What to expect when you visit us with Neck Pain

This post is for anyone with neck pain wondering what to expect as part of your initial assessment with us at Align. 

Neck pain is one of the most common issues people will come to visit us for. We are chiropractors after all. 

The goal of your first visit with us is to determine not only the likely cause of your neck pain, but the best course of action moving forward for you as well. 

If you have been watching the other videos about initial visits that we have posted recently, you will notice there is a certain level of commonality between the different assessments.

This is by design.

The video outlines the common elements to our cervical assessment. 

We want our examination process to be accessible to people with various levels of pain, injury or disability, and at the same time give us enough scope to individualise our assessment on an individual basis.  

There is a transcript of the video below. Although why WOULDN'T you want to see it filmed live?

Hi, Martin from Align Chiropractic and Kieran...also from Align Chiropractic. This video is just going to give you a little bit of an idea of what to expect if you're coming to see us and you're concerned with having neck pain.

The first thing we're going to do, Kieran if you’ll pretend that you’re the person with neck pain is make sure that you get to tell me all that you need to tell me about your neck pain. 

Certainly I have some questions about when it started, what makes it better, what makes it worse etc, and for a lot of people it's really important for us to understand what is it that their neck pain is making it harder for them to do, or stopping them from doing that they need to get back to.  

It’s really important that you get to tell all about neck pain so that we know what's going on. 

Step two: Palpation

When we're assessing somebody who's come to see us with neck pain is a palpatory exam. A plapatory exam is where we use gentle pressure to assess what is happening in your neck, are there areas where the joints are restricted in their ability to move? Are there areas where there's tenderness or discomfort? Are there areas where there's increased muscle tension?

Once we've assessed the neck, often, because the spine is one

integrated system it's all part of one whole system, we extend our palpatory examination through the rest of the spine. 

Sometimes we will also assess other related areas such as your shoulders or your jaw. 

Step 3: Show us your moves

When we are assessing somebody who's come to see us with neck pain is to assess how they bend, move and twist. 

Often when you have neck issues that will affect how far you can go one way compared to the other. The way we measure that is we use inclinometry, which is where we use an accurate measuring tool to see how far you can bend to the left comfortably and then compare the left side to how far you can move to the right. Simple as that.

Step 4: Assess Alignment

When we're assessing somebody who's come to see us complaining of neck pain is that we have a look to see if there’s any alteration in alignment of their spine. 

The way that we do this is we can use specialised software to take a photo of the person and then digitising that photo to see if there’s any misalignment or alteration in their posture. 

The software works by taking a photo and it uses the iPad to make sure that we have a photo that is absolutely vertical. 

The software then places our grid around exactly where straight up and down is and then we can compare landmarks on your body to measure against. 

Your body's landmarks should also be aligned so we can then see exactly how straight up and down or symmetrical your posture is.

Neck Pain

Neck pain is a common condition that most of us will suffer from at some point in our lives. 

It can arise for a whole host of reasons but if you have ever suffered from neck pain, you know that even mild neck pain can feel like  it is taking over your life! It can make it harder for you to sleep, work, exercise and enjoy time with your friends and family.

The most common causes of neck pain  are day to day movements and postural stresses and  neck pain is rarely the sign of a more serious condition.

In case you aren't sure where neck pain is, here is a stock photo to indicate what a pain in the neck neck pain is. In this instance, pain is indicated by redness.

Neck pain can often refer to areas such as your shoulders, arms and upper back, as well as being a cause of headaches.  

Common causes of neck pain include:

•         Poor posture (the way your body is positioned when standing or sitting)
•         Sleeping in an awkward position.
•         Upper back and neck muscle tension.
•         Injury such as a muscle strain.
•         Whiplash. 
•         Prolonged sitting, especially when using a desktop or laptop computer.
•         Arthritis.
•         Degenerative changes in bones of the neck as a part of the ageing process or previous injury.

You will notice a common theme to the list above and that is; all of them appear relatively trivial when compared to the impact that neck pain has on our lives.

In fact, for a lot of our clients suffering from neck pain, that adds to the frustration. It doesn't matter if the pain is mild or severe, recent or decades old, most frequently, our clients will say that it just doesn't add up. “Why they are in so much discomfort? Why won’t the pain just go away by itself? Why does it keep coming back?”

