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Lumbar Disc Herniation (aka slipped disc )

The spine is a very, very strong part of your body. It is made up of solid pieces of bone known as vertebra, joined together by softer pads or discs which act as shock absorbers and maintain flexibility.

The spine is then reinforced by strong ligaments and also surrounded by powerful muscles for support.

By far the most common type of back pain is ‘mechanical’ back pain. This means that the pain is coming from the spinal muscles, joints and ligaments.

Although it can be extremely painful and make even small movements difficult, ‘mechanic’ back pain is not related to any serious underlying condition and there are no trapped or compressed nerves.

Simply put, the pain is from stiff or restricted spinal joints and tight spinal musculature. And it is usually quite a simple condition to treat.

Less frequently, the nerves of the back can become irritated, trapped or compressed by a prolapsed disc or a herniated disc also referred to as a ‘slipped disc’.

The intervertebral disc sits in the space between the bones which make up the spine. The disc normally acts as a shock absorber. It is made of two parts. The center, called the nucleus pulposus, which is spongy and provides most of the shock absorption and the outer strong ligament rings surrounding it, called the annulus fibrosus.

A disc herniation happens when there is a weakness or injury to the outer fibers allowing some of the spongy material to ‘run out’ causing pressure/irritation to the nerve root as it leaves the spine.

In the lower back the most commonly injured discs are the one between the 4th and the 5th lumbar vertebra, the L4/5 disc or the one between the 5th lumbar vertebra and the sacrum, the L5/S1disc. This tends to put pressure on the L5 nerve root or the S1 nerve root ( trapped nerve) and sends severe pain down the leg. This is often referred to as sciatica.

It may also be associated with numbness, pins and needles, tingling and even weakness in some of the leg muscles.

A thorough examination is usually enough to diagnose a lumbar disc herniation but at times we may refer you out for a MRI scan.

Golfers Elbow

The condition known as golfers elbow is similar to tennis elbow in that it is the result of injury to the tendons around the elbow joint. The main difference is that it occurs on the inner portion of the elbow where tennis elbow occurs on the outer portion. The condition is known clinically as medial epicondylitis, and is characterised by pain and inflammation to the tendon holding the muscles to the inner part of the elbow.

Golfer’s elbow is usually caused by overusing the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist. Repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons.

Golfers frequently exhibit the condition, hence it’s name. However, any repetitive motion that puts undue stress on the muscle group can cause the condition. This includes DIY, bowling and basketball.

Symptoms of golfers elbow include swelling, tenderness, and local pain that may run down the forearm and into the wrist. The pain might prevent you from doing simple things like holding a glass to your mouth, lifting shopping bags or opening a door.

As well as treating your elbow, a chiropractor will always check your neck for any dysfunction, as a loss of spinal movement can lead to a weakness in the arm muscles. This is often an underlying cause as you stand a greater risk of incurring golfers elbow if you have weak forearm muscles and then engage in some sort of activity that puts a lot of strain on your elbows.

Frozen Shoulder

Frozen shoulder aka Adhesive Capsulitis affects nearly 3% of the adult population at one time or another.

Most cases occur in people between the ages of 50 and 70 and it affects more women than men.

Frozen Shoulder
It is a very, very painful condition that happens when part of the Glenoid Humeral joint capsule, a big ligament, becomes too small for the joint. This causes severe restriction of all shoulder movements, hence the term ‘frozen shoulder’.

The condition is believed to be caused by scar tissue that forms within the shoulder. If treatment is sought right away, the pain and stiffness can be mitigated and recovery time can be faster. The longer one waits to get treatment, the longer recovery takes.

Most cases of frozen shoulder follow a three- phase process. The first phase can last up to nine months and includes gradually increasing pain and stiffness. The second phase is marked by a reduction in pain but a decrease in movement possible. It can last between 4 and 12 months. The final phase is the healing phase in which the shoulder gradually repairs itself. It can take 1 to 3 years to complete.

But the good news is that conservative treatment in most cases will speed up the recovery.

Chiropractic treatment for a frozen shoulder involves mobilization of the shoulder joint itself, trigger point therapy, massage and stretching of the surrounding muscles,  and the application of heat/ice.

The function of the neck, upper spine and rib cage will also be assessed and some home exercises will usually be prescribed.

