What does a Chiropractor do … on a Tuesday?

Because I work on Saturdays and have Mondays off, Tuesdays start early at 7:30 and begin with an assault on the in-tray: two days’ post, messages, following up patients, phone calls and making sure the social media for the week is planned and posted (thanks goodness for Hootsuite and ‘autoschedule’).

It’s important that the decks are cleared before patients start, because Tuesdays are invariably fully booked … and often overbooked, as was this particular Tuesday, which kicked off fifteen minutes early with an emergency patient, who had cricked their neck sleeping awkwardly the previous day and was nervous about seeing another chiropractor.

The morning consisted of a typical mix of patients: There were twelve cases of low back pain (including one new patient), one hip pain, one ankle injury (tennis), a couple more cases of cervicalgia, and a couple of headache, a child with poor gait, a cartilage injury in the knee, a rotator cuff tendinitis and a lady with temporomandibular disorder … and one no-show, which is always incredibly frustrating when you’re not only full but have people on the waiting list, desperate for appointments.  Fortunately, everyone was getting better and staying better apart from one of the headache patients, who was referred to our next specialist Headache Clinic so the dental and stress components that were preventing the condition from settling could be addressed.

Although I always try to run to time, the last couple of patients proved slightly more complicated than expected and that made lunchtime a bot of a scramble – Tuesday’s morning session is at Yeovil and the afternoon session is at Crewkerne … which gives me the opportunity to stop at home en route and quickly eat a rather belated lunch.

As ever, when time is tight, the traffic on East Street is backed up to Mount Pleasant (someone build a bypass for Crewkerne PLEASE!!) and clinic starts seven minutes late!  This, of course is the immediate cue for patients to be complicated, refactory, or to present with unexpected new conditions.

The first patient was typical of this, a lady with a recovering sacroiliac joint causing buttock pain who had been feeling so much better that she decided to move some furniture and now had raging sciatica and all the signs of a prolapsed lumbar disc.  The next three patients also all had sacroiliac joint problems; however, these were all recovering as per prognosis – improved after three treatments, better after six and two of the patients were ready to start some gentle home-based exercises to stretch out tight, fibrotic muscles and rebuild core stability.

The next case is a tough one – a whiplash injury that has been referred via a solicitor having previously failed to recover.  The delays involved in processing the claim has allowed the injury to become chronic and it’s not just neck pain, like a lot of whiplash there is also a jaw problem (which is preventing the neck from settling), back pain and a shoulder injury … all made worse by the stress of dealing with solicitors and the whole compensation process. Today, at last, there is some sign of improvement: everything is moving better and hurting less – but with so many areas to treat, there is no chance of catching up and now I’m running almost quarter of an hour late.There is, however, no point in worrying about that … most patients understand that sometimes you need to spend longer with a patient – next time, it could be them! 

Fortunately, the next lady in is a new patient: at last a chance to sit down for a few minutes and to take a case history. Fortunately too, her case is relatively straightforward: a long history of migraines, which sound like they’re coming from the neck with no evidence of anything sinister or untoward going on – the physical examination confirms the diagnosis and there’s time to start a course of treatment which turns out to solve fifteen years of weekly misery in just  couple of weeks!

The rest of the evening is full of complicated patients: a knee riddled with osteoarthritis that would probably do better with surgery but the lady’s determined to avoid the kind at all costs; neck pain in an eighty-four-year old lady with osteoporosis who needs particularly careful handling; another case of low back pain following not one but two car accidents (the neck and jaw had already responded to treatment); a lady with back hip and knee pain; a cervical disc injury causing arm pain and, to finish the day, a disc problem which is stubbornly refusing to respond to treatment and needs referral for magnetic resonance imaging in Bridgwater, where we have a special arrangement … all of which means that clinic finishes fifteen minutes late – which is still quarter of an hour earlier than the rest of the week (for historical reasons, Tuesday’s Crewkerne clinic ends at 6:30 rather than 7).

Home at 7pm having left at 7am. Although there is stuff to be done (when isn’t there?), the lure of an early night proves irresistible: tomorrow is going to be another early start with budgets, cashflow forecasts and marketing analysis all to do before another 36-patient day and a fresh brain will be required.

What should you give your body for Christmas?

You’ve ordered the turkey, hung the stockings and wrapped the presents. Chances are you’re either feeling footsore or your neck is stiff; your back may be giving out alarming twinges as you decorate the tree or your shoulders can’t reach to hang the mistletoe; your knees might be making alarming sounds as you squat down to put warm ham in the oven or the sciatica could be protesting at sitting through the Christmas Downton Abbey special.

