Organised by: Co-Sponsored: Malaysian Healthy Ageing Society
Key to back pain is alignment Michael Haneline, DC, MPH Professor, Head of Chiropractic International Medical University michael_haneline@imu.edu.my
Chiropractic is An approach to health care that focuses on the relationship between the body s structure and its function The primary focus of chiropractic is on the spine
If the structure is abnormal Stress is created in many areas of the body which can lead to strain, resulting in pain and dysfunction Common conditions Neck and back pain Headaches Extremity problems Many more
Spinal joint dysfunction Vertebral subluxation The joints between the vertebrae can develop movement problems and/or they can become misaligned Restricted motion (hypomobility) Best treated by chiropractic adjustments or manipulation which reduces stress and strain and may restore the vertebra to more normal position Too much motion (hypermobility) Best treated by efforts to stabilize the unstable joint (e.g., bracing and therapeutic exercise) Patient may be referred for a surgical consultation when tissue damage is so severe that the patient will not likely respond to conservative care
Digital motion x-ray of the neck
Vertebral subluxations can also result in Numbness and / or weakness in the extremities Must be differentiated from disc or other neurological problems Fatigue Poor performance in sports Preliminary studies have shown that chiropractic may be effective for conditions like hypertension, infant colic, and asthma
Typical chiropractic patient complaints from Job Analysis of Chiropractic 2005
Chiropractors correct subluxations Spinal adjustment By hand By instrument
Lower back adjustment
Chiropractic care is considered safe Generally safer than alternative treatments Serious adverse events 1:1,000,000 for chiropractic adjustments 1:100 for back surgery 250 times safer than a course of NSAIDs
Chiropractic training 4 years + 1 year housemanship Basic sciences (anatomy, physiology, etc.) Diagnosis Diagnostic imaging Spinal analysis Spinal and extremity adjustments Rehabilitative exercise Physical therapy modalities Nutrition and dietetics Degree - BSc (Hons) Chiropractic
Research Cochrane Review Lower back pain The use of spinal manipulation for lower back pain was supported More effective in reducing pain and improving the ability to perform everyday activities than sham therapy As good as other common therapies Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No. CD000447.
Research J Alt & Comp Med Lower back pain The mean improvement in RMDQ was 5.5 points greater for the chiropractic group than for the pain-clinic group after 8 weeks of care Reduction in lower back pain was 1.8 points greater for chiropractic group Wilkey A et al. A Comparison Between Chiropractic Management and Pain Clinic Management for Chronic Low-back Pain in a National Health Service Outpatient Clinic. J Alternative and Complementary Medicine 2008 (Jun);14(5):465-73
Research Ann Intern Med Recommendation 7: For patients who do not improve with selfcare options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation
Research Ann Intern Med Spinal manipulation recommended in acute and chronic stages Chou R, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.
Research NICE Guidelines National Institute for Health and Clinical Excellence (NICE) - released May 2009 Were prepared for doctors in the UK who care for patients with low back pain Offer one of the following treatment options, taking into account patient preference: An exercise programme* A course of spinal manipulation Acupuncture
Research NICE Guidelines (cont.) Consider offering another of these options if the chosen treatment does not result in satisfactory improvement Low back pain: Early management of persistent non-specific low back pain http://guidance.nice.org.uk/cg88 *Many chiropractors incorporate rehabilitative exercise
Posture & Ergonomics Posture is a static state A position of the body There is a mental ingredient - mood or emotion Ergonomics is the technology concerned with the creation and arrangement of products and environments that are safe, healthy, and comfortable
The importance of correct posture Standing/ Walking Sleeping 24 / 7 Bending / Lifting Sitting
Imbalance results in wear & tear Proper Posture and Ergonomics Poor Posture and Ergonomics
Chronic imbalances = Chronic pain Prolonged Postures / RS / Poor ergonomics Incorrect Joint Alignment Joint Irritation / Inflammation Inflammation Response Muscle Hypertonicity Muscle Imbalance Reactive Muscle Spasm Nerve Hypersensitivity Chronic pain
Poor posture is responsible for most (non-traumatic)... Neck Pain & Tension Headaches UBP & Stiffness LBP and Spasm Disc problems Sciatica Hip & Knee Pain Plantar Fasciitis Heel spurs
Compensating Mechanisms Proper Posture Awareness Strain Management Skills Ergonomics chairs, shoes, orthotics Good Biomechanics good alignment Good Muscle Tone and Balance Core Stabilization Stress management 30 Minute Rule
Posterior Posture Examination Checklist Plumb line bisects the head and all spinous processes from the cervical through the lumbar spine Left and right halves are mirror images of each other Shoulder heights are level (dominant slightly lower) Inferior angles of scapulae are level Iliac crests are level Popliteal fossa are same height Achilles tendons are perpendicular to floor Medial malleoli are level Muscle definition is symmetrical throughout
Lateral Posture Examination Checklist Plumb line runs through the middle of the ear canal, the acromion process and the greater trochanter Plumb line runs slightly posterior to the patella and anterior to the lateral malleolus Anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) are close to level with each other Leg is perpendicular to the foot Chin is parallel to the floor
Proper Posture Awareness
Sitting Ensure proper lumbar support Keep hips knees - ankles open @ 90-120 Don t cross legs or lean to one side Sit with shoulders straight and parallel to the hips Don t slouch
Chair Ergonomics
Desk Ergonomics The workstation or desk should be at elbow height Keep the wrists straight and aligned with the forearms Support the forearms by adjusting arm rest height Consider using a footrest
Monitor Ergonomics Place the working object so that it can be seen at viewing angle of 10 to 30 below the line of sight.
Mouse Ergonomics
Sitting Posture Tips Don't cradle the phone between the head and shoulder! Hold the phone or use a speakerphone Get up, walk tall and stretch often! 20-30 minute rule!
Sleeping Posture Average of 6-10 hours per day in bed = a lot of time for wear & tear on your body if you sleep with incorrect posture. The normal curves of the spine should be maintained in the neutral position when in bed. A supportive bed maintains the normal body curves.
Sleeping Posture A soft non-supportive bed produces a "hammock shaped" spine: A hard bed forces the spine to curve against its natural curves:
Sleeping Posture Pillow should support the neck and allow it to rest in a balanced position by filling the gap between the head and the bed Orthopaedic pillows can be valuable in achieving this, and choice will depend on personal preference
Sleeping Posture Sleep on side or back not on the stomach Place a pillow under the knees when lying the back to ease low back tension Place a pillow between slightly bent knees when lying on side
In order to have proper posture one must have 1. Good muscle flexibility 2. Normal motion and joint position alignment 3. Strong postural muscles 4. Muscle symmetry / balance 5. Awareness of your own posture, plus awareness of proper posture = conscious correction 6. Practice Practice Practice