Chiropractors Blog

My knee/shoulder clicks, does that mean I have arthritis?

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I often have patients presenting to me complaining of repetitive pain-free joint clicking (crepitus) of their knee or shoulder. This can often cause anxiety as they associate this clicking with arthritis and joint degeneration. It tends to be more common in the morning and after a period of inactivity, though reduces with movement / once warmed up.

A 2017 study by Robertson et al found that knee crepitus lead to worry, anxiety and eventually fear-avoidance behaviour – meaning they stopped doing their regular exercise because of the sounds.

Joint clicking

 

Thankfully, joint crepitus is entirely normal. A 1987 study by McCoy et al found that of 250 normal knees studied (no prior injury and pain free), 99% had knee crepitus! 

So what is causing the noise? First off, it is not bone on bone – as this would be very painful and uncomfortable. The noise is fluid moving within the joint and/or tendons/ligaments rubbing and flicking against the bone on the outside.

The role of health practitioners should be to educate patients and eradicate their fear that no damage is being caused by the sounds.

Knee Crepitus = Normal 

The concluding message is that clicking and creaking in joints is very common and is not a sign of joint damage – as long as there is no associated pain or swelling. If you do have any concern, come in and see us at Mona Vale Chiropractic Centre for a thorough assessment.

 

McCoy G, McCrea JD, Beverland D, Kernohan G, Mollan RB. Vibration arthrography as a diagnostic aid in diseases of the knee. J Bone Joint Surgery (Br) 1987; 69-B, 2: 288-293
Robertson CJ, Hurley M, Jones F. People’s beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study.Musculoskelet Science and  Practice. 2017 Apr;28:59-64

Mitchell Roberts – Chiropractor

 

Rigid vs Kinesio Taping

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Another common question I get asked in clinic is the difference between the two most used taping methods – rigid and kinesio taping. In short, rigid taping is used for joints such as ankles and shoulders to provide added support, while kinesio tape is used for muscles and joints. They work very differently, which I will explain below.

Here at Mona Vale Chiropractic Centre, we use both forms regularly.

Taping

Rigid Taping:

Rigid taping is the most common technique and has been used for a very long time in sport. It is used primarily on joints such as ankles, knees, wrists, elbows and shoulders. The role of the tape is to physically support the joint by limiting movement. The tape is primarily used in returning to sport after a joint sprain, for example an ankle sprain. It provides support and stability that gives the athlete confidence within the joint. It is commonly used in rugby union/league, AFL and netball.

Kinesio Taping:

Kinesio taping works entirely different to rigid. The tape is quite stretchy and is applied in a stretched position. Because it is stretched, it bunches once applied. This bunching lifts up the different layers of skin, fascia and muscles which encourages blood flow and lymph drainage within the area.

This tape does not restrict joint movement, rather it increases joint proprioception. This is very effective in rehabilitating post an ankle sprain, as often the joint is weak and feedback from the joint to the brain for positional awareness is reduced. The tape provides a stimulation of the skin that alerts the brain to the area, thus more muscle and joint activation.

Kinesio taping is also very good at reducing swelling and bruising. As can be seen from the picture below

Another benefit is that kinesio tape can be kept on for 5-6 days post application and can be worn through vigorous training, swimming and showering. Here at Mona Vale Chiropractic Centre we use and recommend Rocktape.

To sum up, both tapes are very effective when applied properly. Contact us at Mona Vale Chiropractic Centre to discuss with us which tape is best suited for your injury

Mitchell Roberts – Chiropractor

 

Exercising into pain with a chronic injury?

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A recent systemic review and meta-analysis titled “Should exercises be painful in the management of chronic musculoskeletal pain?” by Smith et al 2017 was published. It looked at exactly what is mentioned in the title, should it hurt when performing rehabilitation exercises. This is a very common question I get when in clinic and prescribing exercises.

The findings as listed in the paper:

· Protocols using exercises into pain for chronic musculoskeletal pain offer a small but significant benefit over pain free exercises in the short term

· Adults with musculoskeletal pain can achieve significant improvements in patient reported outcomes with varying degrees of pain experiences and post recovery time with therapeutic exercise

· Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes

· Protocols using exercises into pain typically have higher loads and dose of exercise

So the short answer is yes! Exercising into pain is OK if you have a chronic injury.

