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.
Women on boxing training
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 !
If you are like me on the wrong side of 40 you might experience some knee pain when skiing or snowboarding Niseko.
There is already good evidence that weight training can help increase our knee stability and reduce pain but now some surprising new research suggests that marathon running can actually increased the quality of our joint cartilage and internal structures.
So if you are considering long distance running to help your ageing knee’s research suggests that for a health population you may expect some improvement in your joints function.
Hokkaido and seems to have a spike in the number of backcountry incidents over the 2020 season recently that has sadly resulted in some pretty tragic outcomes.
An interesting article was recently published in the International Journal of Environmental Research
and Public Health regarding backcountry accidents. Admittedly it was Switzerland and the stats for Niseko would likely be different due to different relative risks of the terrain but perhaps there is something we can learn from it.
They asked an interesting question.
Given that there has been a big improvement in the quality of backcountry safety gear such as better beacons, airbag systems are we seeing a decrease in the frequency of backcountry accidents.
You only need to play around with one of the first generation beacons compared to the most recent ones of the market to appreciate just how much easier is it find somebody buried under snow with far less in depth training and practice.
We can now access pretty accurate weather and avalanche forecast information on the internet. Surely this should be sending our accident rate down ?
And the answer ?
Surprisingly accidents in Switzerland are increasing or steady despite the quality and safety of gear increasing although we do seem to be loosing our way a little less. Perhaps phone GPS ?
The findings from a swiss study from 2009 to 2018 looking at 3044 accidents found that on average accident rates are not falling and are probably about steady or even increasing slightly for some categories.
But Why ?
The study did not specifically address this question but the authors hypothesized that whilst the gear is indeed getting better the increase in the number of inexperienced skiiers going into the backcountry is causing the accident rate to stay the same.
It certainly does appear that backcountry skiing is getting more popular each year in Niseko so perhaps there are some lessons to be learned here.
I also think it worth noting the accident percentages. Falls counted for 44.6% of injuries and avalanche counted for 18.3%. So you are twice as likely to get in trouble with a fall than avalanche. They did however find that younger skiers are more prone to avalanche risk than older skiers so perhaps the salty old snow dogs experience helps the sniff out trouble early or they are just less likely to try dumb stuff.
I think the take message from this Swiss study to bring to Niseko is
Better gear does not trump experience or getting the right training. ( although you should have good gear too ).
Always go backcountry with friends that can keep you safe.
Re-assess your risk of falling. Are you skiing within your skill limits in the backcountry and are you carrying the gear to manage a fall properly.
Niseko’s Chiropractic’s mobile 2 hour session is really designed to have the time to go deep into long standing issues and also relieve tension throughout the body that can build up when you hit the ski slops again after a long break.
We can come to you and treat you in the comfort of your Niseko based accommodation.
Prior to studying Chiropractic Brent spent years working as certified massage therapists in Australia and if you like your bodywork on the sports side of things that can really address old long standing injuries then our 2 hour session is for you.
Niseko Chiropractic takes the time to properly assess your bodies tension,movement patterns and then start to zoom in individual spinal segments specific joints and then tailor a treatment to best address your individual issues and problems.
If you are looking not just for a relaxation massage but a top end tailored bodywork treatment that targets your problem areas by an experienced practitioner then our extended sessions are you for.
If you were like me before I moved to Niseko there was always the issue of weather to transport your own gear or rent.
Obviously it’s better and often cheaper over the long term to ride your own gear and you can tune it to just your specifications but one big drag is getting trying to drag it through international airports often with family dangling off the other arm. I know for me the thought and cost of dragging all my gear around often lead me to rental decision on several trips.
There is a better way !
Recently a service has opened in Niseko where they can store your own gear right here in Niseko and delivery it your accommodation when you arrive.
This is not just for convenience. At least a few times a year Niseko Chiropractic is called upon to treat injuries created by snow gear before it even gets to the slopes. Carrying awkward heavy bags can be a sure way to ruin a good Niseko ski trip before it’s even began.
You can learn more about the Japan ski gear valet services based right here in Kutchan by going to
They examined the important question of which type of exercises work best for chronic lower back pain ?
Should we be doing yoga, pilates strength training or Mckenzie extension exercises to help our lower back pain. We don’t have time for everything so what works the best ?
Lower back pain that last more than 12 weeks ( Chronic lower back pain ) is a huge burden to society. Although chronic lower back pain only makes up 20% of cases that present to us practitioners it makes up over 80% of the costs for the direct costs of low back pain and if you have chronic lower pain you know you would be happy to try anything for meaningful result.
Each week there seems to be a new ” miracle cure ” or celebrity exercise program that is going to cure all and make all our flabby bits go way. Should we be doing kettle bells squats or swiss ball situps ? what is really going to help ?
And The Answer ?
Well according to authors the good news is that almost all exercise programs that you can choose from tend to make a significant improvement but not 1 thing seems to be so much better than anything else (1) .
So if you already drawn to pilates and yoga and enjoy the social aspect of these programs then pick one of those and stick to it. Niseko has some great yoga and pilates programs running such as Powder Yoga and Yoga with Marika.
