Advice Articles

As a Doctor of Chiropractic I get asked this question a lot. What should I put on my aching muscles, Heat or Ice packs?

Firstly I should mention that, if your back is aching because you fell off the top of a 14 foot ladder, you have a knife stuck in your back, you’ve been shot, or you have severe pain with any of the following new symptoms, numbness in your legs or groin, bladder and bowel weakness , feel unwell, have a previous history of cancer, you are in severe pain and cant get any relief in any position or by resting, or any other symptoms you suspect are not from the muscles and joints in your back, then seek medical attention. NHS Direct is a good start if you are unsure.

There is research to support both Ice packs and heat packs. However 17 years of treating injuries from acute ankle sprains to chronic zygopophyseal joints, has taught me they both are useful, depending on the timing and injury. Remember there are always exceptions and common sense should apply!

90% of the Time I recommend ICE packs. Most recent injuries, sprains, strains and pulled muscles are painful due to inflamed tissues. If you can press on the area and it hurts, inflammation is very likely. You cant always see the swelling. Inflammation releases chemicals that burn the tissues, increases the local temperature, the heat makes all the burning chemicals work even better. The chemicals send pain signals to the brain that sensitize the nerves to signal more pain with less stimulus. This draws fluid to the area that cause more swelling and dilates the blood vessels drawing more blood to the area which carries all the products for even more inflammation. Ever heard of a viscous cycle?

Ice to the rescue. Cryotherapy is the fancy name for using ice packs. Ice will reduce the temperature, making the chemicals of inflammation less active. Ice shrinks the swelling. Ice constricts the blood flow so there isn’t more chemicals coming to fuel the fire. Ice numbs the nerves giving you some pain relief. Ice helps control the inflammation. A natural anti-inflammatory!

The best way to use Ice is wrapping a bag of frozen peas, or crushed ice, or these soft pliable gel packs(available from most pharmacies), in a tea towel. Make sure the frozen peas, the ice or the gel pack is flexible and not in one frozen clump. Place it over the area that hurts when you press, make sure there is some cloth between the pack and your skin. The ice pack will be cold achy and burning at first but should fade away to a “numbish” relief. This usually takes 10 to 20 minutes. Don’t leave the pack on longer than 20 minutes. Take the pack off and put it back in the freezer. You can re-apply the ice pack after 30 minutes. Do check for frost bite or any reaction to your skin that doesn’t settle in a few minutes. If after a few minutes the ice just makes it feel worse and worse, apply common sense and stop using it. Most conditions usually need 3 to 4 re-applications of the ice pack and it may a take a few days of using the ice to completely settle the inflammation. You don’t need to lay on the ice pack, often tucking the ice pack into clothing is the easiest way, especially for the lower back and neck. The ice may make the muscles stiffen but you can usually avoid this by staying mobile while using the ice packs or by getting up half way thru the session and moving gently in the pain free range for a repitions.

You can view my video about proper ice pack use here

People with skin conditions over the injured area, or those with sensory problems (eg Diabetes, neuropathy) should seek further advice prior to using ICE or Heat.

Heat is tricky. Heat is the opposite of Ice. Heat can help the muscles to relax but it can and usually does aggravate inflammation. If you suspect it is just a pulled achy tired muscle then you can try using heat packs. But be warned. Heat always tends to feel good while it’s on. It dilates the blood vessels bringing more soothing warmth to the area, as well as blood and fuel for the fire(inflammation). If there is inflammation present, (and if its fresh there usually is) you may be lucky and feel it while the heat pack is on and common sense would tell you to take it off and not use it again. However, it usually just feels good while it’s on, but an hour later you are worse due to the blood bringing in more swelling, inflammation and the heat activating those inflammatory chemicals. If you don’t know any better, you put the heat on again because it felt so good the first time, and you get relief again, but an hour later you are reaching for the heat pack. Viscous cycle? You are now contemplating putting that hot water bottle on while in bed to help you sleep. Unfortunately you wake very sore, stiff and yes, more inflamed. We swell more at night, our circulation slows, we don’t move around as much and we are usually more inflamed. Please don’t get trapped by the heat pack! If you try heat packs,(maybe because you are nesh and scared of cold), use the Wheatie bags or hot water bottles and make sure it isn’t going to burn your skin. The gel packs are best as ice packs only and I wouldn’t recommend using them for heat. These packs can crack and hot lava like gel on the skin burns! With heat packs they can stay on 30 minutes. Stay vigilant over the next hour and watch for any signs the heat has aggravated any inflammation. You can check by seeing if the pain worsens and if you are now more tender to touch then before. If so, stop using it and consider using the ice packs. Heat packs work very well when it’s just tight muscles and there is no inflammation. One or two applications of the heat pack should have you feeling much better, so if you are on the 4th application of heat and are no better, consider ice.

