Little Collins Street Chiropractor

Manipulation, Exercise or Medication for Acute/Subacute Neck Pain

To kick the year off, there was an article published in the Annals of Internal Medicine journal on January 3, 2012 that was picked up by the New York Times that looked at the efficacy of spinal manipulation, home exercise and medication on acute and subacute neck pain in the short and long term. So here are the results from that study.

It was a randomised controlled study of 272 people between 18-65 years old. who had non specific neck pain of 2-12 weeks duration.

Those 272 people were then split up randomly into 3 different groups, those being treated with spinal manipulation, those being treated with home exercises and those being treated by medication.

Those in the spinal manipulation group received adjustments to the neck and thoracic (middle back) over a 12 week period.
Those in the medication group received non-steroidal anti inflammatories as a first line intervention, if these failed or the participate couldn't tolerate them they were prescribed narcotic drugs and muscle relaxants.
Those in the home exercise group received two one hour sessions spread over 2 weeks, one on one and were instructed to perform a certain set of tailored exercises at 5-10 repetitions 6-8 times per day.

The results were as follows:

For pain relief spinal manipulation had a statistically significant advantage over medication at 8, 12, 26 and 52 weeks. By 12 weeks 57% of people reported a 75% reduction in pain and by 52 weeks 53% of people still reported a 75% reduction in pain.

Home exercises were also superior to medication at 26 weeks. By 12 weeks 48% of people reported a 75% reduction in pain.

Only 33% of the medication group had experienced a 75% reduction in pain by 12 weeks, and by 52 weeks only 38% had a 75% reduction in pain.

One concern that did arise out of the study, as commented on by one of the leading authors Dr. Bronfort, "the people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later."

If you have acute or subacute non specific neck pain, spinal manipulation and exercises should be part of your first line intervention.

To read the article in full it can be found here Annals

Bicycle Setup

With the good weather upon us and Christmas just around the corner there will be many people out and about on a bicycle, so I thought this would make a great opportunity to run through some of the basic points to setting up your bicycle correctly. As an incorrect setup can lead to knee, thigh, calf, hamstring, lower back, shoulder and neck pain.

Adjustment 1. Seat height

Using a tape measure, measure the inside seam length whilst standing with no shoes on. This figure is then multiplied by .88. For example, an inside seam length of 67 cm x .88 = 58.96.

Therefore the height of the seat, measured from the centre of the crank to the top of the seat will be 58.96 or 59cm

Adjustment 2. Seat tilt

Ideally the seat should sit flat/horizontal as increased downward slope causes riders to slip off the seat.

Adjustment 3. Seat fore/aft position

This is how far forward or back the seat sits. Sitting on the bike with pedals in a neutral position (horizontal or parallel to each other), a plum bolt is dropped from just behind the little bump on the leg just below the knee cap (this bump is called the tibial tuberosity) and should land inline with or behind the pedal axis. If you don't have a plum bolt you can use a retractable measuring tape.

Adjustment 4. Cleat position

For those riders who wear cleat shoes this is very important, but is also specific to the individual. As a rule of thumb the base of your big toe should sit directly over the pedal axis.

Happy riding!

Staying The Course

As Chiropractors and primary health care practitioners we are fortunate enough to treat people from all walks of life and all backgrounds, which makes for a rich and rewarding practice and life. One of the greater challenges in practice is helping to educate patients about the importance of a healthy spine and nervous system and the impact that has on achieving, optimised function, health and well-being.

Part of that education process not only involves explaining what we do and why we do it, but it also includes explaining why we need to see patients more than other doctors. For example, those who frequent a medical doctor are used to going once, receiving a script or referral and may or may not be asked back in a few days or weeks time if the problem hasn't resolved. The treatment being prescribed is a course of tablets, cream, drops etc that are to be taken every day or two over the next few weeks.

