching or doing activities -- such as yoga, tai chi, swimming or pilates -- that help keep you limber.

4. Boost your strength by doing exercises that involve the whole body, especially the core muscles of the stomach, back, hips and pelvis. In addition, strengthening your legs and shoulders can help improve your ability to squat, lift and carry items without overworking or injuring your back.

5. Do aerobic exercise, like walking, swimming and running, for at least 20 minutes three times a week. This kind of exercise increases muscular endurance and cardiovascular fitness, improves blood flow to the spine, and helps reduce stress.

6. Practice good posture. If possible, don't sit for long periods of time. Get up every 15 to 30 minutes and move around or stretch. When you're seated, keep your hips and knees at right angles to one another and use a chair with adequate lumbar (lower back) support.

7. When standing, keep your head up, shoulders straight, chest forward and stomach tight. Don't stand in the same position for too long. Use your legs, not your back, when pushing or pulling heavy items.

8. Use proper lifting techniques. When lifting objects from a position below your waist, stand with a wide stance and a slight bend at your hips and knees. Tighten your stomach as you lift and keep your back as flat as possible -- don't arch or bend it. When carrying heavy items, keep them as close as possible to your body. Don't carry items on only one side of your body.

9. Sleep on a firm mattress and box spring that doesn't sag. Sleep in a position that allows you to maintain the natural curve in your back.

10. Warm up before exercise or sports. Increasing muscle temperature and mobility beforehand will reduce the risk of injury.

11. Maintain/adopt a healthy lifestyle. Obesity and smoking increase the incidence of back pain.

Symptomatic Treatment

Symptomatic Back Pain Treatment:

Symptomatic back pain treatment is commonplace in medicine today.

Medical science has not been very effective in curing many common back pain conditions. Most of the accepted treatments for back pain only provide relief from the symptoms, rather than attempt to correct the actual cause of the condition. Symptomatic treatments are fine if the condition is incurable, but if used for curable back pain, they are examples of bad medicine and poor science.

Not all care providers continue symptomatic treatment past its usefulness or instead of a true cure.

A good health care provider will always prefer to cure the condition, and will work tirelessly to assist the patient in their recovery.

Back Trouble UK practitioners strive to treat the cause, not just the symptoms of the Back Pain Condition, with excellent results.

Possibly Dangerous Remedies!

Back pain occurs in many forms. It may be only an uncomfortable twinge in the lower back or so severe that it is disabling. The pain may persist for a week, or for months or years. Back pain is extremely common, and there are numerous methods and commercial products available to treat it.

One common misconception is that back pain is caused by activity and relieved by rest. Unless otherwise advised by a physician, however, you should not treat back pain with extended bed rest. The patient with low back pain should rest for no more than two days and may try nonprescription products. It is better to resume normal activities (even though there may be some pain) than to rest too long and get out of shape, which may increase the risk of future episodes of pain. In one-third of all cases, back pain will heal in a week or so.

Preventing Back Pain:

To prevent future episodes of back pain, ask your physician to refer you to a physical therapist who can teach you exercises to strengthen the muscles of the back. Sitting for extended periods is a primary factor in back pain. Regular exercise can allow the back to better support weight while sitting. If your job involves a great deal of sitting (such as working at a word processor), walking during break periods and after work is a good idea.

Using Non-prescription Analgesics:

A number of safe and effective non-prescription products are available, but they should not be used longer than 10 days. The products should not be used when pregnant or nursing a baby, and they should not be combined with prescription pain relievers unless you ask a physician or pharmacist. Also, you should not combine non-prescription products with each other (for example, ibuprofen plus naproxen) unless advised to do so by a physician or pharmacist. If you drink three or more alcoholic beverages daily, do not use any non-prescription pain reliever without asking your physician.

Choosing a Pain Reliever:

Acetaminophen (Tylenol) is a good first choice because it does not cause stomach problems and is safe with most prescription medications. Other products that may be effective include aspirin, ibuprofen, naproxen and ketoprofen. It is important to note, however, that these medications may irritate the stomach unless taken with food or milk. Aspirin may cause interactions with prescription medication, such as warfarin, other medications for thinning the blood, or medications for gout, arthritis, or diabetes.

Heat and Cold: Your doctor or physical therapist can tell you how to use heat or cold treatments and other products.

Be cautious about internet information:

Patients searching the Internet for information on back pain may be led to devices purported to relieve back pain, including Back Bars (delivering pressure point massage), portable pillows, seating systems, back supports, and driver’s cushions. One device allows the user to hang suspended from the ceiling, supported by an air-filled cushion worn around the waist.

An A-frame metallic device allows one to hang upside-down holding on to its bars.
Another company claims to have the solution for back pain (as well as stress, insomnia, migraine, and arthritis) with automatic Chinese ear acupuncture devices that do not use needles.

One company touts the benefits of proanthenols, which they claim are grape seed and pine bark extracts, for back pain. Since patients often purchase these products in lieu of a physician visit or safe and effective back treatment.

We would like to warn patients to avoid unproven and possibly dangerous remedies.

See Your GP

See your GP:

As a general rule, people with back pain are advised to contact their doctor if the pain is no better after about a 2-3 days.

You should certainly see your GP as soon as possible if you have any of these symptoms:

Difficulty passing urine
Numbness around the back passage or genitals
Numbness, pins and needles or weakness in the legs
Pain running down one or both legs
Unsteadiness when standing
These are associated with uncommon conditions, but ones that need treatment immediately.

What doctors can Do:

There's no quick fix for most back pain and your doctor is unlikely to be able to 'cure' you. However, they will be able to:
Check you don't have a serious condition
Prescribe another type of painkiller
Refer you to other health practitioners who can help
Your doctor will probably give you a physical examination and ask you about your back pain.
Here are some probable questions your GP will ask. Think them through to make the most of your medical examination:

When did your back pain start?
What were you doing when it started?
Have you had any back problems in the past?
Where is your pain?
What sort of pain is it - dull, piercing or shooting?
Does it stay in the same place?
What makes the pain better, or worse?
Do you have any other symptoms, in your back or elsewhere?
What does your back pain stop you doing?
What have you been doing which might have contributed to giving yourself a bad back?
What can you do in the future to try and keep your back healthy in the long term?

If you're not happy with your doctor's diagnosis or if your symptoms keep coming back, go back to your GP or ask another health expert for their opinion.

