Advice from the Chiropractic Clinic during Lockdown

by Philip J Hehir DC

Millions of people around the world are currently facing the challenges of working from home. As such, these can place significant strains on our physical and mental wellbeing.

As I write this article, it is Week-6 of UK COVID-19 restrictions and I have to
report, our clinic is receiving an increasing number of phone calls asking for advice. To help with these challenges, the clinic has been giving free virtual consultations to members of the community which has given us a snapshot of what’s happening out there.

Most requests are related to back, neck and muscle pain; and of course, stress. We believe the most likely culprits for this sudden rise is poor workspace setups and living more sedentary lifestyles. I include here some of the key issues that have cropped up consistently in our consultations and encourage you to take on board:

  1. Assess your workplace Workers who have been asked to work from home do so in environments that aren’t necessarily ideal. Just as you would modify your car seat after your spouse has used it, you should assess and modify your workstation. HR don’t plan to come to your house to do it for you. Here’s the checklist:
    – Eyes: Screen height should be straight ahead at eye level. Adjust the height of your seat. Don’t work with your laptop on your thighs! Consider a verti-lift screen adjuster or if wish to splash out, a sit to standing desk.
    – Good Posture: Elbows level with the desk and shoulders relaxed. Bottom should be against the back seat and shoulder blades should be touching the back rest of the chair. Knees should not be higher than hips. Maintain a relaxed posture. Breathe.
    – Brugger! Google ‘Bruggers Relief’ and do this throughout the day.
    – Standing: Stand up every 45-minutes (at least) and move around, even if it’s just to get a glass of water. This will stop a process called ‘creep’ occurring in your muscles which increases your risk of injury.
  2. Hydrate Have a glass or a bottle of water next to your desk throughout the day to help keep you well hydrated.
  3. Have a break Ensure you have a break in your designated lunchtime. Get out in the sunshine and get some immune enhancing Vitamin D – viruses don’t want you to know about this!
  4. Exercise ‘Sitting is the new smoking’. This WILL be a driver in the surge of aches and pains we will see after the lockdown is lifted. Ensure you use your one-hour every day for some form of exercise. This is particularly important for our mental wellbeing as well as physical.
  5. Offer Support Human beings are social animals. Keeping in regular contact with your friends, families and neighbours and offering to help out whenever you can, causes the brain to secrete dopamine – one of our happy hormones. If you haven’t tried in a while, give it a go.
  6. Watch Your Thoughts Be grateful that you have a roof over your head; a job; a family; a purpose; an opportunity to reflect; an opportunity to plan. A good mindset will most certainly help you and your mental wellbeing get through this time.



Decisions, decisions. decisions

by Alain Michelotti

It has been said that ‘life is just one decision after another’*. Some of these decisions or choices are ready-made for us because of changing circumstances; others involve a lot of soul-searching. The stakes can’t be much higher than when our health is concerned.

It used to be simple; decisions were made solely by the expert professional. They would ask questions, perform an examination and we would be told what we had to do to get better. Patient and practitioner, knew their places and the responsibility was clearly established. As a result of improvements in education and increases in awareness through the media, this model has gradually changed and we are now able, even actively encouraged, to take a more active part in decisions involving our health.

This change of dynamic between patients and practitioner has not been an easy one. Patient’s must actively participate in an often difficult decision making process. The practitioner is required to impart technical information and guidance to the patient which can be time-consuming. Part of this procedure includes detailing a range of alternative treatment options available. This culminates with what is called the ‘informed consent process’ which should take place before the start of any treatment. The main objective throughout is to enable the patient to make an informed decision about whether the benefits of the treatment offered outweigh the risks.

As chiropractors we must not assume that because the patient has made the decision to consult us, we can avoid talking about the range of alternative options available. For the majority of ordinary acute episodes of neck or low back pain, I will usually tell my patients that these conditions are invariably self-healing, that our intervention will simply speed up their recovery and that the alternative to manipulative treatment usually involves pain killers or non steroidal anti-inflammatory drugs have side-effects and can irritate the lining of the stomach. Having made my diagnosis and before starting treatment, I explain the benefits and risks of the techniques I plan to use. I make sure the patient has taken on board my explanations, ask the patient to sign the consent form and let them know that the consent may be withdrawn at any stage during the treatment.

Chronic neck or back pain is more difficult to treat and we regularly explain the principle of the ‘ladder response’. The rungs of the ladder start with medical drug based treatments, stepping up to physiotherapists and osteopaths whose objective is to create a virtuous circle by restoring joint mobility and diminishing pain, allowing the return of normal function. If this fails, the next step is a referral to the GP and possibly a referral from the GP to a consultant. At the top of the ladder the response is surgery, fortunately only necessary in extremely few cases.

It is important for us all to ensure that we understand our options on every rung of the ladder and be prepared to participate in decisions about our health and wellbeing. And you must never be afraid don’t be afraid to ask questions until you’re sure you’ve fully understood everything.

* Jonah Lehrer 2010

Why should you know about Sarcopenia?

