Everything you need to know about ankle sprains
Ankle sprains are one of the most common injuries, affecting athletes, weekend warriors, and anyone who missteps on uneven ground. Despite their prevalence, many people don’t fully understand how to treat and prevent ankle sprains, leading to prolonged recovery, re-injuring or spraining of the ankle, and other chronic issues. This blog post will help you understand the causes, treatment, and prevention of ankle sprains based on recent research and best practices. What is an ankle sprain? An ankle sprain occurs when the ligaments supporting the ankle joint are stretched or torn, usually due to excessive twisting or rolling of the ankle. The lateral ankle ligaments (on the outside of the joint) are most commonly affected. There are three grades of sprains: What causes ankle sprains? According to research ankle sprains often occur during activities involving sudden changes in direction, landing on uneven surfaces, or overuse during repetitive activities. Risk factors include: The long-term impacts of ankle sprains Chronic ankle instability is a common consequence of poorly managed ankle sprains. Chronic ankle instability can be the result of repeated injuries or insufficient rehabilitation, leading to reduced balance and strength, which increases the risk of future sprains. Research shows that a lack of neuromuscular training post-sprain often contributes to chronic ankle instability. Treatment: best practices for recovery Immediate care for ankle sprains focuses on the R.I.C.E. method: However, modern research suggests that early mobilisation is critical for recovery. Functional rehabilitation, including controlled movement and strength exercises, can significantly reduce recovery time and improve outcomes. A new acronym is becoming more widely used and accepted for these types of injuries, called P.E.A.C.E & L.O.V.E & Preventing Ankle Sprains Preventative strategies focus on strengthening the ankle joint, improving proprioception, and wearing proper footwear. Evidence highlights the importance of neuromuscular training, including balance exercises, plyometrics, and dynamic stability drills. Additional tips Final Thoughts Ankle sprains may seem minor, but they can lead to long-term issues without proper care. By understanding the causes, following evidence-based treatments, and incorporating preventive exercises, you can reduce your risk of injury and stay active. If you’re dealing with an ankle sprain or chronic ankle instability, book in with one of our chiropractors and we can assist you with a personalised rehab plan. References
Navigating a New Episode of Low Back Pain
Are you experiencing a flare-up or a new episode of low back pain? Here’s how to navigate it. Low back pain (LBP) is a prevalent condition, often causing discomfort and disruption to daily life. Understanding the best practices for managing LBP is essential for achieving effective relief and preventing further complications. Using clinical practice guidelines, this blog aims to provide actionable advice for when you experience LBP. Before we go any further, it’s important to seek help from a professional when you experience a new episode of pain or intense pain, to determine the need for immediate medical relief. This blog post is targeted to ‘non-specific low back pain’, which is pain that does not have a known patho-anatomical cause. In other words: not caused by serious conditions such as a tumour, infection, spinal cord compression, etc. So with that in mind, let’s discuss how to manage it and when it’s appropriate to see a chiropractor! How you can manage a new episode of back pain by yourself: Avoid bed rest: Most research advises against prolonged bed rest for acute LBP, recommending maintaining normal activities to promote healing. Medication and superficial heat: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended for pain relief, e.g. neurofen (ibuprofen). It’s important to read the label when taking these drugs and consult with the pharmacist to ensure they are right for you. Additionally, heat packs or heat creams can help when experiencing an acute episode of low back pain. For more information on the different medications for back pain read Jess’s blog – medications for low back pain. Exercise Therapy: Exercise is universally endorsed, particularly for chronic LBP, although the type and delivery mode may vary. The recommended exercise varies from person to person, but generally speaking, while suffering from a painful episode of low back pain, gentler exercises will be more beneficial. For example, light swimming, walking, or pilates. Psychosocial Strategies: Cognitive-behavioral therapy (CBT) is widely recommended, addressing psychosocial factors that may contribute to LBP. Generally, CBT strategies are performed by a psychologist and are useful if you frequently suffer from low back pain episodes. Alongside that, regular mindfulness practice is encouraged to decrease the intensity and frequency of back pain. How can a chiropractor help you if you experience a new episode of low back pain? If symptoms persist or worsen, consider consulting a healthcare provider within the first 1 – 2 weeks of the pain for further evaluation and personalised treatment recommendations. Chiropractors can develop individualised exercise programs and provide hands-on interventions to address pain and promote recovery. Additionally, research shows the significance of receiving reassurance from a professional that improvement is achievable while experiencing low back pain. Chiropractors can also discuss with you the strategies that will be most effective when managing the pain at home or outside of the clinic. For chronic LBP, multidisciplinary rehabilitation may be beneficial, involving a coordinated approach with various healthcare professionals. Chiropractors can offer referrals to specialists if you need to look at other options. However invasive treatments such as injections or surgery are generally discouraged unless conservative measures have been ineffective, and specific criteria are met. Long-term management and prevention of back pain Once you have managed to settle down the pain it’s good to implement long-term strategies to avoid another flare-up. Some simple ways include: Lifestyle modifications: