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September 28, 2019 Clinical0

Some interesting research has just come out from the Netherlands.

They did a 1 year follow up with patients that presented with severe lower back pain with nerve impingement often known as ” Sciatica “.

What the researchers found that was after a 1 year follow up there was no correlation between the ongoing presence of a disc herniation and the persons pain level.

The implication here for us humble clinicians is that the physical presence of a disc herniation 1 year after incident is not really a good way of determining in itself whether that disc herniation is actually causing the patients pain and discomfort.

More and more research is now coming in that pours cold water on the notion that we can rely on imaging findings alone to make recommendations and predictions about the best treatment and chances of impairment.

Pain and disfunction are really complex things with many variable coming into play and it’s clear that us practitioners for too long have been giving too much weight to the structural and imaging side of the coin. But let’s through any babies out with the bathwater just yet. MRI imaging has been a great tool in the mix of understanding and helping our patients problems. It’s just not the be all and end all.

You can read the full study here if you are interested

https://www.nejm.org/doi/full/10.1056/NEJMoa1209250?fbclid=IwAR2rQSJ4JyZ2R5A3__baOd-1p-HimJVcf48ISx5RgGEJNt5Gg7GNDV0SPC0

 

Just a reminder that Niseko Chiropractic is still open over the shoulder season for evening and weekend appointments.

 

To book online please go to

 

www.nisekochiropractic.com/appointments

 


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June 17, 2019 Clinical0

There has been a been a lot of talk about the risks of sitting lately. Some commentators have coined the term ” Sitting is the new smoking ” and certainly the research does support the large health risk of sitting too much correlates with poorer health outcomes (1).

But the plot thickens when we start to look further.

How much of the health risk is due to the sitting itself and how much is just because people that sit more tend to exercise less ? What about to standing workstations ? Do they actually help reduce our risk or are they just a fad ? Once again we need to turn to the research to cut the wheat from the chaff.

The dangers of sitting too much

In 1953 Morris (2)  published a paper in the prestigious medical journal ” The lancet “.

Morris noted that bus drivers in the 1950’s had far more heart disease than bus conductors. This was interesting. They both worked identical hours and shared almost identical work environments and backgrounds. The main difference seem to be that one group was sitting and one group was standing. Was sitting causing their heart disease ?

Fast forward to 2016 and several papers did some large meta analysis and it seems yes that too much sitting was associated with a range of problems from Heart disease, to type 2 diabetics and obesity (3).

But the interesting question still remained. Is it the sitting itself that causes the problem or is it the lack of physical activity associated with the sitting that causes that leads to poor health ?

Maybe both ?

Well the research at this point is divided with some experts claiming that doing exercises does not offset the dangers of sitting whilst others claiming daily exercise can mitigate a lot of the the dangers of sitting.

Dr. Alter and colleagues conducted a meta-analysis ( where they study other studies ) of 47 studies that tracked groups of people who reported data on how often they spent sitting and on how much exercise they took.

They found that people who were the most sedentary were more likely to be diagnosed with type 2 diabetes, cardiovascular disease and various cancers, including breast, colon and ovarian cancers. The most sedentary people were also 24% more likely to die during the studies than participants who spent the least amount of time sitting.

Although this association was much stronger among people who spent little time exercising, the study also found that too much sitting time was associated with poor health outcomes, regardless of physical activity (4)

Alter was of the opinion that exercise alone does not reduce the health risks of sitting. He believes we actually need to sit less.

In 2016 a much larger study was published by Owen et al (5) in the reputable journal The Lancet that found that moderate activity ( about 60 to 75 minutes a day ) does seem to offset the health risk of sitting in regards to death rates. They did find however that if you watched more than 3 hours of TV a day then even moderate to heavy exercise did not offset the health risks of the sitting.

So they researchers are still a little divided about whether sitting itself is the issue or if is sitting is a co-founding variable associated with the real culprit, lack of enough activity.

I think it’s safe to say that we should all be aiming to try to get an hours walking in more days than not and also minimizing or at least having breaks with the amount of sitting we need to do over the day. A short walk to the water fountain to bitch about a c0-worker may be healthy.

