Posted on

Bulging Discs

Poor posture, unbalanced tight and weak muscles, stress, over training and joint dysfunction are all possible causes of low back pain. Frequently we see patients who may present with acute low back pain and sciatica.

Sciatica refers to back pain caused by a problem with the sciatic nerve. This is a large nerve that runs from the lower back down the back of each leg. When something injures or puts pressure on the sciatic nerve, it can cause pain in the lower back that spreads to the hip, buttocks and leg.

The most common symptom of sciatica is lower back pain that extends through the hip and buttock and down one leg. The pain usually affects only one leg and may get worse when you sit, cough or sneeze. The leg may also feel numb, weak or tingly at times.

The symptoms of sciatica tend to appear suddenly and can last for days or weeks.

Most people who get sciatica are between the ages of 30 and 50. Women may be more likely to develop the problem during pregnancy because of pressure on the sciatic nerve from the growing uterus and foetus. Other   causes include a herniated or bulging disc and degenerative arthritis of the spine.

What is a bulging disc?

To understand what a bulging disc is, we must first understand the anatomy of the spine.

Put simply, the spine is made up of individual vertebrae stacked on top of each other. Between each vertebrae is an intervertebral disc that provides a cushion so the vertebrae don’t rub together.

The discs between the vertebrae have a gel like material inside (called a nucleus pulposus).

A great way to think of the discs is like that of a balloon filled with water – these discs help resist compressive forces on the spine.

When a disc bulges, the gel like material inside gets pushed back towards the nerves and structures of the spine. This bulge can sometimes        compress nerves in your spine and cause pain, tingling / or burning sensation and / or other symptoms.

It is important to note that a bulging disc doesn’t always touch the nerves and, for many, a bulged disc doesn’t even produce any pain at all. However, it could progress to become a herniated disc eventually, which can be problematic.

What causes a bulging disc?

· Seated with poor posture for long periods of time.

· Repetitive bending, lifting and twisting, especially with poor form.

· Heavy lifting with poor form due to stress on front of spinal column causing disc to bulge out back.

· Can also result from osteoarthritis.

· Trauma such as a car accident.

How is a bulging disc different from a herniated disc and which is worse?

In most simple terms, a herniated disc is when the fluid material from the disc ruptures through the outer layer of the disc and now spills out. This material can directly compress on spinal nerves and spinal structures. If you use the water balloon example but now imagine the balloon has burst under pressure, that’s a herniated disc.

A bulging disc can be resolved over time if managed well, whereas the herniated disc will just scar down since the annulus (outer layer of disc) has ruptured.

A nice visual spine model is provided below differentiating between normal, bulging and  herniated discs:

What are the symptoms of a bulging disc in the lumbar spine?

· Low back pain.

· Leg pain (not absolute).

· Decreased lumbar lordosis (lower back curvature becomes flattened – flatter lower back over time).

· Lumbar and hip muscle tightness.

Posted on

Wrists: delicate but complex

The wrist is one of the most delicate, complicated and vulnerable joints in the body. It’s classed as a complex joint, meaning multiple bones slide against each other to create a more complex movement – necessary in such a tight space and to be able to withstand the compressive forces wrists can handle! It’s capable of every movement possible from a joint in the body. 

The 7 small bones of the wrist sit between the two forearm bones and the long bones of the hand. Their location is from our tree dwelling ancestors and allows the hand to close and open, as well as working with the elbow to rotate up to (and sometimes over!) 360 degrees. Those same tree dwelling ancestors are responsible for some of the muscles acting on the wrist. There are very few muscles that exist in the wrist, the only main one called pronator quadratus. The rest live in the forearm and pass tendons across the wrist into the fingers or hands.

These tendons are the most vulnerable part of the wrist to injury and pass in a series of sheaths around the outside of the wrist, linking the wrist to conditions like tennis and golfers’ elbow. 

The most well known wrist injuries, along with the most common, are traumatic injuries from falls and impact – the typical ‘fall on out stretched hand’ or FOOSH. The small bones and corresponding joints make the area particularly susceptible to injury in this way.

