Dear Patients of Niseko Chiropractic.

Brent will be consulting in Sunabe Okinawa from the 22nd of Jan to the 3rd of Feb and then returning to Niseko from the 4th of Feb.

We apologies that Chiropractic will not be available for 2 weeks in Niseko from late Jan but Maki is still doing remedial massage over this time. If you are in Niseko and needing management of sporting injury we would suggest Niseko Physio over this time.

For online bookings please go to

https://niseko-chiropractic.cliniko.com/bookings?business_id=68869&practitioner_id=107247 

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

Are we moving less since covid ?

I don’t want to offer an opinion on the appropriateness of government interventions and lockdowns of fitness facilities and outdoor exercise classes during Covid-19 but an interesting meta-analysis published in the open British Medical Journal of sports and exercise medicine highlights the issue of decreased aerobic activity.

The articles reviewed 66 published research which nearly all concluded that peoples physical activity had dropped significantly during Covid whilst sedentary activities like watching television had increased.

It’s not just the gym closures, its the fact that people where no longer commuting as much which means less trips to the bus top, less walking around workplaces and just doing less exercise in general.

This problem becomes even more pressing when you consider the new evidence outlining just how strong a predictor obesity is of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) and mortality rates itself ( 2 ).

It’s estimated that western populations now face obesity rates of over 40% and several large studies point to obesity being a direct risk factor in the need for ventilation and other more higher level interventions. The risk of obesity can be summed up nicely by the graphic below.

From a public health perspective the issue of getting populations moving more and loosing weight is now more pressing than it ever was and if any good can come out of Covid the need to focus more on lifestyle medicine is more pressing than it ever was.

I’m guilty

So if you somebody like the me that lost their routine through Covid. At the start of all this they closed the dodgy little Kutchan gym that suited me needs nicely. The strange this is now it’s semi-reopened I still have not been back. Funny how good habits can be broken so easily and bad habits seem impossible to shake.

And if you share  complaints like me that me left knee and other little niggle points are now really sore since stopped my rehab program then I hope you may join me in trying to get our exercise routines back in place as we past the peak and start to move to final stretch of these crazy times.

If you would like to discuss this further or make an appointment with an english speaking chiropractor both in either Niseko or Okinawa you can so here 

References

1. Stockwell S, Trott M, Tully M, et al
   Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review
   BMJ Open Sport & Exercise Medicine 2021;7:e000960. doi: 10.1136/bmjsem-2020-000960

https://bmjopensem.bmj.com/content/7/1/e000960

2. Kwok S, Adam S, Ho JH, Iqbal Z, Turkington P, Razvi S, Le Roux CW, Soran H, Syed AA. Obesity: A critical risk factor in the COVID-19 pandemic. Clin Obes. 2020 Dec;10(6):e12403. doi: 10.1111/cob.12403. Epub 2020 Aug 28. PMID: 32857454; PMCID: PMC7460880.

https://pubmed.ncbi.nlm.nih.gov/32857454/

How prevalent is Low back pain in the US military ?

As Niseko Chiropractic seems to be getting a lot busier in Okinawa I thought it would be worth doing some further study on the prevalence of low back pain in the US military.

And it turns out it’s pretty common. Well low back pain is pretty common anyway affecting up to 85% of adults at some point in their life for an extended period but military training puts some unique stresses on the body.

A high quality research paper published in spine examined the rate of lower back pain over 9 years and is considered the most in depth research on this issue.

They found that the average incidence of low back pain in US forces was 40.5 per 1000 Person years (1). A person year is basically just 1 year of military services. So if you surveyed 1000 military members for 1 year you would expect on average to have 40.5 recorded of documented lower back pain in that given year.

Interestingly the incidences where higher in women with 58.3 incidences per 1000 person years compared to 37.6 incidences  in men although experience in Okinawa makes me suspect that women may also be more likely to actually do something about their pain so maybe the actual underlying differences between the sexes may not be as large as the study suggests.

Age also played a factor with lower back pain pain most common in the 40+ age group ( 1). No significant differences in race was picked up by this study.

And what about service ? Interestingly the Army takes the poll position for the most lower back pain, followed by the Marines with Air force behind that. It would be nice to know what the differences between army training and marine training make up for this difference ( 1)

Perhaps not surprising the higher your rank, the less likely you were to experience back pain. The authors suggested this was most likely due to the more physically demanding roll of enlisted active duty.

Another risk factor they found was having had been married and then divorced.

Ok so what do about it

Firstly if you have chronic lower back pain don’t ignore. If your pain has not gone away in a few weeks to months it is unlikely to do so.