Other people who can help?

If your back problem doesn't clear up quickly, your family doctor may refer you to another health practitioner. This is most likely to be a Physical Therapist and may involve a visit to the hospital for examinations, tests and treatment.

Even if your doctor doesn't refer you to anyone else, you can visit another health practitioner privately. Some people go straight to an osteopath or chiropractor as soon as back pain starts.

Private sessions can cost as little as £35, and the practitioner quite rightly may recommend a course of treatment over several weeks.

If you do decide to see a practitioner privately, personal recommendation is a good starting point.

But remember your back problem is unique - just because a specialist helped a friend it doesn't mean they'll be able to do the same for you.

Don't let it get you down!

Physical Therapy can be passive or active. Passive therapies such as massage and applying heat and cold are typically effective for pain only in the first two to four weeks after an injury. Patients typically do active physical therapy such as exercise and posture/gait correction for up to 12 weeks. These treatments help with chronic pain by building or reconditioning muscles so they can move more normally.

Psychological Therapy can help you sort through the issues that chronic pain can create. Chronic pain can be stressful in that it strains relationships and affects your ability to work or take part in daily activities. In addition, you, your family members, and significant others may bring a unique mix of feelings, expectations, beliefs, personality traits, experiences, support systems, and skills to the situation. Often, psychologists will work with people on relaxation techniques, coping skills, and self-monitoring skills.

WHY DO PEOPLE SUFFER WITH PAIN?

Many people suffer with chronic pain because they are unaware of treatment options that can help them live more normal lives. Others have fears that prevent them from talking about their pain, which in turn creates barriers to seeking adequate relief. (Not all treatment options are applicable to your type of pain.)

Read the following to see if you fall into one of these categories. If you can relate to these fears, remember that help and relief are possible, but only if you discuss your symptoms with your doctor or registered back pain specialist.

Fear of being labelled a "bad patient." You won't find relief if you don't talk with your doctor about your pain.

Fear that increased pain may mean that your disease has worsened. Regardless of the state of your disease, the right treatment for pain may improve daily life for you and your family.

Fear of addiction to drugs. Research shows that the chance of people with chronic pain becoming addicted to pain-relieving drugs is extremely small. When taken properly for pain, drugs can relieve pain without addiction. Needing to take medication to control your pain is not addiction.

Lack of awareness about pain therapy options. Be honest about how your pain feels and how it affects your life. Ask your doctor about the pain therapy options available to you. Often, if one therapy isn't effectively controlling your pain, another therapy can.

Fear of being perceived as "weak." Some people believe that living stoically with pain is a sign of strength, while seeking help often is considered negative or weak. This perception prevents them seeking the best treatment with available therapies.

Because there are many new ways to treat pain, it is important that you speak openly with your doctor or with a doctor who specialises in treating chronic pain. Refer them to this web site so that they too can learn more about natural treatment options for your pain.

A Breech Baby.

The Webster Technique is a chiropractic technique designed to relieve the musculoskeletal causes of intrauterine constraint. This technique is also known by names such as as Webster's In-Utero Constraint Technique or Webster's Breech Turning Technique. The Webster Technique was developed by Dr. Larry Webster in 1978. Dr. Webster was often referred to in the Chiropractic profession as "The Grandfather of Chiropractic Pediatrics." Additionally, the technique is presently taught in many chiropractic colleges and postgraduate chiropractic education seminars.

A recent study was done by surveying a large number of doctors of chiropractic who use the technique to see the percentage of results they obtain on real patients. The survey required detailed information to verify the accuracy of the responses. The results showed that 82% of the doctors surveyed reported a high rate of success when using the Webster Technique.

The results from the study suggested that it may be beneficial to perform the Webster Technique in the 8th month of pregnancy, if it has been determined that the child is in the breech position. This timing is important because from the 8th month on, a breech presentation is unlikely to spontaneously convert to the normal head down position.

The study concludes by saying, "when successful, the Webster Technique avoids the costs and risks of cesarean section or vaginal trial of breech. In view of these findings, the Webster Technique deserves serious consideration in the management of expectant mothers exhibiting adverse fetal presentation."

You Are Not Alone!

Back pain? You’re not alone

Eight out of ten people in the UK will experience some form of back pain at one point in their lives. It's a serious health problem that often goes untreated. One of the reasons back pain is so common is that it can be caused by so many different things.

Work-related injuries
Sports injuries
Poor posture
Stress
Car accidents
Improper lifting

Any of these things can cause your spine to shift from its normal position or affect your range of motion. This puts pressure on the joints, muscles, and nerves in that area, and is what causes most back pain. A healthy back is essential for a healthy body. For some people, chiropractic treatment is like a regular tune-up for their back, to help deal with the daily wear and tear of life. For others, it's an effective treatment when back pain strikes. Take the time to discuss with your chiropractor the level of care that's best for you.

Back problem warning Signs:
Here are some symptoms which might indicate that you suffer from a back problem:

Leg pain with numbness, tingling, and/or weakness

Back or leg pain with coughing or sneezing

Difficulty standing up after sitting for any period of time

Stiffness in the morning that decreases when you move around

Pain in your hip, buttock, thigh, knee, or foot

Inability to turn or bend to each side equally

Unbalanced posture, when your head, neck, or shoulder may be higher on one side than the other

Pain which prevents you from sleeping well

Pain that persists or worsens after 48 hours.

A Physical Therapist treats your back pain by addressing the cause of the pain. A Physical adjustment allows your spine to return to its proper position and improve your range of motion, letting you feel like yourself again. It's simple, and it works.

Just How Safe is Osteopathy?

How safe is Osteopathy?

Osteopathy has one of the best safety records of any medically related profession, however no form of medical treatment is ever 100% safe in every case.

Osteopaths have been trained to recognise any condition that might make osteopathic treatment inadvisable so that they can refer their patients for appropriate medical intervention when necessary. In the same way that a family physician regards safety as the most important factor in selecting the appropriate medication for a particular patient, Osteopaths also select the most appropriate style of treatment with safety as the prime consideration.

Contrary to that which some might try and lead you to believe, NO healthcare professional wants you to come to any harm.

Are there any side-effects or risks to osteopathic treatment?
Yes, but there are risks in everything that we do in life. Most of osteopathic patients feel no reactions at all.

Common: general ache or soreness for 24-48 hours following a positive response to osteopathic treatment.

