What does a Chiropractor do … on a Sunday?

What does a chiropractor do?

That’s a question I often get asked – even people who’ve been through a course of treatment only get a snapshot of a typical clinical day as it relates to their presenting condition … and life as a chiropractor can involve so much more than just turning up and treating patients.

I decided to keep a journal of different days of the week for three months – and then pick one entry for each day of the week at random.

Here’s what I got up to.

A day of rest it isn’t.

As anyone with an eight-year-old will know, Sunday usually begins several hours before dawn as they wake up a good two hours earlier than on weekdays and sneak in to make sure you’re enjoying your lie in.

There is then the after breakfast (bacon, sausage and black pudding butties  – #5stepping is about moderation in all things including moderation) dash to some remote corner of Somerset to collect whichever teenager needs extracting from sleeping over after a play/match/concert/party in time for coffee at Granny and Grandad’s.

Another question I often get asked is what it’s like to work alongside your mother.  The answer is I don’t know – we’re now only in the same clinic at the same time once a week, and she spends her time in her treatment room from 9 till 7, whilst I’m in mine for the same period: if we need a meeting, we have to schedule it … or we get a chance to chat over coffee in between grandchildren and crosswords on a Sunday morning.

Sunday afternoon is dilemma time: family first as it’s our only day together – but there’s also gardening (once a whole family activity but no more) and those little bits of work that you didn’t get done during the week and which you feel guilty for doing and guilty for not having done.

Today though there’s a major – and highly complex – medicolegal report that’s needed by tomorrow and at the 6,200 words I managed to write between 142 patients last week, I’m only halfway finished. These days I have every speed device known to mankind [try TextExpander if you need to type long, technical phrases on a regular basis] and can manage 1,000 words an hour unless I’m on a particularly difficult area … which means I can finish the report and still find time for Harry Potter, help with homework, diary planning for the coming week, five emails from patients and the last ten minutes of Downton Abbey.

At least on Monday, you can guarantee that the eight-year-old will need waking up after the alarm goes off at 6!

Plantar Fasciitis may be a common cause of foot pan … but it’s not the ‘sole’ cause.

Plantar Fasciitis may be a common cause of foot pan … but it’s not the ‘sole’ cause.

When it comes to feet there is a medical truism: we all take them completely for granted – until they start to go wrong!

Complaints about foot and ankle pain are a daily presentation to any chiropractic clinic; particularly so at Yeovil Chiropractic Clinic, where we normally have a podiatrist (foot specialist) working alongside us (get well soon, Robin!). 

Although the complaint itself may appear simple, the underlying causes can often be complex – did you know that a quarter of all the bones in your body are in your foot?To make matters worse, foot problems aren’t just caused by feet.  They can also be the result of knee, hip and low back dysfunction and it’s important that any treatment takes this holistic approach.

 Of the dozens of possible diagnoses, which can include congenital variants, neuromas, stress fractures, arthropathies, sprains, strains, bursitis, tendinopthies and fat pad pathologies we, in this country, appear to have a fixation with one condition – plantar fasciitis (pronounced ‘fash-ee-eye-tis’).

Of course plenty of people do present with plantar fasciitis – it’s a common condition in middle and old age.  It’s caused by inflammation in the soft tissues that make up the arch of the foot – so if your pain isn’t in that area, it isn’t plantar fasciitis.  The onset is usually quite sudden and associated with an obvious cause (change in footwear, walking barefoot, trekking across cobbled streets) and treatment should comprise two elements: symptom relief and determining the reason for the dysfunction and not just the cause of the onset – are the bones of the foot aligned properly? Are the muscles working properly? Is there damage to the ligaments? Are the legs functioning in a balanced and symmetrical manner? Are the nerves that control the feet working as they ought?

The symptoms are usually easy to control: medical treatment usually involves drugs to control the inflammation and advice about footwear (Crocks are our top tip) but if you want the treatment to be as effective as possible and minimise the chances of it coming back you need to ask the basic question: ‘why have I got this problem?’

