Wow.

What a crazy few years. When covid first hit in Feb 2020 we had no idea it would go affect us all for so long. It has certainly been a tough time for all Niseko businesses but thankfully with a skill as portable as Chiropractic we were able to find work in other parts of Japan.

But now we are back from the 14th or December 2022 !

Niseko mobile Chiropractic aims to provide a top end experience for guests that have sustained musculoskeletal injuries whilst enjoying their time in Niseko or those seeeking remedial levels of deep tissue with our popular 2 hour sessions.

If you would to experience our services in the comfort of your Niseko accomodation we hope you can consider using our English Speaking mobile Chiropractic serice in Japan.

Our primary practitioner has 20 years experience and a track record of many happy clients over the 4 years we have been in operation in Niseko.

If you would like to schedule an appointment please use the link below

https://niseko-chiropractic.cliniko.com/bookings?appointment_type_id=517686 

A suprising result for headaches sufferes

If you have ever had a bad migraine headache you would know understand just how horrible they are and would give anything just for them to stop.

The great thing about reasearch is sometimes it can yeild resuls that we may not think to be to be a first glance and this certainly the case with a recent paper that adresses the question

” What works better to reduce the severity and frequency of migraine headaches ? Weight training or exercise ? “

A recently published paper in the ” Journal of headache and pain ” reviewed 1195 migraine cases reported in 21 papers on the subject of Migraine headache and concluded that strenght and weight training actually results in the best improvement for migraine sufferes.

Not that the authors are arguing you head down to squat university when you room is spinnng and your about to stab your eye with spoon but if are a migraine sufferer you may be well adviced to start a weight training program weekly as a preventative measure.

And it’s more interesting too. Even though exercise was effective it was the high intenstity stuff that had a better result than the low intenstity workouts.

Of course both these are not mutally exclusive and you may be better planning on weight training a few times a week and also incorporting some high intensity cardio workouts as well.

But why ?

The paper looked a few possibilities.

Migraines are incredibly complex but there is a leading thoery that there some dysnfuction of the way the trigiminal nerve and nerves from the muscles interact at perhaps weights helps normalise this.

There is also a close association between migraine headaches and neck pain so maybe just adressing the neck pain through better muslce tone reduces the chances of frequency of migraine.

In regards to the high intensity exercise, it’s much more likely to cause chemical changes in the brain as endorphines and other chemicals are released so perhaps thay have a mediating role.

At any rate I doubt the ” why ” question will be understood with certianty any time soon but if you are migraine sufferer you really should try at least a weights program and see if makes any differences on the frequeuncy and intensity of your migraine.

References

Woldeamanuel, Y.W., Oliveira, A.B.D. What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials. J Headache Pain 23, 134 (2022). https://doi.org/10.1186/s10194-022-01503-y

https://doi.org/10.1186/s10194-022-01503-y

We made it

After 2.5 years Niseko now finally gears up for the influx of international tourism.

As of today the 11th of October 2022 Japan is now reopened for Visa free independant tourism.

Essentially the travel rules are now the same as pre-covid apart from the fact that you either need to be tripple vaccinated or provide a negative PCR covid tests.

Many had already booked their Niseko accomodation this season in the hope that this was the case and their optimism has been rewarded with some below market rates. For those that did not Niseko Chiropractic recomends booking early to avoid the Niseko rush.

If you have not stared your pre ski season training yet we suggest you do so and if you do need an english speaking mobile Chiropractor to come to your Niseko accomodation we hope you can keep us in mind.

If you would like to book a Niseko appointment please go to our appointments page

We hope to see many old clients again and thanks for not giving up on Niseko !

Niseko Chiropractic research update

Since starting to consult in Tokyo we have been managing a lot more cervical disc herniation.

Whilst cervical discs herniations are not as common as their lumbar cousins they can cause a great deal of misery and when it starts to affect your arms can really drive you crazy.

The good news is some recent research published in the BMC of MSK disorders  has shed light onto the fact that the correct exercises, performed just a few times a day can actually increase the size of the Intervertebral foramen or IVF which is the space between your vertebra where your spinal nerves comes out.

Just an 8 week program was enough to achieve clinically meaningful results and both flexion towards the size of injury and away seemed beneficial, as well as the ” Chin tuck exercises” so if you are suffering from cervical disc injuries there is hope that a trial of conservative care may help.

