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  • We're coming to the end of National Arthritis Week; whilst today is World Arthritis Day; brought to us by Versus Arthritis (formerly Arthritis Research UK) and EULAR, supported (amongst other) by the BCA. So this week, let’s take a look at degenerative joint disease (DJD).
    AKA Osteoarthritis, Spondylosis, or even “Wear and Tear”.

    DJD is a normal part of aging - just like grey hairs; and is not painful in and of itself; but can cause other structures to become symptomatic. Consequently, whilst medical imaging (X-ray, MRI) can confirm that DJD is present or not; the severity of change on the image tends not to be in proportion to the severity of symptoms the patient is experiencing; and therefore imaging is RARELY appropriate or necessary to diagnose or assess DJD.

    It is caused by an excess of movement or load – whether briefly in the case of traumatic onset; just a little every day, for decades; or through carrying too much weight every day for several years. DJD symptoms include joint pain with stiffness and increased muscle tension as the body try to stabilise the area; eventually growing new bone to buttress the joint.

    Treatment typically involves pain control by medication or other measures; controlled mobilisation of the joint, through exercise and/or manual therapy; and strengthening of the muscles which support the joint, through exercises like pilates or rehab. If you are overweight, weight loss can often help improve DJD symptoms, but is unlikely to be a “golden bullet” unless combined with increased activity and fitness.

    NB: There is no way to treat DJD itself, and any treatment plan can only have the aim of relieving symptoms, which can only be temporary (though “temporary” may mean anything from hours to decades). Consequently, we talk in terms of “management” rather than “cure”; and it may be a good idea to consider maintenance based treatment whilst feeling pain free and mobile, to keep you that way.

    You can find out more here:
    www.nhs.uk/Conditions/Osteoarthritis
    www.physio-pedia.com/Osteoarthritis

    X-Ray Results for DJD / Osteoarthritis

    Pathology of DJD / Osteoarthritis

    DJD / Osteoarthritis Target Sites

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    This coming couple of weeks has a number of awareness events relevant to us, so I’ll be posting more than usual. Next whole week is both Back Care Awareness Week and National Arthritis Week; whilst World Arthritis Day takes place on Friday. So for today, with back care awareness week starting yesterday, let’s take a look at chronic low back pain (Chronic LBP). Back care awareness week is organised by BackCare, and supported by the British Chiropractic Association amongst others.

    Low back pain that has been present for longer than three months is considered chronic. More than 80% of all health care costs can be attributed to chronic LBP. Nearly a third of people seeking treatment for low back pain will have persistent moderate pain for one year after an acute episode. Almost by definition, anyone suffering with chronic pain will also suffer an altered perception of pain, where the brain retrains itself, becoming very good at feeling pain – whether it needs to or not.

    Chronic pain is always a complex condition, involving tissue damage, adaptation strategies, altered pain perception, altered psychology (depression, sleep disturbance etc) and usually secondary complaints brought about by the adaptations – in fact, the original condition can often have already resolved at presentation, but the cascade of reactions is still continuing to cause problems. This makes chronic pain very complex to treat, and means that we need to use manual therapy, home advice and psychological support all at the same time, to get the best results. There are no short cuts when it comes to dealing with chronic pain; and it can be hard work, for both the clinician and the patient.

    You can find out more here:
    www.facebook.com/BackInAction.Tewkesbury/posts/1841525875953305
    www.chiropractic-uk.co.uk/back-pain
    www.chiro-trust.org/…/chronic-low-back-pain-treatment-effec…
    www.physioadvisor.com.au/injuries/lower-back

    Vicious Cycles of Chronic Low Back Pain

    Tips to Alleviate Chronic Low Back Pain

    Maintenance Care for Chronic Low Back Pain

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    This coming couple of weeks has a number of awareness events relevant to us, so I’ll be posting more than usual. Next whole week is both Back Care Awareness Week National Arthritis Week; whilst World Arthritis Day takes place next Friday. The following week includes both World Spine Day (16/10/19) and World Osteoporosis Day (20/10/19).