What about standing workstations

It seems like an obvious solution. If sitting is causing the problem then why not just stand ? The sitting/ standing workstation became an overnight sensation in the corporate world with some pretty hefty price tags too.

The interesting thing here is the jury is still out on weather standing workstations make much of a difference. Surprisingly little research has been done to date on whether a standing workstation is really a viable alternative to combat the risks of sitting.

A Harvard study found that when you sit you burn about 80 calories an hour and when you use a standing workstation you use about 88. Over a 3 hour period this relates to about the same energy difference from eating a carrot ( 6). The authors concluded you would be far better off doing a short walk in your lunch break.

And just to make things even more spicy…….

Maybe standing still all day at a workstation is not that good for your either ! One study find that finding that occupations involving predominantly standing were associated with an approximately 2-fold risk of heart disease compared with occupations involving predominantly sitting (7). With all the media attention on the dangers of sitting some authors noted a gap in the research knowledge on looking at the risks of standing.

Again it seems like gentle daily exercise may be worth impliementing first before you worry about rushing out to purchase a standing workstation.

In conclusion it’s probably safe to say that an doing a job where you sit all day is a risk to your health and this becomes far more serious when you are not doing enough exercises.

So get out there and move more !

 

References

  1. https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(12)00208-2/fulltext
  2. Morris JN, Heady JA, Raffl e PA, Roberts CG, Parks JW. Coronary heart
    disease and physical activity of work. Lancet 1953; 265: 1053–57.
  3. Ekelund, U., Steene-Johannessen, J., Brown, W. J., Fagerland, M. W., Owen, N., Powell, K. E., … Lee, I.-M. (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet, 388(10051), 1302–1310.doi:10.1016/s0140-6736(16)30370-1
  4. https://annals.org/aim/article-abstract/2091327/sedentary-time-its-association-risk-disease-incidence-mortality-hospitalization-adults
  5. https://sci-hub.se/https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2816%2930370-1.pdf
  6. https://www.health.harvard.edu/blog/the-truth-behind-standing-desks-2016092310264
  7. https://academic.oup.com/aje/article/187/1/27/4081581

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June 17, 2019 Clinical0

With the DIY revolution now in full swing many people are now getting familiar with power tools previously left in the hands of licensed professions. Whilst doing some jobs yourself can save you a lot of money and also be very rewarding there are some risks.

A recent study (1) examined the use of power tool injuries causing hospital admissions from 2005 to 2015 and examined what the risk factors are in injuries leading from accidents around power tools.

So what are they ?

Firstly having a penis seems to be a massive problem. Males accounted for 96% of power tool injuries compared to only 4% for females.

So if you do happen to have penis be aware that you are are far more likely to have a power tool injury. The idea that just being male allows you to use power tools safely is unfortunately a dangerous myth.


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“The wise rest at least as hard as they work.”
― Mokokoma Mokhonoana

 

Something interesting happened on the 28th of May 2019.

The World Health Organisation (WHO) officially recognized and classified workplace burnout as a Occupational phenomena but they did stop short of classifying it as full disease (2).

For those interested ” Burnout ” is now officially defined as by the WHO as

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  • feelings of energy depletion or exhaustion;
  • increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
  • reduced professional efficacy

If you are suffering from 3 of the above criteria it’s possible you may actually be suffering from burnout.

It’s important to note that burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.” (1) This is important to note as there is a lot of overlap between burnout and other conditions such as depression so i think the WHO got this right in seeking to limit the definition of burnout to just the workplace.

This is still a significant step forward as clearer terminology leads to better studies and hence better solutions to this perplexing problem. It’s likely as this important topic gets more attention we can better manage burnout and its implications.

Let’s talk more about Burnout

Having experienced a burnout last year I now have more than academic interest in the topic.

The movies like to depict a sudden snap where all of sudden you are wearing your pajamas to work and making goodbye speeches standing on your desk.  The reality is far more boring. And depressing.

You find yourself tired all the time, growing increasingly disconnected from you work and meaning that you attributed to it. Your coping mechanics such as a quick holiday or a few cheeky bevies on the weekend that used to see you through no-longer seem to be effective and in some cases just make the problem worse.