There as many treatments for lower back pain as there are causes and the truth is low back pain is complex and no modality has also the answers or comes out consistently better in the literature than other modalities.

As a Chiropractor I must be declare some bias here but a recent study did find some positive results in the treatment of a military for lower back pain (2). They looked at 110 personal at a Navy hospital in florida and found strength increased of about 5kg after 4 weeks of treatment and a reduction in pain and increase in ability to perform balance tasks.

Certainly Chiropractic stakes up as a good relatively low cost option for military members with lower back pain.

If you would like to discuss this further or schedule an appointment with an English speaking Chiropractor in Sunabe Okinawa or Niseko you can book online on the link below

www.nisekochiropractic.com/appointments

What about exercise ?

Niseko Chiropractic did a summary of great article on this topic a while back. You can read it below

Niseko Chiropractic Research update- The best exercises for chronic low back pain

References

1. The Incidence of Low Back Pain in Active Duty United States Military Service Members

Your not alone with a pregnancy headache

If you are experiencing headaches during pregnancy  you are not alone. According to a recent study published in the journal  Revue Neurologique about 1/3 in women in experience what’s known as secondary headache during pregancy which is higher than the general population.

The first challenge from a management point of is rule out the red flags and nasties.

Headaches are almost always caused so something we can manage but occasionally they can be the first sign of something more serious. Imaging such as an MRI scan of the brain can be a good idea if you suddenly experience a headache that never stops and you not usually a headache sufferer, headaches that wake you up, headaches that get worse when you change posture or also have fever.

If you have experienced any of the above it’s worth consulting your primary care physician and getting the more serious stuff ruled out.

But in all likelihood it’s not of the nasty ones and it’s just a plain pregnancy headache.

The next step from here is determine what sort of headache you have.

Whilst headache research is still evolving we can categorize headaches by patterns such migraine, cluster headaches, tension headache etc and this changes the out come and management a lot.

If you do present to Niseko Chiropractic with a pregnancy headaches it’s worth writing down ahead of time as much information about your headaches as you can think of. Does the headache present at a certain time of day ? Do you have any visual disturbances ? Does it present differently to the headaches that you usually have ?

Amongst pregnancy headaches vascular headaches are the most common with about 80% of headaches being related to hypertension ( 1), particularly in the 3rd trimester .

If you do have your own blood pressure cuff it’s worth checking your blood pressure during a headache to see if it’s related.  We also have to mindful of CVT and stroke but thankfully these are extremely rare. According to the paper only about 3 in 10,000 pregnancies’ will suffer from this problem.

Some good news if you are a migraine sufferer is the research indicates that pregnancy is more likely to decrease your frequency of migraine headaches rather than increase. 42-67% percent of pregnant migraine sufferers reported less headaches during pregnancy (1).

Tension type headaches

Around 12% of pregnant women will experience tension type headaches ( 1) With large fluctuations in hormones, extra stress, and postural stress of a rapidly changing body it’s no wonder than your body can feel overloaded and trigger a headache.

It’s been a pleasure to be working down in Okinawa in where I am now treating many pregnant patients again for the first time in a few years and certainly headaches are one of the most common problems we as chiropractors are called on to manage during pregnancy.

Tension headaches usually respond very favorably to decreasing the muscle tension in the traps and sub-occipital muscles in the base of the skull. It is thought that once of the su-0cciptal muscles go into spasm they further compromise there own blood supply sometimes causing the situation to escalate.  Often just some simple massage and sub-occipital release techniques can bring a lot of relief.

Cluster headaches

If you are a cluster headaches sufferer, firstly my condolences and deep respect. These little bastards are nasty and also very challenging to treat. The research of the prevalence of cluster headaches is very scant but apparently they like migraines tend to improve during pregnancy rather than get worse.

I wish I could say that Niseko Chiropractic can really improve these but my experience with non pregnant patients is that it can be very hit and miss, unlike tension headaches where we almost always get some improvement.

Don’t put up with it

In short, headaches during pregnancy are common and it’s important to first rule that out that we not dealing with anything nasty. If you are experiencing tension headaches these are the ones that are most likely to respond to Chiropractic treatment.

If you would like to schedule an appointment either in Sunabe Okinawa or Niseko with an Australian trained english speaking Chiropractor you can do so on the link below

www.nisekochiropractic.com/appointments

References

1. Headaches during pregnancy

S.de Gaalona A.Donnetb

Service de neurologie, hôpital Laënnec, CHU de Nantes, Nantes, France

https://doi.org/10.1016/j.neurol.2020.05.012

https://www.sciencedirect.com/science/article/abs/pii/S0035378720306226?via%3Dihub

Your head- It’s heavy and important

Chiropractors have long advocated for good posture.

