Senior man is suffering from pain in lower back

Spinal Complaints In The Older Generation

Are you over 65? If yes, then you make up 1 in 7 of the population and you contribute to 9% of the total disability for musculoskeletal conditions! – Disease and disability increases with age and research into this area are significantly important due to the debilitation that it can present.

Study – Spinal Pain in older women and associated Comorbidities

A study involving 579 older community dwelling women with spinal pain found that they had significantly lower mental and physical quality of life scores as well as associated obesity (or were found to be overweight), increased evidence of diabetes, pulmonary comorbidity and cardiovascular comorbidity. Comorbidities were significantly more common in women with spinal pain that in women without spinal pain. It also found that an increase in comorbidities increased the chance of experiencing spinal pain.

Study – Rehabilitation or Spinal Manipulation – Does is Help Older Adults’ with Back Pain?

This study involved 230 individuals over 65 with subacute lower back pain. They had supervised rehabilitation or spinal manipulative therapy (SMT) treatment over a 12 week period with self reported outcome measures of pain severity, back disability, health status, medication use, satisfaction and care and global improvement at weeks 4, 12, 26 and 1 year. The 3 groups were: home exercise: home exercise and SMT: SMT, home exercise and supervised rehabilitation. Pain severity was reduced by 30-40% with the largest difference favouring SMT and home exercise over home exercise alone. The two groups were significantly superior to home exercise alone with satisfaction of care.

Study – Short term and Long term Treatment Chiropractic for neck and low back pain – which is better?

This study involved two groups of 12 weeks of care versus 36 weeks of care for back and neck related disability in older adults.

Both the short term and long term groups reported significant improvements in back disability and the long term management group experienced self -reported greater improvement in neck pain, functional ability and balance at week 36. These findings may be important for healthy aging and spinal care in the elderly and warrant further investigation.

Other Studies

A Nordic Study – Maintenance Spinal Care as Key to Prevention of Low Back Pain

“It has been found that for individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC), as secondary (aiming to reduce the impact of a condition (LBP) that has already manifested) and tertiary prevention strategies (aiming to reduce the impact of persistent or chronic LBP). This is usually done by helping people manage long-term, often complex pain conditions in order to improve their quality of life and ability to function. The aim of this trial was to investigate the effectiveness of MC on pain trajectories for patients with recurrent or persistent LBP”.

Maintenance care is similar to servicing a car or visiting a dentist for teeth cleaning, even though you brush your teeth regularly. The main hypothesis for spinal maintenance care is that treatment may improve biomechanical and neuromuscular function thereby reducing the risk of relapse into pain. This study was actually done on 328 people between the ages of 16-65 years.

The definition of maintenance care is “…a regimen designed to provide for the patient’s continued well-being or for maintaining the optimum state of health while minimizing recurrences of the clinical statue” and “…treatment, either scheduled or elective, which occurred after optimum recorded benefit was reached, provided there was not evidence or relapse”

Hyperkyphotic posture (Dowagers Hump posture) predicts Mortality in Older Community-Dwelling Men and Women

An increase in the thoracic (mid back curve of the spine) has associated risk factors of vertebral fractures, degenerative disc disease, muscle weakness, decreased mobility and according to this study of 1353 individuals, an increase in mortality. Hyperkyphosis was specifically associated with an increased rate of death due to atherosclerosis concluding that men and women with hyperkyphotic posture have higher mortality rates.

Some case reports suggest that myofascial, spinal, and scapular mobilization techniques improve postural alignment in patients with hyperkyphosis. Physical therapists reported reduced hyphosis after soft tissue myofascial, neurodevelopmental, spinal, and scapular mobilization, and active therapeutic movement techniques.

Why not consider a Chiropractor

Our Sydney chiropractors have a special interest in posture correction and are here to help. Our care is gentle and effective care is possible for many. Exercise alone is often not enough for pain reduction, improving function and movement patterns. Even for old or chronic injuries, improvement in functionality and pain scales can still be possible, We have found that our gentle care, with exercise prescription and combined with the application of low-level laser therapy can really make a difference.

