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ACEUPDATE Vol 3 QIssue 13 Q July 2011 Where parallel lines meet Welcome to the latest edition of Ace Update. Since last I wrote there has been a significant addition to the clinic. Kingston Chiropractic Plus (KCP), which was previously on Surbiton Hill, has taken a room, bringing with them a very large patient list and three reception staff. For those of you who have already phoned or visited the clinic since June 20th, you will have noticed the difference. The ladies answering the phone are Sue, Danuta or Rose and Joanna, Stuart’s daughter, is still working on Fridays and Saturdays. So when you phone please book your appointment through them, there is no need to speak to the practitioners in order to do that. the history and philosophy of the profession. There are some differences between the two professions in the way that we work but ultimately we are in the business of pain relief and management. So if you have an urgent requirement for treatment and either Kathy or I are unavailable we will offer you the opportunity to see one of the chiropractors and we are happy for you to if you are as well. Oliver In addition to Neil and Zane, we also have Gary with us now. He is a sports therapist who worked at KCP and he is with us now on Thursdays between 12noon and 4pm. He offers sports injury management and massage and gives us an extra day to offer this service to all patients. So again, if treatment is urgently required and Sophie or Carlie-Ann are not available or are full we will offer you the chance to see Gary if you are happy to see him. KCP is run by Mr Neil Reilly who has been a chiropractor for 24 years, and he has an associate, Zane Hall, a South African, who has been with the clinic since 2004. Now, I am sure some of you are wondering how we can have ‘the rivals’ working at the same place. Well, from our perspective there is the simple economic reason that they are using a room five and a half days a week and paying us for that usage. So, big changes, but we hope that the nature of the clinic will not change. It is busier and a bit more business-like (from our perspective) but we will ensure that the atmosphere of the place remains relaxed and friendly. So, as and when you come in and are greeted by a new face from behind the reception desk, give them a smile, (they will smile back!) and if you do have any comments please pass them on. But actually there is no reason why we should not work in the same premises particularly since we are both established clinics with our own patient lists, individual reputations and are self-sufficient enough not to have the the anxiety of treading on each other’s toes. KCP will soon have their own telephone line installed so when you phone you may still get the answer-phone or you may be asked to wait a little while if the receptionists are on the other line. In either case please be patient and we will talk to you as soon as we can. Stop Press: For the past 3 years we have charged the same price for Osteopathy and we feel it is now necessary to raise them. Therefore, from this September Osteopathy charges will be: £40 – for a new consultation £33 – for a return treatment £45 – for my 1hour ‘osteopathic massages’ In this issue We have a couple of articles from KCP: Neil is writing about the history of his clinic and Zane is writing about 02 Magnesium. Could you be deficient?: Stuart McLean 03 Dealing with Chronic Pain: Sophie Capito 04 All in a line: Neil Reilly 05 What is Chiropractic?: Zane Hall 06 Get fit, live longer: Oliver O’Callaghan-Brown 07 Acupuncture can reduce period pain: Victoria Busk 01 Ace Osteopaths Complementary Health Centre www.ace-osteopaths.com Magnesium Could you be deficient? by Stuart McLean I am writing about this vital mineral due the large number of patients that, on testing, have shown deficiencies. Testing can be done either though a blood test or hair mineral analysis through Biolab laboratories. Another good indicator of possible deficiency can be seen by analyzing a 7 day food and drink diary. Nationally women tend to have lower intakes. According to the National Diet and Nutrition Survey 2003 only 77% of women aged 19 – 34 reached the recommended intake of 270mg/day. An even more worrying statistic is that 20 % of women don’t even reach the lower reference intake of 150mg/day. However a sensible serving would be around 20g, providing 118 mg. The advantage of pumpkin seeds is that they are easy to snack on. Wherever you are, at any time of day, you can pop a few pumpkin seeds in your mouth and get roughly a milligram of magnesium per seed. They are also rich in other essential nutrients such as zinc and selenium and others. The body needs magnesium in order to perform over three hundred different biochemical reactions. Magnesium helps sustain normal nerve and muscle function. It is also responsible for helping to keep blood sugar levels regulated, promoting healthy blood pressure. Magnesium is also involved in protein synthesis as well as energy metabolism. Chocolate Most of us love to eat chocolate – so here’s an excuse, sort of. The estimates of magnesium in chocolate range 100mg to over 500mg per 100g. Milk chocolate or other highly diluted chocolates are well below even the 100 mg figure, and not worth considering for their magnesium value. The thing to remember is that raw cocoa beans would be your absolute best source for magnesium, though they are certainly not to everyone’s taste, and not all that easy to find. A 10g square of 70-85% cocoa solids will provide about 23mg of magnesium. The first symptoms of magnesium deficiency can be subtle. Most magnesium is stored in the tissues, so leg cramps, foot pain or muscle ‘twitches’ are usually the first signs. Numerous clinical studies support that Insomnia, PMS, chronic fatigue, migraine headaches are also very common magnesium deficiency symptoms. Leafy greens All leafy green vegetables are rich in magnesium. 