Chiropractors on the other hand will usually advise the patient they need to come back for a course of adjustments every day or two over the next few weeks, with the adjustments being the treatment. Chiropractors work in a slightly different way, but the end results are the same. Both Chiropractors and doctors prescribe courses of treatment it is just how they are delivered that differs. A course of tablets, drops, cream etc prescribed by a doctor can be taken at home, while a course of adjustments need to be carried out by a Chiropractor.

A common question people then ask, is "why do I have to come back?." The results are often no different in Chiropractic than they are in medicine when one doesn't follow through with a prescribed course of medication. Many times one course of antibiotics isn't enough to kill off a bacterial infection, or a course of antibiotics or drops isn't seen through until the end and the problems returns requiring another course. The same can happen with a course of Chiropractic care, if the problem is bad or has been there for a long time it may require a longer course. Or sometime people start to feel better so they don't think they need to come anymore only for the problem to return later on. So when any doctor prescribes a course of treatment whether that be a course of adjustments or exercises or tablets or creams it is because we know that is what is required to get you on the road to recovery and feeling better faster.

Appropriate Footwear For Running

With the Melbourne marathon not too far away, I thought it would make a great opportunity to discuss footwear. When covering distances as long as half and full marathon's it is vitally important to have the right footwear to prevent over training and impact injuries such as "shin splints", stress fractures, plantar fasciitis.

In a basic assessment of a foot, an individual will fit into one of four categories:

Neutral
Mild over pronator-mildly flat arch causing ankle/foot to roll in
Severe over pronator-no arch (flat feet) causing ankle/foot to roll in
Supinator-usually high arches, little to no roll in of foot/ankle (under pronation)

*majority of the population are neutral to mild over pronators

It is important to identify what category you fit into and then find a shoe that fits your foot type. Examples of different types of shoes to fit foot types include:

ASICS Kayano-Neutral to Mild over pronator shoe

ASICS Gel Evolution 6-Severe over pronator

ASICS GEL Nimbus 13-Supinator (high arches)

It is also important to remember even though a shoe might look new on the outside, on the inside the materials which provide stability, structure and shock absorption are only designed to last a certain number of kilometers. For example the Kayano is designed to last about 500-600 km before they need to be replaced. So bare in mind that while you are training for a distance event it might just happen to be that you clock up 600-700 km in training before your race. Therefore it is always advisable to buy two pairs of shoes and either swap every few days or have a training pair and a race pair. My personal preference as a race pair of shoes for those competing for fun or at an amateur level are the ASICS DS Trainer 16.

Chiropractic Care and Children, response to the Weekend Australian article (2/7/2011)

Dear Patients,

There was a large article in the Weekend Australian magazine (2/7/2011) titled "The Chiro Kids", which examined the role of Chiropractors treating young children and how Chiropractors are encroaching in on the General Practitioner's space as the "family doctor".

In my opinion, Chiropractors have been safely and competently treating young children for decades, with no media publicity, no debate, no public opposition from the medical community and I see no reason why this shouldn't continue on.

In regards to Chiropractors assuming the role of the family doctor, I can never see a Chiropractor replacing a family doctors as they have greater expertise in internal medicine than Chiropractors do. I do see a role for Chiropractors to share some of the load, over stretched family doctors currently carry, as Chiropractors have greater expertise and knowledge in musculoskeletal medicine.

I believe Chiropractors can play a very strong role in being the first port of call for all musculoskeletal injuries acute and chronic, this is what we study for 5 years at university and this is what we see everyday. Whether it be neck pain, headaches, a hamstring strain, a rolled ankle, back pain, an acute knee injury, Chiropractors have the skills, knowledge and expertise to assess, diagnose, image, treat/manage and refer if required.

Ultimately Chiropractors and family doctors should co-exist for the greater good of the patient whether they be an adult or child.

Yours sincerely,

Dr. Nicholas Shannon

Maintenance Care for Chronic Lower Back Pain

Many millions of people all over the world see there Chiropractor for maintenance or preventive care, where they receive an adjustment or correction every 2, 4, 6, 8 weeks. The length of time is dependent upon the chronicity of their problem and lifestyle. As a Chiropractor we recommend maintenance care because we know it keeps the spine aligned and functioning at its best and as a result patients tend to feel happier, healthier and experience less pain and discomfort.

