What is the difference between a chiropractor and osteopath?

If you have ever wondered about the difference between a chiropractor and osteopath, you won't be alone. It's a question that I'm asked all the time.

Osteopathy and chiropractic started out as distinct healing professions in the late 1800s in the USA. Andrew Still, a physician and surgeon 'discovered' osteopathy in 1872 when he became dissatisfied with conventional medicine. He believed the bone 'osteon' was the starting point for pathological conditions. D.D Palmer was the founder of chiropractic in 1895.  Palmer may have been a student of Andrew Still for a short time.

Palmer proposed that spinal manipulation influenced the nervous system whereas osteopaths believed that manipulation had an effect on the body’s circulation. Scientific understanding of physiology was very limited at the time.

Chiropractors and osteopaths treat mainly muscular and skeletal problems. Chiropractors often use manipulation, particularly of the spine as part of their treatment. This is sometimes referred to as an adjustment. To better understand what this is, you may like to read this post. Osteopaths may also manipulate their patients but more frequently use mobilisation. Both professions use various other soft tissue techniques as part of their treatment.

Chiropractic and osteopathic manipulation and mobilisation are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of back pain. I have observed osteopaths treating patients and can see a time when there are much closer ties between the two professions. In the UK chiropractors are regulated by the General Chiropractic Council and osteopaths by the General Osteopathic Council. When deciding whether to consult a chiropractor or an osteopath you may find it most helpful to seek out a personal recommendation from family members or friends. Hope this helps.

Maintaining Good Health

During the 1800's life expectancy was only about 40 years. Today that figure has almost doubled. If the current trend continues 1 in 3 babies born today can expect to live to be 100. However, although life expectancy is now around 80 years, healthy life expectancy is somewhat lower at 63.5 years according to the Office for National Statistics. Prof Les Mayhew, of the Cass Business School at the City University, London argues that although people are living longer, there are concerns about our ability to continue to work up to the new UK full state pension age (68), because of poor health.

Poor health comes in many guises. In recent years stress (and mental health problems) and musculoskeletal problems (of which back pain makes up a significant proportion) have been the main causes of long term absence from work. As we all live longer, it seems there may never have been a more important time to consider ways to maintain good health. In earlier blog posts I've discussed the importance of diet and exercise with respect to keeping healthy. I also believe chiropractic may be able to provide another small part of the good health equation.

In my practice I see more patients with back pain than any other condition. Over recent years there have been a number of studies supporting the treatment offered by chiropractors for this very common problem. Until recently however, support for chiropractic preventative care was more anecdotal than research led. In 2011 however, two important papers were published which begin to build support for preventative or 'Maintenance Care' for chronic back pain sufferers. Chronic back pain is generally defined as back pain which has been present for greater than 3 months. Chronic back pain can be tremendously debilitating for those suffering from it and can put a huge burden on general health resources.

The first of these 2 studies was conducted by Senna and Machaly and published in the journal Spine. Study participants (who had at least a 6 month history of low back pain) were randomised into one of 3 groups:

1. Sham spinal manipulation x 12 over 1 month, plus prescribed back exercises.
2. Spinal manipulation x 12 over 1 month, plus prescribed back exercises.
3. Spinal manipulation x 12 over 1 month, plus prescribed back exercises; plus maintenance care (treatment with spinal manipulation every 2 weeks).

Results:
Study participants who received spinal manipulation were significantly better than the sham treatment group at 1 month, however only the spinal manipulation + maintenance group were still significantly better on all outcome measures at 10 month follow-up.

Conclusions:
Spinal manipulation is effective for nonspecific chronic low back pain. Best outcomes are achieved in the longer term when maintenance treatment and exercise are included.

The second study by Cifuentes, Willetts & Wasiak was published in the Journal of Occupational & Environmental Medicine. This study examined how health maintenance care provided by chiropractors, physical therapists and physicians affected recurrences of low back pain in workers following treatment for an initial episode of back pain. Of the 3 treatments, those who received chiropractic maintenance care had the lowest disability recurrence rate.

In practice, I have found that patients most suited to receiving maintenance care are those who have chronic or recurring back pain. The frequency of maintenance care is something that is highly individual but may vary from a treatment every few weeks in the worst cases to every few months in patients with less unstable back problems. As the first study above indicates, regular exercise to improve spinal stability and flexibility is also an integral part of a health maintenance program.

By reducing back pain related disability, I believe chiropractic can play an important role in improving healthy life expectancy. Chiropractic - helping you be healthy and happy into old age!

Isn't That Sweet?