However, other injuries can come in the form of repetitive strains to any of the joints or tendons and can also show in some of the nerves that pass through the wrist into the hand. The most common of these being carpal tunnel syndrome. Other tunnel syndromes are more rare but do exist, the next most common being a tunnel of gunyon syndrome, also known as a handlebar palsy.

That name is a giveaway as to the most common population to get this type of injury! However, it isn’t just cyclists – anyone with pressure on the ulnar side of the wrist (little finger side) with a gripped fist can be in the firing line, particularly with vibration, so power tools are a common cause.

Something to bear in mind with tunnel syndromes or any injury to the nerves in the hand or extremity is that it’s very important to rule out any other pathology or cause, as conditions such as type 2 diabetes are significant risk factors – they are also very commonly present in pregnancy! 

The high usage of the wrist in nearly any movement using the hand leads to overuse or repetitive strain injuries being very common in the wrist – linked with overuse in sports, actions like using scissors in hairdressing or using keyboards excessively. 

Some of the more interesting aspects of the wrist include a muscle left over from our tree dwelling evolutionary forebears, that isn’t present in everyone, called palmaris longus. This tenses the connective tissue of the hand and assists wrist flexion. One theory as to its development is that it assists climbing primates (and possibly climbing humans?!).  Did you know, the wrist bones in horses have fused to create their longer lower foreleg bones, meaning the joint that looks like their knee / elbow on the front leg is equivalent to our wrist! 

Treatment of the wrist is often complex – reduction in load through rest and active treatments in the form of exercise or stretching are common. Many different methods of management can be performed by chiropractors including taping, acupuncture, manipulation and massage. These are effective in many types of wrist injury but, due to the complex nature of the joint and the structures passing through it, make sure to seek advice from a qualified professional (chiropractor, GP, physiotherapist or similar) before any sort of  intervention! 

https://www.instagram.com/thestudiodurhamhouse/

http://www.durhamhousechiropractic.co.uk/

https://www.facebook.com/thestudiodurhamhouse/

Posted on

Core Strengthening and why its important

Think of your core muscles as the robust central link in a chain connecting your upper and lower body. Whether you’re hitting a tennis ball or mopping the floor, the necessary motions either originate in your core or move through it.

No matter where motion starts, it ripples upward and downward to adjoining links of the chain. Thus, weak or inflexible core muscles can impair how well your arms and legs function and that reduces power from many of the moves you make. Building up your core increases your power, stability and balance. It can help prevent falls and injuries during sports or other activities. A strong, flexible core underpins almost everything we do.

What is core?

Your abs are not just one muscle. The deepest layer of abdominal muscles and arguably the most important, is your transverse abdominis (sometimes called the corset or Spanx of the core), which stabilises your spine and pelvis. Then you have two layers of oblique muscles, which control lateral flexion (side bending),  rotation and other spinal movements. Last but not least is the    topmost muscle, the rectus abdominis, which runs vertically in the front of your abdomen (the six pack). It flexes / crunches your torso forward.

When reviewing your whole core (versus just your abs), there are more muscles involved: pelvic floor, back muscles that stabilise your spine and your diaphragm (the main muscle involved in   breathing).

Everyday benefits of strengthening your core

Bending to put on shoes or scoop up a package, turning to look behind you, sitting in a chair or simply standing still – these are just a few of the many mundane actions that rely on your core and that you might not notice until they become difficult or painful. Even basic activities of daily living like bathing or dressing, for example, call on your core.

Jobs that involve lifting, twisting and standing all rely on core muscles. But less obvious tasks, like sitting at your desk for hours, engage your core as well. Phone calls, typing, computer use and similar work can make back muscles surprisingly stiff and sore,  particularly if you’re not strong enough to practice good posture and aren’t taking  sufficient breaks.

A healthy back

Low back pain, a debilitating, sometimes excruciating problem, may be prevented by  exercises that promote well balanced, resilient core muscles. When back pain strikes, a regimen of core exercises is often prescribed to relieve it, coupled with medications, physical therapy or other treatments if necessary.

Sports and other pleasurable activities

Golfing, tennis or other racquet sports, biking, running, swimming, baseball, volleyball, kayaking, rowing and many other athletic activities are powered by a strong core.

Housework, DIY and gardening

Bending, lifting, twisting, carrying, hammering, reaching overhead, even vacuuming,  mopping and dusting are acts that spring from or pass through, the core.