Infrequent: exacerbation of symptoms due to reaction to osteopathic treatment.

Extremely rare: serious complications requiring medical intervention.

Upper Neck (Cervical HVT or HVLA) Manipulations

This leads us neatly into 'upper neck manipulations'. A topic that at best is described as "run-of-the-mill" and at worst is likened to the "handy-work of the devil himself". As is often the case, the truth is somewhere in between and YOU have to decide whom to believe as there is no simple answer.

If someone is NOT trained and experienced, you are asking for trouble. If your practitioner (osteopath or chiropractor) REFUSES to manipulate your neck, even if they are trained and you insist upon it, then you are a liability to both yourself and your practitioner.

Neck manipulations, whether osteopathic or chiropractic, are exceptionally safe when done by trained and experienced professionals. For example, a woman in the UK has more chance of dropping dead from using the contraceptive pill than suffering a stroke (or worse) from a neck manipulation. Think about it. how many women do YOU know who have died from using the contraceptive pill? For me, none, but I am very aware that inexperience in neck techniques can still be a liability.

Let's clear up exactly what a "stroke" is: a stroke is damage to the brain due to the interruption of its blood supply either by a small clot or a narrowing/overstretched blood vessel. Symptoms can involve headache, dizziness, confusion, visual disturbance, slurred or loss of speech, a difficulty in swallowing and, in some cases, death.

The causes of a stroke are unpredictable and can occur through sudden or extreme end of range positions. Look at the list below:

· leaning your head back over a basin at the hairdressing salon
· coughing
· sneezing
· turning your head while reversing your car
· or any of a number of other day-to-day neck movements.

The problem is this: there is no way possible for any osteopath, physician or chiropractor to predict with 100% certainty whom (if anyone) is susceptible to a stroke, just as we cannot predict which (if any) woman will suffer from using the contraceptive pill.

So how safe are osteopathic manipulations? The British health benefits (insurance) company BUPA describes osteopathy as follows: "There is a general consensus that osteopathy is less risky in terms of spinal injury because osteopaths usually use less forceful manipulation techniques on the spine."

Add the above quote from BUPA to data from North American chiropractors suggesting that 1 in every 1.46 million chiropractic neck manipulations will result in a stroke (1 in 1 million women in the UK will die from using oral contraception) and you can see how safe UK osteopaths can be... and that is not to take anything away from chiropractors and their expertise either.

So why do all the scare-mongers lay in to osteopaths and chiropractors? For me, it is a matter of some members of the public wanting someone to blame rather than taking responsibility for their own actions and also some physicians clinging to "medical paternalism" when the world of healthcare is changing rapidly.

Experience in these matters is essential and that is why full-time specific osteopathic training is second-to-none in the UK. I know that it will upset other countries trained osteopaths when I say this, but if someone is going to manipulate MY upper neck I know exactly whom I want to do it (and whom not). If they haven't had a tutor breathing down their neck daily for 4 years non-stop, then they are probably not as badgered about neck manipulations as our Osteopaths are in Britain.

The bottom line:

· If you have any concerns about neck manipulations, you should refuse them.

· If your Osteopath is concerned, he/she has the right to refuse to manipulate your neck, no matter how much of a fuss you create.

· If you are concerned with ANY symptoms either before or after osteopathic treatment, see your physician.

· If experienced osteopathic and chiropractic neck manipulations are as dangerous as some say, patients would be dropping like flies on a daily basis.

· Make up your own mind and don't let anyone (including me) convince you of something that you are not happy with.

www.backtrouble.co.uk/

Osteoarthritis

Osteoarthritis embraces a broad spectrum of clinical conditions with the common feature being that of primary joint failure.
Prevention is the ideal goal, however opportunities to achieve this are limited by our incomplete understanding of the aetiopathology.

The principles of Preventive Intervention are education about the condition, modification of lifestyle, and judicious exercise and joint protection, together with adequate pain relief. Optimum management involves a team approach that includes orthopaedic surgical expertise, as surgery can provide an alternative to continuing discomfort and limited mobility.

Osteoarthritis (OA) is the most common joint disorder in humans and increases with increasing age. It affects up to 70% of the world population over 65 years of age as well as a significant proportion of younger people. Osteoarthritis is multifactorial in causation and may be defined as primary failure of the joint with degeneration of articular cartilage.

The pathophysiology of the condition has been well reviewed.

Physical, Genetic, Chemical and Immunological factors are involved. The disorder may be primary or the almost inevitable sequel to previous joint damage.

Clinical Presentation:

There are 3 broad groups:

a. symmetrical peripheral arthritis
Heberden's nodes

Primary generalised osteoarthritis (PGOA) in females
Non-nodal OA in males

b. Oligoarticular large joint disease

c. Spinal arthritis
Spondylosis
Apophyseal OA

While OA is generally accepted as non-inflammatory in nature, localised inflammation can be demonstrated and may be prominent in certain forms such as 'erosive OA' of the fingers. However, in most instances, the precise aetiology cannot be defined and changes in articular cartilage are present long before clinical manifestations become apparent.

Preventive intervention:

Osteoarthritis is aggravated by several factors including obesity, occupation, and the nature of any previous joint damage and the presence of underlying joint disease. Recognition of these factors provides an opportunity for primary, secondary and tertiary preventive interventions, which include:

1. Weight reduction
2. Occupational modification (Posture/Occupational Assessments)
3. Joint protection
4. Team management approach (GP, Osteopath, Chiropractic, Surgeon, and Physiotherapist)
5. Analgesic techniques
6. Education groups for patients and relatives

Conclusion:

There are many approaches to the management of patients with osteoarthritis. It is my belief that Preventive Intervention has an important role in the total care of the patient and is often undervalued and under-utilised.

T. O'Brien (Back Trouble UK)

Your Foot & your Leg?

Podiatry is primarily concerned with treating problems and injuries that occur due to altered foot function. Our Podiatrists will look at the relationship between your foot and leg and their working effect on the rest of your body. They will look at the causes of the injury and altered foot mechanics and, where appropriate, prescribe orthotics to improve the foot mechanics. It has been shown that a high percentage of lower back pain, hip, knee pain, shin and foot pain can, in some cases, be improved through improving altered foot function.

Visiting the Podiatrist:

Call us....or request a Free Consultation?