In his classic “The E-Myth Revisited: Why Most Small Businesses Don’t Work and What to Do About ItMichael Gerber talks about another peak in business failure rates around 5 years. It’s not because the the business was unsound, it was financially viable and had found a niche to service and generate income. It had survived the dreaded start up phase. But it failed for another reason. The owner simply burned out from exhaustion.


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May 28, 2019 Clinical0

The Rise of Chronic disease and what to do about it

Do you have any Nastie Oudours in your life ?

I don’t mean to ask a blunt personal question but this is important. We as a species have a little of bit of a problem here.

For the the time in human history we are getting sicker than previous generations.

Life expectancy in the US is now falling with life expectancy now down to 78.6 and falling each year its measured from 2016 ( 1). And even here in Japan, a country that is used to pride itself on how its population seemed to live forever is seeing a decline in its longevity with the average male now living 83.98 years (3) but this is no longer the worlds leading figures (2).

This is even more perplexing when you consider just how amazing some of the recent medical advances in the last few decades have been. We have seen the rise of HIV managed very well with antiretroviral drugs, artificial hearts, Hep C can be cured in some cases. Keyhole surgery and increased sophistication of some anti cancer drugs.

Yet even these can’t quite manage to keep us living any longer.

 

So what does this have to do with Nasty odours ?

Well the reason we are getting sicker is the change from people dying from Acute diseases such as infections, Workplace accidents, Tuberculosis etc to people dying from Chronic disease such as Diabetes, Obesity and Cancers.

The ” sweet spot ” between decreasing Acute and increasing Chronic Disease.

 

Australia has some of the worlds leading researchers into this problem such as Professor Gary Egger and what they are have brought up is the concept of ” Anthropogens“.

Most of of our theories about why we get sick are based on middle ages discovery and 19th century concept of Germ Theory ( 4). This basically states that a pathogen like a virus or bacteria gets into our systems and makes us sick.The founders of lifestyle medicine propose a new term ” Anthropogens ” which can be defined as ” man made environments that can be detrimental to human health ” (5)

That’s right.Humans themselves are making our environment around us unhealthy.

How are we doing this ?

If you add together all things we are doing as a species to make ourselves chronically ill you come up with the acronym Nasty Malodours.

See the graph below

 

This is really important work.

What modern researchers are finding is that things like relationship problems and poor sleep can be just as bad for your health as viruses and bacteria. In fact the components of Chronic diseases are now winning the battle for making our lives shorter and less enjoyable.

 

So what can we do ?

It’s worth having a think about your own situation and the Nasty odours in your life.

What factors have chosen to that you think may be contributing to own chronic disease risk ? Take the time once a month to give yourself and honest self audit of your situation.

  • Is your weight an issue ? That’s a very important area and one that affects many aspects of your life
  • Are you getting enough sleep  ?
  • Are you living work or working to live, does your life give you a sense of purpose ?
  • Do you spend too much time on your mobile phone ?
  • Are you eating poorly ?
  • Are you getting enough sunlight ? This can be challenge for those of us working in Niseko over the winter months.

 

If you take the time to address the Nasty odours in your life you stand a much better chance of not just living longer but living better for longer as well.

 

 

References

  1. https://www.cdc.gov/nchs/products/databriefs/db293.htm
  2. https://www.ncbi.nlm.nih.gov/pubmed/30921413
  3. https://www.google.com/publicdata/explore?ds=d5bncppjof8f9_&met_y=sp_dyn_le00_in&idim=country:JPN:USA:CHN&hl=en&dl=en
  4. https://en.wikipedia.org/wiki/Germ_theory_of_disease
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146357/

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May 20, 2019 Clinical0

 

To stretch or not to stretch ?

Dotted all over the slopes of Niseko during peak season are ski schools packed with eager students going through a stretch routine before they eagerly start their lessons and start carving up Niseko, arguably the worlds most consistent powder snow.

The motivation is good and at first glance, it kind of makes sense. After all we care about our students and hopefully the stretches will help them avoid a ski injury and help them enjoy their time in Niseko and their snowboarding or skiing lesson.