Acute and Chronic Back Pain

Acute back pain is defined as that which is of less than four weeks duration. Chronic back pain is that which exceeds twelve weeks.

There are a number of causes of back pain including muscle and joint strains and sprains, poor posture or postural abnormalities, being overweight, different forms of arthritis, trapped nerves, bulging or herniating discs, or fractures.

Acute and Chronic Back Pain

A chiropractor will undertake a full and thorough case history and examination which includes relevant orthopaedic and neurological testing to determine the cause of the pain. If necessary they will also arrange x-rays or other forms of imaging.

The majority of cases can be treated effectively with chiropractic care, however if any underlying pathology is thought to be the cause then the chiropractor will refer as appropriate.

Chiropractic treatment of acute and chronic back pain involves manipulations and mobilisations of the joints of the spine combined with various soft tissues techniques to restore the normal biomechanics, and reduce inflammation and pain.

We also give specific stretch and strengthening exercises to suit your condition.

Tips On How To Fit Exercise It Into A Busy Life

Finding the time to exercise can be a real challenge. If your days and evenings are busy, busy, busy it can seem impossible to find the time to exercise……

Try getting up 30 minutes earlier twice a week or find a ½ hour exercise video on Youtube that you can do after work in the comfort of your own home. You could then take a brisk walk to the train station or bus stop or go for a brisk walk in your lunch break.

Here are a few suggestions on how to fit exercise into your life and more importantly how stick to your new routine.

1.  Timetable

Make a timetable for yourself – write it down – stick it to the fridge or put it on your phone and remind yourself that working out is a priority worth keeping.   The truth is that when we really need to we can leave the office a bit earlier or get up an hour earlier.

2.  Efficiency is the Key

Choose a workout that you can do almost anywhere, whether you’re travelling to or getting home from the office late. Ideally, this will be a form of exercise that doesn’t require much preparation (maybe save the rock climbing for the weekend) and that accomplishes significant physical gains in a short period of time (sorry, golfers). High-intensity interval training, bodyweight exercises and running are all great choices.

3. Do what YOU Like!

If you hate running or gym classes – that’s okay.  We all need to be realistic and to know what our likes and dislikes are. Some people love running and other people love yoga, weight training or dancing.  Make it easier on yourself by choosing a form of exercise that fits your lifestyle, personality and taste. Not sure what exercise you may enjoy? Don’t be afraid to experiment and try different forms of exercise until you find what works best for you.

4. Be Competitive!

Competiveness can be a motivator to exercise on a regular basis.  Join a club or get your friends involved.  It is possible to find a team or competitor suitable to your skill level in almost any sport you choose.   Sign up, set a target and notice what it does to you-it might well be the push you need to keep yourself in the game.

5. Monitor it

Measuring your progress can help you to stay on track and show if you are slipping.  Make a note in your calendar or check your timetable every time you work out, and add up your workout sessions at the end of each week, month and year and this will identify areas for improvement

6. Some is Better than None

We can all find a few free minutes in our busy days to fit in an effective exercise program which, when done frequently enough, will do wonders for our body and mind.

Lumbar Spine – Lower Back

The lumbar spine has five lumbar vertebrae which are numbered L1, L2, L3, L4 and L5.  These vertebrae make up the lower back portion of the spine and are aligned in a reverse “C” like the cervical spine, creating a normal lumbar lordosis.  The five lumbar vertebral bodies are the weight-bearing portion of the spine. The vertebrae are much larger in diameter compared to the thoracic and cervical vertebral bodies. The upper lumbar vertebrae, L1, meets the bottom of the thoracic vertebrae, T12, located below the shoulder blades and the lower vertebrae, L5, sit atop the sacrum, which is a triangular bone forming part of the pelvis.

The lumbar discs sit between the lumbar vertebra and a healthy disc is cushiony, with a lot of water, and has a sponge-like substance. It acts like a shock absorber in the spine, allowing flexibility and providing protection from jarring movements.

The lumbar spine’s lowest two spinal segments, L4-L5 and L5-S1, which include the vertebrae and discs, bear the most weight and are therefore the most prone to degeneration  and injury. This is the reason why most disc problems (disc protrusion, discus prolapsed) occurs to the disc between L4 and L5 or to the disc between L5 and the sacrum (S1) and why it’s the area of the lower back most commonly affected by wear and tear/osteoarthritis.