The Podiatrist will first take a detailed history of your condition together with any relevant past medical history. A physical assessment will then be undertaken to determine the clinical diagnosis of your problem. The patient's movement may be analysed, walking and running on a treadmill with a digital video camera from the rear and side view. The digital camera allows for freeze-frame analysis of specific points in the gait. Pressure plate gait analysis may also be used to provide objective data on a limb function and foot pressure distribution. From the results of this comprehensive analysis the podiatrist can paint a picture of the causes of the injury problems. These causes are usually a combination of factors, such as poor flexibility, strength and mis-alignment of the foot or lower leg. The main purpose of an orthotic is to place the foot in a position in which it can move naturally and remain stable. Therefore, the orthotic tackles only the mis-alignment problems.

Therefore, the podiatrist works closely at our clinic's with the physiotherapists to ensure that a correct rehabilitation programme is implemented to correct any postural problems, improve core stability, strengthen the ankle muscles, increase flexibility and improve proprioception. If you don't do these things, the money spent on orthotics may be wasted. We look to manage the condition and prevent problems in the future.

Back Trouble UK = 1st Choice for Back pain!

Babies need help 2 ?

Osteopathy for Baby and Child

It is a common belief that babies and children should have no structural stresses or strains in their bodies, because they are so young. The reality is very different.
Birth is one of the most stressful events of our lives. The baby is subjected to enormous forces, as the uterus pushes to expel the baby against the natural resistance of the birth canal. The baby has to twist and turn as it squeezes through the bony pelvis, on its short but highly stimulating and potentially stressful journey.

A baby’s head has the remarkable ability to absorb these stresses in a normal delivery. In order to reduce the size of the head, the soft bones overlap, bend and warp as the baby descends. The baby’s chin is normally well tucked down towards its chest to reduce the presenting diameter of the head.

Many babies are born with odd shaped heads as a result. In the first few days, the head can usually be seen to gradually lose the moulded shape, as the baby suckles, cries, yawns etc. However, this unmoulding process is often incomplete, especially if the birth has been difficult. As a result, the baby may have to live with some potentially uncomfortable stresses within its head and body.

What effect does this have?

Some babies cope extremely well with even quite severe retained moulding and compression, and are contented and happy.
For others it is a different story, and they can display a variety of problems:
Crying and/or irritable baby wanting to be held constantly or rocked...
The reason - the baby may be uncomfortable, with a constant feeling of pressure in the head similar to a headache. This is made worse by the extra pressure on the head when lying down.
Feeding difficulties, often windy...

The reason - feeding is difficult and tiring due to stresses through the head, face and throat.
Sickness, wind and symptoms of colic...
The reason - regurgitation and trapped wind result due to the irritation of the nerves that supply the stomach and diaphragm (which originate in the neck), this constricts the stomach opening causing overfill reflux and difficulty expelling air.

Sleep disturbances...

The reason - the tension on the bony and membranous casing of the skull keeps the baby’s nervous system in a persistently alert state, they may also be uncomfortable. As the child grows: As the child grows, the effects of retained moulding can lead to other problems. The following are the most common but is not an exhaustive list:

Nasal and Ear Infections

Glue Ear
Sinus and Dental problems
Behavioural problems and learning difficulties
Headaches, aches and pains
Attention difficulties
For the older child - growing pains
Osteopathic treatment of babies and children

Treatment using the cranial approach is very gentle, safe and effective in the treatment of babies and older children.

Specific gentle pressure is applied wherever necessary (not only on the head) to enable the inherent healing ability of the body to effect the release of stresses.

Reactions to treatment are variable; often the baby or child is very relaxed afterwards and sleeps well. Others have a burst of energy after treatment, usually followed by a good night’s sleep. Occasionally the child may seem unsettled and this is merely because treatment may take a few hours or days to complete.

On average, 2 to 6 treatments are sufficient. This varies according to the severity of the actual problem and the age of the child.

Ideally it is best to commence treatment early in a child’s life; it is never too early or late to begin treatment. At Back Trouble UK we treat newly born babies and pensioners alike. The vast majority of our practitioners are also trained in structural osteopathy for those children or adults with more structural problems.

Terry O’Brien-Back Trouble UK (www.backtrouble.co.uk)

Does Physio do the Job?

Physiotherapy & Rehabilitation

One of the most important components of each patient's treatment is a progressive, well planned and executed rehabilitation programme. This will focus on maximum functional restoration and return you to a healthy active life-style. Our aim is to fully assess the patient and provide a comprehensive programme of treatment to anable you to get back to your full potential in the shortest time possible. This will consists of a variety of physical therapy techniques and modalities to assist you in attaining your goal.

All Back Trouble UK clinic’s physiotherapists are chartered and state registered.

We are here to help address your pain and discomfort.

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Diagnosing Your Condition:

Clinical Examination:

The exam will probably begin with a medical history during which the practitioner will ask about your symptoms, your lifestyle, and about how the pain affects your daily life. This will help the doctor assess the contribution stress and lifestyle factors make to your pain. If this is your first visit, the doctor will also ask about your other medical conditions and about any surgeries you have had.

The practitioner will examine your neck and/or back and will check your ability to sit, stand, walk, and lift your arms or legs. He/she will also assess sensation (what you feel and how you feel it) and the strength of the reflexes in various parts of your body. This will help determine where the pain originates from (which is not always the same place where you feel the pain), what degree of pain-free motion you have, and whether you have muscle spasms. It will also help rule out a more serious underlying condition as the cause of the pain.

Based on the findings of the clinical examination, the practitioner may recommend some diagnostic tests. The most common ones are:

Xray

Computed Tomography (CT Scan.)

Myelogram

Magnetic Resonance Imaging (MRI)

Electromyogram (EMG)

After the clinical examination and the diagnostic studies, the doctor may determine the best way to treat your pain or may refer you to a specialist (such as an orthopaedist or neurologist), a physical therapist, or a chiropractor for further evaluation and treatment.
If you do not understand what is being explained to you, don’t be afraid to ask for clarification. It is important for you to understand your back pain so you will be better able to make informed choices and to cope with your pain.

Diagnostic Tests For Back Pain:

X–ray imaging can create detailed images of different types of tissues. For example, an x–ray of the spine can show the vertebrae and the central nervous system. It can detect fractures, infections, dislocations, tumours, bone spurs, and disc disease and help doctors evaluate spinal curvature and defects. However, not all spinal injuries can be seen on x–rays, so doctors sometimes recommend other tests such as a CT scan, MRI, or myelogram to provide more information about the structures in the back.

