I often go into offices as do workstation assessments for companies, typically when a member of staff has pain during or after using a computer. One piece of advice I give nearly every time is to get up or change position every 30 minutes – even if it’s just to stand up, stretch, then sit down again. As well as that, trying to, once an hour, walk away from your workstation to get some water go to the bathroom for instance is the sort of advice that can help many of the problems I see.

This is crucially important, humans are made to move – proved by the fact that these days we see more back problems in our clinics from inactivity than excessive activity. I contributed to an article in the Daily Mail last year regarding ways to help keep movement using chair gadgets here.

It’s so crucial to the spine because the discs between the vertebrae have no blood supply and movement allows them to suck in nutrition and secrete toxins. Also, muscles are made to contract and expand. If your back, shoulders or neck aches after prolonged sitting this can be due to a build up waste products such as lactic acid.

So keep moving!

Last week the new NHS constitution became law.  One of the key points is that it gives everybody the statutory right to all NICE approved treatments on the NHS, provided that their doctors says it is appropriate for them. Indeed, one could argue that it is statutorily mandatory for PCT’s to commission all treatments that are approved by NICE .

Of particular interest to me is that this means manipulation for lower back pain provided by chiropractors, specially trained physiotherapist or doctors and osteopaths is one of these treatments. It also means for lower back pain patients can choose a course of acupuncture or a course of exercise classes.

Post Darzi the NHS have a new duty to prevent illness, as well as treat it. This duty applies not only to their patients, but (since last November) also their own staff, when the government accepted the Boorman recommendations.  Preventing illness and promoting wellness is is somehting CAM treatments often focus on, and one way the NHS can discharge its new duty is by integrating NICE approved CAM fully into the NHS, for which Prince Charles’ Foundation for Integrated Health has been campaigning since 1993.

As it happens, some PCT’s have already commissioned chiropractic treatment, to great success, with services providing improved value for money, much better outcomes and less than a 1 week waiting time compared to the previous service.  It was such a success that one PCT, NE Essex won an award last year for its provision.

Indeed, my own PCT here in Brighton and Hove is looking to commission later in the year.  The new constitution is interesting though, as I believe it provides a requirement rather than a choice, to provide chiropractic treatment on the NHS for lower back pain.  This integration, I believe is a great step forward for the profession in this country.  It means providing proven treatment to many who, in the past would not been able to receive it due to it’s cost.  It also is an opportunity to work alongside other health professionals and learn from them, and them from us.  It will also, I hope, provide us with new opportunities to conduct joint research and certainly co-manage conditions with other professionals in a way we have not been able to up to now.

I have been lucky enough to work in a (private) integrated health setting, alongside some of the countries leading medical spine and joint specialists in my London practice, the Broadgate Spine & Joint Centre, and it has been nothing but a great experience.

Symptoms of tennis elbow

Tennis elbow known in medical circles as as lateral epicondylitis because it affects the outside part of your elbow bone called the lateral epicondyle. Tennis elbow develops when the tendon that joins the muscles of your forearm to your upper arm bone (the humerus) tears or becomes inflamed. This tendon is called the common extensor tendon (see diagram).

Tennis elbow most often happens when you have repeatedly overused your arm. This overuse causes inflammation or tiny tears in the tendon. This may become worse if you continue doing the activity that triggered the pain and may cause a more serious tear or rupture your tendon.  Tennis players only tend to develop this if there is a fault in their stroke – hence why not many professional players, certainly not those good enough to play at the Australian Open this week ever have this problem.

The main symptom is pain and tenderness on the outside of your elbow and sometimes in the muscles on top of your forearm. Tennis elbow usually affects the arm of your dominant hand (eg your right arm if you’re right handed) because this is the arm you use the most. The pain may get worse when you move your wrist or if you repeat the activity that triggered the pain,l when you grip or twist something, such as turning a door handle or shaking hands.

Many people with mild symptoms of tennis elbow can use self-help measures to reduce their pain. However, if your symptoms don’t improve after a couple of weeks, you should visit your local chiropractor, physiotherapist or GP for advice.

Diagnosis of tennis elbow

Your Chiropractor, GP or physiotherapist will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your Chiropractor, GP or physiotherapist can usually diagnose tennis elbow from examining your arm and hearing about how your symptoms developed. An X-ray is rarely needed, but occasionally one may be recommended to rule out other conditions, such as arthritis, that can cause elbow pain.

