We are inundated with choices in every area of life compared to previous generations. There are now thousands of electricity and gas tariffs and suppliers that you can compare on hundreds of comparison sites. There are almost as many choices of hot and cold beverage in your high street coffee shop. While choice and personalisation can feel like a nice thing it can also leave us feeling overwhelmed and even when we do make a choice we often end up wondering whether we’ve really made the best one anyway.

It’s difficult enough choosing a coffee let alone choosing a clinic or a healthcare professional to help you deal with a chronic health condition. If you have a chronic health problem (or problems) it’s likely that you’ve tried various different ways of tackling it – from seeing  your GP or a specialist, to researching for yourself, self-help, or consulting other healthcare professionals. If all of these endeavours have not got to the bottom of your problem you’re likely to feel frustrated and disappointed at the waste of time, money, and hope – and the fact that you’re still suffering.

When you’re continuing to look for help and solutions it can be incredibly confusing. Even if we confine ourselves to back pain (approximately 1,110,000,000 Google results) the information and misinformation out there is truly mind-boggling. You want to make the best possible choices for you but how do you even begin to narrow down your options?

As a clinical team specialising in helping patients with chronic back pain we have some advice for you to consider when choosing (or not choosing) a clinic.

  1. Don’t choose a clinic or a clinician who can’t talk to you about and demonstrate the positive (and less positive) results that they have achieved with patients like you. By that I mean patients with very similar conditions to you. Back pain isn’t a condition, it’s a symptom. Back pain can have a myriad of causes. If someone simply says they ‘treat back pain’ they may not have the sufficient expertise to help with YOUR type of back pain.
  2. Don’t choose a clinic or clinician who can’t provide you with any patient testimonials or who nobody you know has ever had good results with. Check out their social media reviews or there are lots of social media forums (support groups for health conditions, local community groups etc. or just your friendship groups) where you can ask for recommendations or post about a clinic you’re thinking of visiting to see if anyone has any experience. Of course just because others have had good or bad experiences doesn’t automatically mean you will; but it can help to reassure you and make your choice easier.
  3. On the other hand don’t choose a clinic or clinician just because they helped your friend / auntie / brother-in-law’s half-sister. Their problems and needs might have been quite different than yours. Also speak to the clinic about your specific healthcare and personal needs to better establish if they are right for you.
  4. Don’t choose anything or anyone who claims a 100% success rate or to be able to treat every type of back pain. There is no clinical evidence of a single product or individual being able to demonstrate this kind of success.
  5.  Don’t choose a clinic without speaking to their team and asking lots of questions. You need to feel comfortable with the personality or ‘vibe’ of the clinic as well as its clinical reputation. If you don’t feel that they ‘get’ you and that you can put your trust in them you are far less likely to achieve satisfactory results. Some clinics (like ours) are very happy to have you visit the clinic to speak to someone in the team and have a look round before you book an initial appointment. This is a good thing. Take advantage of it.
  6. Don’t choose a clinic just because it has a shiny website or marketing materials. While this can sometimes indicate that the clinic is successful and professional it can also indicate that they have focused more on brochureware than on patient care. Have a look for yourself at the premises – perhaps pop in and speak to the reception team prior to booking an appointment. This will give you a better sense of the real clinic.
  7. On the other hand don’t choose a clinic just because it’s cheap. It’s often the case that you get what you pay for. Even good clinics run offers from time to time but clinics that consistently charge under the market rate for a service might have to do so because they aren’t good enough to hold on to their new patients.

Of course there are lots of other factors that can come in to your choice of clinic. But we’ll leave it to 7 for now. After all, you already have more than enough choices to consider. Venti Soy Quadruple Shot Latte with No Foam anyone?

It’s hard enough to lose weight when you don’t have any additional significant health issues. When you also have back pain it can seem like an impossible challenge. Unfortunately, many people (and healthcare professionals) don’t look at and treat these problems as interconnected.