This week I came across a video on YouTube called 'Sugar - The Bitter Truth'. This is a presentation by Dr Lustig, a paediatric endocrinologist at the University of California in San Francisco. If you have the time, it's a fascinating watch.




He talks about the rising problem of obesity and links it with the massive increase in the use of high fructose corn syrup (HFCS) as a sweetener in many foods and soft drinks. Diets with high HFCS content can decrease your ability to feel full (so you eat more). Fructose is readily turned to fat by your liver. Not all fat is the same, but the large amounts of fat produced in the liver when HFCS is metabolised can be deposited in your blood vessels increasing the risk of heart attacks. Other problems such as high blood pressure, type 2 diabetes, liver dysfunction, and pancreatitis are also associated with HFCS.

Dr Lustig recommends 4 effective lifestyle interventions in an attempt to combat this problem:
1. Get rid of all sugared liquids from your home or work; only drink water or milk.
2. Eat your carbohydrates with fibre (remember, highly processed food often contain little fibre).*
3. If you want seconds, wait 20 minutes.
4. Buy your screen time (TV, computer, etc) minute for minute with physical activity (i.e. 30 minutes of surfing the net costs you 30 minutes of exercising or cleaning or walking, etc). Another great reason to use a treadmill desk - immediate payback!

Fortunately, UK diets contain a good deal less HFCS than diets in the USA. I've taken to looking at food labels more closely this week and you'd be surprised what foods are being sweetened. Low fat foods are particularly vulnerable as we find low fat food less palatable, and to increase palatability, the food is often loaded with sugars, which may then be metabolised in the liver into even more unhealthy forms of fat than the fat for which the sugar was substituted. This one reason why dieting is often so ineffective.

Watch the presentation. It will change the way you think about your food and drink and your lifestyle as a whole.


*Wherever there is fructose in nature (in fruit for example) there is also lots of fibre. Fibre is essential because it slows the rate of carbohydrate absorption and increases the speed of transit of intestinal contents, helping us feel more full and less hungry.

Guest Post: Walk this Way

After numerous late nights finishing the latest draft of my novel and a brief holiday, it's time to get back into the swing of things. I've missed my daily desk-walking and this Walk Your Waist Off article in the Telegraph has made me anxious to begin again.

In the article, Joanna Hall claims that daily walking (with the correct posture) improves balance, cardiovascular health and stamina, toning bodies and dropping inches without dieting and back-breaking sit-ups. Sounds good, especially after the amount of ice cream I ingested on holiday.

I've set myself the challenge of walking for 2 hours a day during the school holidays. Not only will it mean that I get some exercise, it will also encourage me to get on with my pile of holiday reading which is probably best done indoors, with a pencil and notebook to hand as I prepare for the theoretical part of my PhD.

Carys

What's The Crack

The cracking or popping sound that is sometimes produced when joints are manipulated, (or as we chiropractors like to say 'adjusted'), seems to evoke strong emotions from some people. I'm often asked what causes the sound. Patients sometimes think it is caused by bones rubbing together or something snapping. Some have had relatives or friends tell them that clicking their joints will cause arthritis. Such misconceptions seem to generate a certain degree of fear of the cracking sound. This fear is slightly irrational when you consider that many of us experience a click from our knees when we squat down to pick something up or even clicks from our ankles or toes when we take our first steps of a morning.

To help us understand what is happening during an adjustment it might be useful to know what joints look like. Most of the joints in our bodies are called 'synovial joints'. These joints normally provide free movement between the bones they join. They are encapsulated by ligaments and contain a lubricating fluid called synovial fluid.

Research over many years has tried to answer the question - 'What causes the crack?' It has been shown in various studies that there is a sudden change in the pressure within a joint when it is stretched. When a chiropractor 'adjusts' a joint, the joint is essentially being stretched very quickly. This rapid stretch and the resulting pressure change within the joint capsule (because there is suddenly more space inside the adjusted joint) appears to cause gas which was previously dissolved within the synovial fluid, to vapourize to fill the increased joint space. The 'crack' (sometimes called an audible release) seems to be associated with this process. The vapourized gas remains contained within the the joint capsule and will be slowly resorbed back into the synovial fluid over a period of 20-30 minutes. During this time it is unlikely that the joint will crack again.

Investigations into the safety of cracking joints have looked at the effects of habitual knuckle cracking. They did not find any increase in the incidence of osteoarthritis in the hands. It appears that very frequent knuckle cracking does reduce grip strength. It has also been shown that spinal manipulation that results in an audible release can lead to greater muscle relaxation than manipulation that does not prouce a crack. Pain reduction after an adjustment however does not seem to be dependent on there being an audible pop.