The lumbar spine is built for both power and flexibility – lifting, twisting and bending and the joint between the L5 and S1 is of most importance as it allows for considerable rotation to enable the hips and pelvis to swing when the body runs or walks. Because of the anatomy and the importance of the lower part of the spine, this is an area of the spine which chiropractors treat very frequently and fortunately most of the problems here are mechanical in nature.

Mechanical back problems mean that the pain is coming from restricted or stiff spinal joints with overlying muscle spasm and back pain treatment often involves gentle adjustments to the back, stretching and soft tissue techniques to free up the restricted/stiff joints and relax the surrounding muscles.

There are nerves that branch off from the spinal column at each level of the spine. They pass through small holes in the back of the lower spine. They then connect together to form the sciatic nerve, which travels into the legs down the back of each thigh and into the calves and feet.

Sometimes degenerative disc diseases to the spinal structures or disc herniations can cause irritation to or put pressure on one of the nerve roots in the lower back. This is often referred to as sciatica.  Spinal disc herniation pressing on one of the lumbar or sacral nerve roots is the primary cause of sciatica.

Sciatica is a relatively common form of low back and leg pain, but the true meaning of the term is often misunderstood. Sciatica is not really a diagnosis but more a set of symptoms caused by the nerve pressure/irritation and a patient’s pain and specific sciatica symptoms depends on where the injured/irritated nerve originates in the lower back.

Treatment for sciatica or sciatic symptoms depends on underlying cause and the level of pain.  A thorough examination will determine this.

Sciatica can be caused by compression of the sciatic nerve roots by a herniated (torn) or protruding disc in the lower back, wear and tear/osteoarthritis, tightness of the piriformis muscle (piriformis syndrome), pregnancy and trauma.

Conditions often associated with the cervical spine that we treat include:

Low back pain, low back pain with pain radiating down the leg, trapped nerve in lower back, disc protrusion, disc herniation, pulled muscle, low back stiffness, sciatica, piriformis syndrome, hamstring problems caused by low back dysfunction, pain around the hip area.

Using an iPad can give you Neck and Shoulder Pain

The iPad has revolutionized the way we all surf the web, watch videos, catch up on our emails and play games, however be aware that the way most people handle the tablet can lead to chronic neck or shoulder pain and even headaches.

Since the ipad came out we have at the clinic certainly seen an increasing number of people complaining of a sore neck, shoulder tension and cervicogenic headaches (headaches coming from the neck)

It is the looking down for extended periods with the head being held in a forward position that is the cause of the problem. This position loads the discs in the neck and puts a lot of strain on the neck muscles and ligaments which can over time cause a neck problem.

The worst posture for tablet computing is holding the device in your lap since it forces you to bend your neck significantly. Therefore, avoid sitting with the iPad on your lap as this position puts the greatest amount of stress on the neck muscles.  Instead put a couple of cushions on your lap and place the iPad on top, as this will make you sit in a more upright position.

Or even better, place your iPad on a table or other surface that raises the height of the tablet and consider connecting a separate keyboard to the device while typing. This position places the least amount of stress on your muscles, discs and ligaments which will help prevent neck, back and shoulder pain from iPad usage.

Get Ready for the Ski Slopes

The ski season is well under way and it’s very important to properly look after your body when you are hitting the slopes.  Skiing injuries occur, not just as a result of falls, but also as it is a seasonal sport often the muscles are not used to the type of activity. If you will be skiing this season it is important to prepare, to help you stay safe in the snow.

Before going on holiday:

  • Keep moving – Improve your fitness levels. Spend time in the gym, in particular on the cross trainer and exercise bikes, rowing and step machines. Core exercises such as plank, lunges and squats will all get the right muscles working.
  • At the very least going for a brisk walk will help improve cardiovascular health. Other tips such as taking the stairs instead of the elevator, walking to work etc., any chance you can to get the heart rate up.
  • Improve your flexibility by taking the time each day to stretch, especially after exercise.
  • Balance is key, if you have access to a wobble board then use this to improve balance, if not you can try standing on one leg, you can even multitask and do this whilst brushing your teeth or doing the washing up!
  • Get your posture and spinal function checked out by one of our chiropractors. You may even find this improves your technique on the slopes as you will be more balanced. Chiropractors will check your spine and use specific manipulations and mobilisations to remove any restrictions or fixations helping you to move more freely. This again helps to prevent injury.

