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Niseko Chiropractic Updates

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August 1, 2022 Uncategorized

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


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June 4, 2022 Uncategorized

Now in Tokyo !

Niseko Chiropractic will be consulting in Minato City, Tokyo from Wed the 22nd  of June.
After providing native English speaking Chiropractic in Niseko and Okinawa for the last 4 years we have now expanded operations to provide Chiropractic services in Tokyo.
If anybody living in Tokyo would like to consult a native English speaking chiropractor you can book online on the link below or you can learn more on our Tokyo page here

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May 31, 2022 Uncategorized

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

 

 


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February 25, 2022 Uncategorized

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.

 


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January 26, 2022 Uncategorized

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 health9, 744601. https://doi.org/10.3389/fpubh.2021.744601

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

 

 

 

 

 

 


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December 8, 2021 Clinical

The Effectiveness of Compression stockings- Research review update

It’s pretty common to see many athletes, particularly runners and cyclists training in Compression stockings hoping to get some extra performance or reduce pain. But are they effective ?

A recent research review published in the Open Access Journal of Sports medicine attempted to answer this question.

What they found when the looked at about 183 studies on this issue is that there is little evidence that they increase athletic performance by such things as improving your lap time etc. They is some weaker evidence that they help muscle recovery the next day but not much to say they reduce discomfort whilst you are competing.

If you are training in winter environments there is some benefit in keeping you warmer whilst still be very light and we have good reason to think they don’t do any harm or pose any risks. There doesn’t seem to be much affect on blood flow despite some manufactures making these claims.

In a nutshell if you find compression garments comfortable to compete in and you find some benefit in wearing compression garments you should continue to do so but they may not be the secret weapon that some clothing manufactures claim.

 

References

https://link.springer.com/article/10.1007/s40279-021-01604-9?fbclid=IwAR1M7rzQZ4VEVmfXl6_1uES5Sj19F5H7VJFKYDk66GkTjUstFX4jr0kU2qM

 

 

 

 

 


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November 24, 2021 Clinical

It’s late November up in Niseko and with the snow starting to fall and the house quiet it seemed like a good idea to catch up on some study.

In 2020 the Journal Spine ( Considered the most prestigious Journal for back pain in the world ) released a very comprehensive summary of the research  around what modalities work best for low back pain, which ones are not that useful and what really helps from  a diagnosis point of view.

It’s mainly written for practitioners and researchers but if you did want to dive in yourself here is a great summary of the state of lower back pain research.

https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Clinical-Guidelines

If you don’t want to read all 217 pages you will be forced to hear the summary thoughts from yours truly.

Well what works ?

The authors graded the evidence from hundreds of studies into an A ( really sure ) B ( probably helps ) and I ( conflicting results ). Nearly everything was an I. As a humble practitioner this is somewhat reassuring. None of the trendy new therapies like ” pain science ” and some of the cognitive therapies really faired no better.

To me it really shows the importance of identifying sub-groups. For example say you gave 100 Patients with short term lower back pain a trial of Chiropractic and 80 had no improvement,  17 had some good improvement and 3 reported their symptoms got worse. When you crunch the statistics you may find that your study concludes no significant improvement with spinal manipulation.

But 17 did. What if you had a way to identify what these 17 patients had in common and made sure they got the Spinal manipulation whilst you directed the other 80 into other directions ? This is where the research is headed and we do have some early indications that there are some key factors.

There was also so B grade support for Yoga so if you have lower back pain it may be worth trying Yoga in conjunction with whatever else you chose to have a go at.

There also seems to be at this point in time no research consensus on what modality offers the best value for money and return on investment. My opinion on this is lower back pain is going to be so suited to your individual circumstances that any findings would never be applicable to an individuals choice anyway. These sort of questions are really more useful to governments and policy makers.

Can lower back pain be predicted ?

Another interesting question is can the research tell us if somebody is likely to have lower back pain based on their imaging or examination findings. Again the cruel lash of research indicates that this relationship is very poor.

What does seem to stand out as a good predictor of lower back pain is…….. ( drumroll) a history of lower back pain. If you are presenting to a practitioner with lower back pain there is fair chance this issue may pop up again for you.

What about Sprays and Gels ?

Suprisingly there was good support in this study for capsican sprays and patches but only a few studies where mentioned so don’t go putting all your eggs in the chilli basket just yet.


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August 9, 2021 Clinical

Getting back into running after birth

A common question Niseko Chiropractic is often asked is ” when is it safe to return to running after birth ” . Of course this question is different for everybody but a great blog has just been published by experienced Pelvic floor physiotherapists by the British Medical Journal that addresses question.

The article in full can be found here

Ready, steady…GO! Ensuring postnatal women are run-ready!

So what did they find ?

Firstly the damage that birth can do is highly variable but their research found that damage to the pelvic floor area is far higher than we probably imagine. They found that between 15-30% of new mums experience some level of urinary  incontinence after birth (1)  and a whopping 50% have some degree of organ prolaps with a 6 month follow up.