It just seemed to make sense to us that our modern lifestyle and work habits are not helping our health. Research is finally catching up to explaining how poor neck posture can adversely affect your health.

Let’s consider your head. It’s pretty heavy.

In a average adult your head weights approximately 6% of your body weight (1)  so that’s nearly 5kg for yours truly or 11 pounds for my Okinawa clients :). Now imagine if you dangle an 11 pound bowling ball hunched over a computer screen. Just keeping your head up requires huge workloads on muscles really only setup for firing for few seconds. For every inch the head goes forward the stress on our muscles builds significantly.

A great study recently published in the International Journal of Occupational Medicine and Environmental Health reviewed 16 previously published studies and looked at the effect of forward head carriage on a very of health metrics.

What they found was really interesting.

Effects of poor head posture

1. The effect on your respiration-Forward head carriage was associated with lower lung volumes. It’s thought that the posture posture limits how much how lower ribs can move during inspiration. This makes our accessory muscles work harder and means we are not breathing deeply or efficiently.

2. Effect on muscle tone- Not surprisingly our neck extensors become short and week which is often a trigger for headaches. Other imbalances and areas of tension where found in accessory muscles once you start to carry your head to far forward.

3. Proprioception- This is our bodies ability to know where it is space just from accessing it’s own movement and tension. Imagine you close your eyes and try to touch your nose. The ability to do this comes from your brain able to interpret the amount of movement in your muscles and tension on joints and ligaments. People with forward head carriage also had poor proprioception. As your posture gets worse you become let aware of your body .

4.  Balance: Subjects with forward head carriage also had poor static balance. If you look at a ballet dancer or athlete they also have great upright posture. This is more than just looking good but also aids their ability to hold difficult poses.

5. Neck pain: One study looked at the question of ” Is forward head carriage a good predictor of neck pain ” and it turns out it is. The more your head starts to be forward of your centre line, the more likely you are to report higher pain levels. If you are experience chronic neck pain it’s really worth having your posture assessed for forward head carriage and starting an active rehab program to address this.

The article also makes a great point about our generation.

Normal may be not be correct anymore. In fact less than 10%  of subjects had neck posture that was considered ” ideal ” (1) So what’s happening here really is a generational problem. As we all grow up with computer workstations and Iphones being the new normal our posture is suffering.

What to do about it

Fortunately it’s not too hard to address the effects of forward head carriage.

1. Get adjusted !– I know this sounds a bit self serving but if you have an area of the spine that has been restricted for some time a short course of adjusting is still is the fastest way to get some movement back and allow you streamline the rehab process. But adjustments won’t fix the underlying problem nor are they are a substitute for an active care approach . That’s going to take some work on your part.

2. Address your work posture. I have been a big fan of the sitting standing workstations and whilst there are some great models around you can also build your own with simple materials. Be prepared to think creative and use what you find at 2nd stores. An interesting example below

3. Aim for 40 minutes walking each and everyday. You can split this up into 2 20 minute sessions if you like.

This topic has been covered in more detail here

The importance of walking

4. Stretch- The real causes of forward head carriage is rounded shoulders. As you shoulders roll forward your pecs and other anterior muscles become short and weak. We need open these back up. The 3 best exercises for this are the brugger self stretch, the chin tuck and the wall angels.

The Brugger self stretch

Chin Tuck exercise

These exercises give a really good stretch out of our tight anterior neck muscles.

Wall angles

A great exercises to open up the chest and stretch tight pecs

5. Stregthen

Here you want to look at building more strength in the muscles that pull our shoulders back. We are thinking things like rowing, seated row gym press and external rotation of the shoulder with free weights.

If you need anymore reason to consider improving your neck posture I hope the article mentioned may stimulate you further into action.

If would like to discuss this article further either down in Sunabe Okinawa or Niseko with an english speaking chiropractor ( well Australian anyway) feel free to book online at

www.nisekochiropractic.com/appointments

References

1. The impact of the position of the head on the functioning of the human body: a systematic review

Elżbieta Szczygieł 1, Natalia Fudacz 1, Joanna Golec 1, Edward Golec

https://pubmed.ncbi.nlm.nih.gov/32713947/

Chiropractic and headaches in Kids

Many people don’t realise that kids can also suffer re-occuring headaches as well as adults. It’s estimated that around 5% of 3 year olds suffer reoccuring headaches and by puberty this number is around 50% (1).

What up to now has been sadly lacking in the literature is any well designed studies that examine what role chiropractic may play in helping these patients.

In recent study published in the journal ” Chiropractic and manual therapies ” with good sample size of 199 children that experienced regularly headaches they were divided into 2 groups. One group received chiropractic manipulation and the other received a ” Sham ” treatment.