CT (computed tomography) scan—sometimes referred to as a CAT scan—can show the size and shape of the spinal canal, its contents, and the structures around it. A CT scan is especially helpful for showing bone detail, including stenosis. Sometimes a CT scan is done in combination with a myelogram of the spine to provide additional information.

Myelogram is a type of x–ray study that uses a special dye to make the spinal canal and nerve roots clearer. After the area is numbed with a local anaesthetic, a thin needle is used to inject the dye into the subarachnoid space (the fluid-filled space between the bones in the spinal column). It is sometimes used when other tests, such as a CT scan or MRI, do not detect the cause of the pain.

Magnetic resonance imaging (MRI) produces a three-dimensional image of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, and surrounding areas and can identify tumours and areas of enlargement or degeneration.

EMG (electromyogram) measures the electrical impulses in a muscle when it is at rest and when it contracts. This allows doctors to diagnose problems that damage muscles, nerves, and the places where nerves and muscles meet. Herniated disc is one of these problems. This test involves the placement of an electrode into a muscle. A wire connects the electrode to a machine that records the electrical activity in that muscle.

Reiki-What's it about?

Reiki

Reiki is the Japanese word for "Universal Life Energy" and is a form of healing which involves the laying on of hands.

This life energy flows through all living things and can be activated by the channeling of spiritual well-being and healing through the hands of the practitioner - it activates the body's own ability to heal and energise.

Whilst treatment is being received, sensations of warmth or cold are often felt and occasionally a tingling sensation is experienced through the areas being touched.

During treatment, patients have often been known to fall asleep as they feel so relaxed. Patients are fully clothed throughout the treament and are usually lying down on a bench (called a "plinth").

This treatment is extremely beneficial to clients who suffer from depression, stress, migraine, menstrual problems, sinus pain, menopause, back pain and so on. Reiki is completely safe and can be used in conjunction with other forms of medication. Each treatment lasts an hour.

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Lifetime "Spinal Health" Programme!

Our network of clinic’s practice is very much a wellness based practice - recommending ongoing preventative treatment rather than alleviating the present symptoms and waiting for a further reoccurrence.

Our Lifetime ("Back" to Health programme) has been developed specifically for patients who have experienced recurring episodes of back pain. It has been developed to prevent continual reoccurrence. Up to now we have as practitioners been using reactive treatment. What we now offer is proactive treatment.

Reactive treatment is likened to saving a drowning woman, emptying her lungs and then returning her to the water. Our spine plays a fundamental role in our health as it supplies every organ in the body sending and receiving messages to and from the brain.

When a vertebra moves out of place it is called a "subluxation". This can cause nerve impingement and can affect the function of the organ that it is supplying. This can prevent "Optimum Health" and can cause degenerative changes leading to stiffness, pain, and other problems.

Recent research shows that within 3 weeks of a subluxation occurring, the first signs of wear can be detected. We therefore recommend monthly spinal health checks so that any misalignment can be corrected before they cause problems.

To encourage patients to attend monthly we have based it on a standing order. The cost is a modest £25 per month, which is less than 83p per day.

To find out more, simply email: consultants@backtrouble.co.uk

Clinical Guidelines for (LBP)

Royal College of General Practitioners Report: On Management of Acute Low Back Pain:

The report on "Clinical Guidelines for the Management of Acute Low Back Pain" was published by the Royal College of General Practitioners in 1996.

It was designed to help doctors and other health professionals with the multi-disciplinary approach to the initial assessment, triage, and evidence-based management of acute low back pain (LBP).

Medical assessment (diagnostic triage) should occur to exclude treatable causes (sciatica, red flags such as carcinoma, HIV, spinal abscess, spinal cord compression). X-rays are not routinely indicated for simple back pain. Biopsychosocial assessment should occur early.

Pain killers (relievers, analgesics) should be prescribed regularly and not "as required" to be more effective. Start with paracetamol, adding in anti-inflammatory drugs (ibuprofen, diclofenac), and weak opioids (codeine) as necessary. Consider a short course of a muscle relaxant (diazepam max. 7 days).

Avoid strong opioids if possible (morphine max. 7 days).
Bed rest is not a treatment for simple low back pain. Bed rest may need to be taken early on in the episode, but this should not be considered a treatment. Bed rest for longer than 3 days has been shown to be harmful by delaying the speed of recovery.

Stay as active as possible and continue with normal daily activities. Gently increase activity levels after an acute episode of back pain over a period of days to weeks. If you are in work, then either stay at work or return to work as soon as possible.

Prolonged periods off work will reduce your overall chance of working again (e.g. only 2% of people can return to work after 1 year off sick).

Spinal manipulation treatment within the first 6 weeks has been shown to be beneficial for pain relief and rehabilitation in those where the back pain does not resolve spontaneously.

Active rehabilitation (exercise programme OR physical re-conditioning) should be started at 6 weeks if there has not been return to work or resumption of normal activities.

The Challenge of Back Pain

In our body, no area presents more of a challenge to doctors than the back.

Second only to that of head pain, debilitating low back pain strikes 80 per cent of us during our lifetimes; it causes millions of lost work days and accounts for a steady stream of patients to general practitioners.

In spite of endless research into its diagnosis, causes and treatment, medical practitioners seem no nearer to understanding back pain. The facts are that misdiagnosis or unproven and aggressive treatment with drugs and surgery contributes more to the problems of back pain sufferers than they do to the solutions.

Conventional methods of diagnosis are still very ineffective. For instance, routine x-rays to determine whether low back pain is caused by a serious condition are virtually useless. By treating back pain as a disease rather than a symptom, we have gone down many one way streets of diagnosis and treatment, with many patients only suffering increased pain from inappropriate treatment.

Some doctors have suggested that conventional medicine should increase its understanding of the back and its problems by adopting an osteopathic / chiropractic understanding of back pain.

The back then becomes part of a whole, complex structure that includes the spine, ribs, pelvis, hips and their surrounding muscles and ligaments and other supporting tissues, as well as the organs contained within those bony structures. Dysfunction or displacement of any of these parts of the structure can eventually lead to back pain.

The vast majority of medical practitioners need to be able to both evaluate and assess the whole impact of the back pain on an individual whilst the individual needs to be able to understand their back pain so that they can work more effectively with their chosen health practitioner.

Ouch! My Back Hurts.