The theory behind why exercising into pain being beneficial is that it effects the central nervous system. The exercises address psychological factors behind chronic pain, that being fear avoidance behaviours. When we have chronic pain, our movement patterns are different – due to the subconscious mind/nervous system tightening up and restricting/guarding against movements.

Therefore, by moving/exercising into pain, it tells the brain that the tissues are OK and that by progressing it is not causing damage to the tissues. A hurdle that is often hard to overcome in chronic pain is that pain does not equal tissue damage.

Please note, that this research is into chronic musculoskeletal pain (lasting greater than 3 months), not acute pain. Consult with your health care professional before starting an exercise rehabilitation program.

 

Smith BE, Hendrick P, Smith TO, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis
Br J Sports Med Published Online First: 08 June 2017. doi: 10.1136/bjsports-2016-097383

http://bjsm.bmj.com/content/early/2017/07/12/bjsports-2016-097383

 

Mitchell Roberts – Chiropractor

What is whiplash?

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Whiplash

 

Whiplash is a quick, sudden hyperextension and then hyperflexion movement of the neck. The most common cause is a motor vehicle accident, although it also can occur in contact sports and falls.

The sudden movement causes the muscles, tendons and ligaments to be stretched beyond their normal limits, resulting in tissue damage and a generalised pain in the neck, upper back and even sometimes in the lower back.  The reason for this generalised pain is that the nervous system is in shock, due to the extreme sudden movement of the neck. Restricted movement results, which is the nervous system protecting the spine from further damage.

 

Whiplash associated disorder (WAD) is categorised into four stages:

  • WAD I – Neck pain with stiffness or tenderness, no physical signs
  • WAD II – Neck pain with musculoskeletal signs, such as decrease in range of motion
  • WAD III – Neck pain with neurological signs, such as numbness, pins & needles or weakness of the upper limbs
  • WAD IV – neck pain with a fracture or dislocation of the neck

The most common presentation to a chiropractor is WAD II.

There is also other symptoms involved with whiplash, which include, but not limited to – headache, arm weakness, jaw pain, dizziness, vertigo and pain when swallowing.

 

Do the symptoms occur straight away?

Whiplash symptoms do not always occur straight away. There can often be a delay of a few days in which the patient will start to report stiffness and a generalised pain around the upper back and neck.

Is an x-ray or MRI needed?

Imaging depends upon the symptoms. For a WAD I & II, imaging is not often required, as the injury is soft tissue. If a fracture is suspected, an X-ray will be needed. If there are neurological symptoms present, MRI is often needed to see and identify what is causing the symptoms.

Do I need to wear a cervical collar to immobilise?

No! A collar is not recommended, unless there is a fracture suspected or neurological signs present. The best thing for whiplash that is diagnosed as WAD I or II post injury is to encourage gentle movement.

How long does whiplash last for?

The duration of whiplash is quite variable and varies between person to person. Typically, recovery occurs withina few weeks, although it can last for up to 6 months and possibly longer. Receivingappropriate treatment and performing the provided exercises ensures the best outcome.

What is the treatment?

After a thorough history and examination, an individual treatment program will be provided with appropriate manual therapy and rehabilitation exercises to help improve joint range of motion, decrease pain and loosen muscles. Joint manipulation is often used, although not always straight after a whiplash injury.

If we deem that chiropractic treatment is not suitable for your injury, a referral to an appropriate health care provider will be given.

 

If you are suffering from whiplash, please contact us on at Mona Vale Chiropractic Centre on 99975773 to make an appointment, so we can help you begin your recovery from a whiplash injury.

 

Mitchell Roberts – Chiropractor

Just how heavy is your child’s school bag?

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I often ask parents how heavy their children’s school bag is and the reply almost every time is ‘far too heavy’. A great new research paper has just come out titled “The weight of pupils’ schoolbags in early school age and its influence on body posture”. I will summarise points below and there is also a link to the paper (full text is available) at the bottom of this post.

 

The study looked at 168 children aged 7-9 over a period of 1 year and looked at school bag weight, length of straps and certain body posture measurements.

