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

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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

• f 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

• Spinal adjustment

By hand By instrument

Chiropractors correct subluxations

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
• ptions, taking into account patient

preference:

• An exercise programme*
• A course of spinal manipulation
• Acupuncture

Research NICE Guidelines (cont.)

• Consider offering another of these
• ptions 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

24 / 7

Standing/ Walking Bending / Lifting Sitting Sleeping

Imbalance results in wear & tear

Proper Posture and Ergonomics Poor Posture and Ergonomics

Chronic imbalances = Chronic pain

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

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

• Ensure proper lumbar

support

• Keep hips – knees - ankles
• pen @ 90 -120°
• Don’t cross legs or lean to one side
• Sit with shoulders straight and

parallel to the hips

• Don’t slouch

Sitting

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
• ften!
• 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.

• 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

Sleeping Posture

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