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.
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
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
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
People that don’t run
People that run moderately
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.
Horga LM, Henckel J, Fotiadou A, et al
3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners
BMJ Open Sport & Exercise Medicine 2021;7:e000997. doi: 10.1136/bmjsem-2020-000997
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
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.
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
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.
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
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
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
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.
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
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.
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.
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.
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.
A great exercises to open up the chest and stretch tight pecs
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
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
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.
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
The with the all the understandable focus on Covid-19 right now it’s vital that we don’t loose of the ground that lifestyle medicine was begging to have on increasing the worlds ageing population.
And we are getting older. Right now 8.5% of the world’s population is over 65 and this will balloon to 17% by 2050 ( 1). That means for just under one quarter of the worlds population, me and perhaps even yourself keeping our bones strong and healthy should be one of life’s goals as we age.
Research from the lifestyle medicine field has shown the importance of healthy eating in maintaining strong healthy bones. One of the leading candidates to assist Omega 3 fatty acids or more commonly know as omega3 oil.
Our bones are constantly being remodeled.
Osteoclast cells are constantly breaking down and absorbing old brittle bone and osteoblast cells are constantly laying down new stronger fresh bone.
If they are forced to operate in an environment of poor nutrition the quality of the new bone laying down is not as good as should be. Over a lifetime even small changes can lead to dramatic result at pointy end of life.
Keeping your weight within a healthy limit is also vital for bone health. When excess fat starts to invade the bone marrow this may also affect our bodies ability’s to create to new health bone ( 1).
The ratio of healthy fat to saturated fat in the modern western diet is now thought to be as high as 25:1 yet in pre-industrial times it was around 2:1. Meaning simply we are eating way to much poor quality fats and not enough good quality fats.
How to get more Omega-3 in your diet
Bear in mind your body can’t make omega-3’s internally like we can some other fats and proteins. You need a constant fresh supply in your diet.
Omega-3s are found naturally in some foods and are added to other foods You can get adequate amounts of omega-3s by eating a variety of foods, including the following:
Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines)
Nuts and seeds (such as flaxseed, chia seeds, and walnuts)
Plant oils (such as flaxseed oil, soybean oil, and canola oil
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
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.
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 ?
Sure there are plenty of other options here in Niseko and Hirafu, but I am still a bit lazy and enjoying a good excuse to delay rehabbing my dodgy knee conditioning my joints for the stresses of doing Chiropractic and bodywork all day.
When I was training last summer season there was a school of thought going round the gym and probably every gym that you really need to keep pushing your reps until you fail, until you are not able to squeeze out even one more press. That was the point that you had a short rest, then repeated the movement. It was based on the idea that by pushing to failure you are more likely to cause the micro-damages necessary to cause muscle hypertrophy and also help train your nervous system to better at muscle recruitment.
Here is the interesting thing. that theory has not been tested by science as much as you think it would have by now. A brilliant study was just published by Lacerda et al ( 2020) that looked at the effect of weight training to failure verses just doing an equal amount of reps overall but not pushing up to the point that you simply can’t perform one more press.
And what did they find ?
The good news is they both work.
If you start training regularly you will get stronger. This is also suits the findings or other research looking at number of reps verses amount of weight etc. Whatever you end up doing. If you do resistance training regularly you will stronger and the difference between various methods may not be as much as we think.
What Lacerda’s study did was divide the group of 10 untrained me in to 2 groups. Over 35 training sessions one group pushed right to failure the other just did the same amount of reps but with a little more rest. Interesting for about 50% there was no difference whilst some individuals found a small difference with some getting better results with going to failure, others getting better results just doing the volume.
But the take of the home message of this study has to be that it’s really the volume and number of training sessions that seems to be more important that if you go to failure or not. This is certainly new news to some gym folk law that is still passed around. The caveat here is still need to be putting in a hard effort however, please don’t misinterpret this message as ” working hard doesn’t matter ” it’s just we are trying to tease out just how important it is if go right to point that we simply can’t perform the last rep.