…and if you feet aren’t giving you any grief, perhaps you should ask yourself ‘what can I do to keep it that way?’ – like many musculoskeletal conditions, the signs are normally there for the expert eye to detect before things actually start hurting: so are you taking your feet for granted?

Arthritis – Should I learn to live with it?

 Arthritis is another of those words that mean different things to different people. To most, it means your joints have got a bit of wear and tear in them; to a specialist such as a rheumatologist or chiropractor, arthritis refers to a very specific group of much rarer inflammatory diseases of which rheumatoid arthritis and anklylosing spondylitis are probably the best known. Wear and tear – often referred to as ‘osteoarthritis’ – is a completely different disease process, which is why specialists prefer the term ‘degenerative joint disease’, or DJD for short.

So do you have DJD?  If you’re over 50, then the answer is almost certainly “yes” – most commonly, it affects the joints that we use the most (thumbs, toes, backs and necks) or the ones that bear the most weight (hips and knees), particularly if you’re carrying extra poundage!  So if you’ve got some swelling or stiffness in those joints, can you do anything about it?

The Key Ingredients to a Healthy & Successful Diet: Shopping Like Gran Did

You are what you eat as the old adage runs – and all the evidence suggests that the huge increase in the average weight of the UK's population is due to precisely that… we are, fuelled by convenience, increasingly champing our way through the heavily promoted products of the ‘food industry’ which are all too often laced with the addictive sweetening agents and fats that are not only guaranteed to make you put on weight, but to make sure that you  to keep coming back for more.

More than half of us are unhealthily overweight – still slightly behind the Americans, but only just – and it’s not just adults: the rise in morbid obesity in children is particularly scary as fat children are actually developing more fat cells rather than doing what adults do, which is simply overfilling the ones they already have. This makes it incredibly difficult for them to lose weight without existing in a state of semi-starvation … for life.

Part of #5stepping is to make sure you don’t eat the wrong food … and then to kick on and make sure your diet is laced with the ‘superfoods’ that can add to your health: it doesn’t mean you can’t ever eat a Big Mac again but, in the same way that cutting out some of the caffeine and alcohol helps reduce toxins and empty calories, putting in place good food habits can benefit you and all those around you – and those habits begin on the high street or more probably the out of town hypermarket because, the way we shop has changed beyond all recognition.  In a single generation, supermarkets have replaced individual high street shops; you can now buy what used to be seasonal fruit and vegetables twelve months a year; and exotic, occasional treats have become weekly staples.

My Shoulder is Frozen!

Have you ever had a shoulder joint that’s painful and restricted?  The chances are you probably thought it was a ‘frozen shoulder’ – and the chances are you were probably wrong!

As with some of the previous terms we’ve discussed, such as sciatica and migraines, the problem lies in part with the difference between what you might mean by ‘frozen shoulder’ (it hurts and I can’t move it properly) and what a musculoskeletal specialist means by ‘frozen shoulder’ (very specifically, adhesive capsulitis) … and differentiating between the two is very important as they can have very different treatments and outcomes.

The shoulder is the most complicated joint in the body – in fact, it’s not one joint at all, it’s three joints plus the articulation between the shoulder blade and the top seven ribs.  If it’s going to work properly, there are over 100 joints, muscles, ligaments and bursae that have to we working normally and integrate smoothly.  Fortunately, of all the things that can go wrong, frozen shoulder (or adhesive capsulitis as we should call it from now on) is one of the less common.

Early to Bed…

So far, #5stepping shouldn’t have proved to onerous – drink more water, walk a little more; drink less caffeine and alcohol, sit a little less … but then that’s the whole point of #5stepping: it isn’t meant to be hard, it’s all about those little incremental changes that stack up to make a big difference.

The third step you can take to make your life healthier is even easier … it involves doing absolutely nothing, and doing it for at least seven-and-a-half hours a day!

That’s the minimum amount of sleep the average person needs to stay healthy yet more than half of us aren’t getting more than around six hours per night – and not enough zeds doesn’t just make you feel a bit slower, it could kill you!