Philip J Hehir DC

Sarcopenia (pronounced sarc-oh-peen-ee-yah) is defined as a loss of muscle mass and function as we age. Sarcopenia results in a decrease in mobility and independence, and the worse it is, the greater the risk of developing other medical conditions.

This process begins as early as our fourth-decade of life (that’s 30-39 years old). By the time we are 80, a decrease of about 30-50% in skeletal muscle mass is expected and can be considerably worse in those who are inactive or who do not load their muscles regularly.

Worldwide today, there are approximately 617 million people aged 65-years or older. By 2050, we can expect this number to increase to around 1.6 billion. Advancements in healthcare have significantly improved our life-spans, but these improvements have had limited effect on our quality of life for those additional years. The amount of sarcopenia an individual has will contribute to a poorer quality of life in those latter years. It is therefore imperative for anyone over the age of 30, (remember it starts in the fourth-decade of life), to try and limit and slow down sarcopenia so they may live more comfortable, independent lives as they age. (It is important that you should discuss this with your GP/chiropractor/physiotherapist before undergoing any new lifestyle regime.)

Simple physical exercise such as walking and doing house-chores can be beneficial, but on its own it is unlikely to slow down sarcopenia. Therefore, it is recommended that additional exercise should be undertaken.

Resistance exercises which includes using resistant bands or weights have been shown to slow down the rate of decline in muscle mass. For those new to resistance training, simply putting weighted sandbag straps around your ankles and/or wrists whilst you go for a walk can be helpful. You can also try speaking to reputable personal trainer at your local gym who can give you a programme of exercise specifically based on your needs.

Aerobic exercise which could include cycling, swimming, running or tennis has also been shown to be beneficial in maintaining muscle mass. The stimulation this has on your heart and circulation causes further blood perfusion to the muscles, giving them greater nutrition. (It is emphasised here that you should speak to a healthcare professional before undertaking any new aerobic activity).

Protein intake plays an important part in maintaining muscle mass. For example, in a 13st individual: under 20-50, a recommended intake of around 65g/day; and for older adults it is recommended 120g/day. Dietary protein particularly rich in leucine is particularly important. Nutritionists often suggest these sources including beans and pulses, Greek yoghurt, eggs and wild salmon. It is to note, that for older adults, it is not advised to take high protein supplements, simply as too much protein can be harmful to kidneys. Getting protein from your diet should be more than adequate. Speak to your GP if you have any concerns.

Limiting calorie intake can also play a role in the development of sarcopenia. Ensuring that we keep our Body Mass Index (BMI) within it’s ideal ranges is also recommended.

Back to school

We all know that, as our children grow, their school uniform, shoes and sports kit need to be replaced. If we are lucky, this may only need doing at the start of each new school year when these items are either outgrown or well past their best. In addition to new uniform etc, children often require new stationery items, and also a new school bag to put things in.

Whilst many junior schools have an official school bag, usually a hand-held book bag for the younger children, and a ruck-sack for the older children, once they get to senior school children often choose their bag according to the latest fashion trends, and not by what may be better for their backs.

In recent research carried out by the British Chiropractic Association, more than a third of parents reported that their child had suffered from lower back or neck pain before the age of 16. Experiencing back pain in childhood is associated with a four-fold increase in the likelihood of developing back pain as an adult. Although there are many possible causes for back and neck pain in children, a heavy school bag or one being carried inappropriately, may often be the cause.

Children are constantly growing, especially during their adolescent years, so it is important not to put unnecessary stress on their developing skeleton in order to limit problems later in life. Scientists have said that carrying up to 10% of their bodyweight should not cause any damage, but carrying 15% of their bodyweight could increase the risk of developing back problems as an adult. However, the charity Back Care found that many children regularly carry 20% of their bodyweight, and if you add in the weight of sports kit, musical instruments etc., some children have been found to be carrying up to 60% of their bodyweight. They also found that up to 4 million children each year carry a bag that is too heavy for them, potentially causing back, neck or shoulder pain.

The best type of school bag is probably a rucksack. It should always be worn on both shoulders, with the shoulder straps tightened up so that the bag sits close to the child’s back, distributing the weight more evenly. A rucksack should never be carried on only one shoulder as this will cause the child to lean to the opposite side, stressing the spine and muscles more on one side of the body than the other, and leading to muscle spasms and back pain.

The ideal rucksack should be lightweight with wide padded adjustable straps, a padded back, and ideally a waist or hip belt. Heavy items like books should be put in the rucksack first so they are closest to the body, reducing the strain on the spine. It should also have several pockets so that items can be distributed throughout the bag, which will also make it easier to find things. Children should be encouraged to only pack what they need for that day, and once a week the parent and child should go through the bag removing any unnecessary things.

If your child refuses to use a rucksack, they can use a messenger type bag worn diagonally across their body, but they should alternate which shoulder they carry it on throughout the day.

Should you require any further information, or are concerned about your child’s back, neck or shoulders, please contact Guildford Chiropractic Clinic to see if one of our chiropractors can help.