Degenerative Joint Disease.

Alternative Names: Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis-Osteoarthritis.

Causes
Unfortunately most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.
The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.

The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.

OA can be primary or secondary.
Primary OA occurs without any type of injury or obvious cause.
Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.

Symptoms
The symptoms of osteoarthritis include:
Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest
Grating of the joint with motion
Joint pain in rainy weather
Joint swelling
Limited movement
Morning stiffness
Of course some people might not have symptoms.
Examination and Tests
A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.
An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment
The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS
The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.
Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.

Other medications used to treat OA include:
COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the Drug Licensing Authorities to re-evaluate the risks and benefits of the COX-2s. Ask your doctor whether the drug is 1. Still available and if so 2. Right and safe for you.
Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.

Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.

LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.
Good nutrition and careful weight control are also important. If you're overweight, losing weight will reduce the strain on the knee and ankle joints.

PHYSICAL THERAPY
Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty )
Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
Surgical fusion of bones, usually in the spine (arthodesis)

Outlook (Prognosis)
Your movement may become very limited. However Treatment generally improves function.
Possible Complications
Decreased ability to walk
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
Adverse reactions to drugs used for treatment
Surgical complications
When to Contact a Medical Professional
Do contact your health care provider if you have symptoms of osteoarthritis.

Prevention
*Weight loss can certainly help in the management of DJD and reduce the risk of knee osteoarthritis in overweight women.

Let us Help?

Are you a candidate for treatment?

Our associated clinics treat both acute and chronic back conditions.

If your symptoms have appeared recently we can use the best manual physical

therapy techniques to facilitate the healing process and restore normal function as soon as possible.

If your symptoms are long-standing (more than 6 weeks) or recurrent you are likely to have developed weakness and instability in your spine and you may be a candidate for our specialised programme of intensive strengthening of the lumbar spine.

We are able to treat anyone between the ages of 18 to 80.
Treatment is as suitable for those with sedentary lives as it is for athletes - we have patients at both ends of the scale.

This list shows some of the the conditions that can be treated successfully using Natural Physical Therapy.

Lumbar strain

Herniated (prolapsed) disc

Sciatica

Degenerative disc (or joint) disease

Stenosis

Spondylolisthesis

Osteoporosis

Osteoarthritis

Hypermobility/instability

Scheuermann's disease

Many treatment methods help only with symptomatic relief but do not address the underlying cause of pain and therefore result in only a temporary solution.

That is why so many people with back pain find themselves in the "Pain Maze" confused over which therapy to undergo, or whether drugs, injections, manipulation or surgical procedures will indeed bring an end to the pain.

That’s why Back Trouble UK was formed, so that Back Pain sufferers could be both more informed and to be able to make a more informed choice of available therapies.

Craniosacral Therapy Whats it Mean?

Let me introduce Craniosacral Therapy, it is a non-invasive form of treatment that has its roots in the earliest days of Osteopathy, but has since grown and developed in its own right to become a powerful, yet subtle form of treatment.

At the beginning of the twentieth century, Dr. William Garner Sutherland, the founder of Cranial work, discovered that the different fluids and tissues (e.g. bones, muscles, organs etc.) of the body express a natural rhythmic motion that can be perceived through a light "listening" touch and can give the practitioner a wealth of information about the functioning of the body. This natural motion is considered to be a direct expression of the state of health of the individual.

Craniosacral therapy works through the practitioner helping to directly influence this most fundamental expression of health within the client. As such, it can be of great benefit to help relieve many physical, psychological and emotional conditions. Unlike other therapies, Craniosacral therapists do not try to directly resolve any symptomatic issues that might be present. Rather, they try to increase the level of available health within the affected area, and the body as a whole by re-establishing natural motion to the problem area. Due to the different experiences of our lives, these natural rhythmic motions may become restricted, or otherwise disturbed.

The more intense the experience (e.g. accidents, i llnesses, surgery, stress, trauma etc.), the greater the effect upon our body. This may lead to the development of various symptoms including reduced blood flow, increased levels of stress, lowered immunity, increased body tension as well as increased pain and dysfunction. It has been found that the most effective way to influence these natural motions, and to help restore the body to its optimum health, is through a light, non-invasive touch, without the use of massage, manipulation or other such techniques.

Where areas of restriction are found, the therapist will subtly encourage or enable the body's own potent healing forces to re-establish themselves in those places, leading to an overall return of healthy movement and function.

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.

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/

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.

www.backtrouble.co.uk/

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.

Call Back Trouble UK or simply Request a FREE Consultation?

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.

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

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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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.

Pregnancy Back pain

Answering "Help" - severe back pain in early pregnancy :

I am 6 weeks pregnant and last week I nearly passed out due to pains across my lower back, it was so intense I had to lay on the floor at work. I went to the doctors and he diagnosed me with a kidney infection and gave me pregnancy safe antibiotics.

The pain was still continuing and not lessening after id finished my 7 day course of antibiotics so I returned to the doctors who told me to go to casualty if I got the pain again. Soon after returning home I got the pains and went to the casualty at the hospital. They referred me to the gynaecology ward & took a blood and urine test & found no signs of a kidney infection and both tests were fine. They prescribed me some pregnancy safe painkillers and said that it was probably high hormone level or ligaments softening for pregnancy.

It has now been 9 days and I’m still suffering with such severe lower back pain that I cannot stand up when it comes, leave the house on my own, drive or go to work. The only symptoms I get are pain in my lower back that comes every 8-10 hours & lasts for about 15 minutes (no bleeding so not ectopic). I’m so upset and distressed now as I cant believe that the ligaments softening is so unbearably painful that I nearly pass out each time it happens and have to lay on the floor and I have no idea of how long this is going to last. The doctors aren’t very helpful either, as they haven’t given me any further medication or any definite answer of what it is. If this is "ligaments softening" has anyone had or heard of anyone suffering pain as severe as this? Please help because I’m at my wits end.

Little Lady one of the priorities of assessment of early pregnancy symptoms of pain and bleeding is to exclude an ectopic pregnancy, as it can result in loss of life. Traditionally, a history of pain disproportionate to bleeding with signs of pain on vaginal examination (cervical excitation) or reduced blood volume (hypovolaemia) will lead to a laparoscopy (See Gynaesurgeon.co.uk - Laparoscopy) to diagnose and treat the ectopic pregnancy.

Over the last ten years, the introduction of routine transvaginal scanning, rapid serum HCG estimation, combined with advances in laparoscopic surgery, has led to a major change in the way that we diagnose and treat ectopic pregnancy.

If the pain persists and you are distressed don’t think that all will work out! Please seek help, see a medical professional as soon as possible…GP ..

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