It’s all very well advising someone to eat less and exercise more to lose weight but if they are hardly sleeping because of pain and seriously worried about injuring themselves by exercising, then weight loss is going to be a real challenge. The flip side is that as long as someone is overweight they are putting additional stress on their spine and other joints, and the quality of their sleep is likely to be affected, and their aches and pains increased. Add to the equation the mental health effects of being overweight, living with chronic pain, and poor sleep patterns and it’s no wonder that people can get trapped in this back-pain-weight-gain cycle for years , with both their mental and physical health affected.

So, what’s the answer?

The first thing to realise is that there can be many reasons why someone is overweight and has back pain so there is no ‘one size fits all’ solution as the promoters of some wonder diets and wonder back pain products would have you believe. What has worked for your friend’s back pain or weight loss might not work for you.

Secondly it’s important to remember that weight gain and chronic back pain don’t happen overnight and nor do they resolve overnight. So don’t set yourself up for failure by hoping for an overnight solution and being disappointed when that doesn’t work.

With that in mind, we recommend some key steps to start to tackle this vicious circl

  1. Get a proper diagnosis for your back pain

‘Back pain’ is not a diagnosis – it’s a symptom. You may have very similar symptoms to your friend BUT quite different underlying causes. So rather than jumping around aimlessly from one treatment to another the first thing you need is an accurate and detailed understanding of the underlying causes of your SPECIFIC back pain.

Until you know exactly why you have, keep getting, and can’t shift your back pain, you can’t treat it successfully.

There are very few doctors and healthcare professionals who specialise in chronic back pain. Find yourself someone who specialises in this treating long term back pain and ask them about their track record (ask for patient reviews or testimonials, case studies or other results) before consulting them.

2. A combination of treatments and self-care are usually required.

If you’ve had back pain for a while or it keeps coming back, it’s likely that you’ve tried various approaches to dealing with it. You may have tried various types of manual therapy like physio, exercise like pilates, or other therapies like acupuncture but if your pain hasn’t gone you may feel they ‘didn’t work’.

However, all the latest research points to the fact that an integrated approach to treatment of back pain is the most successful. Standalone treatments can temporarily relieve symptoms but it usually takes a combination of treatments and lifestyle changes to get to the root of the problem. It’s not that these treatments ‘don’t work’ it’s just that you need to have the right combination of treatments for your particular type of back pain.

Now that you have a proper diagnosis for your specific back pain it might be that treatments you have already ‘tried’ have a role to play in helping you to recover or perhaps something new that you haven’t tried. Again, ask your specialist lots of questions about why they recommend a particular combination of treatment for you and what results they’ve had with that approach.

3. Keep (or re-start) moving:

Contrary to popular mythology it’s rarely necessary or beneficial to rest or refrain from exercise if you have back pain. In fact, it’s important to keep as mobile as possible. However, it’s true that you can do further damage to an injured back (especially if there is discal injury) through poor exercise technique or just bad movement habits (like bending to lift using your spine for power rather than using the proper manual handling techniques).

Seek out an exercise professional who specialises in working with people with your type of back pain and get some coaching in safe and effective exercise techniques for you.

The endorphins released through exercise as well as motion itself can both have a positive effect on pain and mood, as well as boosting your metabolism to help with weight-loss.

4. Nutrition and hormones:

In the weight-loss equation nutrition is generally considered even more important than exercise. This is not about dieting, low calorie foods, or deprivation. It’s about eating a well-balanced diet with as little as possible processed food and sugar, with plenty of vegetables and fruit, protein and carbohydrates. It’s also really important both for weight and back health to keep well hydrated – aim to drink at least 2 litres of filtered water a day.

There’s an increasing body of evidence that both weight gain and chronic pain are made worse by foods that have an ‘inflammatory’ effect on the body (processed foods, alcohol and caffeine are examples). So by cutting down on these foods not only are you likely to lose weight but you may well see an improvement in pain and other health issues (like IBS, skin health etc.)