How can something so mundane cause so much pain?

In these situations it is highly likely that there is an underlying imbalance of function that meant that their body was ‘on edge’. There was a build up of tension in an area of their spine and that mundane event was just the straw that broke the camels back (for the want of a better term).

Does it make sense to you that if your spine is functioning well that a trivial stress would be enough to make your neck hurt? If your range of motion was symmetrical, your muscles, ligaments and tendons were relaxed, elastic and strong  does it make sense that it would suddenly start to hurt you? 

Of course it doesn’t. 

An underlying imbalance of function is most likely why you notice neck pain that comes out of no where, or won’t calm down, or keeps coming back. 

This is why our initial assessment of someone with neck pain looks for two things:

1. What is the cause pain and how do we get it to calm down as quickly as possible? 
2. Is there an underlying imbalance and if so, what can you do to address it to minimise the chances of it coming back?

There are also more serious causes of neck pain that, although much more rare, we need to screen for. 

The more serious causes of neck pain are issues like fracture, disc prolapse compressing on nerves, cancer or meningitis.

We have designed our assessment to be able to determine if your neck pain arises from an issue that we can start to address immediately, requires referring for further testing (such as X-rays or MRI etc.) or if you require immediate referral for medical assessment. 

So how do I know if I need to see you or go to the Emergency Department?

If you are experiencing intense neck pain after a severe head or neck injury, have lost vision due to an accident, are having difficulty swallowing, have lost or severely altered bowel and/or bladder function or your neck pain is linked to intense fever, we advise that you visit your ED as soon as is possible to make sure that you aren’t suffering from more serious conditions. 

If you have any questions or concerns about neck pain, please do not hesitate to get in contact with us at Align.

What to expect when you visit us with Back Pain

This post is for anyone who has back pain and wants to know what to expect if they were to come and see us at Align.

Lets face it...as chiropractors, back pain really is our thing. You might have already guessed but along with neck pain and headaches, back pain makes up a large number of the people who come to visit us initially.

Unsurprisingly therefore, it is important for us to be able to efficiently find out what is happening in these cases and be able to determine their best course of action to move forward. 

The video below outlines very generally what to expect when you first come to see us. 

I use the term 'generally' as obviously, each person is different and so are their injuries, so we treat every client individually depending on their presentation. 

Sometimes back pain sufferers might require a neurological examination, for others we might require X-rays and for some, we may not be the first place they should be at all! 

We take pride in our initial examination's ability to individually assess back pain sufferers quickly and effectively to determine their needs and best course of action.

This video outlines the common elements of our exam.

For those who don't enjoy seeing Martin run an assessment on the Best Looking Chiropractor in Melbourne*, there is a transcript beneath the clip. 

*Not a real competition or title.

Hi, Martin and Kieran from Align Chiropractic and this is a short video to tell you what to expect if you're going to come and see us because you are concerned about back pain.

Step one: History

To be begin, we need for you to tell us all about your back pain; 

-what have you been feeling? 

-what makes it better? 

-when did it start? 

-what makes it worse? 

However mostly we want to understand is; what does the pain mean to you? 

For a lot of people, the pain is only a part of the problem. 

A big part of it is the impact that it's having on your life. What are the things that the pain is stopping you from doing that you love to do or need to do in your life? 

Step one then is for us to get a really good understanding all the ramifications.

Step two: Palpation

Next when you come to see us complaining of back pain, is a palpatory assessment. What we’re looking for with that assessment are areas where the joints are restricted in the motion.

When they are out of balance, they are not able to move the same left and right. 

We also want to see if there are areas where there's increased muscle tension and/or the presence of tenderness.

We are looking for the areas where things are just not working how they should. 

Once we've done that palpatory assessment of the area that is giving you problems, we will often also extend the examination beyond that area of pain because your spine is linked with the way the whole body works and so we will often then extend up into assessing how your neck is working or in other related areas.

Step Three: Assess Alignment

the next step when we are assessing somebody who has come to see us with back pain is we assess the alignment of their spine.