When working at a desk or using a computer, be sure to avoid injuries from strained posture. Sitting all day puts increased pressure on the lumbar discs, making you susceptible to Low back pain. Sitting and using your desk poorly can cause even more problems like fatigue, headache, Neck, shoulder elbow and wrist pain, not to mention trapped nerves.

1. Elbows rule
When sat in your chair, the elbow should be rested at the side of the body, forearms at 90 degrees to the arms and the hands should be within easy reach of the keyboard and mouse. When your elbow come away from this position, they cause strain to the shoulders and cause you to slouch.

2. Don’t be Shy, Sit Closer to the desk
Often the reason why people can’t easily reach the mouse and keyboard (Elbows Rule) is that they are sitting too far away.

3. Apply the Goldilocks principle
Getting the most expensive chair possible doesn’t mean it will be the best, it will just be the most expensive. Look for a chair that swivels, and no arms. Swivels will let you spin around rather than twist your lower back. Keeping your shoulders pointed in the same direction as your knees keeps you from twisting and isn’t really possible unless the chair swivels. No arms means you can keep tip #2 and get close enough to the desk. Arm rests often get caught on the desk and doesn’t allow you to get close enough to your keyboard and mouse. Goldilocks principle, for those that forget the story of the 3 bears, pick the chair that suits you best.

4. Watch your mouse
Often computer users start out with their elbows close but as the day progress, the mouse gets pushed further away by paper work or coffee cups. When the elbow is straightened and you are on the mouse, this strains the shoulder and neck joint. Avoid this by using document holders or keeping paper work and cups on the opposite side of the mouse.

5. Be a Square
Keep your knees and shoulder square on to the computer screen. Having the monitor off to the side will make you twist your neck, not a good idea. The top of the monitor should be level with the top of your head. Often the monitor is too low.

6. Laptops don’t belong in your lap Crazy name really.
If you read the laptop instruction manual (doesn’t everyone?) Its interesting to see that they don’t advise you to use it on your lap. The reason for this is that it will overheat! The air vents are underneath and placing it on your lap blocks them. I would also add that this position will break all the advice above and leave you sitting slumped over in poor posture with burning thighs and a broken laptop. Use your laptop with an external keyboard and mouse and have the laptop raised up on a laptop holder or set of books.

7. Take a break
Have a Kit Kat if you like, but remember to take frequent breaks, ideally every 30 minutes. Computer work can have a time warp effect and you may spend a lot longer on it than you intended. Applying all the rules will only limit the stress of riding a desk, breaks are important.

8. Seek help
If you suffer headaches, neck tension, shoulder pain or other symptoms that get worse at while on the desk or computer... seek help. Check to see if you need to make changes. Often companies will have a workstation assessor, they will assess you equipment, make sure you use it properly. If symptoms don’t clear up soon call for further help.

1.Pick Good parents
There is a genetic link with low back pain. As well as certain types of arthritis and congenital abnormalities, research is also finding that Mechanical low back pain can be caused by inherited weak intervertebral discs. Don't blame your parents just yet. Most health conditions are a result of genetics and lifestyle. If you parents suffered the dreaded lumbago, sciatica, crumbling bones and rheumatics, you should do everything else you can to keep your spine out of trouble. If you have no family history of back trouble you should still keep reading.