It’s also possible that an underlying deficiency or hormone imbalance (for example low testosterone, thyroid issues or vitamin B) could be contributing both to your weight gain and aches and pains. If you haven’t already been tested by your GP it is well worth asking for the relevant blood tests.

If you have been prescribed medication for back pain, or other health issues (perhaps for diabetes) it’s also worth speaking with your GP about how medications for one condition could possibly be increasing other side effects. Sometimes a change of prescription, or treatments or lifestyle changes that enable you to gradually reduce or remove your medications, can make a huge difference. Always consult your doctor before changing your medications.

 

Back pain can be just uncomfortable or absolutely agonising. When you get it, worrying about how to deal with it and fear of making it worse can be almost as difficult as dealing with the pain.

SO WHEN SHOULD YOU TAKE ACTION AND WHAT SHOULD YOU DO?

?Urgent symptoms: if you experience any of the following symptoms in association with a back injury or back pain you should seek emergency medical assistance: numbness of the testes, penis, labia or anus; loss of bladder or bowel control (leakage or constipation), erectile dysfunction.

If you don’t have these symptoms and the pain is not unmanageable….

? Just started….. above all, don’t worry. You almost certainly will be fine within the next week or two. Stay as active as you can, but don’t overdo it. Take some anti-inflammatories and painkillers to help you. Use ice (not heat as inflammation makes the joint swell) and get the rest if you can; everything is worse when you’re tired!

?Started within last two weeks….maybe have a word with an acupuncturist or deep tissue massage therapist if you’re still in pain now. You’re probably stuck in a muscle spasm/joint injury cycle. It’s the body’s way of protecting you but it can mean that trouble goes on for a bit longer than necessary. It also usually means there is possibly some old injury or scar tissue that is perpetuating the issue for longer than normal.

?Started within the last six weeks…if it’s getting better, but slowly: don’t worry! You most likely did some damage to a ligament or a tendon and they take longer to heal and can be very painful. Remain active, try to ignore it, unless you have pain travelling down your leg or arms, experience numbness or tingling anywhere, in which case you need to get an expert opinion. If it’s getting worse you should speak to a chartered physiotherapist or your GP and possibly look into some tests. If you feel ill or feverish, or are experiencing issues with your bowel or bladder: go to your GP immediately, if you can’t get in: go to A&E. Yes, really.

?Started over six months ago… if it’s slowly getting better, and you are experiencing the occasional relapses (week by week things are getting better) then don’t worry! You probably damaged a disc. Contrary to popular myth, they don’t always need surgery, in fact research shows they usually don’t, but they are slow to heal because they don’t have the best blood-supply. Get a specialist opinion though, because there may be things you can do to accelerate matters and a healthy life-style, strong back and remaining active are some key ingredients!

If this isn’t your first rodeo with disc issues or things are not getting any better: it’s time to speak to the professionals. Disc problems, as a rule, don’t just occur, and whilst you don’t need to worry about surgery, it is likely that there are contributing factors if they keep happening. If you developed symptoms down your leg or arm, pain below the knee or into the hand: don’t wait. Just don’t. The longer a nerve is compressed, the longer it will take for the nerve to recover and that is the most painful bit of these. Non-surgical treatment is very effective and usually resolves most symptoms within 6 to 8 weeks.

If you would like some more advice on what the best next steps are for you please message us and we will put you in touch with the best person in our team to help you.

**** The above is general guidance and of course cannot replace the professional opinion or advice of a doctor or expert following a consultation and examination. If you are really concerned about your symptoms, if they have having a significant effect on your life, or you have additional symptoms you should always consult a suitably-qualified health professional ***

We are often asked by our new patients ‘why has nobody else told me this before?’ Why has nobody else found this, got to the bottom of this problem, and given me such a clear recommendation to deal with it.