    So for today, with back care awareness week starting on Monday, let’s take a look at acute low back pain (Acute LBP). Back care awareness week is organised by @BackCareCharity, and supported by the @BritChiro amongst others

                                                                         

    LBP is the fifth most common reason for physician visits, which affects up to 85% of people at some point. The exact cause of the acute low back pain often remains unknown, though thorough examination can reduce the number of possibilities. The back pain can come on suddenly after lifting things, or gradually through overuse, or even for no easily identifiable reason. Many cases will resolve within a few days and minimal intervention (reduced loading, ice and movement). It is rarely serious; though it can be debilitating; and rarely needs imaging – except in cases of direct trauma, suspected inflammation, or medical red flags.

     

    Acute vs chronic are measures of duration, not severity; with Acute being anything that has lasted less than 8 weeks; with Chronic being more than 8 weeks. Between 6-8 weeks duration is often labelled as Subacute.

     

    Whilst most cases resolve within a couple of weeks; for those that do become chronic, the best thing you can do to improve the prognosis, is to start treatment sooner; which is a bit of a catch 22. As a rule of thumb, if the back pain is significantly reduced after 5-6 days, then you shouldn’t need any treatment; if it is barely improved, or still worsening, then treatment might be a good idea, even if it’s just in the form of advice on how to manage the pain at home, and prevent it coming again.

    In the mean time, you can use the POLICE protocol for managing acute pain, and keep your back as mobile as you can, and try not to be over-protective. Mobility, balance and strength training are the best ways to prevent episodes, though these things do happen as part of the human condition. If caused by significant trauma, or if the pain is intolerable, see your GP, minor injuries (Tewkesbury) or A&E Cheltenham / Gloucester).

     

    You can find out more here:

    www.back-in-action.net/blog/15561-acute-injury-care.aspx

    www.physio-pedia.com/Non_Specific_Low_Back_Pain

    www.chiropractic-uk.co.uk/back-pain

    www.sportsinjuryclinic.net/sport-injuries/low-back-pain/lumbago

    Management of Low Back Pain

    Management of Low Back Pain

    Acute Low Back Pain

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Posture 27 September 2019 | Comments (0)

    There is a lot of misinformation, and fear in relation to posture; but ultimately there is no such thing as a frankly “wrong posture”; or a “right posture” for that matter. What is most important is that you don’t maintain any one posture for too long. Having said that, there are variations of “relatively better posture” and “relatively worse posture” that people can use.
    The better the posture the better the bones and joints are aligned, reducing fatigue, strain and overuse. More to the point though, the better the posture, the longer you can hold that one position before fatiguing, straining or overusing your muscles, ligaments and tendons. You can have textbook perfect posture… and still develop fatigue and pain after a couple of hours; or posture to make any therapist flinch… and be happy there… for a few minutes.

    The best posture is your next posture; and keeping mobile is what your muscles and joints really want – it’s what they’re for after all!
    As a rule of thumb, we recommend against holding any one posture for more than 10 minutes at a time. Where that’s not practical (long car journey, board meeting etc) then take a break every hour; and use that break to return mobility to your joints (as opposed to sitting in a different chair).

    You can find out more here:
    www.physio-pedia.com/Posture
    www.physioadvisor.com.au/health/ergonomics/posture

    Different Sitting Postures Are All Healthy

    Different Standing Postures Are Both Healthy

    Posture Cartoon by Jeff Stahler

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Autumn’s Here

    And I’m falling apart

     

    Autumn’s arrived, and the leaves are starting to turn; whilst the swallows flee for warmer climes (probably collecting coconuts). The nature reserve will soon be reserved for nature, as the flood plains become true to their name.

    Winter coats are emerging from wardrobes, as the umbrellas become next to useless; their places in the attic taken by shorts and summer dresses, as we cover up and hunker down… and resist the lure of the thermostat.

     

    We hunch our shoulders; and wrestle the garden furniture back into the garage, whilst the foolhardy contemplate pruning; whether of hedges or for Movember fast approaching.