But there is a small problem. It probably doesn’t work.


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May 7, 2019 Clinical0

A great article was recently published in the British Medical Journal about how practitioners and patients should view osteoarthritis.

Certainly when I went through colleague we were taught that osteoarthritis is degeneration of the cartilage, it was irreversible and leads to pain and dysfunction. In short many medical, physiotherapy and chiropractic schools taught us that osteoarthritis was disease of cartilage.

But there a few problems with model. Firstly more and more studies are coming out that show that the correlation between the decree of tissue damage shown in your joint cartilage correlates very poorly ( if at all sometimes ! ) with the amount of pain and dysfunction a patient has.


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May 1, 2019 Clinical0

What is Sacroiliac pain and why is it overlooked ?

Lower back pain is one of the most reasons a patient may present to a Niseko Chiropractor, physiotherapist or Osteopath for treatment. About 20-30% of the population will experience some episodes of lower back pain that just doesn’t go away so you are in good company (1).

What gets more interesting is what causes the pain. A most common folk diagnosis is to complain of ” Sciatica ” where the pain originates in the lower back and then refers into the hip and leg. But from a practitioners point of view sciatica has a more specific meaning. We would refer to sciatica when there a some pressure or irritation of the sciatic nerve, most commonly a disc herniation or protrusion. This commonly radiates right down the very back on the leg and can also often be associated with numbness and parenthesis and often severe pain.


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May 1, 2019 Clinical0

Manual manipulative therapy may reduce fear avoidance in Chronic lower back pain.

Some very interesting research was just published in the ” Journal of Pain “. The authors looked at the effect of fear avoidance patterns in patients suffering chronic lower back pain.

If you do happen to suffer chronic lower back pain you understand that it’s not just the pain that gets you down but also the fact that you can become fearful to do movements that used to cause you no problems at all .In short you can can become scared to move.


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April 25, 2019 Clinical0

 

There is a really easy way to increase your health dramatically that does not cost any money, does not require any sit ups or resisting chocolate. Do I have your attention now ?

Its sleep. It’s likely you are not getting enough both in quantity and quality.

Niseko Chiropractic recently made some simple changes by cutting out caffeine after 2pm, reducing alcohol in the evenings and tying to be in bed by 9pm and I feel a whole better for it. The results were obvious within a week or 2.

So why does sleep matter ?


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April 13, 2019 Clinical0

 

One of the more exciting things to come along in the last few years is the new discipline of lifestyle medicine. This approach seeks to make changes in our lifestyle as ways to treat illnesses and improve health.

A recent study has found that just 20 minutes a day in nature can have a good effect of reducing cortisol and improving our well being. Yes there is benefits to more but the effect size is less. So based on this if you are a busy person try to aim for 20 minutes a day doing something in the outdoors that finds you peace.

You can read more on the link below

https://www.technologynetworks.com/neuroscience/news/twenty-minutes-in-nature-is-enough-to-cut-stress-hormone-levels-317872?fbclid=IwAR3rBtaPTjxLoWVLFuKBvYuK48xq9D0_UckJ7Fb92UVpPruXTebjOBAPRV0

 

 


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February 27, 2019 Clinical0

Well it’s now late February and the opinion from most old timers here is that the powder snow is now behind us for this season and we are probably in for an early spring.

That means some fast icy hard conditions for Niseko which also increases the chance of an injury.

Yes you need to practise falling in Niseko

What seems to be particularly vulnerable is injuries to the wrist and upper arm in snowboarding injuries.

A recent study in the literature found that nn a study evaluating 7,430 upper-extremity injuries  just under half of all snowboarding-related injuries involved the upper extremities, with male riders accounting for 74% of all injuries ( 1).

Fractures and injuries to wrist make up 21% of all snowboarding injuries ( 2) and often top the list as the most common snowboard fracture. So it pays to protect the wrist. Wrist guards can certainly play a role but the best thing snowboard instructors can do is teach there clients how to fall.


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February 18, 2019 Clinical0

Does it really help to get ” Tune up ” treatments ?

 

Mmmmmm here is a can of worms.

It’s not uncommon for many chiropractors to advocate the idea of Maintenance care.