The findings of this study may be particularly interesting to you if you rehabing an injury. Obviously by pushing to failure there is much high chance of loosing good form in our lifts and also becoming unstable and risking further injury.
So if you are comfortable training to failure and can maintain your good lift form even at failure you are probably just fine to keep on going the way you are, but if you are new to weights, nursing through an injury or worried you may slip and fall then you can pull back from this brink and know you are still getting a great workout.
Niseko Chiropractic can provide quality chiropractic and rehab and consultations are now available at The Studio in Kutchan where Powder yoga runs from.
Lacerda LT, Marra-Lopes RO, Diniz RCR, et al. Is Performing Repetitions to Failure Less Important Than Volume for Muscle Hypertrophy and Strength?. J Strength Cond Res. 2020;34(5):1237-1248. doi:10.1519/JSC.0000000000003438
I’m sorry its like some sort of Niseko Chiropractic tourette’s syndrome.
Do they work ? Sorta.
A recent meta-analsysis was recently published in the Dove Open access Journal of sports medicine that reviewed 21 studies on the usefulness of below knee compression stockings in athletes. If compression stockings are going to be useful they are going to have 2 benefits
Increased performance in competition
Decreased recovery time
What the authors found in a nutshell was that 3 studies out of the 21 showed some performance improvement and others showed mixed or neutral results.
However many more studies found that there was better evidence to support the idea that compression stockings may reduce the number of hours needed for recovery and also decrease the pain from delayed onset muscle soreness associated with high level competition.
So if you are comfortable wearing them in competition and find them helpful then it may be worth considering them but it seems the current evidence casts doubt that this action alone is going to send you to the front of the pack.
On the recovery side of things there is stronger evidence to support their use after competition to improve lymphatic flow and aid circulation.
A nice meta-analysis was recently published on migraine headahces.
The authors reviewed many of the recent research in regard to what affect exercise programs have on the frequency and intensity of migraine headaches.
They found that exercise was particularly beneficial for those suffering from low endorphins in their system as well as those that have other co-morbidity such as neck pain. More interestingly it appears that few bouts of high intensity training may be better than moderate exercise.
It’s certainly been the experience of Niseko Chiropractic that the best migraine treatment involves some moderate changes to lifestyle including a daily exercise program, some release work on the mucles in the back of the neck and having a good look at the triggers. Caffeine and alcohol usually seem to end up in the mix somewhere.
You can read more about the study on the link below
Barber, M., Pace, A. Exercise and Migraine Prevention: a Review of the Literature. Curr Pain Headache Rep 24, 39 (2020). https://doi.org/10.1007/s11916-020-00868-6
Due to the current state of emergency declared on the 13th of April Niseko Chiropractic has made the difficult decision to temporarily cease trading until the state of emergency is lifted or we are directed otherwise by the Hokkaido government.
We wish all our past and future clients the best getting through this challenging period and hope to update further on our re-opening when it is safe to do so.
Steps we will be taking to reduce the Covid-19 transmission
Once Niseko Chiropractic is directed to reopen for business steps our business will take to reduce transmission is
* The use of masks for both patients and practitioner
* Spreading appointment times so that there is no overall between patients
* disinfecting headrest and table after each visit
* Single use towels for each client
* Additional screening for risk factors such as fever and dry cough
* Handwashing for patient and practitioner at each visit
Nobody really knows where the Covid-19 pandemic is heading for Niseko. Let alone me.
A worldwide pandemic of this nature has not been seen since the Spanish flu of 1918 which was still holds the unbeaten record of killing the most humans in one sweep with 50 million lives being taken (1) . Thankfully Covid-19 is far more mild but still a serious concern.
But some of us here in Niseko do not have the luxury of throwing up are hands and saying “well we will just see what happens”
Businesses here must plan for the future and that means having some sort of model or thoughts ( even if they change quickly ) on how this will likely pan out.
I must also add the caveat that I am not suitably qualified to write on this topic and this is my non expert opinion. I’m just trying to get my head around it all like everybody else.
It’s entirely possible that by the you reading this some of the content may be out of date and superseded with better knowledge. However I do have some background in health research and in the absence of somebody more qualified (who I hope turns up soon ) perhaps this little article may at least get us asking the right questions.