For severe tennis elbow that has failed to heal with normal treatment an ultrasound scan can be useful. These give images of the soft tissues, including muscles and tendons, inside your arm.

Treatment of tennis elbow

To make a full recovery, you will need to change the way you use your arm so that your tendon is rested and has time to heal. How you do this will depend on how your tennis elbow developed and how severe it is.  If you did develop this playing tennis then get a professional to look at your technique – it’s likely there is a fault that can be remedied.  Without getting this corrected the problem will return.

Self-help

You can treat your symptoms yourself if you have mild tennis elbow. Some of the main self-help treatments are described below.

• Rest. The most important part of your treatment is to rest your injured tendon and elbow by stopping or changing the activity that is causing the problem.
• Apply a cold compress to reduce your pain. You can use a cold compress, such as ice or a bag of frozen peas wrapped in a towel as soon as you feel any pain. Hold this against your elbow for 10 minutes every two hours. In the days that follow an injury you can use the ice pack for 10 minutes 3 to 5 times a day. Don’t apply ice directly to your skin as it can burn.
• Wear strapping or a splint. You can wear strapping or a splint around your forearm and elbow to help restrict the movement of your tendon and relieve the strain. Some people find that this helps, although there is no evidence to show how well it works. You can buy arm braces and supports from some physiotherapists, larger pharmacies and sports shops. Don’t wear any strapping or a splint continuously – you should leave it off at night time.
• Change the action that caused the problem. If the problem developed as a result of an activity at work, contact your employer’s occupational health advisers, if available, or speak with your employer. They can give advice on how to change the activity that caused the problem, allowing your arm to heal.

Medicines

Your GP or specialist may advise some non-inflammatory medication either as a tablet or as a cream, as this can help the pain and speed up recovery.

Physical therapies

There are a variety of techniques a BCA chiropractor or registered physio can use to help your recovery.  These may include stretching exercises, deep tissue massage, acupuncture and laser therapy.

You may also be shown exercises that  improve the movement and strength of your elbow and wrist. Typically you start these exercises as soon as the pain has eased

Surgery

It’s rarely needed and only if your tendon is severely damaged, or if there has been no improvement after many months of rest and rehabilitation.

Prevention of tennis elbow

The following can help prevent tennis elbow;

• warm up before activity with five minutes of gentle movements – this allows time for your muscles to adjust to the extra stresses and strains
• try not to do the same activity for long periods of time – take regular breaks
• seek advice early if you notice a problem
• stop the activity that’s causing the problem or find a different way to do it
• if you play tennis get advice on your technique from a professional

To prevent an old tennis elbow injury from coming back, you should:

• give yourself proper rest between sessions
• don’t play sport if your arm is painful
• get professional advice on your technique
• perform exercises to strengthen the tendon in your arm, as advised

I read that South Africa’s new young  fast bowler, who was hampered by low back problems in the test last week, is unlikely to be fit for the final test this week.  It seems he didn’t respond to the injections he was given – I suspect these were the very type of injections that caused controversy by being recommended against in the latest NICE guidelines for lower back pain -see page 12 1.6.2 for those who are interested.

Friedel De Wet celebrates

Lower back problems are very common in fast bowlers, often stress fractures or low back  joint (facet joint) inflammation related to overuse or poor actions or both, and many including Ian Botham and my school friend and ex-England 1 day captain Adam Hollioake end up having surgery.

One of the recurring themes in a chiropractic practice is the importance of posture at your desk/workplace/computer  – have a look at my previous post here for some tips.

Other than making sure your posture’s good, the other thing to do is make sure you do some simple exercises, ideally at least on a daily basis, to keep your spine moving.  Have a look at this great vodcast from the BCA for some ideas…

http://www.chiropractic-uk.co.uk/straightenup/default.aspx?m=1&mi=41

Graciela Rocha with one of her Brazilian mint plants

A cup of Brazilian mint tea has pain relieving qualities to match those of commercially available analgesics, a study suggests.

Hyptis crenata has been prescribed by Brazilian healers for millennia to treat ailments from headaches and stomach pain to fever and flu.

Working on mice, a Newcastle University team has proved scientifically that the ancient medicine men were right.

The study is published in the journal Acta Horticulturae.

In order to mimic the traditional treatment as closely as possible, the Newcastle team carried out a survey in Brazil to find out how the medicine is typically prepared and how much should be consumed.

The most common method was to produce a decoction. This involves boiling the dried leaves in water for 30 minutes and allowing the liquid to cool before drinking it as a tea.