Balance and stability

Your core stabilises your body, allowing you to move in any direction, even on the bumpiest terrain or stand in one spot without losing your balance. Viewed this way, core exercises can lessen your risk of falling.

Good posture

Weak core muscles contribute to slouching. Good posture trims your silhouette and projects confidence. More importantly, it lessens wear and tear on the spine and allows you to breathe deeply. Good posture helps you gain full benefits from the effort you put into exercising too.

Weak, tight or unbalanced core muscles can undermine you in any of these realms. While it’s important to build a strong core, it’s unwise to aim all your efforts at developing rippling abs. Overtraining abdominal muscles while snubbing muscles of the back and hip can set you up for injuries and cut athletic prowess.

Where to start?

It’s very important that, once you begin to activate and work on your core, you do so with control and patience. Starting with the teaser or advanced Russian twists will likely result in injury, weakness and imbalance.

Check out our Flexicore classes to help activate the deep internal core and pelvic floor muscles. They are a perfect foundation to build from.

https://www.instagram.com/thestudiodurhamhouse/
https://www.facebook.com/DurhamHouseChiropractic/
https://www.facebook.com/thestudiodurhamhouse/
http://www.durhamhousechiropractic.co.uk/index.htm
Posted on

Understanding Blood Pressure

Normal blood pressure is vital to life, however, blood pressure can become dangerously high and it can also get too low.

What is blood pressure?

Blood pressure is what allows oxygen and nutrients to move through our circulatory systems and is the force that moves it.  It’s an important force     because oxygen and nutrients would not be pushed around our circulatory system to nourish tissues and organs without blood pressure.

Blood pressure is also vital because it delivers white blood cells and antibodies for immunity and hormones such as insulin. Just as important as providing oxygen and nutrients, the fresh blood that gets delivered is able to pick up the toxic waste products of metabolism, including the carbon dioxide we exhale with every breath and the toxins we clear through our liver and kidneys.

Blood itself carries a number of other properties, including its temperature. It also carries one of our defenses against tissue damage, the clotting platelets that prevent blood loss following injury.

But what exactly is it that causes blood to exert a pressure in our arteries?  Part of the answer is simple – the heart creates blood pressure by forcing out blood when it contracts with every heartbeat. Blood pressure, however, cannot be created solely by the pumping heart.

Function

Our circulation is similar to a highly sophisticated form of plumbing – blood has ‘flow’ and arteries are ‘pipes’.’

A basic law of physics gives rise to our blood flow and this law also applies in a garden hose pipe.  Blood flows through our body because of a difference in pressure.

Our blood pressure is highest at the start of its journey from our heart – when it enters the  aorta – and it is lowest at the end of its journey along progressively smaller branches of  arteries. That pressure difference is what causes blood to flow around our bodies. 

Arteries affect blood pressure in a similar way to the physical properties of a garden hose pipe affecting water pressure. Constricting the pipe increases pressure at the point of constriction.

Without the elastic nature of the artery walls, for example, the pressure of the blood would fall away more quickly as it is pumped from the heart.

While the heart creates the maximum pressure, the properties of the arteries are just as important to maintaining it and allowing blood to flow throughout the body.

The condition of the arteries affects blood pressure and flow and narrowing of the arteries can eventually block the supply altogether, leading to dangerous conditions including stroke and heart attack.

Measurement

The device used to measure blood pressure is a sphygmomanometer, it consists of a rubber armband (the cuff that is inflated by hand or machine pump). 

Once the cuff is inflated enough to stop the pulse, a reading is taken, either electronically or on an analogue dial.

The reading is expressed in terms of the pressure it takes to move mercury round a tube against gravity. This is the reason for pressure being measured using the unit millimeters of mercury, abbreviated to mm Hg.

Readings

A stethoscope identifies the precise point when the pulse sound returns and the pressure of the cuff is slowly released. Using the stethoscope enables the person measuring the blood pressure to listen out for two specific points.  Blood pressure readings consist of two figures:

  • systolic pressure is the higher figure caused by the heart’s contraction
  • diastolic pressure is the lower pressure in the arteries, during the brief ‘resting’ period between heartbeats.

The reading is given as, for example, 140 over 90mmHg.