2.Keep Moving
The joints were designed for movement. Contrary to urban myth, the human spine is perfectly designed to walk and stand upright. Unfortunately modern man spends a lot of time sitting, and this is where the spine design can fail. The joints, not just the spine, are nourished by movement that pumps the synovial fluid around. This lubricates the joints, washes the grit away and brings in the nutrients that rebuild the joints.

3. Sleep Tall
Avoid sleeping on your front. If your low back survives years of sleeping on your front, your neck usually wont. To breathe when face down, you have to turn your head to the side. If you knew someone that kept their head turned to the side 7 hours a day would you be surprised if they developed neck pain? Sleep on your back or side. When sleeping on your side, don't curl up into a ball. This puts unnecessary pressure on your back. Try to sleep tall instead.

4. Use a thick chopping board
Stooping at a counter, like when you are preparing veg for cooking, is very tough on the lower back. Using a thick chopping block can raise your work surface high enough so you don't need to stoop. It’s cheaper than having all the counter tops raised. Make sure any work surface, either at home or work is high enough so it doesn't make you stoop or lean.

5. Shave in the Shower
Men Only! this Tip only applies to shaving the face. Lumbar Discs are at most risk in the morning because they are most swollen at this time. They have been soaking up water all night while sleeping, thus we are also taller in the morning. Stooping in the morning can put enough pressure in the lower back to make the fittest persons back ache. Shaving in the shower means you don't have to bend over the sink. This may apply to the way many people wash their face and brush their teeth.

6. Ice
Try an Ice pack when your Low back is hurting. Wrap Ice, gel pack or frozen peas in a tea towel, apply 20 minutes on, take it off 30 minutes and repeat as necessary. Move around a bit if the ice makes you feel stiff. You should discontinue if you feel worse. Heat can help muscles ease, but most recent injuries are inflamed. Heat can make inflammation worse, usually an hour later. Ice is a natural anti-inflammatory and can numb the pain.

7. Don't ignore pain
When you know you have done something out of the ordinary and its upset your joints, give it rest. Pains from strains that hasn't healed up on its own within two weeks may need some help, so seek advice from a health professional. If you can’t think of what you've done to upset things, seek help if it hasn't settled in a week. Most musculoskeletal problems respond very well to treatment. I often hear patients that have suffered for years say they wish they would have come sooner.

8. Don't panic
Low back is rarely deadly or a sign of impending doom. If you have Spinal pain and onset of other symptoms that worry you, then seek help quicker. Needless fear and worrying can turn a simple case of mechanical low back pain into much bigger trouble. Fear adds extra muscle tension as well as making people scared to move at all. As Tip 2 says, you need movement for joints to work properly, including healing themselves. Listen to your body and do what movements you can. For example. Patients with acute neck pain, often become very scared to turn their necks because of pain. They will walk around for days like Frankenstein keeping their necks stiff. This makes things worse. Walking around all tensed will make other muscles stiff and sore and can frighten people into thinking their condition is now spreading! This can fuel their fear and all that extra muscle tension puts more and more pressure on the joints and thus more and more pain. Things can get out of hand for the patient quickly when this happens. If you feel this happening with your Low back or neck, seek reassurance from a health professional quickly.

If you'd like instructions for a morning routine that will help you keep your back in good shape check out this video

I get asked “What mattresses are best and what’s the best pillow?”

My answer has been based on the experience of patients over the last 13 years. There hasn’t been a lot of scientific research to help guide people, until now. After trolling through some journal articles in the Annals of Internal Medicine from 2007 and a recent one from Australian researchers published in Manual Therapy 2009 I can back up my advice with good references.