One pelvic floor muscle known as the  levator hiatus takes up to 6 months to recover full strength. caesarean birth too should not be underestimated with studies showing that by 6 weeks only about 50% of abdominal muscle strength had returned ( 2).

In a nutshell  it’s important that a recovering system is given the right time and rehab before increased demands are placed up on it. Whist jogging may seem gentle enough it’s thought to significantly increase the stresses on the body.

It has also been reported that ground reaction forces of between 1.6 and 2.5 times bodyweight can occur when running at a moderate speed of 11 Kilometers/hour. (2) There is some concern amongst experts that the stresses of jogging may be be enough to further damage recovering muscles and ligaments before they are fully healed.

So when should a women re start jogging ?

The cited blog recommends this handy diagram below. Essentially they are suggesting waiting 3 months or going through the flow chart if less than 3 months.

Something that seems to be missing from the above chart and the literature is previous activity levels.

If you are already an avoid jogger with great form and jogged right up to your pregnancy’s slowed you down you most likely will be weeks rather than months if no complicating factors are present.

Likewise if you have never jogged before but figure it might be a great time to start to lose those post pregnancy’s weight you are probably going to need to much slower start.

In short this article sheds some light that all stake holders are probably underestimating the stresses on the pelvic floor from pregnancy  and there may be some merit in a considered approach to return to exercise.

Some risk factors to be aware of

In closing

Whilst Niseko Chiropractic would love to be part of your  post partum management team we do not consider we have the necessary skillset in pelvic floor management and do suggest you find a good pelvic floor physiotherapist to assist with any specific complaints in this area.

If you would like to make an appointment in Sunabe Okinawa or Niseko with an english speaking chiropractor here is a link below

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

 

References

  1. https://blogs.bmj.com/bjsm/2019/05/20/ready-steadygo-ensuring-postnatal-women-are-run-ready/

2.Milsom, I., Coyne, K., Nicholson, S., Kvasz, M., Chen, C. and Wein, A. (2014). Global Prevalence and Economic Burden of Urgency Urinary Incontinence: A Systematic Review. European Urology, 65(1), pp.79-95.

3 . Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, pp.220–5.


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June 9, 2021 Okinawa

Just a reminder for our Okinawa clients.

Niseko Chiropractic will be returning to Sunabe Okinawa from the 16th of June.

In the meantime we are making the most of our ” downtime ” and enjoying some of the amazing early summer road biking Niseko has to offer.

If you have not experienced Niseko in the summer ( sadly it’s still red zone now ) keep an eye out for a change in policy get up here.

If you did wish to book an Okinawa appointment here is the direct link

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


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June 3, 2021 Clinical

It’s a commonly held belief that running whilst good for the heart etc may actually damage your hip joints and lead to early arthritis.

But it’s just that. A belief.

Okinawa and Niseko ( well in summer anyway ) are both great places to get out bust out some Km’s under foot so it’s good that researches finally directly addressed this question.

Well does it ?

Probably not. The authors found  no difference in the wear and tear on the hip. between the amount of running you do and the damage in the hip joint when undergoing an MRI scan.

The published research time and time again fails to find much of a link between the volume of exercise and the wear and tear on the joints. It seems that our bodies are better then we give them credit for at repairing the damage done and the increased blood flow extra lubrication produced via increased levels of synovial fluid ( joint grease ! ) helps too.

So get moving

The  recently published article looked at the differences in MRI findings on 3 asymptotic groups

  1. People that don’t run
  2. People that run moderately
  3. People that run a lot

 

The article does have some limitations such as a small sample size and they didn’t look at runner that may be overweight or have other risk factors to joint degeneration.

The article still lends weight the idea that most of us can and should exercise regularly and running is not likely to dramatically increase wear and tear in the hip joints.

 

References

Horga LMHenckel JFotiadou A, et al
3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners

 


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April 30, 2021 Clinical

Many elite athletes Niseko Chiro treats both in Niseko and Okinawa swear by the benefits of sports massage but the research literature is unclear on just what the benefits may be.

A recent meta-analysis on this topic was published in the British Journal of Sports Medicine

The study examined 29 published research papers  on the topic and concluded that there is no much published evidence that athletic performance may be increased by incorporating sports massage but there are some studies that conclude that recovery and flexibility may be improved with regularly deep tissue massage.

The research review also found there may be a small benefit in the recovery time of delayed onset muscle soreness (DOMS) if sports massage is used in your athlete routine.

Absence of evidence is of course not evidence of absence and if you are an athlete that feels like getting sports massages increases your performance there is no certainly no reason to doubt this may be true, just not enough evidence to conclude it is true.

There is certainly still a good argument that good deep tissue work after an event or your peak required performance is good idea to keep your muscles in top working order.

If you are new to sports massage, then of it just like regularly massage but with much deeper targeted pressure that seeks to make physical changes in the tissue rather than being relaxing and feeling good.