Acute low back pain

It happens to most of us at some stage in our lives, so how we manage it is vital.

There is good scientific evidence on how we should deal with this.

Back pain is extremely common and nothing to worry about. It may recur but this does not mean re-injury and there will usually be no permanent problems.

Managing episodes of back pain successfully can make a difference to your abilities in the long term.

What to do when you have an episode of back pain:

Do not rest unless you have to, and then 2 to 3 days maximum. Rest is not a treatment for low back pain and can lead to stiffness, weakness, loss of fitness, and disability.

Do seek professional advice early on if you are concerned in any way about your back pain.

Keep up normal activities by giving yourself small goals to keep to, eg to walk around for a few minutes every so often, sit for a certain time etc.

Pace your activities - do normal daily activities but cut them up into small blocks of time that you can easily manage. Increase activities by fixed increments and stick to what you plan, not to how you feel.

Take adequate pain-killing medication. Medication should be taken in fixed doses at fixed times, and not when you feel like it or the pain gets too bad. Drugs used need to be discussed with your doctor or pharmacist.

Recognise negative beliefs and deal with them. Look upon the episode as a relapse, not a disaster.

Manipulation can be useful to provide short-term improvement in pain and abilities. As long as you choose a skilled therapist the risks of manipulation are very low.

Use relaxation techniques, either from classes, books or tapes.

Go back to work/normal activities as soon as possible. Don’t wait.

Do not expect to be completely pain free before resuming normal activities.

You should have returned to normal activities and work by six weeks after the start of your episode. If not you may need to join an exercise programme under supervision or at the gym to prevent long term problems.

Acupuncture For Neck Pain

A study by a team of researchers at the University of Southampton has revealed that Western style acupuncture can be effective in treating chronic neck pain.

Moreover its beneficial effects may be as much to do with the non-specific but powerful effects of the treatment process as the specific effect of the needles.

The results of the study are set out in a paper that appeared in the Annals of Internal Medicine on 21 December 2004.

Chronic neck pain presents a substantial problem and may be responsible for as many days' absenteeism as low back pain. It is usually associated with unspecific degenerative changes such as osteoarthritis.

Acupuncture is the most frequently used complementary and alternative medicine (CAM) therapy for the treatment of osteoarthritis, with approximately one million people in the USA seeking CAM treatment each year. However, despite this huge increase in popularity and use, there has been little sound evidence to date that acupuncture helps patients with chronic neck pain.

Led by Dr Peter White and Dr George Lewith of the University's Complementary Medicine Research Unit, this new study aimed to evaluate whether 'Western style' acupuncture is an effective treatment for chronic neck pain. 'Western style' acupuncture involves a conventional diagnosis followed by the use of an individualised acupuncture treatment using a combination of prescriptive points. In contrast, a traditional Chinese approach formulates an individualised diagnosis based on Chinese theories of meridians and energy.

A total of 124 patients with chronic neck pain aged between 18 and 80 years took part in the study. Patients received eight treatments over four weeks having been randomly assigned either acupuncture or mock stimulation to acupuncture points by the same therapist.

Patients were only allowed to use paracetamol for pain relief and were not allowed to undertake any other forms of treatment - even exercises or stretches - during the study or for two months afterwards. During the treatment all patients kept a diary to record pain and also completed questionnaires before, during and after their treatment to assess ease of movement and quality of life.

The results show acupuncture was effective at reducing neck pain and produced a statistically but not a clinically significant effect when compared to the mock treatment or placebo.
Over the 12 weeks of assessment, patients from both groups reported a similar and significant decrease in pain levels of over 60 per cent. The number of patients taking paracetamol also fell, as did the average number of tablets taken by patients. Interestingly, the study also showed that female patients tended to respond better than males and further research is required to establish whether there is a real difference in response in the sexes.

The results of the study cannot be generalised because only one therapist treated all the patients; more information would be gained by using several therapists. It is also impossible to identify whether treating patients with a traditional Chinese medicine-based approach might produce a different outcome so the research team cannot comment on the 'best' type of acupuncture.

Dr Lewith comments: 'Our rigorous and methodologically sound study clearly shows that there was significant and long lasting improvement for both treatment groups. The implications for this are two-fold. First, acupuncture was clearly very effective at reducing pain, with patients experiencing large decreases over a prolonged period which would recommend its clinical use. Second, our study also implies that most of the improvement gained from acupuncture was not due to the needling process itself but due predominantly to the non-specific yet powerful effects which are probably part of the treatment process.

Pregnancy Back Pain

Osteopathy is well recognised as a treatment for back trouble in pregnancy but most people are unaware of its full potential. Many of the conditions suffered in pregnancy are symptoms of an overall pattern of imbalance in the body. By finding and correcting these imbalances, osteopathy can alleviate many of the adverse side effects of pregnancy in the body. This helps ensure an easier more comfortable pregnancy and improves the chances of a straightforward birth, and a mother that can recover quicker.

The aches and pains that are common in pregnancy, result from the body changing shape to accommodate the increasing size and weight of the uterus. The ligaments of the whole body also soften during pregnancy, due to the action of hormones.
This allows the bones of the pelvis to separate slightly during delivery to facilitate the passage of the baby’s head through the pelvis.

Unfortunately this softening affects the whole body and makes it more vulnerable to strain. Postural imbalances may cause backache, sciatica, neckache, headaches, aching legs, and fatigue. If prior to pregnancy a woman’s body is already under stress from previous strains, trauma or lifestyle factors these changes are likely to impose a physical strain on all the organs and tissues.

Osteopathic treatment aims to assist the body in making postural changes more easily, making the pregnancy more comfortable.

Active Rehabilitation:

Latest thinking on managing back pain - the leading cause of sickness absence in the UK - is unusual.

It encourages a speedy return to work, rather than the traditional prescription of complete rest.

Back Trouble UK believes that employees should not take long periods of time off work to recover from low back injuries, even if they are still suffering from the symptoms.

The most effective route to recovery is for employers to establish a program of active rehabilitation that encourages employees to get back to work as soon as possible.

Occupational health practitioners and managers are being encouraged to tackle the problem, by working closely together, with a common, consistent approach to agreed goals.

Improving Health

As well as affecting injured employees and their families, back pain has a major effect on industry through absenteeism and avoidable costs.

The Confederation of British Industries estimates that back pain costs £208 for every employee each year, while, at any one time, 430,000 people in the UK are receiving various social security benefits primarily for back pain.