Range

The NHS cite normal blood pressure to be below 120mmHg systolic and 80mmHg diastolic.

As a general guide:

  • ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
  •  high blood pressure is considered to be 140/90mmHg or higher
  •  low blood pressure is considered to be 90/60mmHg or lower.

However, blood pressure changes naturally and can have marked short term fluctuations   occurring within a 24 hour period eg beat to beat, minute to minute, hour to hour and day to night changes. There can also be long term fluctuations occurring over more prolonged     periods of time, for example days, weeks, months, seasons and even years.

If you have any concerns about your blood pressure, speak with your doctor.

Tips

The guidelines for doctors list the following measures patients can take to help keep a healthy blood pressure:

  • keep a healthy body weight
  • eat a diet rich in fruits and vegetables
  • cut down on sodium, or salt, in the diet
  • take regular aerobic exercise, such as brisk walking, for at least 30 minutes a day, most days of the week
  • moderate alcohol intake – men should drink fewer than 2 alcoholic beverages a day and women and men with a lower body weight should consume a maximum of one alcoholic drink a day.

Taking these steps can reduce the risk of health problems further down the line.

Check our Instagram and Facebook pages throughout the month for our Top Tips.

equired.

Check our Instagram and Facebook pages throughout the month for our Top Tips for exercises that might help give some relief for TMJ pain.

https://www.instagram.com/thestudiodurhamhouse
https://www.facebook.com/DurhamHouseChiropractic/
https://www.facebook.com/thestudiodurhamhouse/
http://www.durhamhousechiropractic.co.uk/index.htm
Posted on

New year, new habits, new you

How much do you remember about brushing your teeth? Have you ever found yourself scrolling through Facebook or Instagram again when you only just closed it? We spend up to 50% of our day to day lives  performing automatic behaviours, otherwise known as habits. These habits can be so strong that even when we know if a habit isn’t good for us, the habit still triggers and we catch ourselves performing it anyway. So, what are they, why do we have them and how can we help ourselves make new ones?

What is a habit?

According to British dictionaries, a habit is: ‘A settled or regular tendency or practice, especially one that is hard to give up.’

‘Something that you do often and regularly, sometimes without knowing that you are doing it.’

Why do we have habits?

Many studies have been performed to look at habits as they are a frequent obstacle to overcome in healthcare. In our brains, a habit can help to reduce how much energy we spend processing the same set of information if we see it often and regularly enough. This is how we go from needing to check directions to get to a new workplace to unconsciously navigating the route without even checking the signs. The diagram here demonstrates the findings of one of these studies. As you can see, once it has recognised the cue, brain activity drops almost in half right up until the end of the habit where it gets the reward. This introduces us to the basic structure of a habit.

Habits all have:

  • A cue, something distinct which then triggers…
  • the routine, the behaviours that we perform in order to get to…
  • the reward, something that satisfies…
  • the initial craving. The stronger the craving, the more likely a habit will be triggered. Therefore a sugary drink will be chosen more easily than choosing to drink water, as water doesn’t   trigger the same sense of craving or reward.

How can we create new habits?

By understanding what forms a habit, we can start to work out how we can make a new one or alter the ones we have already. Each habit must have each part of the cycle in place, repeated often, in order to create the circuit in our brain. For example, it’s easy to say ‘this year I am going to go to the gym more’, attend the gym a few times and then other priorities get in the way .

The easiest way to create a new habit is to add to one that you already do. That way you don’t need to change too much in your day to fit something else in. For example, we brush our teeth twice in the day. Add to that stretching out neck and shoulders either before or after and, over time, it becomes natural for us to stretch whenever we go to brush our teeth.

Sometimes we want to replace a habit completely, for example snacking on unhealthy foods.

This can be tough because, once we have created a habit in our brain, it can’t be erased. However, knowing what makes up our habit cycle allows us to change it into a different habit.

The key is to keep the cue, reward and craving all the same whilst changing the routine to something that still satisfies that loop. For example, changing our snack food for something healthier that still satisfies us and keeps us full. In  order to help the new habit to form and settle in, we need to put energy into sticking to it over a period of time. Each time we go through the cycle, the circuit we are forming in the brain becomes stronger. Other ways to help can include having an accountability partner or logging your habits in a notebook tracker.

