Dr Liz Borham
A recent paper (1) published in the British Medical Journal (BMJ) looked at paracetamol (commonly known as the brand name “Panadol”) and its safety and efficacy, or how well it works, for neck pain, back pain and osteoarthritis of the hip and knee.
The authors of this paper analysed thirteen different research studies that compared the safety and efficacy of paracetamol with placebo. They concluded that paracetamol is ineffective in reducing pain intensity or improving quality of life in people with back or neck pain who took this drug, when compared with people who took a placebo. In addition, the authors found that people taking paracetamol had a higher chance of having abnormal liver function.
So this high quality study concluded that paracetamol is ineffective in reducing pain or improving function in people with back pain, and in fact it may be causing unwanted side effects in the liver. What options does that leave us in dealing with back or neck pain, a very common and debilitating symptom in our society?
Fortunately there are a range of non pharmaceutical treatment options (2) for back pain that have been shown to not only reduce pain and improve function, but also avoid the common side effects of pharmaceutical options.
- Get adjusted!
There is good evidence for spinal manipulation in the treatment of chronic back pain and in the improvement of function and wellbeing. Chiropractic patients dealing with neck and back pain report reduced pain and better function as well as feeling less need for pharmaceutical pain relief. Using chiropractic techniques such as ABC restore optimal structure and function to the body, resulting in less pain. An important part of your spine’s health and function is impacted by how you sit, sleep and stand. Make sure your sitting, sleeping and standing postures are not putting too much strain on your body and leaving you vulnerable to injury, dysfunction and pain. Ask your chiropractor to show you how to set up your desk at work, or how to set up your pillow. Better still, come to one of our free “Sit, Sleep, Stand” workshops, held monthly at the CBD, Blackburn and Watsonia clinics.
- Get active!
Physical activity is considered important in both preventing and managing back pain. People who are overweight or obese are more likely to experience low back pain, in particular. All forms of exercise have been shown to be helpful in reducing chronic pain and managing your weight is one of the best ways to manage the pain associated with osteoarthritis. Find something you enjoy and do it regularly. Exercising outdoors is even better, as 15 minutes of sunshine is needed daily for vitamin D production by the body.
- Eat well and add nutrients!
Another way to manage pain and to maintain an optimal weight is to eat regular balanced healthy meals. Increase your fish intake to around three times per week, and limiting red meat intake to around twice per week. Moderate coffee and alcohol consumption is recommended, but honestly assess whether these items help or hinder your symptoms. Things to avoid include hydrogenated fats (fried foods), processed sugars and processed foods, for example white bread, white pasta, and pastries. Omega3 fish oils are antiinflammatory and can reduce chronic pain. Certain herbs also have these effects devil’s claw, willow bark and turmeric. Turmeric has been shown to reduce the need for nonsteroidal antiinflammatory drugs, NSAIDs (commonly known by the brand name “Nurofen”). Magnesium is great for treating acute muscle spasms and painful trigger points. Vitamin D3 can help control pain in people who have low levels of vitamin D (checked via a blood test). Topical gels containing capsaicin, comfrey or menthol can provide short term relief. As with all recommendations, these are of a general nature and you should assess for yourself whether you experience benefits from these therapies. A good way to start is to set yourself a goal, introduce one new therapy for three or four weeks and then reassess where you are at. Keeping a diary is a great way to keep track of symptoms and to assess your progress. If you have any questions, ask your chiropractor. Good luck and be well!
1 Machado GC et al, “Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and metaanalysis of randomised placebo controlled trials”, BMJ 2015? 350.
2 Kotsirilos V et al, A guide to evidence based integrative and complementary medicine, Churchill Livingstone 2011.
Your Life Depends On This Mineral
Dr Hasan Helou
If you’re feeling run down, stiff or you just can’t seem to get a good night’s sleep, or if you find yourself tossing and turning with legs that ache, there’s a good chance you may be deficient in magnesium
Magnesium is the single MOST IMPORTANT MINERAL for maintaining electrical balance and metabolism in our cells. It is responsible for over 300 critical enzymatic actions in our body!
What would happen without magnesium?
– Our brains would simply stop working. Magnesium is a highly conducive metal… and our brain works because of electricity.
– Our nerve impulses (how our brain talks to our body) would stop transmitting.
– Our bones weaken, and our joints and muscles stiffen. This is because you NEED Magnesium to move the calcium in your body. One of magnesium’s many jobs is to move calcium from tissue to your bones. This makes your bones (and teeth) strong. So when calcium is not moved… it starts to calcifies your muscles and joints. So, essentially if calcium gets ‘stuck’ in your body except your bones, this could lead to osteoporosis and fractures.
So be sure to include plenty of magnesium rich foods in your meal plans each day. Some magnesium rich foods are listed below:
|Almonds, Brazil nuts and pine nuts||Sunflower and pumpkin seeds|
Osteoarthritis and Nutritional Supplements
Dr Liz Borham
Many people come to our practices having experienced the symptoms of osteoarthritis, or degenerative joint disease (DJD), as it is more correctly called. DJD is the most common joint disease in the world and it is one of the most common causes of pain, loss of function and disability in adults.