LIES, DAMN LIES & STATISTICS

The County Council have gone on the defensive, explaining to the Western Gazette why paralysing the town is in our best interests and how we should be grateful to them for all that they are doing … but let's pretend that we're savvy eight-year-olds and see whether we have the intelligence to read between the lines of spin.

I am, by the way, writing this whilst waiting for my first patient of Friday afternoon to arrive – predictably, the combination of POETS afternoon, school pickups and the genius decision to combine closing Hendford Hill and Brunswick Street with resurfacing work to the A30 (White Post area, start of the week) and A37 (Red House area, right now) means that the town has reached meltdown and is gridlocked.

So here are the roadworks in number form, best Daily Mail style courtesy of the Western Gazette. In nice simple soundbites because we're obviously stupid enough to have elected these people so we don't want any joined-up thinking.

14 – The work's cost in millions of £££s. £3M is being spent on the Eastern Corridor as we speak, with £11M invested in the Western Corridor from January 2016. The work involves improving roundabouts and junctions and providing better facilities for cyclists and pedestrians.

Name me one "improvement" that has actually helped Yeovil's traffic. Every "improvement" I can think of has cost millions, caused weeks or, more usually, months of disruption and made no difference. Add this money to the £3.5M wasted on moving the Reckleford bottleneck 70 yards further up the road and you can't help but think of whether £17.5M couldn't have built some if not all of a proper bypass.

16 – The roadworks are expected to make journey times from Horsey roundabout to Lyde Road 16 per cent faster than if they weren't implemented.

Sounds great doesn't it. How much do you want to bet that: a) This is a guess; b) That it turns out to be wildly over-optimistic; c) that "journey times" includes cyclists and pedestrians at whom all the "improvements" seemed to be aimed despite the fact they can usually travel faster that traffic. There is also the phraseology to consider ……"than if they weren't implemented" – ie, Yeovil is going to gridlock when they build thousands of extra houses that nobody wants but maybe it won't gridlock quite as much if we do this and at least you won't be able to say we didn't do anything. Or maybe they're just getting us used to sitting in unmoving traffic as preparation.

  

Build a bypass guys and then feed your new unwanted and unnecessary estates off the bypass.

20 – There will be at least 20 hectares of employment land to be developed in Yeovil – 4.4 at Lufton and 16 at Bunford Park.

So much for the Green Belt.

Who do they think will want to come to a town with such rubbish transport infrastructure? There is an increasingly strong argument for moving at least one of our clinics out of town (the one that relies on cars to transport patients rather than the faster moving pedestrians).

23 – The roadworks are expected to make journey times from West Coker Road to Thorne Lane 23 per cent faster than if they weren't implemented.

Bearing in mind the decision to feed the access for the 1,000+ cars from the completely unnecessary and universally disliked East Coker development onto the A37 just south of the Hospice, and that much of this traffic will either be going down West Coker Road or Hendford Hill, is there anyone out there that actually believes that transit times will be faster. No? Good, because that isn't what this says.  They will, of course, be slower because of all the extra cars, just maybe not quite as slow as they might have been. Or Not.

123 – the amount in millions of £££s that road users are expected to save over 60 years through reduced delays, vehicle operating costs and collisions on the Western Corridor.

Talk about plucking figures out of thin air.

…But, if they really believe that, just think of how many times over a bypass would pay for itself – you know, one of the traditional ones that goes around the town, taking away all the through traffic.

2,247 – The total number of houses planned to be built in Yeovil. The Brimsmore development involves 830 homes, Lufton 710 and Lyde Road 700. Upgrading Yeovil's roads is a legal requirement for future housing and development.

And here we finally cut to the chase … it's nothing to do with improving Yeovil's traffic flow, it's a requirement to be seen to be doing something to tick the boxes to allow the extra houses to be built.

So here are a few of stats of my own: 

0 – The number of patients to whom I have spoken who want Yeovil turned into city. All those extra patients may be good news for patient numbers (assuming the disruption doesn't bankrupt us) but I came to work in Yeovil because I wanted a market town with a strong sense of community. Who asked the residents whether they wanted all this development?