     

    In these times of shorter days, heartier meals and shoulders stooped against the rain; our moods depress and activity levels plummet; but we still need to look after our bodies. That draft on your neck can cause it to crick, whilst playing garage-tetris can spasm the back, or SAD becomes a tension headache.

     

    Left unchecked, these nagging, dragging pains can be with you for the season. Anything like this that lasts much more than a week, or keeps you from work can usually benefit from an expert eye. A diagnosis and advice may be all that’s required – usually with the application of common sense, (the least common of the senses). For other issues a course of treatment and some active homework should get you back in action; and the sooner started, the soonest mended.

     

    If you are suffering pain, from a mechanical cause, then call Tewkesbury’s Back In Action, on 01684 291 261, and see if we can help. If you’re unsure about your particular condition, then ask for a free chat, with no obligation, for some general advice.

     

    For members of Tewkesbury RFC & Tewkesbury Cricket Club, this may also be a timely reminder that adult players receive a 1/3 discount, whilst juniors (U18) can be treated at 1/2 price.

     

    Tewkesbury Abbey

    Tewkesbury

    Westonbirt

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    Meningitis 13 September 2019 | Comments (0)

    Next week is Meningitis Awareness week, organised by @MeningitisResearch and @MeningitisNow.

     

    Meningitis is a serious condition that occurs when the meninges - protective membranes covering the brain and spinal cord - become infected and inflamed. Early symptoms can be similar to the flu. However, having a stiff neck in addition to flu-like symptoms could be a key clue that meningitis is the problem and should be checked by a doctor.

    Meningitis can start suddenly, or develop more gradually; early symptoms often include one or more of fever, headache or neck stiffness.

    FEVER. Running a fever is a normal part of the immune system’s defence against infections. A fever with meningitis will usually (but not always) be above 39 degrees.

    HEADACHE. A headache caused by meningitis is typically described as severe and unrelenting. It does not subside by taking an aspirin / paracetamol.

    NECK STIFFNESS. This most commonly manifests as extreme stiffness of the muscles that extend the skull on the neck; called nuchal rigidity; and can be very limiting in neck flexion especially.

    RASH. This is typically blotchy and red or purple; it is unchanged by rolling a glass over the rash.                                           

    As time goes on, other symptoms can develop, such as nausea, vomiting, sensitivity to light or noises or blurred vision; amongst other less common symptoms.

                                                                               

    It should be noted that bacterial and viral meningitis are both contagious, so they are more likely to be contracted and spread in areas where people live in close quarters, such as college dorms or military barracks.

    If you have any reason to suspect meningitis; call the NHS on 111; or speak to your GP directly; if rapidly progressing, go straight to A&E.

     

    You can find out more here:

    www.nhs.uk/conditions/Meningitis

    www.physio-pedia.com/Meningitis

    www.meningitisnow.org

    www.meningitis.org

    Meningitis by the Numbers UK

    Symptoms of Meningitis

    Meningitis

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    TENS Machines 06 September 2019 | Comments (0)

    Let’s take a look at TENS machines (Transcutaneous Electrical Nerve Stimulation).
     
    In TENS therapy, a small, device delivers low-voltage electrical current through the skin via electrodes placed near the source of pain. The electricity from the electrodes stimulates nerves in the affected area and "scrambles" normal pain perception, and often feels “a bit tingly”. This can not only reduce the level of pain felt; but also relax muscle tension, and release endorphins within the spinal cord.
    Traditionally used for the relief of chronic pain, there is an increasing body of evidence that TENS is also effective for acute pain; though in general the evidence for TENS is still fairly inconclusive. Given the relative lack of side-effects though, it is often considered “worth a try” to see if it works for the individual, especially in this age of
    “opioid crisis”.
    Please note – TENS passes an electrical current through the skin; please do not use it over damaged skin; or if you have a pacemaker in place; we also recommend against using it over cells that are rapidly dividing, such as testicles, eyes or foetuses.
    NB: TENS therapy is only effective when the machine is switched on; at Back In Action we have a rental machine for you to try for a week before investing £40-£60 in a machine of your own (easily available from Amazon).
     