  • School bag weight ranged between 4.7-9.0kg, with an average weight of 6.3kg. The recommended weight for school bags for students aged between 7-9 should be between 3.1-5.9kg
  • More than 90% of the students improperly put on and took off their school bags. This involved a bending motion accompanied by rotation and a rapid straightening of the lumbar spine
  • 79.3% had the two shoulder straps adjusted at different lengths
  • School bags were most often placed too high, which forced children to lean forward and hence overload the spine

 

Some general tips for carrying backpacks:

  • Backpacks should ideally be no heavier than 10% of the students body weight
  • Use both shoulder straps, both of even length. Do not carry it over one shoulder
  • Use the waist straps
  • Heavy items should be placed at the bottom of the bag and close to the spine
  • Lift a backpack through squatting, backpack held close to the body

If you have any concerns about the effects of your child’s backpack on their spinal health, bring them in to see one of the chiropractors here at Mona Vale Chiropractic Centre.

 

The weight of pupils’ schoolbags in early school age and its influence on body posture. Brzek et al. BMC Musculoskeletal Disorders (2017) 18:117

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1462-z

 

Mitchell Roberts – Chiropractor

A few gardening tips!

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Injuries from gardening is a common presentation to the clinic. We often fine with the changes in season, people come out to garden and do too much the first time after a long break.

Orchid
One of Neil’s Orchids at Mona Vale Chiropractic Centre

 

Gardening is a lot of repetitive movements, of which if not done correctly, could lead to injury. A few tips on ensuring a comfortable gardening session:

  •  Warm up! Walk and a few stretches before you start will ensure your body is ready to start an active session
  •  Reduce the amount of twisting – Twisting places an uneven strain on the muscles and joints. Make sure you squarely face whatever you are working on, this minimises the amount of twisting that can occur.
  •  Take regular breaks! Especially if you are just starting gardening after a long time off. Frequent breaks are a great way to minimise injury and let the body rest and recover. Every 15-20 minutes with a 5-minute break in between is a good start.
  •  Keep your elbows bent when digging – this reduce the amount of strain on the forearm muscles. If they are over worked too quickly tennis elbow can occur – a form of tendinopathy.
  •  Frequently switch sides when raking those autumn leaves, keep the knees and elbows both bent and make sure your grip is relaxed. Also, using a scissor stance is the most efficient technique.
  •  Kneeling on one knee is the best position for weeding
  •  Use your hips and legs when picking up pots – stand square on bend at the hips and knees while keeping your back straight (think hinging at the hips). Keep the pot as close to your body as possible and avoid twisting while holding it.
  •  Plant pots on a table, not the ground

The most important thing to remember is to pace yourself!

Mitchell Roberts – Chiropractor 

Ice or heat?

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Ice or heat? Which is better?

I am often asked by patient which is best, ice or heat for an injury. The simple answer is that it depends on the type of injury and how long it has been there for.

Firstly, let’s see what impact ice and heat can have on the bodies tissues:

Ice:

  •  Decrease blood flow to an area
  •  Decrease swelling/inflammation
  •  Generalised numbing of an area
  •  Constrict/tighten muscles

Heat:

  •  Increase blood flow to an area
  •  Relaxation of tight muscles
  •  Increased movement/mobility

As you can see, ice and heat have opposite effects.

 

When to apply ice – Immediately  and up to 72 hours after an injury has occured, with the aim to reduce the pain and swelling. The most common areas being ankle, knee, wrist and shoulder. Use ice for a period of 20 minutes every 1-2 hours

When to apply heat:

  •  Chronic injuries – longer than 12 weeks
  •  Muscle or joint stiffness/tightness
  •  Osteoarthritic joints – warms the joint up, encourages blood flow to the area before moving
  •  Before exercise – especially that early morning golf tee-off

 

When not to apply ice – Onto burns or sensitive skin. Avoid using before or during exercise, as it may reduce the flexibility of a joint/muscle

When not to apply heat – On acute inflammation (swelling, redness or hot), open wounds and avoid using if you are diabetic.

If in doubt as to which one to use, ask your chiropractor!

 

 

Mitchell Roberts – Chiropractor

Updated low back pain treatment guidelines

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One of the top medical journals – The Annals of Internal Medicine, has published a paper updating the guidelines for the treatment of low back pain. The paper is titled ‘Non invasive treatments for acute, subacute and chronic low back pain: A clinical practice guideline from the American College of Physicians” February 2017. The authors of the guidelines looked at studies of non-invasive (IE not surgical) interventions for treating acute, subacute and chronic low back pain.

It should be noted that acute pain lasts less than 4 weeks, subacute lasting between 4-12 weeks and chronic being pain lasting longer than 12 weeks.