It’s also been a very emotional journey for all of us Niseko locals.
If feels like our little hedonistic Niseko bubble where we could just hide from the cruel world, discover our inner child again, let out a yippee !! and slide down the pow then party after has been burst.
An entire seasonal staff crew was laid of early and there is now sadly some downsizing already of some valued year round staff identities as the Niseko comes to grips with a cessation of international tourism for the time being.
What was already a season of marginal snow quality ended sharply in a way we could never have imagined. Stories from our friends and family back around the world regarding job looses and economic hardships also weigh on our minds. And it’s only just began.
Getting to the meat and potatoes.
What is Covid-19 and what does it mean for Niseko ?
I think this question is best split into 2 parts
The Health implications for the Niseko region and Japan in general
The economic impact of Covid-19 on Niseko and it’s implications for next season
1. Covid-19 health implications on Niseko and Japan
coronavirus 2 (covid-19 ) was first identified in Wuhan in Dec 2019 spreading quickly through China resulting in the world health organisation declaring it a pandemic on the 30th of January 2020 (2)
But firstly what makes Covid-19 a nasty little critter are 3 things
For most it’s just a nasty flue but In a very small minority of cases Covid-19 can result in a viral pneumonia which essentially means your drown in your own lung fluid if you can’t get access to an ventilator. Covid-19 is deadlier than the seasonal flu so forget those bloggers trying to play it down but It’s nowhere near as deadly as ebola and would not be usually such a big problem if was not for point 2. Which brings us to…….point 2
Covid-19 is relatively easily transmittable. Epidemiologists have used the term R0 to describe how easily transmittable a virus is. It’s essentially how many people you are likely to affect once you have it. For covid-19 that number is estimated to be somewhere between 1.5 and 3.5 people depending on your source ( 3 )
So if you have Covid-19 it’s likely on average that you pass it to 1 to 3 of your friends. That’s actually not as high measles (12 to 18 people ) which is really contagious before vaccination started but it’s still pretty high (3).
And that brings us to the topic of exponential growth. There is an old myth that the inventor of the game of cheese requested his payment from the king be a single grain of rice placed on a chess board. So on sqaure one would be one single grain, sqaure 2 would contain 2 grains, square 4 would have four grain. By the end of the chesboard the king was unable to pay as the rice would cover the entire continent of India deeply and be greater than the worlds rice production by several thousands of times.
A great video about exponential growth and it’s implication for viruses can be found here
3. Last point 3. Covid-19 has another secret weapon compared to other viruses doing the rounds.
It has fairly short serial interval (4) This is the time it takes for one person to start to get symptoms before the next person gets symptoms. Say you contracted Covid-19 on Sunday. By about friday you are developing symptoms. But you already gave it your friend Jake on Wednesday before you developed symptoms. Jake starts to feel crappy by the following Tuesday but has already passed it Sally on the weekend.
So the serial interval of Covid-19 is about 4 days.(4) from the time you got symptoms on Friday to the time that Jake got symptoms on Tuesday. The implications of the short serial interval is that means Covid-19 is sometimes transmitted by individuals that do not have symptoms at the time.
A recent study from the Diamond Princess that made the perfect controlled environment for study estimated that the asymptomatic transmission rate of Covid-19 is about 20% (6) so there is a 1/5 you will catch or give the virus to somebody else before either of you know it.
This has implications for Niseko employers and accommodation providers too. Screening for symptoms is still going to miss 20% of possible transmissions of your guests and staff. We still need to be cleaning like crazy to minimize transmission risk.
So now we have a virus that is relatively nasty particularly for elderly, is transmitted up to 3 people on average and is hard to detect because you get it from people that are not displaying symptoms yet. Oh goodie.
So where are we now ? By the time you read this graph it will be well out of date but it does demonstrate just how quickly this have grown around the world since Dec 2019.
It’s also very interesting to see the different rates between vary countries. Researchers are scrambling to try and explain the differences and probably making some mistakes along the way but it’s going to a be complex interplay between geography, population density, climate,culture etc.