Posture is the window for us to be able to assess alignment.

To do this, we use specialised software where we can take a photo from the side and from the front. 

We then digitise those photos and then analyse them to see if there are indications of misalignment in the spine.

The way the software works is that we first take a photo and it uses the iPad to make sure that we have a photo that is absolutely vertical. 

The software then places a grid around exactly where straight up and down is and then we can compare landmarks on you that should also be aligned to see exactly how straight up and down or symmetrical your posture is.

Ice Ice Maybe?

Before I get into this, I need to clear up two things.

1. When I use the term 'Ice' or say, 'use ice' I am of course ONLY referring to frozen water. Whatever you do, DO NOT take those terms out of context.

2. let's just get it out of the way:

An obvious yet somehow necessary gag to put at the top of a discussion on anti-inflammatory protocol

There, now that this blog has a soundtrack, we can get started. 

Should I use ice or heat?

As Chiropractors, we get asked this a lot. There appears to be a lot of confusion out there about what you should use, when and why, and that confusion is not just limited to the general public! 

There is a lot of debate and conflicting info about ice vs. heat amongst different health care professions and even between practitioners within the SAME profession, so it is little wonder that when people are injured, they aren't sure what to try. 

In this post I will attempt to explain a bit of the ins and outs of the issue, as well as some of the  the common sticking points in the discussion and ultimately, try to give a summary of the basic approach you could try, based on the best and most current research I am able to get my hands on. 

So, if you are the type of person who just wants to get a few tips WITHOUT having to go through the rest of it (and to be honest, I don't blame you if you do), then please feel free to skip down to the bottom of this post where I will summarise the main info in bullet point form. 

However, if you're like me and you're kind of into the back ground of things, then please read on. 

So why would I use ice or heat anyway?

Full disclosure...this will not be an exhaustive explanation of how inflammation works because that would be WAY too much info to put in this blog and to be honest I really couldn't do the topic justice with my explanation anyway (however, if you would really like to geek out and marvel at just how incredible the human body is, and get a much more complete picture of what is happening at a cellular level in detail, I suggest you check out a video called "Basic Inflammatory Response". Be warned though, videos like this are only the start of a fascinating rabbit warren so be sure to have a clear afternoon for all the other info you'll want to follow it up with).

To EXTREMELY oversimplify the situation: 

1. You injure yourself
2. Your body detects the injury
3. Chemical signals are released to signal to your body to begin healing and cleaning the injury up.
4. The chemicals also cause more healing factors in your blood to come to the area/slow down in the blood stream at the site of injury and help to clean up/heal
5. The resulting 'inflammatory Soup' causes redness, swelling and alterations of movement at the affected site as well as activation of nerves that carry information about the damage to your brain where it is registered as being painful.

As stated above, this is a very simplified version of events that skips many steps in the process but I feel gives you an idea of the situation. 

The most important take home message though? The body is very smart and so it does all this to HELP you, so we want to allow healing to occur as much as possible without hindering the healing process too much.

The reason then that we employ heat or ice is to limit the levels of swelling and discomfort you have to experience, while allowing all these steps to occur and let you live your life while your body gets on with the task at hand. The cooling or heating of tissues is used to constrict or dilate blood vessels in order to modulate the inflammation to inhibit or help the healing factors to arrive at and move on from the site of injury.

Heat and ice have the added bonus of having relatively few side effects compared to their pharmaceutical counterparts, something I find clients are generally very keen to avoid having to take where possible.

Kieran, you haven't answered the question yet, do I use heat or ice? 

That depends on the injury. 

Generally speaking, we use ice for acute injuries (i.e. injury that has only occurred in roughly the last 48 hours) and heat for more chronic injuries (i.e injuries arising more than 2 weeks ago). 

In yet another simplification, we use different modalities because in the early stages of injury, the inflammatory soup is different to one that has been around for a longer period of time. In the gap between 2 days and 2 weeks, you can use ice or heat, or ice AND heat. 

You can however have a chronic injury that you exacerbate, in which case you might need to act like its a new injury and switch back from heat to using ice on it again. 

By now I am sure you can see why so many people can become confused as to what they should do. Don't worry, Ill still give that summary below. 

