Don’t you just treat backs?
Dr Jess Milsom It’s a misconception that chiropractors should only be sought after when you have back pain, neck pain or a headache. It’s commonly believed that if you suffer from an injury to your upper or lower limb, then you should see a physiotherapist. While there is nothing wrong with seeing a physiotherapist, chiropractors have spent the same amount of time studying upper and lower limb injuries. Also, they have been taught how to effectively assess, diagnose, and treat these limb injuries. Some common conditions we’ve treated here at Pittwater Chiro include (but are not limited to): Chiropractors are taught university-level anatomy and physiology for all parts of the body. To become a chiropractor in Australia, you must complete a bachelor’s degree in health sciences and a Master of Chiropractic. Anatomy – the structure of humans – and physiology – normal functions of the living organism – units are required as part of the undergraduate degree. Chiropractic students are taught in the same classes as physiotherapy students. Alongside those units, chiropractic students complete ‘chiropractic’ classes, which are held around three times a week for the entire degree. Chiropractors are thoroughly taught in the assessment, diagnosis, and management of upper and lower limb injuries. For an entire year and a half at Macquarie University, classes focus solely on the assessment, diagnosis, and treatment of upper and lower limb injuries. Furthermore, these injuries are then further studied in the final two years of the postgraduate degree with a sport’s specific focus. To graduate and become a qualified chiropractor, a student will have learnt, and assessed on, key orthopedic, neurological, and functional testing of the entire body. Also, we are taught and assessed on our ability to incorporate the findings of the testing and form an accurate diagnosis and treatment plan. Alongside all those units, we are required to complete research units as part of our postgraduate degree. This unit further develops our ability to treat in an evidence-based manner. Essentially, the degree teaches us how to access the best quality of research and evidence. This means weeding out studies and information which is perhaps biased or untrue. This means the way we assess, diagnose, and treat is in tune with the best clinical guidelines and recommendations. Chiropractors can perform manipulations and mobilizations for upper and lower limb injuries. Part of your treatment with a chiropractor can include joint manipulations and mobilizations of the upper or lower limb. Alongside this, we are taught various soft tissue techniques, including active release, post-isometric relaxation, and simple massage techniques. At Pittwater Chiro, all our chiropractors are qualified in dry needling. In addition, we also offer shockwave and cupping. We have a lot of tools in our kit when approaching the treatment of an upper or lower limb injury. Chiropractors can create safe and effective rehabilitation and exercise programs. Chiropractors can create tailored rehabilitation programs to safely increase your range of motion, endurance, load tolerance and/or power generation. This is a crucial part of returning from an injury to ensure you don’t reinjure the area. Chiropractors can refer and point you in the right direction. We’re also well-versed in recognizing if your condition needs co-management with another health professional, such as an orthopedic specialist. Chiropractors possess the expertise and knowledge to treat injuries in both the upper and lower limbs effectively. Their holistic approach, extensive training in anatomy and physiology, targeted adjustments, and focus on rehabilitation make them valuable healthcare partners in helping patients recover from musculoskeletal injuries. By considering chiropractic as a viable treatment option, individuals can find a non-invasive and drug-free path to healing.
Why we don’t recommend Dr Google
You have a headache, jump on to Dr Google to see what is wrong and end up reading you might have cancer. For those of us who can decipher the quality of the information, self-diagnosing via Google can be helpful. We can weed out the poor information and find quality research that gives us a greater understanding of our pain. But, for most of us, it can cause more harm than good. The Dr Google results found online can be: The wrong diagnosis When you enter all your symptoms into the search bar, it will present you with a list of conditions. These will generally be ranked from least to most serious. Your eyes will scan through all the options and leap to the most severe and usually most unlikely cause. When a health professional completes an assessment, they do not just think about your list of symptoms. What is considered is your family history, past medical history and then they will perform a thorough physical examination. They will also ask ‘red flag’ questions that often rule out these severe conditions. They will then use the results of all the information to rule out the majority of the list, leaving them with the most likely cause. There’s a saying in the health industry that common things happen commonly. When we google our symptoms, we take away the learnt experience and knowledge of a university-trained health professional. A common condition – tension headache – could be misdiagnosed by Google as a much less common pathology – stroke or a brain tumour. Potentially lead to health anxiety If we misdiagnose ourselves with a severe and concerning condition, that will undoubtedly lead to anxiety and stress. When this happens, we can be on high alert for other symptoms and signs that fit into the picture of Dr Google’s diagnosis. For example, you injure yourself at soccer training. You have pain that goes into the back of your thigh. You ask Dr Google, and it says you have sciatica. Then it tells you that you may have weakness in your leg. Suddenly, your leg feels difficult to move due to the pain. For more information on the links between chronic pain and mental health, read our blog. Dr Google is missing the information that sciatica (radiculopathy) can be confirmed or denied by a neurological examination performed by your health professional. Your chiropractor will complete a thorough neurological exam; of leg strength, pinprick sensation, and reflexes. If all tests are negative – you have strong muscles, intact sensation, and strong reflexes – then it is not sciatica and is more likely a muscular or joint cause. Dr Google has made you stressed and anxious when this injury will recover with minimal treatment and slight changes in your daily activities. On the flip side, the diagnosis may be correct. However, how the information is described, might change your perception of what your recovery looks like. Without the big picture, we may be pessimistic about our recovery. For example, if you are told you have a ‘slipped disc’ you subconsciously associate your back as a fragile body part that may play up at any moment. If you are told, you have a ‘disc herniation which can heal’ you’re less likely to feel you have a fragile back and are more likely to participate in weight-bearing activities which will be crucial to recovery. Be generic, and not specific to your situation Google will not consider all life factors, like what medications you currently take and your stress and training load. Health, well-being, and pain perception are multi-layered. Often looking at the structure independent of the surrounding joints will be limited in how well you can recover from your pain. Be written by anyone Anyone can make a website, offer advice on a forum and edit a Wikipedia page. Not all resources are written by university-trained health professionals. While this is what makes the internet such an interesting place, it can also lead to a lot of poor quality, and often incorrect information. Furthermore, some websites may even play into our health anxieties so they can push their product or service onto us. Google will not highlight the best quality literature, clinical guidelines, and empirical research. This ability to source the best research and weed out the rubbish are skills taught to university-trained health professionals. This ensures the methods used in clinical practice are effective and safe. Long story short: speak to a health professional! A good rule of thumb is if you are worried enough to google it, it is time to get a professional opinion. We have done all the hard work at university to give you the most likely diagnosis. Also, we have the best information on how to get better. The human body is complex. You are more likely to recover quickly if you see a chiropractor than if you were to seek help from Dr Google.