The good news that must viruses tend to mutate and burn out long before we are able to come up with vaccine. There is some pleasing news from China and South Korea that peak infection rates may have already occurred. The jury seems out on how long new hotspots will keep emerging there as public freedoms increase again.
So how does this effect Niseko and Japan ?
There is some good news here. Japan has not seen the crazy growth of Italy Iran or the US and in fact has not even seen the moderate growth of Australia. As of the 13th of March Japan has 1307 cases (7)
For Hokkaido we seem to be steady over the last week or 2 as of the 26th of March at 163 cases but only 2nd to Tokyo as being the highest in Japan (7). Japan seems to be doing a pretty good job of ” flattening the curve” with the culture of cleanliness, social distancing and adhering to government advice far better than other countries.
Perhaps the culture of not shaking hands and not socializing as much has helped. As the husband of a Japanese wife I can tell you how hard it is to get somebody around for a dinner party !
It’s too early say for sure but It’s entirely possible and maybe even likely that Japan may be able to quell the rate and dodge an economic bullet that smashed europe and now the US.
Niseko has been all but shut down to international visitors and with domestic tourism not due to pick up until July anyway we have a nice little window of quiet and less humans moving through here so that should aid containment a lot.
Should Japan see an exponential rise in cases they are also better placed to handle it than many countries with a good track record of handling disasters and one of the highest rates of hospital beds of 13 per thousand in the western world (9)
Some bad news: Japan was slow to start test and still does not have a high testing rate. South Korea over the last month was testing at rate 10 times higher than Japan (10). Japan also has not taken the kind of action as Australia and New Zealand such as limiting public gatherings etc.
Tokyo’s population density is one of the highest in the world and I think those will be the figures to watch closely to see if Japan can bring this back under control.
Should Japan see a rapid rise it also has larger problem than many other counties. It has a very high percentage of elderly and high risk patients. over 28% of Japan’s population are over 65 and 14% are over 75 (11). Should Covid-19 take hold in japan the death rate would far higher than average than purely based on the age distribution.
Japan in my mind does not have the option of the ” herd immunity ” strategy that was briefly discussed by the UK and now seems to be considered by Trump as a possible strategy for the US. They must stamp this out at any costs.
In Kutchan the main town services Niseko the number of people over 65 makes up 60% of our 15,000 odd population( 11) and the effect of outbreak would be a little ugly.
Japan can’t afford to be complacent and although the rate is far lower than other countries cases are still growing daily and I think we can expect pretty draconian action from the government such as limited travel over prefecture borders etc should number of cases build over a few thousand in the next few weeks.
So in summary my current read on the health implications for Niseko is we have a good chance here in Hokkaido of bringing this under control by the end of summer (13) but if we see sharp rise in the mainland I think we should prepare for a similar journey that western countries are now starting to live through with tight restrictions on public gathering and hospitality to come under lockdown too.
So that concludes my thoughts on the health situation and risk but what about the econcomic impact to a small Ski town that depends greatly on international tourism ?
The economic effect of Covid-19 on Niseko
Without yet knowing how this is going to pan out in Japan and Hokkaido it’s really hard to say but I think we can start to draw some conclusions for the implications for next season.
I think it’s fair to say that distantly viewed in the scheme of human health threats Covid-19 is getting an unfair amount of coverage.
In 2018, there were an estimated 228 million cases of Malaria worldwide and the estimated number of malaria deaths stood at 405 000 in 2018 (15) but the economic hardships will be very real and very pressing and I think still not fully appreciated.
The UN is anticipating the effect of Coronavirus on the world economy of 1 Trillion dollars (18) with global production . I don’t even know how much a trillion is so I had to write it down.
1,000,000,000,000. You could give ( or perhaps more accurately take ! 1 million dollars from one million people !
I think the 3 key questions are
Can people even get to Niseko ?
Will they want to ?
Can they afford too ?
Can our international guests even get to Niseko ?
1. Many international airlines will collapse. Qantas in Australia just laid off 20,000 flight staff and grounded it’s entire international fleet (12). The larger airlines are seeking government bailouts of up to 50 billion of taxpayers dollars and may likely get them but many smaller operators that our guests use for those affordable direct Niseko flights will sadly probably collapse.