 

 

Rotator Cuff Injuries

Why Does My Shoulder Hurt? Rotator Cuff Injuries Explained

A pain in the shoulder region is a common musculoskeletal condition. When it is of no specific cause, it is often given the general diagnostic term of rotator cuff related shoulder pain (RCRSP). Simply, it is an umbrella term that can encompass a spectrum of shoulder conditions including tendinopathies, impingement syndromes and rotator cuff muscles tears.

RCRSP are the most common forms of should pain, often presenting with pain and weakness, particularly on shoulder elevation and external rotation (turning the hand to an outwards direction).

Most often, pain is precipitated by an event that has involved an excess or incorrect load. Many factors can also contribute including genetics, co-morbidities, lifestyle factors, central nervous system disturbances, psychosocial and even biochemical factors.

The difficulty with assessing the shoulder lies in the fact that the tendons of the rotator cuff sling create an intimate relationship with the surrounding capsule, ligament and bursal tissue. Due to this fact, the possibility of individually assessing each muscle/tendon complex in isolation through orthopaedic testing is not 100% accurate. A comprehensive clinical interview and examination is still however very important in providing a working hypothesis.

Rotator cuff injury Treatment & Exercise

How Do I Get Better – the evidence

There is strong evidence for the benefits of multiple forms of exercise as the most important management strategy. Included are such things as shoulder blade stability, strengthening of the rotator cuff muscles and shoulder flexibility. There is moderate to high level of evidence for the combination of manual therapy with exercise.

There appears to be limited benefits in corticosteroid injections for rotator cuff injuries, potentially only for short term benefits for some and the evidence for medium or long term use is unclear.

PRP or Platelet-rich plasma is also another form of injectable therapy however researchers concluded it had negligible to only a small degree of success. These findings are not surprising as it is well documented that pain is often poorly correlated with tissue pathology. A lot more research into surgical repair is required including methodology improvements and placebo controls as at present there is not a great support for a non-conservative procedure.

Manual Therapy for rotator cuff injury – from our Sydney chiropractic clinic experience alone, we have found that many shoulder injuries come from the sustained loading of the shoulder muscles due to poor postural control. Compression at the collar bond joint through rounded shoulders is common. The shoulder blades essentially drift outwards away from the thoracic spine causing the muscles under the shoulder blade to overload as well as all the important sling muscles of the shoulder joint. Micro-tears can then become a common feature. Also, through poor postural control, restrictions in the thoracic spine are common. In some cases, the nerve supply to these important muscles can then become compromised and a lack of ‘firing’ is possible causing significant weakness. Manual therapy and specific muscle retraining exercises are then often required. Postural control exercises are therefore very important to implement regularly, Taping is a useful technique for support, relief as well as acting as a reminder.

Immerging Therapy For Rotator Cuff Injury

We have found that low level laser (LLLT) for healing is helpful. More research is required in this immerging field. The theory behind implementing low level laser is that it stimulates energy within the cell. When energy is increased, healing can fasten. One of the most commonly damaged muscles is called the supraspinatus. In many people, the blood supply to this muscle is very poor and it needs all the help it can get for recovery. With the use of the photohaemotherapy application (increasing the blood supply) in LLLT to this muscle this procedure could be potentially significant in the recovery.

In summary, for many people shoulder pain can come on suddenly from what can appear an insignificant event. Consider your posture and consider a Chiropractor for shoulder pain to improve neuromuscular control.

patellofemoral pain syndrome runners knee

Running & Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFP), pain at or near the knee cap, is traditionally known as movie-goers knee or patella tracking disorder. It actually accounts for almost 50% of all running injuries and is usually a poorly localised pain found around, near or under the knee cap. It has a greater predilection in females and is often aggravated by running hills, descending stairs, lunging, squatting or sitting for prolonged periods. Read more

knee osteoarthritis treatment sydney

Managing Knee Osteoarthritis

Knee Osteoarthritis (KOA) is both a prevalent and challenging condition to treat, commonly been seen as a structural problem with only surgery as the solution.