At any one time, a third of us are suffering from musculoskeletal pain – so what could you consider putting under the tree to help alleviate that aches and pains that are waiting for you in 2016?  Here are our top tips for healing and pampering those painful problems.

•   Do you need a new mattress?

The average lifespan of a mattress is about seven years, even with regular turning, though a top of the range model might last twice as long … and you won’t get one of these for under £1,000. You might baulk at spending that much on a mattress but ask yourself this: How much did you spend on your three-piece suite? – and how long do you spend sitting on it compared with the amount of time you spend in your bed?

• And how about a pillow to go with it?

One of the questions we’re asked most often is ‘which pillow should I use?’.  The problem is there’s no easy answer to this … trial and error tends to lead to the best solution.  There are hundreds of ‘orthopaedic’ pillows on the market and the best way to tell if it suits you is to use it.  This can be expensive, which is why we keep a stock of pillows for (non-smoking) patients to try (smokers’ breath makes the pillow unusable after a fortnight’s trial).  The rule is that a pillow should keep your neck in line with the rest of your spine – which will also depend on how hard your mattress is – and remember goose down may well be better than the most modern hi-tech materials.

• And when you’re awake?

The right office workstation can make all the difference. Your office chair should have adjustable height, tilt and a sprung back; it should have arms that are level with the top of your desk.  Typically such a chair will set you back around £120 – and it costs even less to make sure your screen is at the right height and that you’re using the right hardware: a trackball can put so much less strain on your arms and shoulders than a mouse for half the price of a chiropractic treatment.

 

• Prevention is better than cure

We spend a lot of time discussing with patients how to prevent problems.  We have masseuses in all our clinics to prevent the build-up of muscle tension and an Alexander Technique practitioner to remedy postural problems and we prescribe exercises to move fibrosis and improve stability.

• Put it right

If it hurts, it’s because something’s wrong.  If it keeps on hurting, it’s because there’s too much wrong for your body to heal – which is when you need a helping chiropractic hand.

How to avoid Christmas being a pain in the …

Of all the clinics of the year, the ones immediately after Christmas are the one that stirs the most emotions.  Although we’re used to a wide range of presenting complaints, the ones following the season of festive brouhaha, are often the most bizarre but often reflect how a family’s seasonal holiday was ruined by avoidable injury.

Most existing patients are rightly keen to prevent this, which is why the December patient lists are groaning at the seams as people book for ore-Christmas check-ups or finally resolve to fix the niggles that may have been mothering them for days, all to be right for the Big Ho-ho-ho.

So what steps can you take to avoid musculoskeletal misery over Yule tide?

• Don’t stress yourself out.  Christmas is often a time that we spend with people we feel we ought to rather than people we want to – and emotional stress causes muscular tension far more often that it puts your blood pressure up. Plan to be cheerful and polite but build in some solitude time so the effort doesn’t have to be constant: anything from a soak in hot tub to testing out the kids’ new headphones.

• The one thing we all tend to do more at Christmas is be sedentary – be it standing for hours peeling the sprouts or slumped on the sofa watching Downton Abbey. Prolonged standing and sitting are both bad for the spine, so vary your position and take every opportunity to move about, preferably before it starts to hurt!

• When we do finally decide that we’ve spent too long indoors, what do we do?  Go out for an over-ambitious Boxing Day family ramble with no thought as to how far each member of the group might be able to walk comfortably, and often we chose places that are guaranteed to cause backache: walking on broken surfaces such as shingle beaches or through thick mud will often trigger low back problems – the key rule: little and often beats seldom and long!

• Most people’s Christmas includes a tipple … or three.  But if you don’t want it to lead to injury, then DO mix your drinks: intersperse an alcoholic drink with a soft one, and put a glass of mineral water next to your wine on the dining table (as all #5steppers know).  Alcohol induced injuries include falling asleep in awkward positions, muscular dehydration and falls.

• The final danger – and one that often strains the physician’s straight-face – is the over-exuberant unaccustomed activity. Every year we see uncles who thought they could beat their niece at Twister; Wii-induced Granny pains from the expectation that they could play living-room tennis in the same way as they did the real thing half a century ago; pulls, twists and sprains from over-ambitious romance gone wrong (you don’t have to lift someone off their feet to kiss them under the mistletoe) and no Dad should be allowed to dance after more than 5 units of alcohol (if at all).

… and finally, when you’re lifting the turkey out of the oven – bend your knees!

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.