There is strong evidence that physical activities at work, such as manual handling, account for only a small number of low back injuries among employees. Workers in heavy manual jobs report more low back pain symptoms, but people in lighter jobs have similar problems, related to normal everyday activities such as bending and lifting.

As a first step, health practitioners should raise awareness among employers and employees that work-related activities are not the only cause of lower back pain. But it should also be made clear that work activities can make the symptoms worse.

The next step is to carry out a pre-placement assessment to identify employees who may be more likely to develop lower back pain while carrying out particular work activities. This should include finding out whether employees have a previous history of pain. Care should also be taken when placing individuals with a strong history of lower back pain in physically demanding jobs.

The longer a worker is off work, the lower their chances are of ever returning to work. In fact, evidence shows that, whereas half those injured return to work after six months, only five per cent return after a year off work.

Employers are being encouraged to establish an active program of rehabilitation to help employees stay active and return to ordinary work activities as early as possible. This can lead to a faster recovery than traditional medical treatment, while the business benefits can include shorter periods of work loss and reduced sickness absence.

Occupational Issues

One way of promoting a quick return to work is for organisations to establish joint employer-worker initiatives to facilitate and support workers remaining at work or returning as soon as possible.

Back Trouble UK recommends that health practitioners should:

Initiate communication with the primary health care professional early in treatment and rehabilitation;
Advise the employee to continue as normally as possible and to provide support to achieve this;
Advise employers on the actions required, which may include sympathetic contact with the absent worker;
Consider how an employee's work tasks can be temporarily modified or how they can be given lighter work until they are fully recovered.

Guidelines suggest implementing rest pauses, work rotation, or using mechanical handling aids to carry out lifting operations to achieve this aim.

Other practical steps that can be taken to tackle the problem of low back pain include advising employees on current good working practices - for example, good lifting techniques - and issuing them with user-friendly information, such as HSE guidance publications.

Employers are also encouraged to:Consider joint employer-worker initiatives to identify and control occupational risks;

Monitor back problems and sickness absence due to Lower Back Pain;
Recognise that high job satisfaction can help to reduce disability and sickness absence rates attributed to Lower Back Pain.

Conventional tests such as X-rays and clinical examinations are of limited value when it comes to assessing and preventing lower back pain.

It is important to identify work-related factors. For example, dissatisfaction with work may get in the way of an employee's recovery and may cause symptoms to persist.

Please join us, we welcome your comments.

You can email us at: consultants@backtrouble.co.uk

My Brain Hurts?

CHRONIC BACK PAIN EATS AWAY AT BRAIN

Scientists in Chicago have discovered new clues into what role the brain plays in chronic back pain (CBP).

The investigators used magnetic resonance imaging brain scans to compare the morphology of 26 individuals with CBP with 26 pain-free control subjects.

According to the report "patients with CBP showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm(3) loss of gray matter for every year of chronic pain."

The study also showed that CBP patients had decreased gray matter density.

"Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes," conclude the authors.

Decisions, Decisions!

CHRONIC BACK PAIN IMPAIRS DECISION MAKING

Scientific evidence supports the hypothesis that chronic pain impairs an individual`s decision-making capability.

As part of one study, investigators compared 26 healthy people with 26 patients with chronic back pain (CBP) and 12 patients with a condition called chronic complex regional pain syndrome (CRPS).

CRPS is a chronic nerve disorder typically afflicting the arms or legs, which usually onsets following an injury.

The study participants were asked to perform a test researchers use to assess emotional decision-making. The test, called the Iowa Gambling Task, is a gambling card game.
Subjects with CBP performed 41% worse than did pain-free individuals. Those with CRPS performed even poorer.

The study`s authors conclude that "our evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact everyday behaviour especially in risky, emotionally laden, situations."

"Other cognitive abilities, such as attention, short-term memory, and general intelligence tested normal in the chronic pain patients."

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Smoking!

SMOKING, A CAUSE OF BACK TROUBLE?

Epidemiological studies strongly imply that smoking may be a risk factor for back problems. It has been speculated that this is due to frequent coughing, unhealthy life style or osteoporosis in smokers.

All of these hypotheses, however, do not accord with the experimental evidence. A new theory is therefore proposed. It suggests that smoking leads to malnutrition of the disc which in turn renders it more vulnerable to mechanical stress.

Malnutritition can be brought about by carboxyhaemoglobin formation, nicotine-induced vasoconstriction, arteriosclerotic vessel wall changes, impairment of fibrinolytic activity and changes in the flow properties of blood.

Future studies should test the above hypothesis experimentally.

No Pain No Gain? Surely Not!

Sources of Back Pain:

Herniated Discs - As people age, the outer rings of their discs weaken and may tear. The gel-like inner portion of a disc bulges outward, putting painful pressure on nearby nerves. This is commonly called a “slipped disc.” People who are obese, use improper lifting techniques or have bad posture are all at risk.

Slipped Vertebra - Joints or discs weaken and can no longer hold spine segments in place, causing one vertebra to slip over another. Shifted bones push against nerves, causing pain.

Disk Degeneration-Discs start out spongy, but lose water with age, becoming brittle. Weaken discs collapse under weight from above, causing vertebrae to scrape against each other.

Strains/Sprains - Sudden traumatic injuries or repetitive motions can stretch and tear muscles or ligaments. The damage may be accompanied by painful spasms and inflammation.

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Acute & Chronic Pain

Doctors make a distinction between acute pain and chronic pain. Acute pain usually goes away quickly. It's useful, because it warns you of sources of harm and tells you to protect yourself while the body heals.

Chronic pain can be just as unpleasant but lasts much longer. If you have pain in the same place for 12 weeks or more, it is likely to be classified as chronic pain. Because it lasts so long, it's of less value as a warning.

Most people have acute pain, and common painkillers usually help if taken regularly and according to instructions. The body also produces its own natural painkillers called endorphins. Exercise and treatments such as Chiropractic Therapy, Manipulation and Acupuncture, help increase the endorphins in your body.

Chronic pain is more difficult than acute pain to help and sometimes does not respond to treatments such as over-the-counter painkillers and conventional physiotherapy alone. People with chronic pain often need specialist advice and support and are sometimes referred by doctors to Specialist Chiropractic Clinics.