At first glance it seems a perfectly plausible idea, much like getting maintenance on a car maintenance on your body should catch problems problems before they present and symptoms and lead to better movement and less pain and suffering.

But does it ?

To quote probably the world’s leading spinal pain research Stuart Mcgill ” It depends ” .


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February 8, 2019 Clinical0

With February 2019 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.


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January 28, 2019 ClinicalNiseko life0

Staying in safe whilst out and about in Niseko

Recently I have been treating a number of injuries that occurred not on ski slopes but either on the way to ski slopes or more likely from the way home from the bar !

This brings us to an important and overlooked topic.

How to walk safely on ice and snow.

Ice falls in Niseko can be nasty.

It’s very easy to fracture a wrist or collarbone as you instinctively brace yourself from going over. Ice is an incredibly hard and unforgiving substance and with temperatures often sitting well below zero here in Niseko for most of the winter you are going to see a lot of it. Lower Hirafu can be particularly treacherous.

Sure you think you can walk. You probably a great walker and been doing it without thinking since you were a baby.  But millions of years of evolution has led to humans having a truly remarkable gait that is not well suited to snow and ice.

What do I mean by this ?

Walking is essentially falling forward and catching yourself each time. To do this safely we rely on the friction generated from the back foot to drive all the the front foot to launch forward and catch us before we fall flat on our face.  This gait is very efficient and one of the reasons it allowed our ancestors to move and spread to all continents of the globe using far less energy than our four legged friends.

When we are dealing with the ice and snow the rules should change.


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December 20, 2018 Clinical0

A premium mobile soft tissue management service

Niseko Chiropractic has been surprised by the demand for our 2 hour mobile session and this is by the far the most popular of our services.

Niseko Chiropractic 2 hour extended session

By taking the time to do a complete examination and history we can deliver an exceptional bodywork experience in the comfort of your own Niseko accommodation.

We are confident this will appeal to even the most discerning customer seeking the very best in high end bodywork.

You can ready more about our extended duration sessions by clicking here 


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November 11, 2018 Clinical0

Niseko Chiropractic skiing as you age in Niseko

Can we all be as lucky as George Jedenoff pictured above who celebrated hitting 100 by skiing from the top of Hidden Peak to Tram Tower 4 in Utah ? You can read more about George’s story here

Those close to George attributes his amazing feat to his regimented training and positive outlook but we can probably sprinkle in a bit of genetic lottery good luck as well.

So does age affect us more mortals and is there much we can do it about ?

Well the bad news is that certainly most of systems start to slow from our peak in our mid 20’s and certainly by our 40’s we start to see significant changes in quite a few of our systems.

The good news is that there is still a lot of debate about how much deconditioning is responsible as opposed to the ageing process and the right training at any age can often result in marked improvements.


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November 3, 2018 Clinical0

Niseko Chiropractor visits can now be booked through Roomboss

If your accomodation or booking service uses Roomboss you can now book your Niseko Chiropractic visits directly through your hotels Roomboss booking Portal.

We are really excited about the convenience of on being able to offer on the spot bookings for accommodation providers in Niseko. You can read more by review our Agent information page

For further information about the roomboss platform click here

 


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November 2, 2018 Clinical0

It’s now early November and for those of you that are eyeing of a trip to Niseko this year or even early 2019 you should certainly be starting to consider your conditioning routine.

Here are 3 exercises that Niseko Chiropractic feels are great to incorporate into your injury prevention and performance exercises program before you start to carve up the pow.

They have been chosen as any experts in the field such as Arne Ekeland ( PHD) and David Murry seem to focus on them as well as because they introduce a small amount of instability into the exercise which helps to train our balance and proprioceptive systems.

Be aware that some of these exercises may not be appropriate if you have a pre existing injury or a new to strength training. It’s really worth your time to get some expert advice from a physiotherapists or sports Chiropractor if you want the most out out of your pre season training.






Contact us

Please do not hesitate to contact Niseko Chiropractic if you have any questions.We apologize in advance if there is some delay in our response during peak periods. You can contact Niseko Chiropractic at info@nisekochiropracic.com


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