Forget about sleeping on doors and floors. An old wives tales that helped the old wives kick their husbands to floor every time he complained of his back pain, she was only curing her “pain in the neck” figuratively speaking. Don’t sleep in a super soft cushy bed like Goldilocks either. This fairytale ended up with that poor little bear’s porridge eaten, bed slept in and chair broken. If she had a bad back before her journey of destruction, Goldilocks back wouldn’t have felt any better from an afternoon in that super soft bed.

The researchers found that a medium firm mattress offered more relief to those with chronic Low back pain than a soft or firm mattress. Personally the vast majority of patients do well with the memory foam beds and most only need a “topper” put on their existing mattress to do the trick for them. Apply the marmite principle or roll the dice when it comes to waterbeds, you’ll love it or hate it. Remember to sleep tall, not curled in a ball and stay off your tummy when sleeping. A small Pillow between the Knees can often stop your pelvis from twisting and help relieve hip and Low back pain. The research with Pillows was on side sleepers. They haven’t done the studies with people who sleep on their backs and don’t advise (as I do) people to sleep on their fronts.

The winner in the study was …Rubber Pillows but don’t worry you probably already have the 2nd best one. The study found that Rubber Pillows were best and that the subjects usual (i.e. the pillow they already had on their beds at home) was second best. The rubber pillows are also called Latex pillows and are not like what’s on an inflatable lido. The study actually used Dunlopillo makers from the UK. I am not sure if “old wife tale tellers” promoted Feather pillows, I just imagined they would, but feather pillows were found to be the worst and cause the most pain. They also found that normal shaped pillows were better than contoured and “lipped” shaped pillows. The pillow height recommended was 115mm. With regards to pillow positioning, remember to keep the pillow and pillow case only for your head and not your shoulder. Consider your pillow as the culprit if your sleep is poor, can’t get comfortable at night, wake with stiff necks or suffer chronic neck aches, especially if you feel much better when you go on holiday and use a different pillow. If you change your pillow it may take 2 weeks to settle into it.

If you'd like to know how to get in and out of bed when suffering from Lower back pain please check out this video

The only thing worse than a pain in the back, is a pain in the back going down your leg. (Although I believe patients with Disc bulges in the neck would make most back pain sufferers feel quite lucky). If you are unfortunate to have leg pain associated with back pain this article may help. Sciatica, technically speaking, should mean irritation of the sciatica nerve causing pain in the distribution of the sciatic nerve. (Which should involve the pain extending from the buttock, down the back of the thigh and calf into the toes).

However Sciatica has taken on a life of its own and most people use the term to refer to any pain down the leg, even if it’s in the front of the leg, or only to the knee. Unfortunately, this can cause problems finding the right diagnosis and therefore the right treatment. Sciatica can be confused for pain coming from the hip. Osteoarthritis of the hip often involves some pain around the hip, the buttock, lower back, outside of the upper leg, inside of the upper leg where it attaches to your body(most people call this the groin). Not everyone is an expert in anatomy and when you are in pain you might just say “it hurts in my back and in my leg”. You wouldn’t be wrong. (I had similar misunderstandings when I first came to the country asking patients to take their pants off, I wasn’t wrong either because pants meant trousers in Canada! Oh the funny looks I got) Your parents suffered sciatica, so when your told its sciatica, you may be happy to join that never ending queue of people suffering too.

Unfortunately, if you do have a worn out hip that gets diagnosed as sciatica, you probably will be a very long time before you get an Xray to get the hip diagnosed. A fairly simple way to tell the difference is the figure four test. Lay flat on your back, bend the knee on the bad leg up until your foot is resting on the ground at the same level as the good knee. Keep the foot where it is, but now let the bent knee fall out to the side(slowly). If the hip is in good shape and your knee reaches more than half way to the floor without bringing on hip or groin pain(not just a stretch from your inner thigh muscles) your legs will resemble the figure 4(well your right leg will, the left will look more like a P). If this position recreates your pain and doesn’t make it over halfway to the ground then its likely your hip is the source of your problem. While hip replacement surgery is quite successful, there is an ideal age range to be in to get the maximum benefits. Low back pain and Sciatica sufferers don’t always know their treatment options.