Understanding your symptoms:

People injure their backs in all manner of ways, and often the pain is a result of a strain rather than a dramatic accident. So why do we experience so much pain and what can we do to reduce our risk of injury? Download a free copy of “Where Does It Hurt?” today a unique book about Back Pain, Treatments and Rehabilitation.

Sport & Low Back Pain:

About 80 per cent of the world's residents suffer from low back pain at one time or another, and an athletic lifestyle offers no warranty against the problem.

low back pain is a common ailment among runners, cyclists, and other athletes, and until now no one has been exactly sure what sports-minded people should do to alleviate - or prevent - the complaint. Now, thanks to research carried out at the University of Copenhagen in Denmark, it appears that special co-ordination exercises can help get athletes' backs 'back on track'.

The Copenhagen investigations add some clarity to what has been a muddled picture concerning the proper therapy for low back pain. Sports scientists have been pretty certain that inadequate strength and endurance of the back muscles increase the risk of low back pain, suggesting that back-strengthening exercises would be an ideal preventative.

However, it's been impossible to determine which back-muscle strengthening programme is optimal, and recent research has even called into question the validity of traditional back-strengthening therapy. For one thing, scientists have shown that some popular low back exercises actually magnify 'intradiscal pressure' in the spine, possibly INCREASING the risk of difficulties. In addition, other studies have suggested that back-strengthening exercises are no more effective than short-wave diathermy or ultrasound at ameliorating low back pain.

Developing smoother back movements:

So, the Copenhagen investigators decided to take a new tack. Instead of assuming, as almost all other researchers have done, that muscle-strengthening routines are the answer for low back pain. The Danish researchers reasoned that healthy functioning in the low back does not depend on muscle strength, endurance, and flexibility alone - but also on the CO-ORDINATION of movements involving the lower back.

They theorised that individuals who moved clumsily might put inordinate strains on their low back muscles, connective tissues, and spinal structures, even if their basic muscle strength was pretty decent, leading to the onset of pain. As a result, the Danes hypothesised that training to improve co-ordination - but not necessarily muscle strength - might help individuals develop smoother movements of the lower back, which would then decrease the risk of harmful stress on the low back and thereby reduce the risk of pain. Forty Copenhagenians aged 18 to 65 with chronic low back pain took part in the study.

The subjects had all experienced low back pain for at least three months in the preceding year, but none of the individuals suffered from serious problems such as osteoporosis, painful osteo-arthritis, inflammatory rheumatoid arthritis, or disc degeneration.The subjects were divided into two groups, each of which trained for one hour two times per week over a three-month period. One group carried out conventional endurance/strength training for the low back, while the other conducted the special co-ordination training. After a 10-minute warm-up, the endurance/ strength group completed four key exercises:

Leg Lifts, in which subjects stood by the end of a table, leaned over into a prone position with the hips against the edge of the table and the chest flat on the table, and then lifted both legs behind them to the greatest possible height.

Trunk lifts, in which subjects lay prone on a table with their hips at the edge and the upper part of the body extending out over the edge of the table face-down (a strap over the calves kept individuals from toppling off the table). With hands behind their heads, the participants lowered their trunks and then lifted their trunks upward to the greatest possible extent (very much like traditional 'Roman-Chair' exercise).

Abdominal contractions (sit-ups), in which individuals lay on their backs with their knees flexed, feet on the floor, and arms behind their heads and then slowly 'sat up' in a straight- forward direction; and
Lat pull-downs, in which participants sat on a seat, grasped a weight lever, and then pulled the lever down behind their necks and shoulders, lifting a weight stack which was attached to the lever.

During the strength/endurance workouts, subjects did as many repetitions of each exercise as possible (but no more than 100), with 30-second pauses after each set of 10 repetitions.

At the end of the workout, participants completed about 10 total minutes of stretching, using 30-second static stretches of the various muscle groupsLike the strength/endurance people, the co-ordination-trained subjects started their workouts with 10 minutes of jogging and warm-up activity. They then completed four co-ordination exercises, including 1) "Knee-elbow touches'' in which they started in an upright, standing position and then rotated their trunks to the right, lifted their right knees while standing on their left feet only, and touched their right knees with their left elbows. They then returned to the standing position, rotated their trunks to the left, lifted their left knees, and touched their left knees with their right elbows. This alternating pattern - left elbow touching right knee and right elbow touching left knee - continued for up to 40 repetitions. 2) 'Balancers,' in which subjects started out on all fours (hands and knees on the ground) and then extended their left legs straight back and their right arms straight ahead, while remaining in balance on their right knees and left hands.

They then went back to the starting position and moved their left arms ahead and right legs back before alternating this pattern for a total of up to 40 reps.
3) Modified sit-ups, like No. 3 from the strength/endurance training except that instead of sitting up straight ahead, subjects moved forward alternately to the left and then to the right as they did their 'crunches'; and
4) Proprioceptive training, in which the participants stood on a wooden disk with a sphere attached to its undersurface. Subjects tried to keep balanced on the sphere without letting the edges of the disk touch the floor - while twisting their bodies and bending at the knees.

Participants stood on both feet at the beginning of the study but progressed to one-footed balancing (alternating feet) after several weeks. Post-workout stretching was the same as for the strength/endurance group.

And the results?

After three months of training, both groups had less low back pain, better mobility of the low back, and less trouble carrying out their daily activities, and the co-ordination group improved just as much as the strength/endurance group. Consumption of drugs to control low back pain was reduced by about two-thirds in both groups as well. Notably, back-muscle strength increased in the strength/endurance group but not in the co-ordination subjects, yet each group made similar improvements in low back function, demonstrating that an upgrade in strength is not the only thing which can heal a 'bad back'. Supporting this idea is the fact that there was not a strong correlation between improved back strength and reduction in low back pain in the Copenhagen research.

What does the Danish research mean to you?

If you suffer from low back pain or want to minimise the risk of low back pain in the future, improving your back-muscle strength is a decent idea, but it's not the complete answer. You should also carry out the co-ordination drills completed by the Danish athletes to 'smooth' and co-ordinate the functioning of your lower-back muscles and spine, and you should probably also improve the flexibility of your low back by stretching out your low back muscles AFTER they are thoroughly warmed up.

With improved strength, co-ordination, and flexibility in your low back, you should be able to exercise more efficiently and with less fatigue in your low back area. In addition, the prevention of low back pain should allow you to train more consistently, leading to higher-quality performances.