Book Prescriptions

Today I learned that in some areas of the UK the NHS is providing Book Prescriptions. It is a scheme that aims to help people with mild or moderate emotional problems to make use of high quality self-help books. It has proved to be very successful. GPs and other health professionals recommend/prescribe a therapy book which the patient can then go and borrow from the library. Through reading the book patients are better able to understand their problems and learn more about possible strategies they can employ to help themselves. This is good as it helps the patient feel more engaged and committed to the process of getting better.

This principle is also very relevant to chiropractic care. I encourage patients to get involved in their own care because getting better and improving health is a partnership. I provide some hands-on treatment at the clinic and then I send patients away to do some things to help themselves. I may ask them to do something simple, such as take a 20 minute walk each day or wrap a tea towel around an ice pack and apply it to the painful area for 10 minutes every few hours.

Sometimes I also recommend that a patient read a book, or a chapter of a book. I usually suggest the patient buys the book but occasionally I lend patients my own copies. Books I have recently recommended/prescribed are:

The Barefoot Book by Daniel Howell
Trigger Point Therapy for Myofacsial Pain by Donna Finando
Back Care Basics by Mary Pullig Schatz
Treat Your Own Back by Robin McKenzie

Let me know if you can think of others I should consider.

Back Pain Breakthrough - Update

Over the past couple of weeks, as I've had conversations with some patients about the recently released research regarding the use of antibiotics to help some forms of back pain (see earlier blog post), I've encountered some recurring questions. Patients wanted to ask about concerns over the long course of antibiotics required to get results in the study and antibiotic resistance. They also had questions about the quality of the research. Some were also surprised that I would openly talk to them about a back pain treatment that might result in less patients requiring treatment from chiropractors.

It seems to me that concerns over long courses of antibiotic used for treating any condition are real. Antibiotic resistance is an increasing problem. There are serious concerns about how long it will be before antibiotics are no longer effective for many common ailments. I suspect those with chronic, severe pain will be willing to take their chances if such treatment becomes openly available. Over time, if antibiotic resistance continues to develop, this treatment option may not be viable.

I was interested to read a review of this new research on the NHS Choices website. The article was generally complimentary about the quality of the study. It did however raise some questions about the impartiality of a neurosurgeon who has been quoted in much of the popular media in connection with this study. The emphasis now seems to be that further research is required to test the reliability and potential scope of this treatment protocol.

I will continue to talk openly with my patients about this topic. My aim is to help people recover from back pain and other musculoskeletal problems. It seems to me that the type of patients who may benefit from antibiotic treatment, are patients who are less likely to make good progress with standard chiropractic treatment and if there is another potentially more effective treatment option available, I will be very happy to recommend it.

Finally, if you are interested in reading the research in full click here.

Guest Post: Treadmill desk update

I'm still walking as I work. It's a bit addictive to be honest and it's starting to feel odd when I sit down. The walking doesn't seem to require any extra thought and it's really easy to concentrate on other things while my feet move. 

One of the great things about the desk space is it's big enough to hold huge piles of student essays, stories and a rather odd PC solution (while I decide what to do about my ancient, but very much loved laptop). I've got a monitor propped up on packs of A4 paper so it's at eye level which works well (there's probably a more aesthetically pleasing solution, but I'm quite happy with it like this).

I've walked more than 40 miles in the past 3 weeks. I had expected the total to be higher and I think it may have something to do with the amount of time I've spent reading and marking student work - I found I needed to walk really slowly as I did this, sometimes at 0.5 mph - perhaps slower speeds are necessary for contemplation.  

Now that I'm back to editing my novel a steady 1.4 mph seems to be working pretty well and I take back what I said previously about not being able to eat or drink while walking - it's actually pretty easy (although probably not recommended).

The children love the desk, too. They like to take it in turns to use it for homework - and anything that makes homework more enjoyable gets a massive thumbs up from me.

Carys

Back Pain Breakthrough

The European Spine Journal has just published a new piece of research which may prove to be a breakthrough for sufferers of some types of chronic low back pain. The type of person who may benefit from this breakthrough is one who has experienced a disc herniation, often referred to as a 'slipped disc'.

It has been observed that on MRI (Magnetic Resonance Imaging) scans individuals who have disc herniations will also often have changes in the appearance of the bone in the adjacent vertebrae. These changes are described as modic changes. The cause of these vertebral changes has until recently been unclear, however it is now thought that they are caused by a low grade bacterial infection within the spine.

This new research (a double blind RCT) investigated the effect of a 100 day course of antibiotic treatment for patients suffering with low back pain of greater than 6 months duration. These subjects had confirmed disc herniation and vertebral modic changes on MRI scans. The results showed that the group treated with antibiotics had a highly significantly greater reduction in back pain and back pain related disability at 1 year follow-up when compared with the control group who took the placebo.

In my chiropractic practice I certainly see some patients who may benefit from this new treatment. I don't as yet know how the national health service here in the UK will respond to this new research. It appears that there may already be some private options for those keen to investigate this further.

It should be noted that this treatment is not for all chronic back pain patients. Back pain is common; said to affect 80% of people at some point in their lives and nearly 50% of people are likely to have an episode of back pain at some point this year. This new treatment looks most likely to help those with severe, chronic back pain following a disc herniation confirmed by MRI.