Whatever the outcome, sciatica or hip trouble, manual therapy is an excellent treatment for both conditions. Doctors of Chiropractic use osseous(bony) manipulation, neural mobilizations, soft tissue therapy and exercise to help restore normal function and bring relief.

If you'd like to know how to exercise lower leg nerve mobility check out this video

Rheumatism is an old label given to achy joints and muscles. The usual diagnosis for most rheumatics is actually Osteoarthritis. Unfortunately most people here the word arthritis and conjure up images of wheelchairs, surgeries and endless suffering. There are various types of arthritis and one of the types that can be more severe is Rheumatoid Arthritis, also called RA. This sounds a lot like Rheumatics and this is what confuses people. RA is an autoimmune disease where the body’s immune system turns on itself and attacks the patient’s own joints.

When these attacks happen and the patient suffers a “flare up” there is usually very visible redness, swelling, hot to touch and constant pain around the joints as well as flu like general unwell feeling. Repeated flare ups can be quite destructive. (If you have these symptoms for the first time, you need immediate examination to rule out infection which can be very quickly destructive in the joints) Fortunately strong medication can help stop the flare ups. With Osteoarthritis, aka Rheumatics, there is usually just pain and stiffness. The analogy I give my patients is comparing it to rusty joints.

A rusty door hinge will get stiff and creaky when you haven’t used it in days. It will also creak and groan from constantly being used or when it is slammed shut. The joints are the same, sit with your hips and knees bent for hours and they will be stiff and painful when you get up, like wise if you go for a challenging walk you may get aches and pains. Usually there can be a balance of keeping that hinge well oiled, use it properly every day and it creaks and groans a lot less. Sometimes you need a new hinge; we can only have replacements for some joints! Patients suffering Osteoarthritis are usually prescribed anti-inflammatory medication like naproxen and diclofenac. These patients also do very well with mobilizations and manipulation (having their joints manually stretched open to decrease the pressure on them), acupuncture, massage therapy and home exercises.

For those over the age of 65, a specific form of low back pain which can also produce lower Leg symptoms and significantly affect quality of life is lumbar spinal stenosis (LSS).

Narrowing of the spaces where the nerves travel through in the lower spine is called Lumbar Stenosis. The nerves carry messages to and from the brain down into the legs and feet. When these nerves get squeezed by a narrowed or “stenotic” spine, problems arise usually as an ache or weakness in the legs. This narrowing usually happens slowly over time from ligaments that thicken and narrow the space for nerves or from of wear and tear bone spurs common in the lower vertebrae. Sometimes it’s just the shape of their vertebrae (blame your parents). Symptoms usually progress over months but can be much quicker.

Patients with Lumbar Stenosis usually suffer with Low Back pain and Leg problems like fatigue or heaviness in the legs. This makes standing or walking for long periods of time very difficult. Most noticeable when standing in a shop to have a chat with friends. Bending or sitting gives quick, although temporary, relief. Often the patient is quite comfortable or pain free at rest while sitting.

Once they start walking, maybe 50 yards more or less, the legs become very heavy or painful. Patients often feel like someone is turning the power off in their legs with each step but as soon as the patient bends over or sits down, the pain is gone and after a short rest they can walk again, albeit a limited distance. Patients suffering Lumbar stenosis can often cheat by pushing a grocery cart and leaning over. They can walk much further this way. If slowing your speed makes it possible to keep walking further, then the problem is more likely fuel to your muscles. This is caused by blood circulation problems.

A recent research article suggested Chiropractors may help these patients by improving movement in joints around the narrowed vertebrae particularly the Hip joints and upper back. Chiropractic manipulation certainly helps as well as the advice on specific exercise to increase strength and mobility.

If you're having trouble getting up from a chair then try the method in this video.