0 – The number of patients who think the "improvements" will actually improve anything.

6 – The millions of hairs Yeovil's traffic planners have caused me to pull from my head.

352 – The number of patients who were affected by the traffic last week.

The people I feel really sorry for (apart from the traders who can only sit and count the cost of their potential customers avoiding Yeovil like the plague) is those well-meaning souls charged with reinvigorating the High Street. What is the point when nobody wants to come as it isn't a shopping destination and you have to pay a fortune to park when you get there; and how will it ever become a shopping destination when you CAN'T get there.

Cut the Rates – Fire the Planners – Build a Bypass. 

How Can You Have Road Rage If All The Roads Are Shut?

The Americans of course have a word for it; unfortunately, it’s a rude word so I’ll allude to it directly only the once: ‘Clusterf*ck’ (herefter emphasised to ‘CF’).  

So what is a CF? I’m so glad you asked: a CF is where you do something really, really stupid and rather than say ‘that was a bit daft’, you try to fix the problem … which makes it worse.  Then, through a dogged mixture of pride, stubbornness and sheer bloody stupidity, you try to fix that problem too … which makes things even worse but by now there’s no going back so you carry on and by this time usually your house has been burned to the ground, your business bankrupted or, in the case of Yeovil, the traffic gridlocked to the point where everyone goes to do their shopping in Sherborne or Dorchester.

Some fifty years ago, councillors decided that putting a bypass round the town would be far too conventional and also stuff their chances of a local game of golf and so, with great foresight and no self-interest whatsoever, elected to put it through the middle of town instead, at once ensuring Yeovil was cut in two; became dirty, noisy and smelly; and frequently gridlocked by the simple fact that, at several points, two lanes merge into one, thus causing turbulent, chaotic flow as soon as the traffic volume reaches a certain point (can you tell I used to be a physicist?).

Since then, the traffic department (now conveniently situated out of town and staffed by people who don’t actually have to drive in Yeovil), have been convinced that they are just one simple fix away from solving the problem: a new set of traffic lights, a one way system, a mini-roundabout – this, ladies and gentlemen, is a CF: so much so, that it is now, I am reliably informed, highlighted at at least one American University as the classic example of CF in town planning.

The latest futile attempt consists of three months of blocking both western approaches to our clinic (and pretty much the whole of Yeovil) in order to put some traffic lights on a roundabout.  As a daily commuter down Hendford Hill, I agree the system does’t work – particularly during school time when the queues are three times as long.  Anyone who drives in Yeovil could tell you that … which is why the Taunton-based County Council decided to start the work on the LAST day of the Summer Holidays!

Having driven past yesterday evening, it was nice to see that, after four days, they’d managed to break up some tarmac.  Nobody was working of course; the idea of overtime during the daylit evenings or weekend working to speed through the paralysis of the town not having occurred to anyone who doesn’t actually have to come to Yeovil: it is, after all, only the A30. 

Gardening without the pain

The gardening season has started and, all over Britain, hundreds of chiropractors are rubbing their hands in glee as thousands of gardeners beat a hasty path to their doors to remove the pain from their shoulders, the ache from their backs and the cricks in their necks… but it needn’t be like that.

There is a myth that things need to hurt after a day in the garden, so accepted by gardeners and physicians alike that nobody bothers to do anything about it other than suffer in silence, reach for the pain killers or give up gardening – which is a shame because gardening is not just good for the soul but can be an excellence source of exercise, fresh air and sunlight, if done right.

Sciatica is not the only condition that’s a pain in the ar•e

Sciatic pain is a common presentation to any chiropractic clinic and one of the commonest complications of low back pain… but, for every ten patients who think they have sciatica, probably only two or three actually do.

Part of the problem is that sciatica is used in everyday terms to describe pretty much any pain that runs down the leg; however, to a back specialist, such as a chiropractor, it refers very specifically to pain that arises from the sciatic nerve or its branches and it has a very specific pattern of distribution: down the buttock and the back of the thigh, often into the back of the calf and the sole of the foot. If it’s down the side or the front of your leg, then it’s not sciatica – but don’t worry, a chiropractor can probably tell you what it is !