What they found was that the kids that received Chiropractic treatment had significantly fewer episodes of headaches with around a 20% improvement. No serious side effects were reported and the study concluded that given it’s relatively cheap cost and lack of side effects Chiropractic treatment for Children is a good first line treatment options for kids with recurring headaches.

Further research is needed to help classify what types of headaches in kids respond best to chiropractic treatment as there are many types of headaches out there and some seem to respond better than others.

If you would like to make an appointment in Niseko or now also in Sunabe Okinawa with Brent Verco you can do so on the link below

www.nisekochiropractic.com/appointments

References

1. Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7–14 years – a randomised clinical trial

https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00360-3

With 2020/21 dumping snow Niseko Chiropractic has been busy treating many injuries that did not occur on the ski slopes. Snow shovelling has to be up there somewhere high if not top of the list.

Sure you can probably use a shovel already.

Most of us would claim not to need a lesson on how to shovel snow. But like many everyday things such as ridding a bike or a few tips from people that have given it some more thought can be very helpful and can be make a big difference to how you feel at the end of it and also help your efficiency.

Tip number one is if you don’t have to lift the snow then don’t.

Have a look at the elderly residents of Niseko town that have mastered the art of not shovelling but rather just pushing it out of the way. When I first moved to Niseko I was amazed at how they would flock out of their houses within hours after a heavy or even during a heavy snowfall. There is method in the this approach as snow is so much easier to move when it is still powder snow and can be cast aside with the greatest of ease.

If you do find yourself needing to shovel then there a few things to consider.

Reflections from Chiropractic experience in  Okinawa

One of the great things about being able to work in Okinawa was to rekindle an interest in managing lower back pain through pregnancy and also shortly after.

Lower back pain is very common in pregnancy and usually peaks in the middle of the 3rd trimester with as many as 75% of women reporting pain in either the lower back area or lower down over the joints of the sacrum ( 1). Most women reported on average that this pain was rated as around 4/10 on a visual analog scale so it’s fair to say it hurts, and can make life pretty uncomfortable.

What causes low back pain in pregnancy

Surprising it’s not as well understood as you think.

One of the pain factors is the obvious one of the weight gain of a little human now growing inside your belly but its not just the weight but the way your posture changes that also causes more stress on your joints and ligaments.

There are also some hormonal changes at play. As your body prepares for pregnancy a hormone called relaxin readies the body for birth and soften the ligaments around our joints, particularly the sacro-illiac joints on either side of the sacrum.

Interesting the relaxin levels actually spike around the 1st trimester but it takes a few weeks for the effects to be fully translated in the body. The graph below is handy reference for the various hormones at play.

Then there are are also some genetic and invidual variations. If you already have a history of low back pain you are in more of a high risk group.

Talking about weight

One of the best predictors of pain in pregnancy seems to be one when you carrying over 15Kg of extra weight over your normal healthy weight (2) so if you are planning on getting pregnant or in the very early stages and are overweight it may be well worth your time to consult with a health profession on coming up with plan to address this.

Carrying a kilo’s was also associated with a much higher risk of developing pain that lasts months to years after birth. Interestingly researchers found that just a few extra kilos ( under 10 ) was so significantly related to low back pain so you don’t have to go crazy just make sure you are not over the 10-15gk of extra weight.

Exercise is medicine

There is also some good evidence that exercise therapy can reduce pain over pregnancy’s. The jury is still out on what seems to be most effective. Is it yoga or piliates or core work ? Crossfit ? Even from a good review of the literature published this year we still don’t know ( 4).

There was some weak findings that work on ” core ” was better than general exercises but What does seem to be most important is that you do something and that it’s safe. Try and find a qualified fitness instructor that really takes the time to understand your needs and most importantly pick something that you enjoy.

Manual therapy

Lastly I we should talk about the role of manual therapy. Many women report great results with Chiropractic or physio interventions right up to the birth. Whilst most of a chiropractors job is to get stuck joints moving again often in pregnancy we are faced with joints that may be too mobile.

As such the approach tends to change a bit from traditional chiropractic techniques to more lower force joint mobs and muscle work to increase comfort levels although I do find chiro adjustments can still be very helpful in the mid thoracic spine throughout pregnancy.

I guess I also have to bring the often misunderstand Webster technique. Webster is a chiropractic technique that has a system of analysis that involves leg length and SI joint checks and then some specific release work around the pelvic ligaments and the round ligament of the uterus. The Webster technique is not an ‘external cephalic version ” were the pressure is applied over the uterus itself.