     
    You can find out more here:
    www.sportsinjuryclinic.net/treatments-therapies/electrotherapy/tens
    www.electrotherapy.org/modality/transcutaneous-electrical-nerve-stimulation-tens
    TENS Machine, recommended settings
    TENS Electrode Placement
    TENS
    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.
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    This coming week is Migraine Awareness Week here in the UK, so let’s take a look at migraine headaches.

    A migraine is a severe headache felt as a throbbing pain on one side of the head typically aggravated by physical exertion, and lasting 6-72 hours; they can occur several times in per week, or once every few years. Many people also have symptoms such as nausea, vomiting and increased sensitivity to light or sound; these symptoms may appear before the headache, alongside it; or even without any head pain at all. A migraine is not “just” a severe headache.
    Migraines classically affect 20% of women and 7% of men; usually beginning in early adulthood.

    Migraines usually have a specific trigger, and the key to long-term management is to identify the trigger, and avoiding or mitigating these wherever possible; which is often easier said than done. Medication can also help significantly (usually the triptan group); but prevention is still preferable to cure. Migraines can be extremely delibitating whilst being suffered; though most people tend to find that both the severity and frequency reduces as they age; possibly as a result of identifying and avoiding their individual triggers.
    As with tension and cervicogenic headaches, there is a large overlap with other headache types, so the incidence rate is probably higher than stated here.

     

    You can find out more here:
    www.physio-pedia.com/Migraine_Headache
    www.chiro-trust.org/headaches/is-it-a-migraine-2
    www.migrainetrust.org

    Headache pain distribution, migraine

    Migraine Symptoms and Stages

    Common Triggers for Migraine

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Lumbar Disc 23 August 2019 | Comments (0)

    Let’s take a look at lumbar disc herniations; also falsely known as “slipped disc” – please note, the disc does not slip, this is a horrible term that deserves to be consigned to the dustbin of the English language!

     

    Lumbar disc herniations are most common in people aged between 30 and 50. They affect twice as many men as women. They are a form of sciatica, typically caused by injury to the lower back, and leading to compression/irritation of the nerve root as it exits the spine. Severe pain, numbness, pins & needles and even loss of strength are common symptoms of disc herniations, and can be felt in the lower back, or in the leg (where it’s often called “sciatica”). Suffering the above symptoms in both legs, including particularly private areas &/ loss of control/sensation of bowel or bladder are a cause for significant concern, and should present to hospital as soon as possible.

    Disc herniation can occur as a result of age-related degeneration of the annulus fibrosis. However trauma, straining, torsion and lifting injury are also frequently involved. Disc herniations are common incidental findings on MRI scans; with about half of 40 year olds having a bulge which presents with no symptoms whatsoever. Approximately ¾ of symptomatic disc herniations will recover spontaneously; over a 6-9 month time-frame. Symptomatic disc herniations are most likely to occur in people aged 30-50; and most likely in the lower 2 discs; though above that age, they become more common higher in the spine.

     

    You can find out more here:
    www.sportsinjuryclinic.net/sport-injuries/low-back-pain/herniated-disc

    www.chiro-trust.org/advanced/lumbar-spine-herniated-intervertebral-disk-discogenic-radiculopathysciatica

    www.coxtechnic.com/about-us/flexion-distraction-relieves-spine-painLumbar

    Lumbar disc injuries

    Disc MRI

    Low Back Pain

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    We all want to find out more about any medical conditions we may suffer, but the information out there is almost always confusing, and always conflicting. Here’s a basic guide to filtering through the information to get what you need.
     
    The first point shouldn’t really need to be said, but please, remember that a little knowledge can be a dangerous thing, and that spending an hour or so on google does not provide you with a better qualification than your medic/therapist’s degree and experience. However, you probably are an expert in your own body and how it feels.
    Use you medic/therapist as a first port of call for information, they should be happy to explain to you the basics of what is going on, and may provide you with, or point you in the direction of more information.
     
