References

Niseko Chiropractic research update

There are 2 questions that Chiropractors get asked a lot

1. What is the cracking noice ?

2. Does it matter ?

The first question is lot easier to answer than the 2nd one.

In a health joint the joint is essentially a sealed cavity occupied by a small amount of synovial fluid that acts as a lubricant and also carries nutrients around the joint. This is why it’s important to stay hydrated but that’s a topic for another blog !

When you rapidly expand a joint, as happens in spinal manipulation and ” cracking ” your knuckles the space suddenly gets much larger. Becuase the pressure in the joint and fluid drops very rapidly gas comes out of the liquid which causes a ” popping sound ” . Think of it a bit like the bubbles in a can of Coke. when you pop the lid you decreased the pressure and gas comes out.

What the noise certainly isnt is bones cracking. If that was to occur we are going to have to call our malpractice insurer but in 20 years of doing this and over 20,000 treatements delivered I am happy to say this has never happened !

Does it matter ?

Short answer is probably not.

In a meta- review published Octber 2022 Morman and Newell reviewed 5 quality studies on the subject and concluded that the presence or absense of a ” pop ” did not have any measurable outcome on patients pain levels after a series of treatments.

Most chiropractors ( and patients )  including myself would propably prefer to hear it as it let’s us know that we have provided the joint with the right amount and direction of thrust to create a neurological response that is only seen in high velocity low amplitude thrusts otherwise known.

What is more important is that the joint ” free’s up ” a bit after a therapuetic intervention and this can be achieved by many different methods. So there is good news too if you are one of those people reading this that prefers the lower force techniques. It’s quite possible that techniques not incorporating the “pop ” are still just as effective.

This is probably yet another example of why Chiropractic needs to attapt and change in light of new evidence. There are plenty of the ” old guard ” that will go noise hunting to make that joint sing rather than bother to retest the joint and see if there has been a change in tone and range of motion.

And once again that old cavete. There are probably times when it probably really does matter too we just don’t have any good way of indentify what those clinical presentations may look like and how to correctly identify them.

The good news is it’s your body and that puts you in a unique to postition to help practioners understand what works best for you.

References

1. https://chiromt.biomedcentral.com/articles/10.1186/s12998-022-00454-0?fbclid=IwAR0LKs3v5DI7d5450DDHWXB65vnPZ5OA6wgpMza387d6yO6cU9OmPc0TszM#citeas

2. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119470

The Effectiveness of Compression stockings- Research review update

It’s pretty common to see many athletes, particularly runners and cyclists training in Compression stockings hoping to get some extra performance or reduce pain. But are they effective ?

A recent research review published in the Open Access Journal of Sports medicine attempted to answer this question.

What they found when the looked at about 183 studies on this issue is that there is little evidence that they increase athletic performance by such things as improving your lap time etc. They is some weaker evidence that they help muscle recovery the next day but not much to say they reduce discomfort whilst you are competing.

If you are training in winter environments there is some benefit in keeping you warmer whilst still be very light and we have good reason to think they don’t do any harm or pose any risks. There doesn’t seem to be much affect on blood flow despite some manufactures making these claims.

In a nutshell if you find compression garments comfortable to compete in and you find some benefit in wearing compression garments you should continue to do so but they may not be the secret weapon that some clothing manufactures claim.

References

https://link.springer.com/article/10.1007/s40279-021-01604-9?fbclid=IwAR1M7rzQZ4VEVmfXl6_1uES5Sj19F5H7VJFKYDk66GkTjUstFX4jr0kU2qM

It’s late November up in Niseko and with the snow starting to fall and the house quiet it seemed like a good idea to catch up on some study.

In 2020 the Journal Spine ( Considered the most prestigious Journal for back pain in the world ) released a very comprehensive summary of the research  around what modalities work best for low back pain, which ones are not that useful and what really helps from  a diagnosis point of view.

It’s mainly written for practitioners and researchers but if you did want to dive in yourself here is a great summary of the state of lower back pain research.

https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Clinical-Guidelines

If you don’t want to read all 217 pages you will be forced to hear the summary thoughts from yours truly.

Well what works ?

The authors graded the evidence from hundreds of studies into an A ( really sure ) B ( probably helps ) and I ( conflicting results ). Nearly everything was an I. As a humble practitioner this is somewhat reassuring. None of the trendy new therapies like ” pain science ” and some of the cognitive therapies really faired no better.