Even if it is running down the back of your leg, sciatica still isn’t a definite diagnosis as sciatica isn’t the only thing that can cause pain in the back of your leg. Identical symptoms can arise from the ligaments, joints, muscles and bones in your spine or buttock – in much the same way that pain from the heart refers to your left arm in angina.

#5Stepping Part 2: Stepping Out!

The second step to a healthier, wealthier you is almost as simple as the first: keep drinking the water… and start taking some steps – and more than just five of them!

Once upon a time when, if you wanted to get somewhere, walking was most likely the only option.  As hunter-gatherers, most days would have probably involved walking ten to twelve miles, presumably with days off if a mammoth had been bagged recently.  Then someone invented the wheel, domesticated oxen to pull them, bred horses to pull them faster and discovered how crude oil could be refined to make them go with a bang.  These days, few people even manage ten miles per week.

#5stepping to Wealth, not just Health

Another very good reason to drink water is that it’s the world’s best diet drink … it has ZERO calories!!

By comparison, the typical ‘2 unit’ alcoholic drink contains between 200 and 300 calories, and a bottle of cola or an energy drink over 300 – and what’s worse, they’re ‘empty’ calories, devoid of any nutritional value.

So, if you’re #5stepping (and, if you’re not, you should be), you’ll see why replacing one alcoholic and one caffeinated drink per day is going to help you lose weight – to put it into perspective, 500 calories a day is ONE-THIRD of the average daily requirement for most adults, it’s the equivalent of two Mars Bars, it’s 3,500 calories a week, it the equivalent of a whole meal, it’s 182,000 calories a year!

Who needs to diet if you’re #5stepping?  

Are you getting Cold Dehydration?

Another good reason for drinking water is that it stops you getting dehydrated.

Obvious?  The average adult is made up of about 40 litres of water – that’s 60% of your body mass.  Lose as little as half a litre, and symptoms start appearing; by the time you’ve lost a litre, you’ll be suffering from impaired cognitive function, reduced physical performance, headaches and symptoms of fatigue.

In the long-term, there is evidence to suggest that chronic mild dehydration is associated with increased risk of a number of conditions, including constipation, urinary tract infections, hypertension (high blood pressure), coronary heart disease (CHD) and strokes.

But you won’t get dehydrated in Winter because it’s cold … WRONG!

It’s actually easier to become dehydrated in winter.  In summer, it’s hot (well, sometimes) and you sweat, both of which trigger thirst – which makes to want to drink.

STEP #1: WATER, WATER EVERYWHERE … SO WHY NOT DRINK SOME!

So the thirteenth day of Christmas has arrived and within the seasonal conundrum of how to lose the half a stone gained over the previous fortnight and pay off the credit card purchases that didn’t seem a problem until the statement arrived.

It’s time to start #5stepping, and you can follow the campaign with daily tips and updates @5stepper and on Facebook http://ow.ly/GVb6H

So, in the spirit of seasonal panto, let’s start with a simple question: Do you take drugs?

Oh no I don’t…

Oh yes you do…

Although most of us wouldn't dream of consciously taking psychoactive drugs or drinking poison, how many of us down caffeine every day in our teas, coffees, colas and energy drinks – or even in products such as waffles, sunflower seeds, trail mix, jelly beans and chewing gum? The UK's Food and Drug Administration's recommended maximum intake is the equivalent of four to five (regular) cups of tea or coffee per day: without any extras from other caffeine containing products.

Then, when we’ve finished spending the day downing caffeine (a stimulant), we're countering it with a poisonous depressant – alcohol! Almost everyone thinks they drink less than they actually do; often by underestimating the size of home measures or the strength of the drink, and about one-third of the adult population are estimated to be seriously damaging their long-term mental or physical health by the amount of alcohol they consume.

Cutting down on coffee and booze are usually top of the New Year's Resolutions list but, rather than giving up, why not do something positive about it instead?