Regularly change the position you’re in – making sure you’re not staying in the same position for too long e.g. sitting or standing for too long, engage in regular exercise, and manage stress to reduce the risk of recurrent LBP episodes. Education and self-management: Research shows that when you understand how pain is perceived in the body you are less likely to catastrophise a flare-up, subsequently decreasing the intensity and duration of that flare-up. Empower yourself with knowledge about LBP management strategies and adopt self-management techniques to address symptoms proactively. If you regularly get pain flare-ups have a look at Lorimer Moseley’s Ted talk on YouTube called “Why Things Hurt”. Regular follow-ups with healthcare providers such as chiropractors can help monitor progress, adjust treatment plans as needed, and address any new concerns or symptoms. Experiencing low back pain can be challenging, but with the right approach, relief and recovery are achievable. By adhering to evidence-based recommendations such as those discussed in this blog, individuals can navigate LBP with confidence and take proactive steps towards improved health and well-being. Remember, you are not alone in your journey, and there are resources and healthcare professionals available to support you every step of the way. Stay informed, stay proactive, and prioritize your health for a brighter, pain-free future. References: Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, van Tulder M, Koes BW. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3. PMID: 29971708. Chou R, Côté P, Randhawa K, Torres P, Yu H, Nordin M, Hurwitz EL, Haldeman S, Cedraschi C. The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. Eur Spine J. 2018 Sep;27(Suppl 6):851-860. doi: 10.1007/s00586-017-5433-8. Epub 2018 Feb 19. PMID: 29460009. Ladeira CE. Evidence based practice guidelines for management of low back pain: physical therapy implications. Rev Bras Fisioter. 2011 May-Jun;15(3):190-9. doi: 10.1590/s1413-35552011000300004. PMID: 21829982. Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S, Goldgrub R, Nordin M, Gross DP, Shearer HM, Carroll LJ, Stern PJ, Ameis A, Southerst D, Mior S, Stupar M, Varatharajan T, Taylor-Vaisey A. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017 Feb;21(2):201-216. doi: 10.1002/ejp.931. Epub 2016 Oct 6. PMID: 27712027. Lorimer Moseley G, Leake HB, Beetsma AJ, Watson JA, Butler DS, van der Mee A, Stinson JN, Harvie D, Palermo TM, Meeus M, Ryan CG. Teaching Patients About Pain: The Emergence
Maintenance care for chronic low back pain
Low back pain (LBP) is a common and burdensome health issue affecting millions worldwide. Its recurrence and persistence pose significant challenges, often leading individuals down a frustrating path of pain and reduced mobility. A lot of chiropractic treatment helps to decrease pain intensity but a proactive approach decreases the likelihood of pain flare-ups. Chronic LBP has a ripple effect on individuals, affecting their families, work, lifestyle and society. It is the leading cause of work absence and activity limitation globally. Its recurrent nature increases this burden, highlighting the critical need for preventive strategies. Alongside hands-on chiropractic treatment, exercise and education play pivotal roles, offering hope for individuals grappling with recurrent LBP. Have you had a recent flare-up? Read Jess’s blog on how to deal with a new episode of low back pain. Chiropractors, skilled in musculoskeletal assessment and treatment, play a pivotal role in managing LBP. Manual therapies, including spinal manipulation and mobilization, are commonly employed to alleviate pain and improve function. Additionally, chiropractors often recommend maintenance care — a preventive approach aimed at reducing the risk of relapse and optimizing long-term well-being. Current Research A 2018 randomised controlled trial by Eklund et al. investigated the effectiveness of maintenance compared to symptom-guided care in individuals with recurrent or persistent LBP. The study replicated real-world clinical practices, offering valuable insights into its efficacy. The trial compared maintenance against symptom-guided care. The maintenance care group aimed to schedule chiropractic appointments before substantial pain, meaning appointments were pre-booked and controlled by the clinician. In the control group, the patients were instructed to book when pain occurred, meaning the appointments were not pre-booked and were controlled by the patient. The trial revealed that maintenance care was more effective than symptom-guided care in reducing the total number of days with bothersome LBP over 52 weeks. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, maintenance care should be considered an option for long-term prevention. In the struggle against recurrent LBP, exercise, education, and chiropractic emerge formidable allies. By embracing proactive strategies and evidence-based interventions, individuals can reclaim control over their well-being and navigate the journey of recovery with resilience and optimism. As chiropractors continue to champion holistic approaches to musculoskeletal health, the promise of maintenance care shines brightly, offering hope and healing to those in need. References Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, Bodin L, Axén I. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain – A pragmatic randomized controlled trial. 2018 Sep 12;13(9):e0203029.Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74. 10.1136/annrheumdis-2013-204428da Silva TM, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. 2017:1–27.Steffens D, Maher CG, Pereira LS, Stevens ML, Oliveira VC, Chapple M, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(2):199–208. 10.1001/jamainternmed.2015.7431ringsli M, Berntzen A, Olsen DB, Leboeuf-Yde C, Hestbaek L. The Nordic Maintenance Care Program: Maintenance care—what happens during the consultation? Observations and patient questionnaires. Chiropr Man Therap. 2012;20(1):25 10.1186/2045-709X-20-25
Exploring the Interconnectedness of Chronic Pain and Mental Health Disorders