Nutritional supplements that promise to help with DJD/osteoarthritis are heavily promoted in the media – fish oils, glucosamine, krill oil, topical gels and creams, pharmaceutical pain relievers – the list is long and varied. People with DJD commonly ask what they can take to help with their symptoms. Do these things actually work? Can they reverse the disease process?
This article discusses some of the nutritional supplements that research has shown to be effective, and other lifestyle changes that people can consider to improve their quality of life.
DJD can be thought of as “wear and tear” of joints. It is caused when there is damage to the articular cartilage of joints – the material that keeps joints moving smoothly. This usually happens in joints that bear the weight of the body – hips, knees and the low back. Common signs and symptoms of DJD are a deep, aching pain and stiffness that is generally worse after a period of rest, such as first thing in the morning. People with DJD report that it “takes a while to get going” in the mornings, but they are generally fine with some movement and perhaps a warm shower. They also report feeling some “crunching and creaking” in affected joints, and they usually know when it is going to rain!
Glucosamine sufate has been shown to improve mobility in patients with DJD (less stiffness and better movement) as well as reducing pain.
In severe DJD, especially in the knee, a glucosamine/chondroitin combination supplement is more effective than glucosamine on its own.
The usual dose of glucosamine sulfate is 1500mg 1-2 times daily, and 1200mg per day for chondroitin sulfate. It can take a long time to see changes, at least 4-6 weeks. Take the supplement for at least two months before deciding if you notice any difference.
A couple of warnings with glucosamine – it is usually made from seafood products so avoid it if you have an allergy to shellfish. It can also interact with some drugs, including warfarin and NSAIDs (anti-inflammatory medications). It may aggravate asthma in some people. Always tell your prescribing doctor and pharmacist about any supplements that you are taking.
The usual dose is 3-7g per day. Some pain relief should be seen after about a week of taking fish oils. There are few side effects; fish oils are generally well tolerated especially if taken with meals.
Beware if you take anti-coagulant/blood thinning medications such as Warfarin – high doses of fish oils can be dangerous in these cases. Always mention to your prescribing doctor that you wish to take fish oils and they can advise you. Also avoid fish oils if you have an allergy to seafood.
S-Adenosyl Methionine or SAMe has been shown to be as effective as NSAIDs (anti-inflammatory medication) in reducing the side effects of DJD, with significantly fewer side effects. SAMe might be worth a try if you experience troubling side effects from NSAIDs, or can’t take them due to ulcers.
The usual dose for SAMe is 400mg 2-3 times per day, and people usually see changes within 1-2 weeks. Side effects are mild and rare, but avoid use with anti-depressants and bipolar (SAMe may interact with anti-depressant medications). Do not use during pregnancy or lactation.
What else can I do?
DIET – your dietary choices can have a major impact on DJD symptoms. Obesity is a well recognised risk factor for DJD so keeping your weight at an appropriate level is important. While there is no evidence recommending any particular diet or eating plan, some patients find great benefit from a primarily vegetarian or Mediterranean-style diet – that is one composed mostly of vegetables and fruits, fish, wholegrain cereals, beans, nuts and seeds. There is limited red meat and dairy in this type of diet. Extra virgin olive oil, a staple of Mediterranean diets, contains oleocanthol, which acts as a natural anti-inflammatory and may help reduce arthritic pain.
Some small research studies have shown that a diet rich in vitamins C and D – citrus fruits, blackcurrant, capsicum, kiwifruit, eggs – can slow the progression of DJD in some people.
Some foods are also good sources of fish oils – try adding herring, salmon, sardines or mackerel into your diet as these are the best sources of omega-3 EPA and DHA essential fatty acids.
In addition, avoid highly processed foods, hydrogenated fats, salt, fast foods, coffee and chemical additives.
EXERCISE – physical activity is one of the best things you can do to alleviate the symptoms of DJD. Many research studies have shown improvement in patients who undertake almost any form of exercise – so do something you enjoy. Water-based activities are particularly good – swimming, water aerobics – as the water provides some buoyancy and improves the range of motion of joints.
If you want to try a nutritional supplement, choose a good quality product in consultation with your chiropractor and prescribing GP. Give it a try for a couple of months and see if it makes a difference for you. Also try some dietary modifications and get moving!
Kotsirilos V, Vitetta L, Sali A. A guide to integrative and complementary medicine. Churchill Livingstone; 2011.
Sarris J, Wardle J. Clinical naturopathy: An evidence-based guide to practice. Churchill Livingstone; 2010.
Yochum TR, Rowe LJ. Essentials of Skeletal Radiology. 3rd ed. Lippincott Williams & Wilkins; 2005.