    Secondly there are various website, some specialising in 1 condition, some being more generalised. I will include a list of those that we like and trust at the end of this post.
     
    Now, how can you tell if the information you are reading is trustworthy? This is the big one; and essentially boils down to having a good bulls*** filter. Firstly, be suspicious of any site that is trying to sell you things; they may be more interested in your money than your health. Does the information ring true – does the information remain roughly the same across multiple independent sites? Or do they all disagree with each other on the broad strokes, let alone the details. The next thing is how it reads – does it appear to be written by and for professionals, or by and for laymen. The final thing to look at is the references – does it have any? Are they mostly written by the same person? Does there appear to be a good spread for the root source of information? Do those references look reputable (something like the British Journal of Sports Medicine looks (and is) legitimate, something hosted on Blogspot less so).
     
    These are some of the sites I trust, and often point patients to for further information:
    www.nhs.uk/pages/home
    www.physio-pedia.com/home
    www.physioadvisor.com.au
    www.sportsinjuryclinic.net
    Research
    Dr Google
    Dr Siri
    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.
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    The biceps muscle sits at the front of the arm, connecting your shoulder to your elbow, and predominantly flexes the arm when used. At the elbow it has just the one tendon; but at the shoulder it has 2, a short head which attaches to the upper humerus; and a long head that reaches up to the top of the shoulder blade.

    Injury can occur is the biceps is asked to work too hard too quickly – such as catching a heavy weight; with the long head being the most vulnerable part; alternatively, they can rupture after a long-standing degenerative process. A rupture of this tendon is rare in young athletes but more common in older ones. It is also possible to damage the tendon close to the elbow; or the belly of the muscle itself, though these are much less common. Tears are graded as I (mild) II (partial tear) or III (rupture).

     

    Symptoms include a sudden sharp pain at the front of the upper arm. There may be pain and swelling over the front of the shoulder joint. Contracting the biceps muscle against resistance is likely to be painful, certainly in the first couple of days and in particular for the long head of the biceps, lifting straight up forwards up above the head against resistance is likely to be painful.

     

    If anyone suspects this injury they should apply the POLICE protocol for acute injury care and see a sports injury specialist, physiotherapist or doctor as soon as possible. A professional therapist will advise on treatment and rehabilitation typically based around ice, massage and gradual return to strengthening. For complete ruptures, or competitive athletes, surgery may be required to repair the tendon.

     

    You can find out more here:

    www.physio-pedia.com/Rupture_Long_Head_Biceps

    www.physioadvisor.com.au/injuries/shoulder/biceps-rupture

    Biceps Anatomy

    Rupture of Biceps Long Head

    Exercises to Rehab Biceps Tendon Injury

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Let’s take a look at patellofemoral pain syndrome (PFPS).
    AKA runners’ knee.

    PFPS is pain that originates between the kneecap and thighbone. The pain is felt at the front of the knee, either under or around the edges of the kneecap; it is typically more noticeable going up stairs or walking or jogging uphill. The root of patellofemoral pain can vary and may be difficult to identify.

    Potential causes include a sudden increase in training, or simple overuse for a period of time. Muscle imbalance that can cause the patella to aberrant gliding within its groove (patella tracking); injury elsewhere in the kinematic chain; so a sprained ankle, or a lower back problem, left for too long, may develop into knee problems. Simple body weight, especially if matched with an increase in training load, such as taking up jogging in an attempt to reduce weight. Women are more prone to PFPS than men, especially as related to patella tracking, probably due to wider hips, and consequent knee alignment, especially if coupled with a narrower stride width.

    You can find out more here:
    www.physio-pedia.com/Patellofemoral_Pain_Syndrome
    www.webmd.com/pain-management/knee-pain/runners-knee#1

    Forces Effecting the Patella

    Kinesiology Taping for PFPS

    Exercises for PFPS

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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