The authors concluded that the following can help as a first line treatment (before taking medications) for acute/subacute low back pain:

  •  Heat
  •  Spinal manipulation
  •  Massage
  •  Acupuncture

Medication should only be considered if there has been no improvement. Patients should discuss the possibility of taking ibuprofen or muscle relaxants with their health care professional.

For chronic low back pain (lasting more than 12 weeks), the authors concluded that the following can help as a first line treatment:

  •  Exercise
  •  Rehabilitation
  •  Spinal manipulation
  •  Acupuncture
  •  Mindfulness based stress reduction – meditation

At Mona Vale Chiropractic Centre, we can use the above recommended techniques to assist and help relieve low back pain. Also, if you are not keen on having spinal manipulation, there are many other techniques that we can use to get the results you are after.

Click on the link to read the full article: http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

Mitchell Roberts – Chiropractor 

Chiropractic could save you $000’s in surgery for your dog

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Beau came to me yesterday from Blacktown.  Beau was suffering complete loss of the use of his back legs.  Bowel actions plus urination had seemingly lost control.  He had no control of the tail and was not even able to wag the tail.
He possibly suffered a fall injuring a lumbar disc it seemed to be L 4/5 .
Beau had 2 visits to the Vet.  Surgery was recommended at a cost of $8,000 .The Blacktown vet Dr Russ Dickers suggested that Beau see a Chiropractor first.
Wendy and Billy, Beau’s owners drove to MONA  Vale to have a treatment .
On exam I observed an inability to walk and a loss of bowel control.  Motion palpating of the back revealed a lumbar disc lesion at L4/5 with a subluxation.  Acupuncture was done to the lumbar spine using bladder points and adjustments to the lumbar spine L5 and the RHS Psis which was P.I.  I also used cold laser to the lumbar spine.
Wendy reported Beau slept all the way home and on arrival at home he walked into the house and was wagging his tail.  I have recommended full rest, meaning no activity, and a follow up treatment on Saturday .

Sciatica

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Sciatica is a common presentation to the chiropractor. We often hear a patient saying they have a ‘pinched nerve’, but sciatica is normally not that simple as there are a number of factors that can cause it.

We will start of with some simple anatomy – The sciatic nerve arises from several segments in the lower back, in the lumbar and sacral spine, joining together to form one big nerve which travels through the hip, buttock and all the way down to the toes, branching out as it goes.

sciatic-nerve

Symptoms are often varied, although the main one is pain down the leg, with the ‘classic’ sciatica causing pain in the calf and foot. Other symptoms can include pins and needles, numbness and weakness of the muscles. Very rarely, losing function of the bowel and bladder can occur, which requires urgent medical intervention.

Causes: There are a number of causes for sciatica, here are the most common ones:

  • Disc – A herniation or rupture to a disc can cause leakage of disc contents into the spinal canal and thus place pressure on the nerve. Furthermore, inflammation associated with the injury can also irritate the nerve.
  • Bony growths – These can narrow the canal of where the nerve exits the vertebral column, reudcing the amount of space for the nerve to exit
  • Piriformis syndrome – In a small percentage of individuals, the sciatic nerve passes through the middle of the piriformis muscle (gluteal region). When it is tight it can compress the nerve
  • Joint strain – Inflammation from a joint sprain can irritate the nerve
  • Spondylolistesis – A forward slippage of the vertebra which can compress the spinal cord or exiting nerves

Sciatica causes

Diagnosis – Here at Mona Vale Chiropractic Centre we will perform a thorough history and examination involving orthopaedic and neurological testing to come to a diagnosis. If we believe you require imaging such as x-ray or MRI this can be arranged and we will refer accordingly. Communication with your GP will also occur and if we feel chiropractic treatment is not appropriate for your condition, a referral to the appropriate healthcare professional will be done.

Treatment – There are a number of different treatment options, some of the ones we use include: Adjustments and mobilisations, muscle releases, dry needling, stretching and rehabilitation exercises. The treatment will be aimed to address the cause of the sciatica through improving movement, decreasing inflammation and strengthening surrounding muscles.

What can be done in the meantime for sciatica? Keep moving is the simple answer! Avoid aggravating movements such as bending,twisting and prolonged sitting. Moving encourages blood flow through the joints and muscles to reduce the chances of the lower back from tightening up. Heat is recommended if the injury has been longer than 24 hours.

Mitchell Roberts – Chiropractor