Braun L, Cohen M. Herbs & natural supplements: an evidence-based guide. 3rd ed. Churchill Livingstone; 2010
Why Do I Have To Keep Coming?
Dr Ben Coupe
Let’s start off with a classic chiropractic joke. “How many chiropractors does it take to change a light bulb?” “One, but it’ll take three times a week for four weeks then one time a week for the next 8 weeks etc etc”
There’s no doubt that chiropractors get slack for their schedules of care. Whether it be schedules lasting weeks when all you want is for us to “put it back in” or that once you start you always need to keep coming.
This is reflected by how some people present to our office. They desire care but are already on the defensive about how often they need to come in. In fact I’m sure this results in some people never walking in to a chiropractors practice in the first place! It can even go a step further and create a level of mistrust in the chiropractor. A sense that we schedule this way for our own hip pocket!
I thought I’d take this opportunity to help explain why we do schedules of care.
First and foremost let me make it perfectly clear. You don’t have to keep on coming! In fact you don’t have to do anything in our practice. You decide exactly how much care you desire. The choice is always yours.
If your goal is to feel better as soon as possible, well have a guess what, that’s our goal too. I mean who wouldn’t want to feel better ASAP?
The difference with our practice is that we know there’s potential for better. Many times the pain that you present to our practice with is just the tip of the ice berg. Skeletal misalignments and their resultant compensations can start from a very early age. Even at birth for some unlucky ones. It takes years however for these misalignments to build up enough, one on top of another, to manifest into postural problems that lead to pain and/or dysfunction. The more we can work back through those layers, the better you are.
This is not just a concept either. At our practice we can measure this through photographic and x-ray evidence. Those who have been with us long enough will have numerous examples of massive improvements in photos and x-rays that correlate with massive symptomatic improvement.
This is also why we have tailored our schedules of care to help you define your goals more easily. Whether you’re after short term pain relief, further stabilisation of the underlying problem or full body optimisation, the choice is yours. You tell us what you want and we’ll tell what’s required to get there.
So in summary it’s not about having to come in a set number of times but rather a system that delivers the best possible result. We hope to inspire you to want more than just resolution of pain, and instead for a body that feels and moves optimally. The choice however is always yours. We see our role as getting you as far as your want to go.
On Throwing Out Birkenstocks and Sleeping on the Floor
Dr Richard Martin
Birkenstock sandals were my stock standard Summer casual footwear for years. You know the
ones, formed like a hard mould of your footprint. I even used to think they were good for me, I
guess I just assumed their marketing was fact without thinking much about it. In a way though they
were good for me – a good compensation for the state my body was stuck in at that time. Then I
started ‘unwinding’ (getting adjusted regularly using the Advanced BioStructural Correction ™
method). Pretty soon Birkenstocks started to be the shoes I couldn’t wait to take off, my body was
changing and the ‘support’ was a hinderance. I began feeling the hard shape, it ached, my feet and
body got tired whenever I wore them. Eventually I swore off them and in a watershed moment I
rounded up my three or four pairs as well as some walking boots that boasted a similar feature and
I threw them out. I hated myself for the waste but in that moment of clarity I couldn’t have in clear
conscience given them to anyone else. On testing, my body had became slouchier when in them
and having been in them my posture would never quite recover. It was clear to me that they were
re-setting misalignments and slowing down my unwind or at least making the process a lot less
Of course I had been warned about all this. It’s not my discovery, I just didn’t believe it would
matter that much. It does! (Side note: this Summer choose firm thongs or sandals without any
arches – get to a Sit Sleep Stand class to learn why).
Anyway speaking of slow learning…. I was away for the long weekend recently and hit another
watershed moment: I’ve finally decided not to waste holidays with a drained body and mind caused
by soft beds (I long ago sorted this out at home). There I was feeling sore and tired despite having
a relatively relaxing break when I read a post of Dr Viktor Otterskog’s bemoaning his lethargy and
soreness whilst sleeping on a soft bed during his travels. An immediate recovery on returning to my
home bed confirmed my suspicions: again, it matters that much.
This somewhat spoiled family holiday made me think of how many of our patients feel unwinding is
less powerful or slower or more symptomatic than it should be as they haven’t been to our Sit
Sleep Stand (SSS) class or implemented these strategies for staying stable during unwinding.
Herein lies the apparent contradiction: the more locked up in a twist your body is, the harder it
seems to be put out further by bad shoes or beds or seats. This is why when people first hear our
SSS advice they don’t always convert their behaviours. Conversely, as you free your body up:
1. Your expectations of body ease and function are reset and you become more intolerant of
things that would previously seemed normal.
2. Your body is in a state of continuous change and you will more readily ‘upset the applecart’
doing the habits you once didn’t notice problems with.
So, at some point it becomes: follow the advice or feel less good than you should be feeling.
Twisted / Locked structure:
is LESS effected by inappropriate SSS behaviour but generally feels and functions POORLY.
is READILY influenced by inappropriate SSS behaviour but generally feels and functions BETTER.