Does it matter where the injury is? 

No, that shouldn't be a factor.

In the past, some health professions have prescribed ice for acute inflammation for everywhere on the body EXCEPT the spine. For some reason they appeared to have forgotten that the spine is made up of joints, ligaments, tensions, muscles, blood vessels that have the same characteristics as other areas of the body. 

So, in cases of acute injury and pain in the neck and/or back, you should still use ice like you would on a knee. 

Some important points to remember...

As I have said, this is not an exhaustive discussion of this topic, and there is still a lot of argument among researches and practitioners as to the best practice for ice or heat (just type ice vs heat into Google and you'll get a sense of what I am talking about) I am just attempting to summarise what I have discovered from the best sources of research information I can find, as well as my experience with clients with acute and chronic injury in practice. 

Other important points to remember are:

• It appears that crushed ice in a bag is more effective than traditional cooling packs
• Do not return to activity immediately after using ice
• Don't use ice for more than 20 minutes of constant contact/ 
• If you have any questions or concerns about your injury, contact your health practitioner immediately.
• If either of the approaches make you feel worse, stop using them immediately and contact us to discuss your options. 

In Summary:

• Ice for acute injury (roughly under 48 hours old).
• Use ice for 10 minutes on, 10 minutes off, repeat as often as you like.
• Heat for more chronic issues (especially for injuries over 2 weeks old)
• You can alternate heat and ice for 10 minutes of one, 10 minutes of the other 
• There is no hard and fast rule, these are tools designed to make you more comfortable so let your body be your guide. 
• I would still recommend avoiding heat for acute inflammation.
• Do not just put up with pain or even just hope for the best with an injury, the earlier you act the better your prognosis. 
• Call us at Align to have a chat about your injury and discuss how to get back on track. 

If you're the type of person who would like to know where the information I have talked about here came from, please feel free to contact me at the practice at any stage and I will send you through the details of the research articles I have used, 

I will be keeping my eye out for newer, more definitive research and promise to update this post if anything new comes to light.

If you have any other questions or concerns, please do not hesitate to get in contact. 

Kieran

What is the best way to sit?

"How should I be sitting?"

We often get asked this by our clients and on the surface it sounds like a pretty simple and straight forward question but when you think about it, its a much broader subject than it first appears. 

If you subscribe to the theory that the researchers at QI are correct about pretty much everything (and let's face it, who doesn't?) then this video will explain to you a little about the *ideal* way to sit, but what do they mean by the BEST way to sit?

For instance, it could be argued that what you are sitting FOR might actually dictate how you could best attempt to sit. Then again, there are some people who argue that we shouldn't be sitting for more than just short periods at all! 

In this post I wanted to discuss a few different types of sitting and when you might want to use them.

But Kieran, what do you mean by different types of sitting?

I'm glad you asked! there are a few different ways in which we position our bodies when we sit and each has its own set of pros and cons. 

In the video above, they make reference to sitting with an angle between your low back and your hips of roughly 30 degrees. They don't specify this in the video but sitting with an angle like that refers to research for the best sitting position to ease pressure on your lower lumbar vertebrae and disks, hopefully reducing the risk of low back pain or injury including disk bulges. 

When I was studying biomechanics as part of my Bachelor of Applied Science (Chiropractic) at RMIT, (back then, the course was an undergraduate degree and a Masters by course work instead of the 5 year Bachelor degree Chiropractors currently undertake...also Youtube was only 1 year old...thats not relevant to that last point other than it gives you an indication of how old I must be) we learned that the ideal angle to sit was indeed NOT sitting up straight but between 100-110 degrees. Definitely within the ball park of what this episode of QI suggests.

So why are we always trying to sit up straight?

It seems strange doesn't it that despite scientific evidence to the contrary, that we should still be obsessed with sitting up straight. 

I can't find any rational reasoning for this but I posit that it's due to our societal awareness of posture in reference to our shoulders and head forward positions, rather than any awareness of our spinal health at large. 

Well then...which is it? Posture or low back health?

To be completely honest, I do not believe that there is one answer to this question. 

