Malaysian Healthy Ageing Society Key to back pain is alignment - PowerPoint PPT Presentation

Organised by: Co-Sponsored: Malaysian Healthy Ageing Society

Key to back pain is alignment Michae ael l Hanelin line, , DC, MPH Professor, Head of Chiropractic International Medical University michael_haneline@imu.edu.my

Chiropractic is… • An approach to health care that focuses on the relationship between the body’s structure and its function • The primary focus of chiropractic is on the spine

If the structure is abnormal… • Stress is created in many areas of the body which can lead to strain, resulting in pain and dysfunction • Common conditions – Neck and back pain – Headaches – Extremity problems – Many more

Spinal joint dysfunction Vertebral subluxation • The joints between the vertebrae can develop movement problems and/or they can become misaligned – Restricted motion (hypomobility) • Best treated by chiropractic adjustments or manipulation which reduces stress and strain and may restore the vertebra to more normal position – Too much motion (hypermobility) • Best treated by efforts to stabilize the unstable joint (e.g., bracing and therapeutic exercise) • Patient may be referred for a surgical consultation when tissue damage is so severe that the patient will not likely respond to conservative care

Digital motion x-ray of the neck

Vertebral subluxations can also result in… • Numbness and / or weakness in the extremities – Must be differentiated from disc or other neurological problems • Fatigue • Poor performance in sports • Preliminary studies have shown that chiropractic may be effective for conditions like hypertension, infant colic, and asthma

Typical chiropractic patient complaints from Job Analysis of Chiropractic 2005

Chiropractors correct subluxations • Spinal adjustment By hand By instrument

Lower back adjustment

Chiropractic care is considered safe • Generally safer than alternative treatments – Serious adverse events 1:1,000,000 for chiropractic adjustments – 1:100 for back surgery – 250 times safer than a course of NSAIDs

Chiropractic training 4 years + 1 year housemanship • Basic sciences (anatomy, physiology, etc.) • Diagnosis • Diagnostic imaging • Spinal analysis • Spinal and extremity adjustments • Rehabilitative exercise • Physical therapy modalities • Nutrition and dietetics • Degree - BSc (Hons) Chiropractic

Research Cochrane Review • Lower back pain – The use of spinal manipulation for lower back pain was supported – More effective in reducing pain and improving the ability to perform everyday activities than sham therapy – As good as other common therapies Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low-back pain. Cochrane Database of Systematic Reviews 2004 , Issue 1. Art. No. CD000447.

Research J Alt & Comp Med • Lower back pain – The mean improvement in RMDQ was 5.5 points greater for the chiropractic group than for the pain-clinic group after 8 weeks of care – Reduction in lower back pain was 1.8 points greater for chiropractic group Wilkey A et al. A Comparison Between Chiropractic Management and Pain Clinic Management for Chronic Low-back Pain in a National Health Service Outpatient Clinic. J Alternative and Complementary Medicine 2008 (Jun);14(5):465-73

Research Ann Intern Med Recommendation 7: For patients who do not improve with selfcare options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits — for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation

Research Ann Intern Med Spinal manipulation recommended in acute and chronic stages Chou R, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med . 2007 Oct 2;147(7):478-91.

Research NICE Guidelines • National Institute for Health and Clinical Excellence (NICE) - released May 2009 • Were prepared for doctors in the UK who care for patients with low back pain • Offer one of the following treatment options, taking into account patient preference: - An exercise programme* - A course of spinal manipulation - Acupuncture

Research NICE Guidelines (cont.) • Consider offering another of these options if the chosen treatment does not result in satisfactory improvement Low back pain: Early management of persistent non-specific low back pain http://guidance.nice.org.uk/CG88 *Many chiropractors incorporate rehabilitative exercise

Posture & Ergonomics • Posture is a static state – “A position of the body” – There is a mental ingredient - mood or emotion • Ergonomics is the technology concerned with the creation and arrangement of products and environments that are safe, healthy, and comfortable

The importance of correct posture Standing/ Walking 24 / 7 Bending / Sleeping Lifting Sitting

Imbalance results in wear & tear Proper Poor Posture Posture and and Ergonomics Ergonomics

Chronic imbalances = Chronic pain Prolonged Incorrect Joint Joint Irritation / Postures / RS / Alignment Inflammation Poor ergonomics Muscle Muscle Inflammation Hypertonicity Imbalance Response Nerve Reactive Muscle Chronic pain Hypersensitivity Spasm

Poor posture is responsible for most (non-traumatic)... • Neck Pain & Tension • Headaches • UBP & Stiffness • LBP and Spasm • Disc problems • Sciatica • Hip & Knee Pain • Plantar Fasciitis • Heel spurs

Compensating Mechanisms • Proper Posture Awareness • Strain Management Skills • Ergonomics – chairs, shoes, orthotics • Good Biomechanics – good alignment • Good Muscle Tone and Balance • Core Stabilization • Stress management • 30 Minute Rule

Posterior Posture Examination Checklist  Plumb line bisects the head and all spinous processes from the cervical through the lumbar spine  Left and right halves are mirror images of each other  Shoulder heights are level (dominant slightly lower)  Inferior angles of scapulae are level  Iliac crests are level  Popliteal fossa are same height  Achilles tendons are perpendicular to floor  Medial malleoli are level  Muscle definition is symmetrical throughout

Lateral Posture Examination Checklist  Plumb line runs through the middle of the ear canal, the acromion process and the greater trochanter  Plumb line runs slightly posterior to the patella and anterior to the lateral malleolus  Anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) are close to level with each other  Leg is perpendicular to the foot  Chin is parallel to the floor

Proper Posture Awareness

Sitting • Ensure proper lumbar support • Keep hips – knees - ankles open @ 90 -120° • Don’t cross legs or lean to one side • Sit with shoulders straight and parallel to the hips • Don’t slouch

Chair Ergonomics

Desk Ergonomics • The workstation or desk should be at elbow height • Keep the wrists straight and aligned with the forearms • Support the forearms by adjusting arm rest height • Consider using a footrest

Monitor Ergonomics • Place the working object so that it can be seen at viewing angle of 10° to 30° below the line of sight.

Mouse Ergonomics

Sitting Posture Tips • Don't cradle the phone between the head and shoulder! Hold the phone or use a speakerphone • Get up, walk tall and stretch often! • 20-30 minute rule!

Sleeping Posture • Average of 6-10 hours per day in bed = a lot of time for wear & tear on your body if you sleep with incorrect posture. • The normal curves of the spine should be maintained in the neutral position when in bed. • A supportive bed maintains the normal body curves.

Sleeping Posture • A soft non-supportive bed produces a "hammock shaped" spine: • A hard bed forces the spine to curve against its natural curves:

Sleeping Posture • Pillow should support the neck and allow it to rest in a balanced position by filling the gap between the head and the bed • Orthopaedic pillows can be valuable in achieving this, and choice will depend on personal preference

Sleeping Posture • Sleep on side or back… not on the stomach • Place a pillow under the knees when lying the back to ease low back tension • Place a pillow between slightly bent knees when lying on side

In order to have proper posture one must have… 1. Good muscle flexibility 2. Normal motion and joint position – alignment 3. Strong postural muscles 4. Muscle symmetry / balance 5. Awareness of your own posture, plus awareness of proper posture = conscious correction 6 . Practice… Practice… Practice