Government travel bans on hotspots such as China and Italy seem likely for many months yet and as of the 26th of March about half of the international flights scheduled out of New chitose are cancelled and the recent boom of options for international flights into Niseko is going to be over for probably a few years.
It seems likely that travel bans will start to be lifted after Japan’s peak infection rate tipped to be around late April and last until August (13) but the worldwide trend towards maintaining self isolation after international travel may be with us for 6 months or more so I think it’s likely that we can dismiss any chance of much summer international tourism in Niseko purely based on the physical logistics of getting here.
Winter should be possible if the rest of the world also peaks around May but again I think we need to see the removal of the 14 day self isolation rule that many countries have imposed for some time before we see chance of a viable winter season again. I can’t imagine punters wanting to sit around their hotel rooms for 14 days before they hit the pow.
By June we should see what the trend is here in regards to government policies on travel over our precious booking window but the chances of any bookings coming in early for next season seems greatly reduced. Needless to say heavy restrictions still in place by December on international travel would catastrophic for Niseko and it’s economy.
Do they want too ?
It’s no doubt the world has changed.
The effect of Covid-19 is probably the most significant event in consumer behavior since the great depression. I think we will see a lot less buying on credit for nice things like holidays and much less buying in advance and people may feel that travel now has risks in both personal and economic security that will be with us for some years yet.
Many consumers will have lost money on overseas holidays and will rightly be asking themselves ” What’s the real advantage of booking ahead at the moment ” and is travel going to increase my chances of acquiring an infection. You can bet our bastard insurances companies are busy changing policy wording to make getting healthcare from Covid-19 whilst traveling that little bit trickier too.
Given that most businesses are looking at reduced occupancy rates perhaps it worth reviewing cancellation policies to allow a full refund for anything but very last minute cancellation if there is any chance of getting forward bookings for the next season ?
It seems going to be a bumpy ride with a lot of uncertainty and last minute bookings and this is going to make planning for staff numbers very tricky indeed.
But let’s remember too. People have short memories and us humans are not very good at panicking for that long.
The pow in Niseko is not going anyway and many astute snow lovers may realise that next season may be a very good chance of seeing a significant improvement in the crowd factor that quickly chops up Strawberry fields !
Can they afford too ?
By now it’s becoming apparent just how bad the effects of some of the some of the government polices on controlling the outbreak have had on economies. Australia’s unemployment rate is forecast to go from 5 to 11% and the amount of disposable income is going to drop to a trickle (14). The effect of restaurant closures and the hospitality and tourism sector is going to be brutal.
There is also the effect of exchange rates to consider. In times of global uncertainty the Japanese Yen grows strongly in value and this will make the average ski holiday a few thousand dollars more expensive that it was last season. In March 2019 the rate was 80 yen per dollar but that has now dropped to around 60 and this may be a factor in the affordability of Niseko.
I think it’s fair to say for the average Aussie family that did the odd Niseko holiday that next season just got a little trickier.
But Niseko has been changing. The “average ” Australian ski family now makes up a smaller proportion of our international guests as interest from the top end of town from China and South East Asia and I there will still be no shortage of demand from the wealthy for a trip to Niseko even in times of economic uncertainty and job losses.
Perhaps it’s also time Niseko concentrated on an unfairly neglected part of it’s success.
Japanese domestic tourism.
In all our interest to bath in our new found glory as the Swiss alps of Asia have we treated the Japanese tourist as well as we should have ? I remember one of my wife’s friends being upset that no staff in her hotel she checked into spoke the language that should be used here. Even now I still have not got around to making a Japanese version of my website.
Can we lift our game to cater better to the people that allowed Niseko to get established as the worlds best powder resort ?
Anyway more questions than answers perhaps on all of this and I would to wish everybody the best of luck in getting through this together and also remind you and me and that as long as the slopes stay steep, the powder stays deep and mount Yotei humbles us we will get though this.
Oh and Kutchan has it’s own toilet paper factory !
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