From time to time one has patients who have side effects from treatment.  If negative, these are usually minor – such as temporary soreness or stiffness.

Sometimes side  effects can be positive.  I had a lady (actually a Countess) in 4 days ago with mid back pain.  She explained that this was a problem she has once or twice a year, and in the past she has had some soft tissue work and manipulation to relieve her symptoms.  An associated symptom is that she has a worsening in her heart palpitations, or “flutterings” a she called them.  This is a complaint she has mildly anyway and is managed by her GP.   Relief in her mid-back also results in a complete settling of her heart symptoms too.  Strange but true.   She has had this all investigated thoroughly in the past, and had only a month earlier had a full cardiovascular check up.

She was of course keen for me to treat her mid back, and after running some checks and encouraging her to visit her GP regarding her increased heart symptoms, decided to go ahead and treat her mid back pain, with “no promises” regarding her other symptoms.

Some trigger point work and mid-thoracic manipulation afforded “instant relief” from both mid back pain and heart symptoms.  I saw her for a follow up yesterday, where she announced herself 99% better in both back her back and palpatations.

There might be a few ways to explain this, and I would be interested to hear what other people think.

I’ve blogged before about chiropractors being included on the NHS here and here.   There are some forward thinking PCTs who have already commissioned chiropractors, and it’s proved to be an unreserved success.

Indeed, my own PCT in Brighton and Hove is currently redesigning it’s neck and back pain service and I’m very hopeful that we will be included. More news of that soon.

Back to the successes of the chiropractors that have already been comissioned.    A year ago in NE Essex they commissioned 3 practices on a 1 year pilot and the success has been remarkable.  The figures aren’t public yet, but having had the heads up I can say that the quality of care scores, patient satisfaction and outcomes have all been enough for the practices to be put on a full 5 year comission and to win the coveted NHS Acorn award which recognises excellence in primary care.

In Cheshire, a chiropractor has been commissioned to provide assessment and treatment for low back pain patients for the past 10 years, and his recommisioning in 2006 speaks for itself.  His latest results, which are impressive to say the least in every regard, will be published in the coming months.

And for the the flat earthers, there is no evidence of any bait and switch tactics being employed.   Just treatment of back and neck pain, using spinal manipulation, soft tissue therapy, exercise and lifestyle advice.  This has resulted in, compared to the PCTs’ other back and neck pain provision, improved outcomes, better quality of care, improved patient satisfaction and  reduced costs.  What’s not to like?

So, after showing off about how a chiropractor has helped prolong the career of AC Milan’s players, Beckham goes and tears his achilles tendon. Typical.

It’s one of the injuries that a footballer fears most, along with a double ankle fracture similar to Eduados’ and an anterior cruciate tear, like Gazza.

How does it happen?

Although incredibly strong it is the most frequently ruptured tendon in the body – runners and jumpers particularly fear a ruptured Achilles tendon.Overuse, starting up too quickly or rapidly increasing your training puts you at greater risk of rupture. In Beckham’s case, it may be something that has been brewing for some time.  He has been playing matches back to back with little chance to rest and recover, and at the age of 34, his tendons are starting to become more prone to injury.

When the tendon snaps there is a sudden sharp pain as if you have been hit by something in the back of the leg. This will often be accompanied by a loud crack or bang.  You will be unable to walk properly and unable to stand on tip toe.  A gap may be felt in the tendon and there will be a lot of swelling.

How is it treated?

A complete rupture, like Beckham’s, usually means surgery followed by weeks of rehabilitation with no guarantee of a complete recovery. Smaller tears may require rest and rehabilitation alone.

Beckham arrived in Finland at 1400 GMT on Monday to undergo surgery at the clinic of knee specialist Dr Sakari Orava in Turku. This involved stitching back together the ruptured ends of the tendon so it can heal. After the surgery, which takes about an hour, a cast or brace is put on the injured leg to aid the healing.

What is the outlook?

Dr Orava gave a bleak outlook of Beckham’s hopes of recovering in time for the World Cup, explaining that it will be the middle of June before he can resume training, and at least another month before he can return to action.

“To start kicking and playing football will take about three months,” stated Dr Orava. “For maximal performances and maximum kicks and jumps, maybe it takes one month more, three to four months before one is able to do light playing.

“It’s a total tear of the Achilles tendon. If there is any weakness then a graft can be taken from the calf and put over the injury site to make it stronger. This kind of procedure is planned.”

It is thought that up to three in 100 people who have surgery are at risk of re-rupture. As with any surgery, there is also the risk of complications such infection and dangerous blood clots.

Yesterdays Daily Mail describes how AC Milan’s ageing stars arrive for their Champions League clash with Manchester United straight from….the Lab of the Gods

The Milan Lab is where careers are boosted and prolonged. It is the secret behind AC Milan’s success and one of the reasons why their ageing squad arrive at Old Trafford tomorrow hoping to stay in the Champions League, despite trailing 3-2 from the first leg.