To make an appointment out our Sunabe, Tokyo and Niseko clinics go to

https://niseko-chiropractic.cliniko.com/bookings#location

References

Wu, SK., Chen, HY., You, JY. et al. Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation. BMC Musculoskelet Disord 23, 728 (2022). https://doi.org/10.1186/s12891-022-05670-6

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05670-6?fbclid=IwAR2-LbFYlViKSasnwasvkn_cNslkAcGh8JfMv5f-hTQ6GXzhlvNBL_DeH-Q

Research review/ update for Chronic neck pain

If you suffer Chronic neck pain ( neck pain that lasts more than 3 months ) you are not alone. Recent research found that Chronic neck pain makes up  14.6% (1 )  of all MSK problems that present to practitioners like Chiropractors and PT. Up to 50% of adults will experience neck pain at least once this year but for most the problem quickly resolves.

Sadly not all people have a quick recover and if you are one of the unlucky people that has experienced neck pain for more than 3 months you know the effect it can have on your quality of life and wellbeing. In the military community in Okinawa there does seem to be a little more neck pain that I used to see back in Australia which I attribute to some hard training coupled with the effects of desk based computer work.

How to get the best results

A recent study ( 1) some great research by looking at the results in changes of Range of motion (ROM ) between a group that received exercises only against a group that received manual therapy as well as doing some exercises.

The found that ROM was significantly better when the subjects got manual therapy at the same time as doing starting some exercises.  The thinking is some the manual therapy gives better movement of the joints which the allows the exercises to be more effective.

You can read the full paper of the link below but for now the take home message for chronic neck pain is that a multi-model approach looking at manual therapy and exercises is going to yield the best results.

If you would like to make an appointment with an English speaking Chiropractor at either Sunabe Okinawa or Niseko you can book your Chiropractic appointment on the link below

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

References

1.  “Is Cervical Stabilization Exercise Immediately Effective in Patients with Chronic Neck Pain and Upper Cervical Spine Dysfunction? Randomized Controlled Trial “

Life 2022, 12(5), 714; https://doi.org/10.3390/life12050714

https://www.mdpi.com/2075-1729/12/5/714/htm

Niseko Chiropractic research update:

There have been some amazing improvements over the last few decades in imaging for lower back pain. most notably the MRI scan ( considered the gold standard ) has the ability to clearly show soft tissues such as discs, ligaments and muscles as well as give an overview of bones. There has also been crazy advances in CT imaging such as the gap is now a lot more narrow.

But with the advance comes another problem.

Over imaging.

Counter- intuitively getting an image taken is often associated with poorer outcomes for our patients due to some of the psychological reasons associated with seeing your insides less than perfect  and also reinforcement from our treating Dr’s that we are truly broken. Early MRI in patients with non-specific LBP has been shown to result in more back surgery, increased use of opioids and a higher pain score (1)

That’s not to say that imaging is not vitally important and necessary in many circumstances. It’s just that we need to make sure the image is ordered in the appropriate conditions.

A recent study looking at over 4000 referrals from Denmark looked at problem and concluded that 75% of MRI imaging referrals for lower back were either inappropriate or did not contain enough information to make a call (2)  Only 25% of imaging referrals meet the standards of appropriate lower back imaging referral as agreed by the Nice imaging guidelines. This is is keeping with other research which also finds similar rates of over-imaging (3) As clinicians we need to do better  !

The final decision for image should really be up to your treating Dr to decide and there is often things happening we may not be aware of but it is important to remember that most instances of lower back pain get better within 4 weeks so just having a sore back is not reason enough alone to order imaging.

For imaging to recommended early before 6 weeks of symptoms we are really looking for other ” red flags” such as neurological symptoms, rapidly worsening symptoms or suspicion of fracture or serious injury to warrant an image at early stage.

So if your primary care physician has decided not to order an image they may be not slack or not thorough they might just be following best practise ! That being said if you feel something is not right you should always go with your gut and mention it to your Dr.

References

1. Jenkins, H.J., Kongsted, A., French, S.D. et al. What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study. Chiropr Man Therap 29, 46 (2021). https://doi.org/10.1186/s12998-021-00403-3

2. Krogh, S.B., Jensen, T.S., Rolving, N. et al. Appropriateness of referrals from primary care for lumbar MRI. Chiropr Man Therap 30, 9 (2022). https://doi.org/10.1186/s12998-022-00418-4

3. Jenkins HJ, Downie AS, Maher CG, Moloney NA, Magnussen JS, Hancock MJ. Imaging for low back pain: Is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine J. 2018;18:2266–77.