A recently published PubMed article is titled “Arthroscopic surgery for knee osteoarthritis? Just say No” -offering these suggestions below as an alternative.

Using analgesia – However, it does discuss gastric toxicity.

Nonpharmacological therapy – stating “physical therapy and regular exercise typically reduce pain and improve function of an arthritic knee. Acupuncture may have a small benefit as well.”

Consider a combination of glucosamine and chondroitin – The two combined may provide some relief associated with moderate to severe knee osteoarthritis.

If you are interested in this article, please visit and you can follow the reference points.

One suggestion this article fails to mention is Low Level Laser Therapy (LLLT) or Photobiomodulation for pain relief. Published articles of the benefits of LLLT have been available for at least the last 8 years, around the length of time we first received our Low Level Laser unit to our Lane Cove Chiropractic Centre.

Alignment is the Key

As Chiropractors, we understand this paragraph perfectly and couldn’t have said it better so..

“The human body is a complex mechanical unit composed of many joints held together by muscles, tendons and cartilages which also allow articulation. Gravitational forces must be balanced at all times at each link.

The line of gravity, one of the body’s most important factors as described by Harada, passes through the outer ear-opening and intersects the center of gravity of the human body (located adjacent to the sacrum) and the center of the knee joint.

The understanding of the function of the locomotive apparatus in the upright position and the dynamics of the body is one of the most important factors, so that the gravitational torque has a tendency to extend the knee joints in our daily life”

Here is the article in full for you with the conclusion that low level laser therapy can provide pain relief. One study in 2014 on rat knees showed prevention of degradation of cartilage with LLLT. More studies of course need to be done, but this is promising information. This particular article states “LLLT stimulated cellular activity of cartilage repair and collagen synthesis, accelerating the breakdown of cartilage destroyed by collagenase and stimulating the fibroblast to synthesize repairing collagen III”

In summary, it is saying growth and repair of cartilage! Further information on Low Level Laser Therapy is found below.

For non-traumatic causes of knee pain, we especially like to look for the cause and not purely treat just the symptoms. Non-traumatic knee pain simply means that pain that has not been caused from a direct trauma to the knee itself. Many football playing injuries or skiing injuries for example can have a direct trauma cause of KOA. The majority of knee osteoarthritis cases we have seen however have been the non-traumatic type and respond to a thorough investigation as well as addressing potential foot function issues, hip and pelvic alignment and muscle weakness (particularly the gluteal muscles). Remember, the foot bone is connected to the thigh bone, which is connected to the hip bone! The knee is the middle joint and is thereby subjected to altered functionality if the foot and the pelvis have any distorted movement patterns as mentioned in the above PubMed paragraph. Our in house Foot Leveller orthotics are actually called “Pelvic Stabilisers” for good reason!

Further Knee Osteoarthritis Treatments

Hyaluronic acid appears superior to corticosteroid injections with beneficial effects on pain and function. Published results cause consideration of this with the low-quality evidence supporting corticosteroid injections.

Platelet-Rich-Plasma (PRP) currently appears to be beneficial and superior to placebo and Hyaluronic Acid both in function and pain.

Glucosamine and Chondroitin maybe beneficial and appears more efficacious that paracetamol.

Exercise has high quality evidence supporting this treatment for decreasing pain, improving functionality and the quality of life. Certainly, it is important to have the correct Knee Osteoarthritis exercises given particularly with examination of all associated muscle systems including those associated with hip stabilisation.

Knee Replacement. Let’s face it, sometimes things are beyond repair, however conservative treatment would always be the first recommendation to try.

On a final note, Look to the cause to help create the solution. And remember, when one part of the body is not functioning well, it cannot be isolated. In time, it will cause distortions elsewhere. Good mechanical functioning creates far better loading patterns.

For further reading of the benefits of Low Level Laser Therapy, please click Here and contact us directly if you require the research papers addressing the above mentioned treatments.

If you need a chiropractor for knee pain treatment in Sydney, please get in touch today.

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