Yes there is some anecdotal evidence from Chiropractors, proponents selling or teaching the webster technique ( major conflict of interest ! ) and mothers themselves that a potential breech birth was corrected soon after a webster procedure sadly this has not yet been verified in a well designed randomized controlled trial and it makes me slightly angry and disappointed that this study has yet to be done all these years later. It’s impossible to say from a research perspective how many of these births may have resolved by themselves and how many were directly helped from the Webster protocol.

Most of the benefit of Webster in my humble opinion is simply increased comfort around the pelvis and less pain levels.

So I think as Chiropractor webster is one tool of many for the evaluation of a pregnant patient we must be guarded in what we can state with certainty as to what it can and can’t achieve and I truly hope that in a few short years we have better published data in the research literature.

If you would like to schedule an appointment with an English speaking Chiropractor either in Okinawa or Niseko please go to

www.nisekochiropractic/appointments

References

1. https://www.painmanagementnursing.org/article/S1524-9042(20)30131-4/fulltext
2. https://pubmed.ncbi.nlm.nih.gov/31593058/
3. https://pubmed.ncbi.nlm.nih.gov/32011431/

A nice little summary of how to manage soft tissue injuries was recently published in the British Journal of sports medicine. PEACE in the first phase of injury and LOVE as thing start to turn a corner.

When I was at university the it was old about RICE but the use of ice and even too much rest for that matter may actually interfere with the bodies natural healing pathways. The inflammatory process whilst a sometimes a bit painful is actually the bodies way of creating the right chemical cascade to allow our injuries to heal at full strength.

The take home message here is in that acute phase make sure you protect the joint from further injury or take anti-inflammatory to quickly ( there are exceptions here and your GP for good reason may see a benefit ).

After a few days rest getting extra blood the area can actually be a good thing and the use of gentle walking for about 40 minutes, the use of an exercise bike or even aqua acrobics can be really helpful.

It’s often not a bad a idea to get an injury professionally assessed and I also amazed how much relief can often come by addressing some of the secondary spasms in surrounding tissues as well.

If you would like schedule a session with an English speaking chiropractor now in Okinawa as well as Niseko you can book online at

www.nisekochiropractic.com/appointments

If you would like to read the full article here is a link below

Soft tissue injuries simply need PEACE & LOVE

New Research hot of the press

If you have ever strained an ankle it’s a horrible feeling. What’s worse is that a small minority of acute acute ankle injuries go to become chronic. Balance and proprioceptive training has shown to be useful in rehabing ankle strains but what about when it’s too sore to stand on and why does balance training even work anyway.

Try the other leg !

Here is where things get a weird.

A recent study in the International Journal of the Care and Injured did something pretty interesting. They took a population of being with ankle strain on the right side and gave them exercise and balance training on the left side which had no injury. And guess what happened ? Well the injured side improved significantly even they did all there training on the other leg.

What just happened ?

It goes to prove just how important the brain is in recovery from an injury. The brain helps control the neural pathways that provide splinting reflexes and also control muscle growth and activity. By doing some training on the unaffected side the system improves bilaterally so that you can get still get benefit even when you don’t work on the injured site.

Well ok What does this mean for me ?

It doesn’t mean we should all start working on the other leg.

What it does mean is that proprioceptive training is really important in dealing with a chronic ankle injury and also that a significant part of healing lies in a reflexes muscle tone and splinting reflexes.

So if you have an injury that is too sore to stand on it may be a good idea to at least start working on the side that can comfortably bear weight.

Please don’t give up on your chronic injuries ! There is often always something you can do and even though sometimes getting older can be an exercise in patience and niggle management it’s almost always trying something even if you can improve something rather than completely fix it.

References

https://www.injuryjournal.com/article/S0020-1383(20)30800-7/fulltext

The forgotten message

Interesting article about the importance of a good diet during the whole covid-19 pandemic.

Whilst I think it’s a stretch at this point to think you can change your chances of getting covid with your diet you can make a drastic change in your chances of a better recovery with a good diet.

A healthy diet lowers the amount of what is known as meta-inflammation in your body. Having a body that does not have a chronically high level of baseline inflammation may put you in a better position to avoid the cytokine storm that has been an issue for some covid patients.

Likeways make sure you are doing some moderate to high cardio-vascular exercise a few times a week to ensure you have a good residual lung capacity.

Have the governments not given enough attention to this simple thing that the world needs to do anyway  in their covid-19 messages to the public ?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284818/

Just a reminder that Niseko Chiropractic is available for mobile consultations over the Niseko summer as well as appointments now available at the kutchan studio run by Powder yoga.

For online bookings go to

www.nisekochiropractic.com/appointments