If doing some lower back exercises at the gym is more your thing then some good news there. They also seem to help so again there are some great options at the local Kutchan gynamisium or also I believe we know have a Niseko Crossfit opening in Kutchan.
Stretching by itself seemed to have very little improvement so if you are trying to treat your back pain just with stretches you watched from youtube you may have work cut out trying to get a good result.
The Mckenzie method which seemed to be darling child of rehab for few years got poo pooed in the study (1) My thoughts on this is that the Mckenzie method really seems to shine when you are dealing with a disc issue and much of non specific lower back does not really have a firm diagnosis so perhaps we may be making the sample size a little to general here. (1)
And The Winner ?
This study seemed to indicate that the pilates method seemed to yield the highest results but only by small margain against the others. The authors also sound significant improvements for mental health so if we can get off just looking at pain for a moment there are far higher reaching benefits to choosing an exercise activity that works for you.
Just my hunch but one reason I think the mat classes do so well is the social interaction and support you get from them. There is a big plus to exercising where you have friends waiting your attendance and have somebody to share a coffee with afterwards.
Even simple old arerobics seemed to get some positive results so even joining a fitness class or taking up light jogging my useful.
Us manual therapists also received a kick up the bum. It’s hard when research does not always agree with your clinical experience but if you are going to have some faith in the science then we are going to have to eat humble pie sometimes. As therapists we must try harder to incorporate exercise therapy into our treatments and also help hold the patients accountable for commitment to their chosen exercise program.
We must be a little cautious here. the beauty of the meta-analysis is that it allows a bit more power in finding what really works but the downside is that by throwing so many studies everything can get so generic that it can loose relevance to the actually condition.
This study only looked at ” non specific lower back “. If your therapist is confident of a structural diagnosis for your symptoms then some of the conclusions here may not be relevant for you. I’m thinking disc herniation or chronic SI ligament problems etc.
So the take home message for those in Niseko experiencing chronic lower back is that what is important is to pick an exercises intervention that works for you and stick to it.
In conjunction with a trial of manual therapy you will be well positioned to give yourself every chance of an active and enjoyable recovery.
If you would like to make an appointment with an English in speaking chiropractor in Niseko Japan you can do so on the link below
It’s long been established that snowboarding carries a slightly greater risk of injury that alpine skiing. A recent study found snowboarding carrying a risk of around 345 days of injury free days over season compared to 400 days for skiing (1).
You can see what injuries are more likely from each sport on a previous article here. But in a nutshell its wrist and upper extremity injuries that you are most likely to experience on the Niseko slopes.
The good news is that helmet use is now well over 60% with no significant difference between skiers and snowboarders and skiers and surprisingly the study found that both skiers and snowboarders were taking about the same level of risky lines and challenges.
But there still seems to be a difference in their injury rates !
But why ?
Some recently published from Austria ( it figures ) has shown there may be a more interesting reason snowboarders are more prone to injuries.
Some of them may be ” on the turps ” as us Australians may say. Snowboarders reported that 45% of them had been on the booze at least once over the previous 5 skiing days ( only 25% for skiers reported to be drinking ) (2).
This is kind of important as research from the Dolomite mountain seasons in 2009 showed that of 200 snowboarding accidents that presented to the local hospital for snowsports injuries a whopping 43% had high blood alcohol levels. So getting on the booze increases your risk of a snowsport injury substantially ( 3).
It’s so tempting to booze up here in Niseko where some of the sweetest tasting beer in the world is available icy cold and cheap from every vending machine all over the slops but with the added risk of dehydration you are really much better off leaving your drinking and partying down below.
There are no good easy or cheap accidents on the snow and an off piste injury can leave you in world of physical and financial pain, even if you have travel insurance.
So stay safe and do your partying in Hirafu or Kutchan. And do some for me too.
3. Gaudio, R. M., Barbieri, S., Feltracco, P., Spaziani, F., Alberti, M., Delantone, M., … Avato, F. M. (2010). Impact of alcohol consumption on winter sports-related injuries. Medicine, Science and the Law, 50(3), 122–125. doi:10.1258/msl.2010.010007
If you are struggling with Patelo-femoral pain ( runners knee ) if your lead up to the Niseko Ski season you are not alone. It’s a very common condition that can shorten your time and enjoyment on the ski slopes.
Get to work on those hips
Some interesting research has just been published on the importance of exercising the entire kinematic chain. The authors did a study of many other studies ( a meta-analysis) and found that your knee pain is likely to resolve better when you work strengthening the hip muscles ( specically the abductors that pull your legs sideways ) as well as just the flexors and extensors of the knee in your pre Niseko workouts.
The take home message here is ( and we have said it before ) that you should not only focus on addressing the joints that are pain but look making sure your entire bio mechanics are doing the right thing by you. One of my mentors used to say ” the knees are the punching bags of the body ” so if you have problems somewhere else they are often the place that you feel the blows.
You can see a link to the full study on the link below
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
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.
Morris JN, Heady JA, Raffl e PA, Roberts CG, Parks JW. Coronary heart
disease and physical activity of work. Lancet 1953; 265: 1053–57.
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
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.
“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 It” Michael 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.
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 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.
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.
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.
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.
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.
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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