Both chronic pain and mental health disorders are extremely common conditions within the general population. Up to 80% of Australians will experience back pain in their life, and it is the leading cause of loss of work and income poverty in Australia. It’s estimated that 43.7% of Australians have experienced a mental health disorder in their lifetime. Epidemiological studies suggest a bidirectional relationship is present between mental health disorders and chronic pain. Observations from these studies even suggest shared neural mechanisms for these conditions. These neural mechanisms are referred to as the pain matrix. There are many reasons an individual may suffer from chronic pain, however, in this blog post, we will mainly discuss the impact of musculoskeletal causes of chronic pain. Chronic pain is defined as a persistent discomfort that lasts longer than 3 months, creating interference with activities of daily living, due to fear avoidance behaviour. Additionally changes to an individual’s mood, relationships, sleep and overall quality of life are often negatively impacted when suffering from a chronic pain condition. An individual suffering from chronic pain is at an increased risk of depression, anxiety, substance abuse disorders, and suicide. For more information on how to manage chronic low back pain effectively, read Jess’s blog on maintenance care for low back pain. What is the pain matrix? The “pain matrix” refers to a network of brain regions involved in the perception and processing of pain. It’s a term used in neuroscience to describe the complex system that coordinates the experience of pain within the brain. The pain matrix involves various regions of the brain that work together to process and interpret pain signals. Regions of the brain Somatosensory Cortex: Responsible for processing sensory information, including pain, and identifying the location and intensity of the pain. Thalamus: Acts as a relay station for sensory information, directing signals from the spinal cord to the different areas of the brain involved in processing pain. Insular Cortex: Plays a role in integrating sensory information, emotions, and cognitive processes related to pain perception. Anterior Cingulate Cortex (ACC): Involved in the emotional aspects of pain, such as the unpleasantness or distress associated with it. It also helps regulate attention and decision-making related to pain. Prefrontal Cortex: Responsible for higher cognitive functions, including decision-making, memory, and emotional regulation related to pain perception. It’s important to note that as the interpretation of pain occurs along different levels of our nervous system, and within these levels are various synapses and pathways, these are essentially the delivery system of the pain message to the next region of our brain or nervous system. This is important because we have the potential to alter the message that is sent to the next level of the pain matrix. We can amplify it, or attempt to stop it in its tracks, meaning pain can be either intensified or softened by our emotional and behavioral states. The pain matrix operates dynamically and can be influenced by various factors, including emotions, past experiences, expectations, and individual differences. For example, factors like anxiety, stress, or attention can modulate the perception and experience of pain by affecting how the pain matrix functions. The link between chronic pain and mental health disorders – a vicious cycle Research shows a clear link between individuals suffering from a chronic pain condition and the presence of depressive symptoms and major mood disorders. For example, an individual suffering from fibromyalgia, chronic back pain, temporomandibular joint disorders, or chronic abdominal pain is 50% more likely to suffer from a high-level depressive disorder. There is an estimated prevalence of depression exceeding 20% in those suffering from painful arthritic conditions, migraine headaches, and pelvic pain. A population-based study involving 845 adults who had mild or disabling neck or lower back pain found that these individuals were 2.0 – 2.5 times more likely to experience a depressive episode at 6 – 12 month follow-ups when compared to individuals without back pain. On the flip side, pain-free individuals who suffered extremely elevated levels of depressive symptoms were 4 times more likely to develop lower back or neck pain at the 6 – 12 month follow-up when compared to individuals with lower levels of depressive symptoms. Similar studies also concluded that the rate of depression increased with greater pain severity. These findings suggest a bidirectional relationship between chronic pain and depression, in which one condition can worsen the other. They also suggest the severity of depression can be heightened by the intensity of the pain, and vice versa. Not only that, but imaging of the brain also displays alterations in regions of the brain responsible for the processing of emotional stimuli and pain stimuli in those suffering from chronic pain and depressive disorders. So how do we address this connection? Addressing the link between mental health disorders and chronic pain is a very important first step to managing these conditions. It is important to understand that pain is extremely multi-faceted, and the more research that is done on pain the more we understand there is a lot more than biomechanical causes of pain. When managing a chronic pain condition it is important to implement the following approaches into your care plan: Holistic Approach to Treatment Treating chronic pain should involve a holistic approach that considers both physical and mental well-being. Integrated therapies that address both aspects can be more effective. This could mean seeing a chiropractor alongside seeing a psychologist. It also means addressing your well-being as a whole; look at what you’re eating, and drinking, how you spend your day, your social support systems, how you’re sleeping, etc. Mental Health Support Patients with chronic pain should have access to mental health support services like counselling or therapy to cope with emotional distress. As discussed, there is a bidirectional relationship between chronic pain and depressive symptoms, and while you might not think therapy or psychology is for you, cognitive behavioural therapy has very favourable results in managing chronic pain and depressive disorders. Cognitive behavioural therapy should only