During the holiday:

  • Make sure to warm up before hitting the slopes, and finish off the day with a good stretch.
  • Rest up – fatigue is one of the main causes of injury. Make sure to get plenty of sleep each night and take breaks during the day.
  • Increase energy intake – be sure to load up on carbs as required when exercising at altitude. Dried fruit, cereal bars and nuts are all good sources of carbohydrates.  Low carb intake can lead to fatigue and therefore an increased risk of injury.
  • Avoid dehydration – this is a common problem as fluid is lost more easily at altitude combined with the extra physical exertion of skiing. Apres ski activities frequently involve alcohol which will also dehydrate you. Make sure to drink plenty of water to keep you hydrated.
  • Appropriate equipment is key – well fitting ski boots and bindings, warm and waterproof clothing and helmets are all recommended. Those with little or no experience should always get advice from a qualified instructor.

Advice For Parents : Children Need to Practice Good Computer Ergonomics, Too

In the UK, 40% of 11 to 16 year olds have already suffered from back or neck pain which in most cases is a direct result of using a laptop, tablet or computers combined with carrying heavy schoolbags and not getting enough exercise.

This scary statistic really does sum up the importance of teaching kids good habits and how to achieve proper ergonomic posture to prevent injury when using computers for extended periods.

If children and adults in your home share the same computer workstation it is important to make certain that the workstation can be modified for each child’s use.  Computer workstations that don’t fit a child’s body during the developing years can have harmful physical effects that can last a lifetime.

Computer Ergonomics for Kids:

  • The chair should fit the child correctly. An ergonomic back cushion, pillow or a rolled-up towel can be placed in the small of the child’s back for added back support. There should be two inches between the front edge of the seat and the back of the knees. If possible the computer chair should have arm supports so that the forearms are supported..
  • Position the computer monitor so the top of the screen is at the child’s eye level. This can be done by taking the computer off its base or stand, or having the child sit on firm pillows or phone books to reach the right height.  Also make sure there is adequate lighting to reduce eye strain.
  • The computer mouse should be close to the keyboard and close to the edge of the table to prevent the child from sitting with an outstretched arm. Wrists should be held in a neutral position while typing and not angled up or down.
  • The child’s knees should be positioned at an approximate 90 to 120 degree angle. And the legs should not be dangling but rather the feet should be placed on a foot rest, box, stool or similar object for support.
  • Limit your child’s time at the computer and make sure he or she takes regular breaks every 45min during computing time.
  • Your child’s muscles need adequate hydration to work properly and avoid injury. Encourage your child to drink at least four 8-ounce glasses of water a day. Carbonated beverages, juices and other sweet drinks are not a substitute.
  • Also get in touch with the child’s school to make sure good workstations are in place and education on correct computer ergonomics is a priority.

Keeping your back strong and supple is the best way to avoid getting back pain. Regular exercise, maintaining good posture and lifting correctly will all help prevent future problems.

Mid Back Pain

Mid back pain refers to that which occurs between the bottom of the neck and the lumbar spine (lower back) and is also known as thoracic pain. The thoracic vertebrae articulate, or join, to the ribs and form the rib cage, or chest, which protects the internal organs.

Most commonly mid back pain originates from strain of the facet joints which lie between the vertebrae (bones of the spine), irritation of the muscles that attach to the spine or problems with the soft tissues, or at times the rib joints.

Mid Back Pain
These problems can arise from poor posture, sitting at a computer for prolonged period of time, carrying heavy backpacks, overuse injuries, or trauma from falls or rugby tackles.

Mid back pain can also be referred from the neck, or due to a more serious underlying pathology. Your chiropractor will carry out a detailed examination to determine the cause of the pain and refer to an appropriate healthcare professional if necessary.

Rib pain can occur as a result of injury, or inflammation of the muscles and joints that connect the ribs to the vertebrae of the spine, and to the sternum (or breastbone), at the front. It can also be a result of straining the joints of the rib cage from coughing or sneezing.

Chiropractic treatment is very effective for mechanical mid back pain. Treatment involves manipulations or mobilisations of the joints to restore normal movement and function and decrease muscle tension and pain.

Chiropractic treatment also works to correct postural changes and often exercises to increase core strength and stability are recommended. This all helps to improve function and general wellbeing.

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