Niseko Chiropractic research review

We have been seeing quite a few US military pilots down in Sunabe Okinawa and it perked our interest to do a bit more study. It turns out lower back pain is responsible for about 75% of non-combative injury discharge cases so there is great merit in getting this right.

It turns out lower back pain is very common with a recent study of Chinese Military pilots with a recent study finding that on average around 1 in 3 ( 37%)  of Pilots experience episodes of lower back pain with the highest being military helicopter pilots ( 45% ).

Fighter pilots experienced more issues do the G force and helicopter pilots were thought to get more problems from the vibrations transmitted through the cabin.

Flying more than 6 hours a week seemed to lead to greater risk in fighter pilots and but interestingly in helicopter pilots the number of flying hours did not correlate with a change in lower back pain.

The authors of the study concluded that preventing lower back pain in pilots is going to take a combination of managing the correct amount of flying hours, active rehab with focusing on hip muscles and some further core training.

Further research looking at weather this is replicated in the US military experience is needed.

References

Yang, Y., Liu, S., Ling, M., & Ye, C. (2022). Prevalence and Potential Risk Factors for Occupational Low Back Pain Among Male Military Pilots: A Study Based on Questionnaire and Physical Function Assessment. Frontiers in public health, 9, 744601. https://doi.org/10.3389/fpubh.2021.744601

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8764305/

Should we be using anti-depressants for lower back pain ?

An interesting meta-review was just published in the journal of Systematic reviews.

They were trying to answer the question of weather physicians should be be prescribing anti-depressants as a means to assist with the pain and disability caused by lower back pain ?

Certainly I seeing a lot more patients on anti-depressants since working with a more American population in Okinawa and I guess the stress of the covid-19 pandemic has only increased the this.

The authors concluded that in a review of 23 quality randomized controlled trials the best evidence available does support the prescription or efficacy of anti-depressants to address low back pain. In there words ” Taken together, these data indicate treatment of LBP symptoms with antidepressants has no important benefit; is less acceptable, less safe and less tolerable; and may be harmful, compared to treatment with a placebo medicine “.

That’s not so say that antidepressants  don’t have legitimate reasons for their prescription. Simply that they should be prescribed as a modality to treat lower back pain or perhaps even the depression that can be directly linked to the chronic pain.

What does seem to offer better results are exercise therapy, physical therapy or when that fails  other medications commonly used to treat chronic pain such as  pain medications and anti-inflammatorys and muscle relaxations.

Remember too you should never decide to alter your medication by yourself and in some cases this may be dangerous . Always talk to your primary health care practitioner that prescribed your medication and discuss with them.

If you would like to read the article it is below.

References

1. Ferraro, M.C., Bagg, M.K., Wewege, M.A. et al. Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis. Syst Rev 10, 62 (2021). https://doi.org/10.1186/s13643-021-01599-4

   https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01599-4?fbclid=IwAR3LSMT10GSsi5W2lYfsfiiae623-_FHQ32bWz2Tu-3PcNBe4MBkamvGuK4#citeas

Covid cases continue to fall in Hokkaido

From a peak in late November 2020 it’s great to see the sharp drop in Covid-19 cases in Hokkaido. To be honest I have no idea why the number of cases continues to fall but very happy to see it.

Research Update

Interesting study from the Journal of manipulative and physiological therapies on the effect of dry needling for muscle pain. 

They were looking at the effects of dry needling ( acupuncture without meridian theory ) on the women that had upper trapezius pain.

What they found that was the effect was of greatest benefits when the needles were inserted away from the trigger point ( tight knot located in the muscle belly ) rather than trying to needle directly in the middle of the knot.

This makes sense as often when a needle is inserted directly into a ” hot ” are sometimes the body just reacts more once it’s alarm bells have been activated.

I had quite a few neck torticolis to deal with last time in Okinawa and that was often the same lessons. Sometimes a gentle indirect approach is best. The rule of thumb is if so something is hot go in indirect and if something is chronic then sometimes a bit of caveman soft tissue work can be indicated.

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

www.nisekochiropractic.com/appointments

References

Dry Needling and Photobiomodulation Decreases Myofascial Pain in Trapezius of Women: Randomized Blind Clinical Trial
Dalpiaz Et al
Published:November 26, 2020DOI:https://doi.org/10.1016/j.jmpt.2020.07.00

https://www.jmptonline.org/article/S0161-4754(20)30149-4/fulltext

Niseko Chiropractic research review:

A surprising result

A few years ago the research began to show that strength training also leads to gains in range of motion.