Unfortunately this area of maintenance care isn't supported by a wealth of scientific evidence, its grounding is in our experiences as Chiropractors and what we see day-to-day in our clinics. But the Spine Journal in February will be releasing an article which looked at the role of maintenance care in patients who suffered from chronic lower back pain.

This study split 60 patients who had been suffering lower back pain for more than 6 months into 3 groups, one group received 12 sham spinal adjustments over 1 month, the second received 12 spinal adjustments over 1 and no follow up treatment for 9 months and the final group received 12 treatments over 1 month and maintenance adjustments every 2 weeks for 9 months. The results showed those in the second and third groups had significantly reduced pain and disability after 1 month over the first group. But only the third group showed future improvements in pain and disability over the following 9 months, with the second group returning to pretreatment pain and disability levels after the 9 months.

This study is the first stepping stone in supporting what we have long known, that maintenance Chiropractic care is beneficial in reducing patients pain and disability, keeping them happy and healthier. Hopefully be the impetus for future research into maintenance care.

The Spine Journal

Congratulations T.O.P - AXA Racing

Congratulations to all the pilots, crew and members of T.O.P - AXA Racing on a wonderful performance at the 57th Macau GP. 6 time champion Michael Rutter came second following a tight battle for first. Our other pilots Joao Fernandes, Anthony Dos Santos and Martin Jessop all put in fantastic performances.

Formula Ford Pilot-Trent Harrison

We wish Formula Ford pilot Trent Harrison all the best for the remaining 2 race meetings at Simmons Plains in Tasmania and Sandown in Victoria. Trent stepped back into the Evans Motorsport team car after 12 months out of the car for the Gold Coast event in October and turned in a remarkable performance with two fourths and a fifth, finishing fourth overall for the round.

We make sure Trent is well adjusted and aligned so he can perform at his best under the highly stressful and physically demanding conditions experienced within the cockpit of his Formula Ford.

You can follow Trent's progress at Trent Harrison

T.O.P Macau Moto GP 2010

The Macau Moto GP 2010, is only 2 weeks away now. This year I will be looking after T.O.P - AXA Racing pilots Michael Rutter (6 time Macau GP winner), British Super Bike Champion Martin Jessopp, French Champion Anthony Dos Santos and local Champion rider Joao Fernandes. With the right set up and keeping the pilots well adjusted so they are in optimum physical condition, we will be hoping for a strong result.

An inconvenient truth: the real evidence about stroke and manipulation and autism and vaccinations

I have just read a wonderful article about the truth of stroke and manipulation and the inconvenient truth between autism and vaccinations. To summarise, the author Dr. Perle puts forth the evidence that on stroke and manipulation, which shows there have only ever been 3 true unbiased studies that have looked at stroke and manipulation although many other practitioners will claim there are many more. They showed there is a slight risk of stroke, but that risk of stroke following a Chiropractic visit is no greater than the risk following a visit to a Medical doctor. This indicates that the reason people "assume" there is risk of stroke following neck manipulation is because they are looking for someone to blame for the stroke once it occurs and Chiropractors fit that bill.

It is no different to the so called link between autism and vaccinations. The truth is, there is no scientific evidence that links autism to vaccinations. But the parents of the children who develop autism, look for someone to blame and that is the company that produced the vaccination, and then doctor who administered.

To read the full article head to :

http://smperle.blogspot.com/2010/04/sc http://smperle.blogspot.com/2010/04/science-sometimes-stroke-and.htmlience-sometimes-stroke-and.html

Macau GP Nov 2010

I have been accepted to work as the team Chiropractor for the motor sport group "Team of Paris" at this years Macau GP, who for the last 3 years have been the largest motor sport team competing at the Macau GP. The Macau GP runs through the streets of Macau (an island off Hong Kong) and is a historical and prestigious motor racing event steeped in over 50 years of history.
For more information on the team head to:

www.teamofparis.com/news.html