It is where neurology, biochemistry, psychology, dentistry and chiropractic are used to maintain fitness and to detect potential injuries.

Sportsmail’s MICHAEL WALKER explores the background to the state-of-the art training facility which is the envy of world football . . .

Old Trafford and the Champions League mean a lot to AC Milan – and not just because of that penalty shootout triumph over Juventus there in the 2003 final.

Three years earlier, Fernando Redondo’s magnificent performance in Manchester for Real Madrid convinced AC Milan to buy him. They thought they were getting the best midfielder in the world, paying Real 15 million euros (about £13.5m) and Redondo three million euros for five years.

But Milan ended up with a crock and a medical determination to never again make a multi-million-pound mistake.

Survivor: Andrea Pirlo, who played in the 2003 final, is still in the Milan team.

From there the club developed the famed Milan Lab, which is why tomorrow night, seven years on from that European triumph, no fewer than seven of Milan’s 2003 starting XI and three used substitutes will again be in their squad. Five of them: Dida, Nesta, Gattuso, Ambrosini and Pirlo are likely to start.

At the San Siro they do not doubt that such longevity is due to the Milan Lab and its appliance of science in the field of sports medicine. Longevity is the goal.

The man behind this is a 63-year-old Belgian chiropractor called Jean-Pierre Meersseman, and the likes of Paolo Maldini and David Beckham have testified on behalf of Meersseman’s methods.

‘The fundamental concept,’ Meersseman said more than a decade ago, ‘is to determine whether the players are whole. And physical wholeness is the daughter of three mothers: equilibrium, endurance and co-ordination.’

That may sound a touch Californian but Meersseman’s success is not in question. He was advising AC Milan in 1998 when he said that.

Survivor: Andrea Pirlo, who played in the 2003 final, is still in the Milan team.

Meersseman had been doing so since 1986 but he was being given more control and in that first full season, Milan reported: ‘Total practice days lost down 43 per cent, use of medicines down 70 per cent. Player injuries dropped by two-thirds.’

Forced to leave Belgium in the early 1970s as it was then illegal for doctors to offer chiropractic, Meersseman went to America. He was one of the doctors in the USA Olympic team in Los Angeles in 1984.

Next he went to France, then to Italy, where he set up a practice at Lake Como. In residence nearby was AC Milan owner Silvio Berlusconi. A connection was made that would see Berlusconi explode in rage at Redondo’s breakdown, fire the existing medical staff and appoint Meersseman as medical director with a broad, powerful remit.

Milan mastermind: Meersseman

‘Since our model is deeply rooted in the philosophy, art and science of chiropractic, the medical staff were quite closed to the idea when I first arrived,’ said Meersseman of the cull. ‘So I had to fire the medical doctors who did not want to come on board.’

No longer was transfer money to be lost. Meersseman’s prudent idea was to predict injuries, prevent them and thereby extend careers. Kinesiology is one of his key words: the study of human movement.

‘Age doesn’t exist,’ he once told a Belgian interviewer. ‘What counts is that you are physically and psychologically ready to play. It doesn’t matter if you are 21 or 41.’

Meersseman would revolutionise Milan’s system. In came neurology, biochemistry, psychology as well as chiropractic, kinesiology and plenty of staff. Dentistry is a significant factor.

A computer system developed in partnership with Microsoft pulls all the information together. While that is being done, players unwind in what the club describes as ‘a glassed-in mind room’.

The club’s willingness to talk about their Lab site at the Milanello training ground has led to others following, which is why Bruno Demichelis, Meersseman’s partner, is now at Chelsea. And it all begins with a jump, or a dyna-jump.

‘We did a pilot study on the analysis of a jump,’ Meersseman has explained. ‘You basically measure the angles of the knees with electromyography hooked up to the muscles. We measured flexibility, speed, etc, on a platform, and we had about 60,000 bits of data.

‘If you put the data from the dynajump into the system of neural networking, the injury rate could be predicted with a 70 per cent accuracy, which is much better than flipping a coin.

So, you could do an analysis of a simple jump, put it into the system and predict with a 70 per cent accuracy whether the player is going to get hurt or not. And that is interesting.

‘If that is true, and all the mathematicians who work with us – and there are quite a few – confirmed these figures, it would be interesting to start accumulating data in all areas.

‘We started to accumulate data from the structural area, i.e. how is the spine working, the teeth, feet, etc, and biophysical data plus the psychological data. We set up the Lab with apparatus that could feed the neural network and come up with results. Players are tested every fortnight and cause-and-effect data is collected every day.’

Beckham’s body-fat percentage was sliced almost in half within days of his return to Milan. The 34-year-old midfielder’s teeth were re-examined because teeth matter to Meersseman due to their skeletal relationship. He is said to have refused to sign off the purchase of Porto’s Aly Cissokho due to a malocclusion.

Tennis player Kim Clijsters returned from Milan last year with a gumshield and saying: ‘In the past I always had continuing hip problems. I got in contact with Jean-Pierre Meersseman from the Milan Lab, who tested me. First, I had to get used to it, but now I feel really good with it . I feel more stable and my bones react better in heavy matches. It’s a small detail that can make a difference.’