So what does all this mean? Firstly it suggests that cracking or popping joints need not be feared. It is a common occurrence that doesn't only take place when a chiropractor adjusts a joint but can happen spontaneously when joints are stretched. Secondly, the evidence does not link it with arthritis. Finally, there does not necessarily need to be a click when a joint is adjusted in order for a pain reduction to occur.

Chiropractic Manipulation Benefits Back Pain Sufferers

A study has just been published in the medical journal Spine titled 'Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: the results of a pragmatic randomized comparative study'. It compared outcomes of acute low back pain patients treated either with standard medical care (consisting of pain killers, anti-inflammatories, education about self management, physical therapy and referral to a pain clinic) with patients treated with standard medical care plus chiropractic manipulative therapy (consisting of spinal manipulation and ancillary treatments as indicated, performed by a chiropractor).

At 2 and 4 week follow-up the patients treated with chiropractic manipulation combined with standard medical care reported significantly less disability and pain than did those who received standard medical care alone.

73% of patients in the group which included chiropractric manipulation reported that their pain was either completely gone, much better or moderately better. The figure was 17% in the standard medical care only group.

Finally, the group whose treatment also included chiropractic manipulation had higher satisfaction ratings of 8.9 compared with 5.4 (on an 11 point numerical rating scale) in the standard medical care only group, at 4 week follow-up.

The study does have some limitations (slightly disappointing follow-up rates especially in the standard medical care group; participants and clinicians were not able to be blinded to treatment group assignment) however the overall take home message seems to be that chiropractic treatment for patients with acute low back pain can significantly improve outcomes compared to standard medical treatment alone.

I treat a lot of back pain in my practice and this study supports what I see day to day. It also correlates with the recommendations in the National Institute of Clinical Excellence (NICE) guidelines published in 2009 (page 6-7) regarding the treatment of recurrent or persistant back pain.

Chiropractic spinal manipulation may be the missing link in your recovery from back pain!

Ergonomics

A national newspaper last week reported on a study that found  'Badly set up desks and chairs cost companies more than £7 billion a year in sick pay'. I see patients very regularly who are suffering with neck and shoulder pain, headaches, and back pain. Many of them do not remember a single incident which caused these problems. Further questioning will often reveal that they sit at a desk most of the day. Then in the evening they sit on the sofa with a laptop on their lap for another hour or two. Such a lifestyle can be a recipe for problems.

As you may have seen in some guest posts written for this blog by Carys over the past few weeks, we've just invested in a treadmill desk, which we bought from Gym World. Carys uses it for several hours, most days of the week, as she gets on with her writing. She thinks it's great. A big advantage of working at a treadmill desk is that you are not sat still for what sometimes turns out to be hours at a time. Prolonged sitting at a desk can put a lot of stain on the lower back. I don't believe we were designed to sit nearly as much as many of us do.

Our treadmill desk is set up for Carys to use. The desk height is set so that her elbows are almost bent at right angles. This means her wrists rest comfortably on the foam rubber wrist pad on the front edge of the desk while she's typing. We raised the monitor by placing two reams of paper under it so that it is now just slightly lower than her eye-line. A little further adjustment may still be needed. Having the monitor and desk at the correct height is critical as it can significantly reduce the strain on the neck and shoulders, and lower back. Getting these factors (the ergonomics) right is really important.

When I use the desk I have to adjust the height. I need it to be at least two or three settings higher than Carys because I am several inches taller than she is. This can be done by one person, but is more easily accomplished by two people. The desk is sturdy and heavy, so making the adjustment is a bit of a hassle. If I was planning to use the desk more regularly I would be considering upgrading to the desk which has electronic height adjustment. I would strongly recommend this option for anyone planning to use a treadmill desk in an office where it would have several users - a hot-desk.

The above mentioned report also found that 'Half of office workers say they've had no work station risk assessment in the last 12 months'. Employers should perform these assessments so employees need not be afraid to ask for them. There are also some useful self help guides on-line to assist you in setting up your own work station. I like this one produced by Boston University.

Laptops are a very practical computing solution for many due to their portability. They can however pose some real ergonomic problems. On a desk or table top the screen is likely to be too low and when placed on a higher surface the keyboard will probably be too high. When used on the lap, upper body posture is usually horribly rounded. Neck and shoulder pain and associated headaches are common consequences. The use of a laptop stand, an external keyboard and mouse and separate monitor can all help. I like the pointers this video clip provides for various situations in which a laptop may be used. You can also look at the Open Ergonomics illustrations produced by Loughborough University for further detailed set up advice.

Finally, if you're still experiencing pain, get in touch and I'll do my best to help you.