Many of our new patients have a long history of back pain, headaches, or recurring injuries. Some have been struggling with these types of problems for ten or twenty years or more. They have – they tell us – tried everything. Chiropractors, osteopaths, acupuncture, yoga, physio, different types of pain-killers. Some help a bit, some not at all. But none of them have got to the bottom of the problem for a sustained period or for good. Check out a social media support group for people with chronic back pain and you will how much people suffer and how many different strategies they try – and often fail with.

Many of our patients have had surgery before they come to us. Multiple surgeries even. And yet they are still in pain; still unable to enjoy the ‘normal’ things in life that many of us take for granted. Like sleep. Air travel. Picking up a grandchild. Even tying a shoelace.

How can it be that these patients who have consulted so many doctors and therapists over the years, can walk into our clinic to be asked questions that they’ve never been asked before, assessed in ways they’ve never been assessed before, and given diagnoses and successful treatment protocols that they’ve never been given before?

Well, there are a few reasons, but here we’ll talk about one.

Firstly, like all types of expertise, as people become more ‘expert’ in healthcare or medicine they often tend to become more specialised. You start training as a doctor, then you specialise, and eventually you become a consultant in quite a specific area of medicine – knees perhaps, or wrists. While expertise can be a great thing it can also lead to a narrowing of focus and a reduced tendency to think laterally. If your primary tool is a hammer, then you will tend to see a lot of problems as nails.

However, most chronic musculoskeletal problems – like back pain, hip pain, knee pain (or all 3 together if you’re really unlucky) which haven’t been resolved by one tool or technique – for example physiotherapy – aren’t caused by just one thing and won’t be solved by just one thing. Even the best physiotherapist in the world (or best chiropractor or best pain specialist) has a limited scope of expertise, skills, and tools in their toolkit. They may be able to help you – to an extent – but it’s only by having the right combination of expertises, skills and tools, that complex long-term problems can be resolved.

Our new patient assessments and consultations take at least an hour and often more. We take very detailed medical histories; carry out a whole range of physical, neurological and functional tests; speak to our patients at length; carry out a range of biometric tests (spinal scans, body composition scans) and more. Often patients are assessed by two or more clinicians in our team, with different expertises. Sometimes the patient’s condition is complex and it’s easy to understand why nobody has got to the bottom of it so far. But other times there is something frustratingly simple at the root of their long-history of suffering.

Why do we pick up on these things when so many other clinicians and therapists haven’t? Because we don’t just look at the place where the patient is experiencing pain, we look at the whole patient, through the eyes of different experts and we work together to build a full picture. Or, to put it another way – we see the whole elephant.

 

Running Technique for recurrent injuries

Whenever you head out these days you are sure to see people running, donning the latest activity wear, water bottles, headphones and tracking technology. And why not, running is after all a great way of exercise, get out, gain stress relief and become a part of a community heading out for parkrun, fun run, marathons, travel …

However, the enjoyment for the majority is hindered by the utter frustration of injury and recurrent injury. It’s not surprising really, considering that a keen runner will put in a quite a few hours per week, each step taking 3 – 5 times the bodyweight in impact. If you weigh 75kg for example, that would be between 225 – 375kg per step for tens of thousands of steps per week. Much moreso if your technique is not good.

Answers to injury are often sought in the latest pair of trainers, exercises, and blogs. Perhaps rest is the answer, let it settle and try again, only to be disappointed. Of course keen Runners are desparate to get back out there and will just as soon as they can. Unfortunately, injuries lead to many giving up on the activity they love.

Were you ever taught to run?

Have you ever been taught and trained on HOW to run? Perhaps you went to swimming classes, golf lessons, your parent taught you to kick a football or throw a netball, the PE teacher taught you to forward roll or throw a javelin. Were you ever taught to run though?