Firstly, if you know you have, or at risk of a low back injury, then it is reasonable for you to, as much as possible while sitting, attempt to have an appropriate angle of between 10 and 30 degrees beyond sitting up straight. I would also add, if you have or believe you are at risk of a low back injury, please contact us at Align Chiropractic to see what ELSE you can do to get on track beyond remembering how to sit. 

Secondly, if you don't have a specific reason or concern in reference to your low back, then as stated earlier, perhaps it is best to remember the context in which you find yourself sitting. 

If you are going to be at a computer for most of the day, then a focus on correct sitting posture. 

A couple of quick reminders are:

• Key board - Positioned more directly in front of you, so you aren't reaching for it or turning your     wrists to get the correct angle.
• Screen - Directly in front of you,at a height where your eyes are aimed directly in the middle just about the centre of the screen.
• Chair - Adjusted to a height where your feet can easily touch the floor with your hips at or just past 90 degrees to your torso.
• Mouse - Just to the side of the keyboard, easy to reach in a way that keeps your arm bent, not reaching for it.
• Alignment - Sitting up straight, don't slouch and don't let your head and shoulders slump forward. 

Always remember to keep what you need to use IN FRONT OF YOU in an easy position to use.

Computers and equipment was designed to fit US, not the other way around!

Your other best line of defence is to try utilise a standing desk for at least some part of the day!

However, the above video raises an interesting point, If sitting more casually, i.e. watching a movie etc, then sitting up straight as if you are using a computer doesn't really feel like it makes much sense. Lets face it, it doesn't matter who you are, no one can sit up straight for extended periods of time. 

It makes sense to do it while working, where we can get up from the desk to stretch, get water or to stop our body from fatiguing, but if you're planning to sit and enjoy Casino Royal, re watch the Back to the future trilogy or binge The Sinner, then you can hardly annoy everyone you're watching with and interrupt the show with incessant stretching. 

This is where finding that 10 to 30 degree angle for your low back really comes to the fore.

Similarly while driving, I do not expect you to stop every 20-40 minutes on your daily commute for a walk, so keep that position in mind when you set up your car seat (I will post about correct driving position in the near future, but as a general rule, give yourself that slight angle, position the steering wheel so you aren't leaning forward to reach for it and make sure your head isn't being pushed forward by the headrest).

Another question we get asked frequently is should you sit on a gym ball instead? 

My answer is always the same...if your living room or office aesthetics suit the presence of a gym ball as a permanent piece of furniture, then perhaps posture and sitting is NOT the biggest issue you are currently experiencing. 

More seriously though, in my experience, sitting on a gym ball doesn't provide you with a better sitting technique for an extended period. Like anything, our body will fatigue if we ask it to hold a more rigid position for a long time and eventually we all end up slumping. Personally, I believe that a gym ball can actually help you to slump your shoulders forward as it offers you no form of support to relax into a better position. 

If you DO insist on sitting long term on gym ball, always be mindful of when your head slumps forward and your low back has started to curve in the opposite direction. 

Yep, just like any product sold on late night infomercials, the sad reality is, sitting on a gym ball will NOT automatically give you abs. 

The same can be said of ergonomic chairs or those kneeling 'chairs', not only are they usually more of an eyesore than you would hope them to be, they are really about trying to make the most of a crummy situation. They will try place you in a better posture but without adjusting your position, mindfulness of your body and remembering to get up and move frequently, your body will always try to reduce energy expenditure and slack off as soon as you aren't looking. 

So what SHOULD I be sitting on?

For a hint at the type of chairs we at Align DO actually like people to sit in, look at the furniture in our practice. 

The Eames chairs we have in the practice weren't just chosen for how beautiful they are, or how well they stand up to being sat on by hundreds of people, they also allow you to be comfortable in a relatively good position for a reasonable period of time. 

At the end of the day, there really is no substitute for body awareness. 

Listen to your body. Stand up when you need to stand up, move when you have to move, and re-position yourself when your body tells you it needs re-positioning. 

To discuss the best ways to combat bad posture, exercises to improve your ability to sit better, or discuss your concerns about your posture, contact us at Align on (03) 9696 1057, or bring it up during your next visit so that we can discuss your issues specifically and tailor an approach to your and your needs.