Chiropractic continues to be well positioned to help treat simple or mechanical low back pain as outlined in 2009 NICE Guidelines. I am however excited by this new research as it may provide a new and effective avenue to help some sufferers of back pain.

Finding My Feet

A few years ago a good friend of mine took the bold decision to live a barefoot lifestyle. Steve Bloor of Natural Feet is bio-mechanical podiatrist with a particular interest in foot and lower limb mechanics. He was instrumental in the development of a barefoot trail created by the National Trust and also runs a weekly barefoot walking group. Following conversations with Steve I decided to try out some barefoot activities for myself. I read 'The Barefoot Book - 50 Great Reasons To Kick Off Your Shoes'. It reminded me how important proper foot function is to the ankles, knees, hips, pelvis and spine. I learned that removing the artificially flat, smooth cast of a shoe improves proprioception (the ability of the body to know exactly what position and where the limbs are relative to the rest of the body).

For about a year now I've been experimenting with a little barefoot running and walking. Last Autumn I attended a workshop run by Anna Toombs and David Robinson from Barefoot Running UK. They evaluated my shod running style and then taught, evaluated and corrected my barefoot running technique. Thanks to my training as a chiropractor much of the theoretical instruction was just revision, however I came away realising that running in shoes and running barefoot are quite different activities. When running barefoot, strides are shorter and faster, knee lift is higher, the feet strike the ground fairly flatly and are directly under the hip when ground contact is made. You also run with very light steps.

The past winter has felt very long and cold and I've not been inclined to brave the world while barefoot on more than the odd occasion. Spring finally seemed to arrive in Liverpool two or three weeks ago, so since then I've put my 'best (barefoot) foot forward' and got out for some barefoot walking and running at least a couple of times each week.

Yesterday was the 2013 International Barefoot Running Day. Official events were organised in countries all over the world. The UK event was held in Brighton. Unfortunately the distance between Liverpool and Brighton is over 270 miles, so it was impractical to join the official UK event. A small group of keen 'athletes' joined me for our own local event around Hesketh Park in Southport. We ran a refreshing 2km around the circumference of the park on the wonderfully smooth  and forgiving surface of quarry tiles. Thanks to those who joined me in our little local Barefoot Running Day. My appreciation also goes out to Steve, Anna and David for their invaluable instruction, which has helped me find my feet again.

Guest post: Just Keep Walking

The treadmill desk arrived on Friday evening. It's pretty big and we had to rearrange the lounge in order to fit it in. We decided to put it in the window so I've got something to look at when I'm not looking at the screen.

Minor Issues:

When I first tried to work on the treadmill on Friday evening, the desk was a little wobbly. We tightened the nuts with a socket wrench and now it's great.

I think I probably need to adjust the desk to make it a little higher, but it's quite heavy and I need to get someone to do it with me (Neil did this last night - I think it will probably need to go a bit higher so I'm not looking down all day).

I don't have Bluetooth on my phone or laptop so I can't access the online stuff which sounds great (stats, exercise plans etc.). I'm not too bothered about this at the moment as I can write down how far I've walked and how much time I've spent walking at the end of each day.

Things I've learned:

It's very easy to walk while typing/marking essays/messing about on the internet/talking on the phone.

Different tasks seem to work with different walking speeds. 1 mph is about right for editing and typing.  

Good stuff:

The desk itself is pretty big so there's loads of room for piles of marking and/or books and files etc. 

It's much easier to walk than it is to stand still, so even if I'm just checking my emails or messing about on Facebook for 10 minutes, I switch the treadmill on.

I've walked more than 20 miles since Friday evening and my calves are zinging (in a good way).

I can see that if I just stop eating so much chocolate it's going to be a great way to lose weight. Plus, while it's easy to walk and type, it's actually quite hard to walk and eat and/or drink (yes, I've tried both).

The treadmill goes up to 4 mph which, if you've got legs as short as mine, is a jog, so there's scope to go a bit faster at times.

Carys

Guest Blog: Treadmill Desks

I'm Neil's wife and I'm a writer. I spend hours and hours sitting down. I haven't exercised properly for ages. I know I should get up earlier; I should take a break in the middle of the day and go for a walk; I should go out running once the kids are in bed - I should do lots of things, but I don't.

I know exercise has been shown to help low back pain and that walking is good for heart health. I've read things like this Telegraph article which discusses the benefits of walking for an hour a day for elderly people and the American Heart Association study which has found walking to be as effective as running (if one expends the same amount of energy). I've looked at research that shows walking 10,000 steps a day will significantly improve health, build stamina, burn calories and benefit the heart, but I still don't exercise.

Neil recently told me about treadmill desks (can you see where this is going?). He said he'd be interested in discovering more about them, but he needed to find someone who sits at a desk all day and doesn't do any exercise at all. He didn't have to look far. Guess who's trialing the treadmill desk? 

We went to Gym World in Oldham this week and had a look at a desk. Neil was impressed (I was too - it turns out I can type AND walk at the same time) and we're taking delivery of a one next week. I will be blogging about the desk here and over at my own blog. 

I'm off now, until next time, when I will be righteously exercising while typing, rather than sitting on the sofa, trying not to drop the hundreds and thousands from my Nobbly Bobbly between the laptop keys.

Carys