Many people suffer headaches, even more with all the doom and gloom in the media at the moment. It is always surprising for me hear people say they just suffer normal headaches. People can be suffering from headaches for years and become used to living with pain in their head and neck, missing out on activities because of bad heads and getting nasty with friends and family. Headaches are very common, but are not normal. Most over the counter medication tries to relieve the pain, some prescription medicine can help with the cause of the headache, but unfortunately not always successfully. There are different types of headaches, with different causes and knowing the cause can often lead to the cure.

Headaches can be caused by reactions to foods. Migraine type sufferers will have noticed they my be sensitive to trigger foods like shellfish, cheese, red wine, unfortunately chocolate or foods containing chemical additives. Ladies may see a pattern with there headaches coinciding with their menstruation cycle or ovulation and may also notice changes in their headaches when they are pregnant or go through the menopause. Dehydration and low Blood sugar is often a culprit in headaches and solved by drinking plenty of water, (sorry tea and coffee wont do, drink water), and not skipping meals. Some people with hypoglycaemic headaches (low blood sugar) may also need to have a snacks in between meals. Oats, nuts, dried fruit and meat release their energy slowly and keep blood sugars more level. Sugary foods like chocolate may stave off a Hypoglycaemic headache for a short time with a quick spike of blood sugar but this is usually followed by a quick drop an hour or so later.

Medication is a frequent cause of headaches. Analgesic (pain relief medication) induced headache is a paradoxical vicious cycle. People start taking pain medication for headaches. After a while of continuous use, usually many months, their body get used to the drugs and they end up getting withdrawal headaches when the drugs wear off. This leads to them taking the drugs again, setting themselves up for the next headache when their body craves its next dose. If you have found yourself taking analgesic medication most days for headaches, this may be you. Checking with your GP or having a Medicine Use Review(MUR) at the pharmacy can often help.

The most frequent cause of headaches I treat is Cervicogenic, a fancy way of saying its coming from the neck. It may be the muscles, vertebral joints or nerves that become irritated by stress, tension, strained postures, road traffic accidents, arthritis(spondylosis) and repetitive strain injuries. The pain from these headaches can be felt in the shoulder blades, neck, back of the skull, around the ears, eyes, temples, all over the skull or all of the above.

Weekend headaches, (not from the night out) can be caused when you sleep in longer than normal. This means your neck stays stuck in a position hours longer than normal, upsets the joints and voila, a headache for you start the weekend. Solve this by getting up after your normal number hours of sleep, stretch your neck a few times (look all the way to each side and then downwards) then go back for a few more hours sleep. Sleeping face down will likely aggravate any neck problems, even on a weekday! Vari-focal eyeglasses cause people to tilt their heads, often straining the neck and causing a headache. Try using reading glasses for reading. Reading with a book in your lap (or worse…laying on your side in bed!) will strain the neck as well. Try sitting up tall with the book resting on pillows in your lap. This should raise the book closer to eye level and stop you from having to look down. Consider a visit to the optometrist if your headaches are brought on by reading and its not relieved by posture changes. Patients suffering these types of headaches often find themselves rubbing their necks (or getting someone else to if they are lucky!), are likely to have poor posture or work posture(looking down at a workbench or computer screen) and have often had a neck injury.

Once the history and neurological examination help rule out most nasty causes of headaches, the orthopaedic exam will usually reveal restricted neck movements, reproduction of pain when the culprit joints or muscle is pressed and often relief when the strain is removed. Cervicogenic headaches can often be solved by using proper posture when at work, home, sleep or play. Headaches of this type respond very well to chiropractic treatment and acupuncture. Don’t continue to suffer needlessly. Headaches are rarely caused by something terribly serious.

Please seek medical help if you have a change in your headaches with frequency or severity, you have a severe headache which comes on suddenly, and is unlike anything you’ve had before, you have a severe headache which comes on suddenly, accompanied by a very stiff neck, fever, nausea, vomiting, and confusion, your headache follows an accident, especially if it involves a blow to your head, or you also experience weakness, numbness, slurred speech, and/or confusion. These symptoms need to be checked quickly.