Disc Herniations Explained
We hear in the clinic that you slipped your disc, giving you a dodgy back. More often than not, this is not true. Spinal discs do not slip out of place. This thought process alone may make our symptoms worse. If we think our discs are unstable – likely to slip out at any moment – we are much less likely to apply forces (exercise) and loads (heavy objects) to the back needed to create a strong back. So instead of a slipped disc, the correct term is disc herniation. To explain why, we will look at the anatomy of the lower back. Lumbar Spine Anatomy Your spine has 33 vertebrae – 24 are moveable and the remainder are fused. The discs sit between the vertebrae and act as a shock absorber, providing cushioning and flexibility. They also aid in the transfer of loads and forces and help to create smooth movements through our spine. Each disc consists of a tough outer layer called the annulus fibrosus and a gel-like inner core called the nucleus pulposus. Above and below the discs at the top and bottom of the adjacent vertebral bodies are vertebral endplates. These endplates hold the disc firmly in place, making it impossible for the disc to slip out. Are you more a visual learner, click on the link to see a video going through the anatomy – lumbar spine anatomy. When a disc herniation occurs, a small part of the nucleus pulposus (the gel-like inner layer) breaks through a part of the annulus fibrosis. A disc herniation can contribute to irritation and inflammation of the surrounding nerves due to compression of that nerve. These nerves often travel down and branch off to other nerves that supply the muscles and skin of our legs or arms. This is why back or neck pain can sometimes travel down our arms or legs, sometimes causing numbness, tingling or sharp pains in the affected limbs. Cause of Disc Herniation The cause of disc herniation is somewhat debatable. The original theory is that bending forward, twisting movements and lifting heavy loads will cause disc herniation. However, research is beginning to suggest this is not necessarily true. There is emerging research stating that genetic components and lifestyle factors can make an individual more susceptible to disc herniations and the degenerative process. Research suggests that not everyone with a disc herniation has symptoms or pain. Individuals may even have disc herniations which can severely compress a nerve and be completely symptom-free! Corresponding research suggests herniations can heal without surgical interventions, regardless of the size. Furthermore, the size of a disc herniation does not impact the degree of symptoms the individual experiences, meaning some may experience a high degree of pain with a minor disc herniation, and others may experience minimal pain with a large herniation. While this is baffling, it is very encouraging, as it suggests pain symptomatology can be affected by, and in terms relieved by, lifestyle modifications and assessing wellbeing holistically without the need for surgical intervention. Summary of Research With the above information, it would be sufficient to say that most people do not need surgery for a disc herniation. Again, research suggests that most people suffering from the symptoms of a disc herniation who undergo surgery have similar long-term outcomes to those who do not. A study found that those who did undergo surgical intervention, initially had a greater relief of pain, a quicker return to activities and decreased impact on daily living in the short term. However, when re-assessed a few months later, these individuals reported having the same levels of pain, functionality and contribution to activities of daily living as those who did not undergo surgical intervention. Surgical intervention may be necessary for those who are suffering severe and progressive neurological symptoms, however non-operative management is often recommended at the first trial of care. Non-surgical treatment can include chiropractic treatment, prescribed exercises and activity modification. For more information on management of chronic low back pain, read our blog. So, what can you do at home to relieve disc herniation symptoms and decrease the likelihood of a recurring flare-up? Identify what triggers and aggravates your symptomatology. Work postures, patterns of movement, stressful periods of life, poor sleep, alcohol or smoking, poor nutrition, weight, etc. Once you understand what flares up your pain then find ways to avoid it. This could be changing your diet, drinking more water, avoiding sitting for prolonged periods or going to bed a bit earlier. Exercise! Evidence suggests that exercise combined with manual therapy is the most effective way to relieve chronic pain. However, there is no evidence to suggest one form of exercise is better than another form of exercise. So, do what feels good for you and, more importantly, what you enjoy doing! Anything is better than nothing. Assess your lifestyle and other factors of health. Similar to the first point, looking at your health holistically ensures you know how to manage your pain and prevent the likelihood of injury recurrence. Stress is one of the main drivers of the majority of prevalent diseases. Pain is multifactorial and often linked to poor stress management, mental health, and/or lifestyle choices. Disc herniations can cause significant discomfort and impact an individual’s quality of life, this does not have to be the case. Finding out what works best for you, what triggers your pain and how to avoid it is the key to empowering you to take control of your health. Making these choices will get you back to doing what you love quickly.