To me it really shows the importance of identifying sub-groups. For example say you gave 100 Patients with short term lower back pain a trial of Chiropractic and 80 had no improvement,  17 had some good improvement and 3 reported their symptoms got worse. When you crunch the statistics you may find that your study concludes no significant improvement with spinal manipulation.

But 17 did. What if you had a way to identify what these 17 patients had in common and made sure they got the Spinal manipulation whilst you directed the other 80 into other directions ? This is where the research is headed and we do have some early indications that there are some key factors.

There was also so B grade support for Yoga so if you have lower back pain it may be worth trying Yoga in conjunction with whatever else you chose to have a go at.

There also seems to be at this point in time no research consensus on what modality offers the best value for money and return on investment. My opinion on this is lower back pain is going to be so suited to your individual circumstances that any findings would never be applicable to an individuals choice anyway. These sort of questions are really more useful to governments and policy makers.

Can lower back pain be predicted ?

Another interesting question is can the research tell us if somebody is likely to have lower back pain based on their imaging or examination findings. Again the cruel lash of research indicates that this relationship is very poor.

What does seem to stand out as a good predictor of lower back pain is…….. ( drumroll) a history of lower back pain. If you are presenting to a practitioner with lower back pain there is fair chance this issue may pop up again for you.

What about Sprays and Gels ?

Suprisingly there was good support in this study for capsican sprays and patches but only a few studies where mentioned so don’t go putting all your eggs in the chilli basket just yet.

Getting back into running after birth

A common question Niseko Chiropractic is often asked is ” when is it safe to return to running after birth ” . Of course this question is different for everybody but a great blog has just been published by experienced Pelvic floor physiotherapists by the British Medical Journal that addresses question.

The article in full can be found here

Ready, steady…GO! Ensuring postnatal women are run-ready!

So what did they find ?

Firstly the damage that birth can do is highly variable but their research found that damage to the pelvic floor area is far higher than we probably imagine. They found that between 15-30% of new mums experience some level of urinary  incontinence after birth (1)  and a whopping 50% have some degree of organ prolaps with a 6 month follow up.

One pelvic floor muscle known as the  levator hiatus takes up to 6 months to recover full strength. caesarean birth too should not be underestimated with studies showing that by 6 weeks only about 50% of abdominal muscle strength had returned ( 2).

In a nutshell  it’s important that a recovering system is given the right time and rehab before increased demands are placed up on it. Whist jogging may seem gentle enough it’s thought to significantly increase the stresses on the body.

It has also been reported that ground reaction forces of between 1.6 and 2.5 times bodyweight can occur when running at a moderate speed of 11 Kilometers/hour. (2) There is some concern amongst experts that the stresses of jogging may be be enough to further damage recovering muscles and ligaments before they are fully healed.

So when should a women re start jogging ?

The cited blog recommends this handy diagram below. Essentially they are suggesting waiting 3 months or going through the flow chart if less than 3 months.

Something that seems to be missing from the above chart and the literature is previous activity levels.

If you are already an avoid jogger with great form and jogged right up to your pregnancy’s slowed you down you most likely will be weeks rather than months if no complicating factors are present.

Likewise if you have never jogged before but figure it might be a great time to start to lose those post pregnancy’s weight you are probably going to need to much slower start.

In short this article sheds some light that all stake holders are probably underestimating the stresses on the pelvic floor from pregnancy  and there may be some merit in a considered approach to return to exercise.

Some risk factors to be aware of

In closing

Whilst Niseko Chiropractic would love to be part of your  post partum management team we do not consider we have the necessary skillset in pelvic floor management and do suggest you find a good pelvic floor physiotherapist to assist with any specific complaints in this area.

If you would like to make an appointment in Sunabe Okinawa or Niseko with an english speaking chiropractor here is a link below

https://niseko-chiropractic.cliniko.com/bookings?business_id=94455#service

References

1. https://blogs.bmj.com/bjsm/2019/05/20/ready-steadygo-ensuring-postnatal-women-are-run-ready/

2.Milsom, I., Coyne, K., Nicholson, S., Kvasz, M., Chen, C. and Wein, A. (2014). Global Prevalence and Economic Burden of Urgency Urinary Incontinence: A Systematic Review. European Urology, 65(1), pp.79-95.

3 . Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, pp.220–5.

It’s a commonly held belief that running whilst good for the heart etc may actually damage your hip joints and lead to early arthritis.

But it’s just that. A belief.