For a few maybe, but for the majority No, of course not, you just do it don’t you, you crawl, walk and then run, right? Well in theory yes, but running is a skill and can be trained. Running technique can be the difference between efficient, enjoyable injury free miles or struggling and recurrent injuries. Overstriding, hip drops, a collapses, a cross-over, are some of the habits that may have developed but for that individual they aren’t helping.

Thankfully these can be assessed and re-trained. David Brown BSc (hons) is a Movement Coach at Core Clinics, Warwickshire and has a program to help. An initial assessment will consist of a Video Biomechanical Analysis to identify any areas of your technique that may add to your injury risk or lack of efficiency. A Functional Movement Analysis will also cross-check these factors. If changes are needed a program of 6 sessions of re-patterning is usually sufficient to retrain these habits, although some may need additional sessions or may need some preparation or rehab sessions before the program.

Sam recently ran 50miles, ‘I loved every minute, I can definitely tell the difference’, Shimmy had his assessment session due to recurring ankle pain, the following day he beat his Parkrun personal best and ran pain free! Debbie was suffering with her hamstring, but enjoys pain free running now. Helen arrived with knee pain, a few sessions later she was pain free, we then corrected her running pattern and now she’s happily putting in the miles…

Suitable for every runner, from Beginner to Serious Amateur, for Adults and Kids, for those who struggle and want to improve, for those who run in other sports and for those who are good and want to get better.

If you are enjoying injury free efficient running then there’s probably no need to change, however if you are blighted by recurrent running injuries book in now for an assessment session with David Brown, Movement Coach.

Core Clinics also have a range of clinicians to support Runners, from Sports Therapists, Podiatrists, Physio’s, Chiropractors, Dieticians, Psychologists, and Massage Therapists.

There used to be a coffee advert, I think it was the one with the couple flirting, where they boasted that it is the right blend of roasts that create their unique flavour. Well for people suffering with long standing musculoskeletal pain it is the right blend of interventions that are going to have the best success.

When clients come to Core, they all too frequently say ‘I’ve been to them all, you name them I’ve seen them, some of them help for a bit but then it just comes back. I had all but given up and then I heard about Core from a friend, so I thought I’d give it a go’.

Now over the years, they have probably been told numerous reasons for their pain, a spine out of line, weak muscles, foot collapse, tight tissue, blocked energy, the wrong foods; it’s all in your head … and so on. And to be fair, many of them would have been right; however the problem has been that each therapist has tried to only treat it from their own individual professional perspective and skill set.

If you only straighten the spine then the foot collapse and tight tissue will likely throw it all out before the week is out; if you level the feet but the joints are super stiff and you’re limping with an out-turned foot you’ve still got problems; if you do a really thorough soft tissue release but the skeleton and gait are all out of sync then it’ll likely all tighten up again pretty soon. I could go on and on . . .

However what if your programme consisted of the most pertinent two or three interventions for you, as you are presenting at that time. So now within the same period of time your feet are better aligned, your spine is straighter, your soft tissue is more mobile and you are walking and moving better. Perhaps that is not the right blend for you, perhaps it’s Massage, Shockwave Therapy and mobility exercises. Perhaps, it’s Podiatry and Movement Re-patterning or Chiropractic and IDD (Intervertebral Disc Decompression). But don’t decide on your own, let one of our clinicians plan it with you.

By having two or three clinicians working with you towards the same goal, using their own specialist skills, the piece of the jigsaw comes together and like many of our clients before you, you are suddenly enjoying a life free from pain.

Two or three clinicians wait a minute that sounds expensive; I’ve already spent a fortune trying to get this right. Well in the short-term there is an investment to be made to get on the right track, however before long as things ease the level of input required is reduced until you reach a stage when you just need to pop in once in a while to make sure things are still on track.

So going back to my point, for chronic pain, an isolated intervention may help but is unlikely to unravel all the problems you have been experiencing for all these years, however the right blend is the most likely to give life changing relief.

David Brown BSc (hons)

Movement Coach