This is not new news for those following sports research but what’s really interesting is a recent high quality meta review examining 11 published articles in the research literature asking the question ” Does strength training lead to the same increase in flexibility as stretching “.

Here is the interesting thing.

The researchers found that there was no significant statistical difference between the flexibility gains from weight training and those coming from a stretching program. This is certainly news to me and really puts a rocket up the idea that you should not start the a gym program if you are worried about loosing flexibility.

The study did not specifically examine the question of just how much exercises is needed to get the job done however it’s thought that most of the studies suggested about 2 times a week for 5 weeks straight was sufficent to see some improvements (1).

What can we take from this ?

Well firstly it’s a false dichotomy to assume it’s one or the other.

There are no reasons why you can’t include strength and flexibility in your weekly training regiment. If you are however short on time or motivation and already have some underlying strength issues then this may tip the balance for you to move towards more strength training.

The golden rule of Niseko Chiropractic is that you have to find something you actually enjoy doing. If that’s yoga then carry on with that and yoga also builds get strength at the same time.

It does also tell us that we should probably not be afraid of the effect that our strength training may have on our joint flexibility, its probably good news !

Like all things there are limits and caveats.

I worked with a lot of “Gym junkies ” back in Australia and even a few now in Okinawa and it’s pretty obvious that they have trained to such a level that there flexibility is starting to go down but these are extreme cases from people to willing to push there bodies far further than the average person.

Studies like this are also great for determining what’s good for population but less good for determining what may be in your best unique interest. That’s why research is always only one arm of evidence based medicine.

Above all, get out there, move and do something you enjoy.

If you would like to discuss these findings further or schedule an appointment with an english speaking chiropractor in Okinawa or Niseko you can do so on the link below

www.nisekochiropractic.com/appointments

References

1. Strength training is as effective as stretching for improving range of motion: A systematic review and meta-analysis. 2020 Afonso et.al
2. https://osf.io/preprints/metaarxiv/2tdfm/?fbclid=IwAR3_bPysWdFc0bdj9ChvHFe0e9xdxFQA8fm3VshpyyE2gtcu0Rab1QiGVxY

Cutting your risk of sitting yourself to an early death

Brilliant research just in from the British Journal of sports medicine

They did a review of previous studies with a combined sample size of around 44,000 people and looked at the risk of sitting causing an early death and how much ( or actually little ) exercise is needed to combat this effect.

Hard to find data from Japan but Americans spend on average 55% of their day sitting or 7.7 hours sitting ( 2) and we are starting to learn that this is associated with shorter lifespan, increased risk of cancer and type 2 diabetes. This result was not linear either. In other words your risk increases greatly once you go past the 8 hour mark. Even a few extra hours rapidly increases your risk.

So that’s not really new news.

What makes this study interesting is they examined just how much exercise you need to do mediate the damaging effects of sitting.

And it’s not much !

Just about 30-40 minutes a day was the amount needed to mitigate the increased risk caused by sitting but even as little as 11 minutes a day still was found to significantly helpful and reduced the risk of all but the most prolonged sitting.  Previous studies on this topic concluded that at least an hour a day was needed but this new better designed study actually reduces the amount needed.

The new guidelines from the UK, the USA and WHO recommend that adults should participate in physical activity for 150–300 minutes of at least moderate intensity every week (1)

Even better news is that there seems to be no difference if you break this up. So if you don’t have time for a 40 minute walk break it up into 2 2o minute walks. Even if the smallest things can really help. Always try and take the stairs instead of the elevator.

This is not say you should exercise less of course. There are still many other benefits to more than 40 minutes such as weight loss, improvement in mood and better sleep as well.

So get out there and get moving !

If you would like to make an appointment with an english speaking Japanese registered Chiropractor in Sunabe Okinawa or Niseko Japan please go to

www.nisekochiropractic.com/appointments

References

1.https://bjsm.bmj.com/content/54/24/1499

2.https://link.springer.com/article/10.1007/s10654-018-0380-1

Niseko Chiropractic is now back in Okinawa and accepting consultations until the 18th of November.

If you would like to make an appointment with an Australian trained and Japanese registered and insured  English speaking Chiropractor you can do so on the link below.

Niseko Chiropractic is currently operating from just near the sea wall in Sunabe. For those that can’t make it this visit we will be back from the 10th of December.