Okinawa and Niseko ( well in summer anyway ) are both great places to get out bust out some Km’s under foot so it’s good that researches finally directly addressed this question.

Well does it ?

Probably not. The authors found  no difference in the wear and tear on the hip. between the amount of running you do and the damage in the hip joint when undergoing an MRI scan.

The published research time and time again fails to find much of a link between the volume of exercise and the wear and tear on the joints. It seems that our bodies are better then we give them credit for at repairing the damage done and the increased blood flow extra lubrication produced via increased levels of synovial fluid ( joint grease ! ) helps too.

So get moving

The  recently published article looked at the differences in MRI findings on 3 asymptotic groups

1. People that don’t run
2. People that run moderately
3. People that run a lot

The article does have some limitations such as a small sample size and they didn’t look at runner that may be overweight or have other risk factors to joint degeneration.

The article still lends weight the idea that most of us can and should exercise regularly and running is not likely to dramatically increase wear and tear in the hip joints.

References

Many elite athletes Niseko Chiro treats both in Niseko and Okinawa swear by the benefits of sports massage but the research literature is unclear on just what the benefits may be.

A recent meta-analysis on this topic was published in the British Journal of Sports Medicine

The study examined 29 published research papers  on the topic and concluded that there is no much published evidence that athletic performance may be increased by incorporating sports massage but there are some studies that conclude that recovery and flexibility may be improved with regularly deep tissue massage.

The research review also found there may be a small benefit in the recovery time of delayed onset muscle soreness (DOMS) if sports massage is used in your athlete routine.

Absence of evidence is of course not evidence of absence and if you are an athlete that feels like getting sports massages increases your performance there is no certainly no reason to doubt this may be true, just not enough evidence to conclude it is true.

There is certainly still a good argument that good deep tissue work after an event or your peak required performance is good idea to keep your muscles in top working order.

If you are new to sports massage, then of it just like regularly massage but with much deeper targeted pressure that seeks to make physical changes in the tissue rather than being relaxing and feeling good.

If you would like to discuss this study further or make an appointment with an English speaking Chiropractor in Okinawa or Niseko you can check our schedule on the link below

Niseko Chiropractic Online bookings

References

1. Davis HL, Alabed S, Chico TJA
   Effect of sports massage on performance and recovery: a systematic review and meta-analysis
   BMJ Open Sport & Exercise Medicine 2020;6:e000614. doi: 10.1136/bmjsem-2019-000614

   https://bmjopensem.bmj.com/content/6/1/e000614

Research update on Patello-femoral syndrome

If you are like me you probably have recurring  knee pain in least of your ” punching bags of the lower limb”. In fact it’s so common that one of my recycled jokes is ” Remember when you were young enough to call your knees left and right instead of good and bad”.

Knee pain is only 2nd to low back pain in it’s commonality. According to a great meta-analysis of 22 published trials with over 1472 participants the most common cuase of knee pain is known as Patello-femoral syndrome ( PFP) ( 1)

This basically translates as pain in around the kneecap that gets worth exercises such as stair climbing or jogging. It differs from some other knee complaints in that it’s not related to a tear of your internal ligaments or cartilage disc, but rather comes from irritation of ligaments and muscles around the patella.

Nearly 40% of those with PFP continue to experience symptoms after 2 years, which is associated with frequent use of pain killers, lowering of physical activity levels and low quality of life.

So what works ?

Well we know what doesn’t work.

Doing nothing.

Just ignoring knee pain and hope that it’s gets better is the poorest outcome. The wait and see approach has the poorest outcome from the all interventions mentioned and my personal experience is once knee pain has set in for months to years it’s probably going to hang around for the long term unless you take an active approach.

There has been a trend to ” patient education ” and a lot of more passive modalities recently in the industry but this study fails to find that these are any better than exercise.

Given that you get a whole lot more benefits from exercise plus the pain the reduction the position of Niseko Chiropractic is that a knee specific gym training exercise under the management of well qualified personal trainer is still the best option. I was I could say that just seeing a chiro for chronic knee pain would get you sorted but honestly in this area exercise seems to trump physical therapy.

Some of my favourites that help me manage my dodgy left knee are this article here

What exercises are best to prepare for a Niseko ski trip ?

References

1. Winters M, Holden S, Lura CB, et al
   Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis
   British Journal of Sports Medicine 2021;55:369-377.

   https://bjsm.bmj.com/content/55/7/369#T4