Niseko Chiropractic UpdatesNEWS AND ANNOUNCEMENTS
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Niseko’s mobile remedial massage and Chiropractic service took a break for some family time over the Christmas period but we are back in action with appointments available from the 28th of Dec.
If you would like book a mobile 90 minute remedial massage you can see our availability and book online on the link below
It’s not suprising given her reputation but we are already getting a lot of interest and bookings in the return of Maki Moloney after she took some time off to start a new family last season.
If you are seeking mobile massage in Niseko with a firmer pressure and looking for a 90 minute season rather than the stadard hour we strongly suggest you book more massage here in Niseko at least a few days ahead to avoid disapointment.
Maki is taking massage bookings right through the 2022/23 season and entire upcoming season is now available for mobile massage bookings in Niseko.
To learn more about the Niseko Mobile massage now offered by Niseko Chiropracic please go to
Niseko Chiropractic is very excited to welcome Maki Moloney to our line up for this upcoming 2022 Niseko season.
There has always been a gap in the Niseko market for Mobile treatments that feature a therapeutic level of pressure and we are super excited to feature legendry local therapist Maki to our practioner line up.
You an choose between the Sweedish oil massage style or the more traditional dry Shiatsu style with more elbow pressure.
Maki has the training and experience to find and release your knots so you can be get back on the slopes in tip top condition and ride to your full potential.
Maki also concentrate on 90 minute sessions on rather than the traditional 60 minute mobile sessions allowing more time to for the tissues to relax and also time to concetrate on more than area. In short a 90 minute session yeilds far superior results than the standard Niseko massage timeframe.
Maki combines her Japanese Shiatsu training with western swedish techniques to get great results every time.
To book your Mobile Massage in Niseko please go to
Niseko Chirorpactic official opens again on December the 14th but if any Niseko locals or property owners are town just letting you now Brent is available for some limited hours consultations from now until the 21st of November.
If you would like to consult an english speaking Chiropractor for the management of your soft tissue injuries in Niseko you can book online at
https://niseko-chiropractic.cliniko.com/bookings?appointment_type_id=517686
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.
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
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
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.
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.
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
There are 2 questions that Chiropractors get asked a lot
The first question is lot easier to answer than the 2nd one.
In a health joint the joint is essentially a sealed cavity occupied by a small amount of synovial fluid that acts as a lubricant and also carries nutrients around the joint. This is why it’s important to stay hydrated but that’s a topic for another blog !
When you rapidly expand a joint, as happens in spinal manipulation and ” cracking ” your knuckles the space suddenly gets much larger. Becuase the pressure in the joint and fluid drops very rapidly gas comes out of the liquid which causes a ” popping sound ” . Think of it a bit like the bubbles in a can of Coke. when you pop the lid you decreased the pressure and gas comes out.
What the noise certainly isnt is bones cracking. If that was to occur we are going to have to call our malpractice insurer but in 20 years of doing this and over 20,000 treatements delivered I am happy to say this has never happened !
Short answer is probably not.
In a meta- review published Octber 2022 Morman and Newell reviewed 5 quality studies on the subject and concluded that the presence or absense of a ” pop ” did not have any measurable outcome on patients pain levels after a series of treatments.
Most chiropractors ( and patients ) including myself would propably prefer to hear it as it let’s us know that we have provided the joint with the right amount and direction of thrust to create a neurological response that is only seen in high velocity low amplitude thrusts otherwise known.
What is more important is that the joint ” free’s up ” a bit after a therapuetic intervention and this can be achieved by many different methods. So there is good news too if you are one of those people reading this that prefers the lower force techniques. It’s quite possible that techniques not incorporating the “pop ” are still just as effective.
This is probably yet another example of why Chiropractic needs to attapt and change in light of new evidence. There are plenty of the ” old guard ” that will go noise hunting to make that joint sing rather than bother to retest the joint and see if there has been a change in tone and range of motion.
And once again that old cavete. There are probably times when it probably really does matter too we just don’t have any good way of indentify what those clinical presentations may look like and how to correctly identify them.
The good news is it’s your body and that puts you in a unique to postition to help practioners understand what works best for you.
2. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119470
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 !
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
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
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.
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
Life 2022, 12(5), 714; https://doi.org/10.3390/life12050714
https://www.mdpi.com/2075-1729/12/5/714/htm
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.
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.
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.
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.
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/
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.
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.
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.
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.
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.
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
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.
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.
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
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.
Just a reminder for our Okinawa clients.
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
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.
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.
The recently published article looked at the differences in MRI findings on 3 asymptotic groups
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.
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
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
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
Copyright by Niseko Chiropractic 2018. All rights reserved.
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