If you would like to discuss this study further or make an appointment with an English speaking Chiropractor in Okinawa or Niseko you can check our schedule on the link below

Niseko Chiropractic Online bookings

References

  1. Davis HLAlabed SChico TJA
    Effect of sports massage on performance and recovery: a systematic review and meta-analysis

    https://bmjopensem.bmj.com/content/6/1/e000614

 

 

 


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March 31, 2021 Okinawa

Just a courtesy message that Niseko Chiropractic’s Sunabe Okinawa May dates have now been released for for online bookings.

The dates available for consultations are the 12th-23rd of May 2021

April dates are also available for booking from the 14th-25th of April 2021

 

If you would like to make an appointment either in April or May here is a direct link to the Okinawa Chiropractic appointments booking portal

Okinawa Chiropractic Bookings


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March 31, 2021 Clinical

Research update on Patello-femoral syndrome

If you are like me you probably have recurring  knee pain in least of your ” punching bags of the lower limb”. In fact it’s so common that one of my recycled jokes is ” Remember when you were young enough to call your knees left and right instead of good and bad”.

Knee pain is only 2nd to low back pain in it’s commonality. According to a great meta-analysis of 22 published trials with over 1472 participants the most common cuase of knee pain is known as Patello-femoral syndrome ( PFP) ( 1)

This basically translates as pain in around the kneecap that gets worth exercises such as stair climbing or jogging. It differs from some other knee complaints in that it’s not related to a tear of your internal ligaments or cartilage disc, but rather comes from irritation of ligaments and muscles around the patella.

Nearly 40% of those with PFP continue to experience symptoms after 2 years, which is associated with frequent use of pain killers, lowering of physical activity levels and low quality of life.

So what works ?

Well we know what doesn’t work.

Doing nothing.

Just ignoring knee pain and hope that it’s gets better is the poorest outcome. The wait and see approach has the poorest outcome from the all interventions mentioned and my personal experience is once knee pain has set in for months to years it’s probably going to hang around for the long term unless you take an active approach.

There has been a trend to ” patient education ” and a lot of more passive modalities recently in the industry but this study fails to find that these are any better than exercise.

Given that you get a whole lot more benefits from exercise plus the pain the reduction the position of Niseko Chiropractic is that a knee specific gym training exercise under the management of well qualified personal trainer is still the best option. I was I could say that just seeing a chiro for chronic knee pain would get you sorted but honestly in this area exercise seems to trump physical therapy.

Some of my favourites that help me manage my dodgy left knee are this article here

What exercises are best to prepare for a Niseko ski trip ?

 

References

  1. Winters MHolden SLura CB, et al
    Comparative effectiveness of treatments for patellofemoral pain: a living systematic review with network meta-analysis

    https://bjsm.bmj.com/content/55/7/369#T4


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March 10, 2021 Clinical

Are we moving less since covid ?

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

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

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

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

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

 

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

I’m guilty

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

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

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

 

References

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

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

 

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

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

 


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March 2, 2021 Uncategorized

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

 

 


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February 10, 2021 Uncategorized
Just a reminder that I will be available in Niseko for 4 more days before returning to Okinawa from the 17th-25th Feb.

Please note I will not be in the same purple house by the Sea Wall in Sunabe but rather a house just around the corner ( by strange co-indicine also purple ! ). I have updated the confirmation email with you new directions so for anybody booked it might pay to give the it a quick read once you make a booking in Okinawa.

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.


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February 9, 2021 Clinical

How prevalent is Low back pain in the US military ?

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

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

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

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

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

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

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

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

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

Ok so what do about it

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

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

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

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

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

www.nisekochiropractic.com/appointments

What about exercise ?

 

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

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

 

References

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

Knox, Jeffrey MD*; Orchowski, Joseph MD*; Scher, Danielle L. MD; Owens, Brett D MD; Burks, Robert PhD§; Belmont, Philip J. MD

2. Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial
Vinning et al. J Altern Complement Med  2020 Jul;26(7):592-601.

 

 

 

 

 


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February 5, 2021 Clinical

Your not alone with a pregnancy headache

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

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

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

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

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

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

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

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

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

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

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

Tension type headaches

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

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

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

Cluster headaches

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

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

Don’t put up with it

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

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

www.nisekochiropractic.com/appointments

References

  1. Headaches during pregnancy

S.de Gaalona A.Donnetb

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

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

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

 

 

 

 

 

 


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February 3, 2021 Uncategorized

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


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February 1, 2021 Clinical

Your head- It’s heavy and important

Chiropractors have long advocated for good posture.

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

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

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

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

What they found was really interesting.

 

Effects of poor head posture

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

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

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

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

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

The article also makes a great point about our generation.

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

 

What to do about it

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

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

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

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

This topic has been covered in more detail here

The importance of walking

 

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

The Brugger self stretch

 

Chin Tuck exercise

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

Wall angles

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

 

5. Stregthen

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

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

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

www.nisekochiropractic.com/appointments

References

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

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

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

 






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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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