So, to summarise:

  • Habits are automatic behaviours we use to save energy for our brains.
  • A habit is made up of a cue, a routine, a reward and a craving.
  • In order to change a habit we must keep the cycle the same and change the routine.

Here are some ideas for habits to include in your day:

  • Think of 3 gratitudes, something you are grateful for, each day.
  • Getting up from your desk once an hour to help your joints.
  • Drink more water in the day.
  • Spend 15 minutes a day reading a book.
  • Compliment someone every day.

Check our Instagram and Facebook pages throughout the month for our Top Tips for exercises on the subject

https://www.instagram.com/thestudiodurhamhouse/
https://www.facebook.com/DurhamHouseChiropractic/
https://www.facebook.com/thestudiodurhamhouse/
http://www.durhamhousechiropractic.co.uk/index.htm

All pictures from Power of Habits by Charles Duhigg

Posted on

TMJ

Let’s talk this over !

TMJ stands for temporomandibular joint and refers to your jaw. It consists of a lower and upper part, on each side, that articulate together and are separated by a disc.

The anatomy of the jaw is such that the lower part or mandible has a condyle that rests in the socket of the upper part of the jaw, which is the temporal bone and is part of the skull.

There are two main movements of the TMJ – a hinging action that is then immediately followed by a forward gliding motion which is facilitated by the intra-articular disc. The correct movement of the jaw is important for normal function and helps to keep people pain free.

This is quite a vulnerable joint and can create problems for people. It’s one of the most frequently used joints and can be overlooked when being examined for certain issues, such as headaches. It’s estimated that the temporomandibular joint is used between 1,500 – 2,000 times a day during  activities such as chewing, talking, swallowing, yawning and snoring.

When a clinician is assessing someone’s jaw, first they will start by taking a history and asking  questions. By doing this they are hoping to narrow down the possible pain generating tissue.

The TMJ can cause multiple issues. The most obvious might be direct jaw pain or restricted  movement but issues such as headaches can be less obviously associated with the jaw.

Other jaw issues are:

  • ear ache
  • lock jaw
  • tinnitus
  • clicking or grinding sounds
  • bruxism (grinding of the teeth or clenching the jaw)
  • nerve irritation and resultant nerve pain.

The clinician will inspect the jaw by looking at the movement as you open and close your mouth. Primarily they are looking for asymmetry such as that depicted below (jaw span), a bony and soft tissue palpation, where they feel the joint and, as it moves, try to determine any bio-mechanical problem. There is some simple muscle testing and a few neurological tests that may be performed too.

If a problem is found then some treatments can be offered by your chiropractor, but others may  require a dentist or doctor.

There are a wide range of management options, from manual treatments to home treatments,  including ice or heat, jaw exercises / stretches, muscle relaxation techniques, medication and mouth guards.

Possible issues

Some issues we see are muscle tightness which can cause asymmetrical movement of the jaw, pain and referred pain.

There are 4 muscles of mastication (chewing) that move the jaw; the temporal muscle, medial and lateral pterygoids (found inside the mouth) and the largest, the masseter. If these get tight and tense they build up with toxins and become painful. If very painful, they can refer pain.

Bruxism is a common issue and is characterised by jaw clenching and teeth grinding. This is often done unconsciously and can be caused by emotional stress. Physically it can result in muscle tightness which can be treated by a manual therapist and also with a mouth guard from the dentist. A mouth guard can help off load pressure from the jaw and protect the enamel on your teeth. If the main cause is possibly psychological, then relaxation techniques and regular stretching is a good  approach to manage this.

Intra-articular disc issues can be very painful and can be more complicated. The disc can become displaced or can degenerate which can alter the smooth movement of the jaw.

If simple treatments are not helping then sometimes surgery is required. Before this is considered though, a full consultation with a doctor is required.

Check our Instagram and Facebook pages throughout the month for our Top Tips for exercises that might help give some relief for TMJ pain.

https://www.instagram.com/thestudiodurhamhouse/

https://www.facebook.com/DurhamHouseChiropractic/

https://www.facebook.com/thestudiodurhamhouse/

http://www.durhamhousechiropractic.co.uk/index.htm