You can book online at

www.Nisekochiropractic.com/okinawa

Is Niseko open for tourism this season ?

Niseko Chiropractic hike to the crater on Mount Yotei (1898 metres ).

Well we finally have some degree of certainty for Niseko’s 2020/21 ski Season.

Sadly the word from the Japanese government is that Japan will be closed for international tourism until April 2021. Source: https://www.japan-guide.com/news/alerts.html

There is some opening of borders under the ” Business track system ” for business travel from limited countries such as South Korea and Singapore but you will still have to undergo a mandatory 14 days quarantine and 2 rounds of Covid testing so getting here is going to no easy feat even for those with a vaild business reason to travel.

I think we can be be fairly certain on the April timeframe too.

Japan has expressed an iron clad determination to see the rescheduled  July 2021 Olympic games take place and they will need open borders weeks to months before this event if it is going to be success.

If you are yet to see Niseko in Spring and Summer I urge you to consider making here up here in the green season during the 2021 warmer months.

For those that can manage to get to Niseko this Winter it will no doubt be unforgettable. For those that can’t us local riders are committed to shredding the Pow in your absence (its the least we can do )  and will do our best to find pick off the fresh lines.

Some more info on resorts is below.

Niseko Resort announce lift operations

Crazy deal on Moiwa season passes

Update to Business hours this week

If any locals wish to book in with Niseko Chiropractic this week I have Some options business hours this week.

If you would like to book a session click on the button below

Where do we stiffen up ?

It’s no surprise to you dear reader that our flexibility and range of motion decreased in our spine as we age but there is not as much published research as you would think as to where this occurs within the spine, particularly in the normal population.

In a great new study published in Springer Nature the authors looked at 600 people that did not report significant neck pain and they examined what individual segments we actually loose range of motion in our necks as we age.

What they found was pretty interesting. The older you get the more range of motion you loose in the lower part of your neck but the upper part where the spine joins the base of the skull remains pretty mobile your entire life. This is reassuring both for patients and therapists that the range of motion in our upper joints stays pretty good.

You an see the differences clearly in the graphs below

The other thing that surprised me was how linear the loss was up until about age 70 where after that it actually slows down a bit. I would have guessed that the most marked loss of range of motion would have been in the last decade of the graph.

Just a reminder that Niseko Chiropractic will be available for mobile locals consultations over the summer and also at the  ” Studio ” powder yoga’s newest premises.

To make an appointment with Brent Verco please click on the link below

www.nisekochiropractic.com/appointments

If you would like to read the full study you can do so on the link below

https://pubmed.ncbi.nlm.nih.gov/32694318/

Consulting from Powder Yoga every Tuesday

Niseko Chiropractic is now consulting from ” The studio ” a great little space in Kutchan located just 4 doors up from the sprout cafe.

If you would prefer your treatments not to be mobile based this is a great chance to get a relaxing treatment in the heart of Kutchan.

Brent will be consulting all day tuesdays and other times by prior arrangement. Please be mindful of the Powder Yoga teaching schedule which is subject to change.

If you would like to make an appointment with an Australian university trained English speaking chiropractor you can do so on the link below

www.nisekochiropractic.com/appointments

Amazing conditions today

It’s great to be busy in business. But one of the downsides of living and working in Niseko is whilst you  watch these amazing conditions from the work window is you can look but not touch.

But not today. Today Niseko Chiropractic was able to get some great slides with bluebird conditions on the back of the mega dump that came on the 17th of January.

To be fair it was not so much a powder day but the snow quality at the moment is just superb for getting out there and throwing down some nice carve turns. Beginners were also enjoying the nice conditions and it is certainly a lot easier to learn when the snow grips so well under your feet.

With moderate snow forecast again on Monday and Tuesday we should see some classic Niseko conditions return after what has been a slower season that previous years.

If you need a mid season tune up or wish to book one of our mobile sports massages right here in Niseko, Annupuri or  Rusutsu  we would love to be able to help.

You can book online for Niseko Chiropractic and we can come to you at

www.nisekochiropractic.com/appointments

Rusutsu Chiropractic now open for business

Just a reminder that Niseko Chiropractic is now available for consultations within the Rusutsu resort area. As this is an increased distance from our usual treatment area there is an additional 2,000 Yen charge for extra travel but this can be waived if 2 or more consultations are booked.

If you would like to book an English speaking Chiropractor during your stay in the Rusutsu resort complex please go to

www.nisekochiropractic.com/appointments