The team found that when the mint was given at a dose similar to that prescribed by traditional healers, the medicine was as effective at relieving pain as a synthetic aspirin-style drug called Indometacin.

They plan to launch clinical trials to find out how effective the mint is as a pain relief for people.

Lead researcher Graciela Rocha said: “Since humans first walked the Earth we have looked to plants to provide a cure for our ailments – in fact it is estimated more than 50,000 plants are used worldwide for medicinal purposes.

“Besides traditional use, more than half of all prescription drugs are based on a molecule that occurs naturally in a plant.

“What we have done is to take a plant that is widely used to safely treat pain and scientifically proven that it works as well as some synthetic drugs.

“Now the next step is to find out how and why the plant works.”

Graciela is Brazilian and remembers being given the tea as a cure for every childhood illness.

All the ice an snow outside has led to a few sprains and strains coming into the clinic. One of the most frequently asked questions is what to use on this type of  injury –  a cold or heat pack?  There’s been quite a lot of debate over this amongst the sports medical community in the last decade but the consensus seems to be this:

In an acute (sudden) injury like a sprained ankle or strained muscle try to get a cold pack on it asap.  Make sure if its freezer cold that its in a light wrapping such as a tea towel or kitchen roll – you don’t want to add a cold burn to the injured area!  Keep it on for 10-15 minutes and try and repeat it frequently (maximum once an hour) for 2-3 days. This will decrease the amount of swelling that forms.

After that, and until the swelling has reduced, I now suggest that if possible put a moist heat pack or wrap on for 10 minutes (eg flannel that has been run in hot but not scalding water) always followed by a cold pack for 10 minutes. It seems that this causes a flushing effect, dispersing the swelling more effectively.  If you only have time for one of them, do the cold, as this is the “safe” option – as if you do heat alone it could increase the swelling.

Chronic (long term) stiffness and tightness in muscles and joints, without swelling is usually helped best by moist heat, applied as suggested above.

This takes ice baths to an extreme!

I had a really interesting case yesterday – sometimes the effectiveness of manipulation for migraine sufferers is amazing.   Andy, 34 a sporty Australian who landed 2 weeks ago in the UK,  presented to me yesterday with the warning signals which precede the onset of his migraine – often called “aura”.  A black spot appears in the top right corner of his vision – this gradually increases in size over a day and then a severe headache begins, which can last for 24 hours. 

Andy has had these symptoms monthly since he was 13 years old.  During his teens in Australia he had every neurological test imaginable  and tried every type of medication available.  He has no underlying disease and no medication makes any difference.  He tried dietry changes and stopped playing sport – still no difference. 

When he was 21 he decided to give a chiropractor a try. With amazing results. If Andy gets a treatment soon enough after the black spot appears in his vision it reverses and starts to decrease in size, and no headache results.

Since then that’s precisely how he manages the problem – he gets one treatment as soon as he has the black spot in his vision, which reverses the onset of his migraine.  The frequency of the migraines has also decreased to once every 3 months.

Having  recently landed in the UK  he was looking for a chiropractor to continue helping him, and his migraine aura had just begun when I saw him.  His chiropractor in Brisbane  had given him my name – always nice to have referrals, even nicer from Brisbane!

After our first treatment yesterday the black spot in his vision was receding by the time he left the waiting room. 

His parting words made my day – ” Cheers mate, you pom chiro’s are ok, see you in 3 months”

A sports doctor I work with asked me to help an England rugby player last week.  The player presented with what he described as “a locked neck” for 2 days.  Following training his neck gradually stiffened and he was pretty much immobile when he arrived today.

The physio hadn’t had much luck “unlocking” the neck, so he was referred on.   Turns out he had the same problem during a tour to New Zealand a few years ago and he was seen by a chiropractor there who “performed a miracle” and resolved things with one treatment.  Hence I was in the frame to repeat this.

No pressure then!

I can’t claim to be a miracle worker, but I can tell you that he walked out “90% better”.  I asked him to come back in a few days to review things, but he rang in to say he was fine and was back in full contact training.

Perhaps England will win the rugby this weekend, which would be  a miracle!

To my surprise I was elected to the BCA council, without the use of the tour bus mentioned in an earlier posting!  There seemed to be total support at the AGM for the profession to move in an evidence based direction with a focus on integrating more with mainstream medicine.  At the AGM the new president Richard Brown presented a  new “Visions, Values and Identity” which was adopted by unanimous vote.  Quite an endorsement and a real mandate for the new president to carry out his objectives.