Whether Meersseman can stimulate a second-leg Milan recovery at Old Trafford is another matter. It will depend on many small details, you imagine.

Alexandre Pato underwent a scan to help determine his readiness prior to flying out with the squad. That is one small detail, which includes another: that AC Milan still suffer injuries. Another is that Jean-Pierre Meersseman, medical guru, smokes.

Meersseman treats a AC Milan player

For the first time in the history of the Olympic Games, the 2010 Winter Games in Vancouver, Canada, included chiropractic care inside the Olympic Village Polyclinic, a multi-disciplinary facility that offers comprehensive health care and medical services. Whilst chiropractors have  been included on the Olympic medical staff for the US, Canadian, South African and Australian teams for 20 years, the upcoming events mark the first time that chiropractors from the host country will be treating athletes and officials from around the world directly inside the Polyclinic.

There are plans for the 2010 London Olympics to have chiropractors at the polyclinic too. This is as much driven by medical opinion as by the demands of athletes, many of whom already use chiropractors not just for treatment of injuries but for pre and post event treatment to enhance performance and injury prevention.

The most up to date review of research on manual therapies has concluded that there is good evidence for effectivness for a wider range of conditions than ever before. The full article is available here.

It concludes that spinal manipulation/mobilization is effective in adults for:

• acute, subacute, and chronic low back pain;
• migraine and cervicogenic headache;
• cervicogenic dizziness;
• a number of upper and lower extremity joint conditions.

Thoracic spinal manipulation/mobilization is effective for:

• acute/subacute neck pain.

When combined with exercise, cervical spinal/manipulation is effective for:

• acute whiplash associated disorders;
• chronic neck pain.

In the commentary from probably the worlds leading authority on the subject,  Scott Haldemann, it states that there is good evidence that spinal manipulation is effective  for the conditions that 90% of the public see chiropractors for.  When you put this together with the other methods that chiropractors use such as exercises and lifestyle advice I’m glad to say it’s a strong endorsement of the way I practice .

In my case the conditions listed above make up 99% of what I see.  The article also looks at the evidence for manual therapies effectiveness in treating non-musculoskelatal conditions. The evidence for effectiveness is not  positive.  That’s not a surprise to me, and as I don’t treat those disorders it’s not going to affect my practice.

It’s the next round of the 6 nations rugby this weekend, and I had an email from a concerned mum this week regarding a common rugby injury.  I’ve reproduced it and my reply below (names changed for anonymity).

“My son plays rugby at school last week and after tackling a bigger boy says he has pain in his shoulder and pins and needles in his right arm.  Should we try and get some treatment for him?”  Mary, Brighton.

I think the first think you should do is get your son to a health professional to have this problem assessed.  The most likely cause of the problem is what’s called a “stinger” injury – I will come on to what that is in a moment – but it might be a disc injury in the neck which would need to be looked at with an MRI scan.

A stinger injury occurs frequently on the rugby pitch, either when making a tackle or during a scrum. The injury usually involves nerves travelling from the spinal cord to the arm, but sometimes involves nerves in the neck. This happens in one of two ways: either the head and neck are forced toward the shoulder, compressing the nerves that lead from the spinal cord to that arm, or the head and neck are forced away from the shoulder, stretching those nerves. Symptoms often disappear within minutes and usually within hours, sometimes however, they continue for longer. Repeated nerve trauma can cause recurring stingers, ongoing pain, and muscle weakness.

The good news is that these problems usually recover, and that correct treatment can speed this up.  Prescribed anti-inflammatories help (speak to your GP for these), as does gentle mobilising treatment, muscle work, exercises and advise from a chiropractor, physiotherapist or osteopath.

I would strongly recommend that your son doesn’t play contact sports again until he has had the problem looked at and the symptoms have resolved, as another injury to the same area could make things much worse.

Many people heading to the slopes, perhaps inspired by Brighton’s own Olympic skier Chemmy Alcott.  According to my colleague Matthew Bennett here at Sundial Clinics,  most injuries occur at 4pm on the third day of skiing holiday.

Chemmy Alcott

Matthew, chiropractor to the British Alpine Ski Team says “after 3 days of skiing using unaccustomed muscles skiers become confident, but are more physically tired, and their capability isn’t necessarily matched to their confidence”.

Prevention is of course better than cure, so if you need some tips to avoid injury here’s a good place to find some.

I’ve been enjoying in particular the racing disciplines at the winter Olympics, particularly those where they race against each other, rather than against the clock like this snowboarding event.

http://news.bbc.co.uk/sport1/hi/olympic_games/vancouver_2010/8517392.stm

Mind you, I’ve had a couple of very painful coccyx injuries from snowboarding this year, so for all the budding Olympic snowboarders out there I recommend a “coccyx guard”  or “tailbone protector” inside your ski pants – otherwise you might have a painful time sitting for a few weeks.

http://www.alpsgear.co.uk/

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!