50g of raw spinach about 5 leaves provides 40mg of magnesium while 100g of cooked cabbage provides 24mg and just 5 brussel sprouts provides 20mg. So don’t forget the greens. So how can we ensure adequate intake of this vital mineral? Fish Many patients try hard to eat fish, objecting mainly to the taste. However Halibut is a fish renowned for its lack of taste needing to be spiced up. But it is very rich in magnesium, a 100g portion provides 107mg of the stuff; a good reason to eat fish. Best Sources of Magnesium: Oats Start the day with breakfast, oats and wheat bran are excellent sources of magnesium. Although cooking reduces its level it is still a good source. 40g oats cooked with water provides 11mg of magnesium. If you add an additional 5g of wheat bran, you add another 31mg of magnesium. In conclusion, eat a varied diet containing nuts, seeds, whole grains, vegetables and fish to maintain healthy levels of this mineral and thereby ensuring good health and vitality. Pumpkin seeds Pumpkin seeds are in a category of their own so far as magnesium rich foods go, at 592 mg per 100 g serving. Ace Osteopaths ™ Complementary Health Centre ™ Update ™ Volume 3 ™ Issue 2 ™ May 2008 02 Ace Osteopaths Complementary Health Centre www.ace-osteopaths.com Dealing with Chronic Pain Chronic pain refers to pain that continues or persists over an extended period of time. This could be from an injury, accident or even after surgery. Pain itself is difficult to define as everyone feels pain differently. The definition of pain devised by the International Association for the Study of Pain (IASP) is “pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. This is a widely used and accepted definition of both short-term acute pain and chronic pain. By Sophie Capito Exercise produces endorphins which are brain chemicals that help improve mood but can also block pain signals. Exercise also strengthens muscles, helping to prevent re-injury and further pain. Walking may be all the exercise that is necessary it will depend on each person’s circumstances. If you’re unsure what exercise is best for you seek advice. Reducing stress levels is very important. Stress and tension increase sensitivity to pain. Sometimes stressful situations cannot be avoided in life so another way to help deal with this would be to learn some relaxation or meditation techniques. Improving your diet can help with pain as can reducing the consumption of alcohol or stopping smoking. A well balanced diet will help prevent weight gain and improve sleep. Acute pain is the body’s warning system that protects itself from further injury. Chronic pain is when there are changes in the nervous system and brain so that the pain system no longer functions as a warning system. It fails to “switch off” sending information to the brain via the nerves that tells us how much pain and where it is coming from but also sending information to the emotional areas of the brain. Last but not least, keep a journal of your pain. Out of 10 (10 being the worst) make a note of what level you are at when you wake up, before you go to bed, after taking any pain relief or after receiving any treatment. Though you’ll be asked verbally by your doctor or practitioner how you are feeling people tend to use the same words to describe how they are feeling, when in reality they may well be improving. Putting your pain level down in writing helps the brain to “see” the improvement that you may not even be aware of yourself. You should be able to see more clearly what treatment, exercise or pain relief works best for you and also how you can become worse if you do the wrong things or have too much stress. Try it for 2 weeks to see if you can break your pain pattern! Most pain eases in a normal healing time so chronic pain is defined by the IASP as “pain which has persisted beyond the normal tissue healing time”. There is no formally accepted time frame for this but one can assume most chronic pain is that which persists for more than 3 months. There are numerous articles on chronic pain so there is no point in my going over all that is out there. My intent here is to give you some hints that are most recently accepted as ways to help deal with chronic pain. The main aim is to alter the brain’s reaction to pain, to de-sensitise it, thus giving some relief. Massage is widely accepted now as a way to relieve pain and tension. The effects may only be temporary but it allows the brain to “remember” what it feels like to be pain free. It is especially effective for back, neck and shoulder pain. 03 Ace Osteopaths Complementary Health Centre www.ace-osteopaths.com All in a line By Neil Reilly, Principal, Kingston Chiropractic Plus Being something of a fanatic about correct alignment it has become apparent to me that I have even managed to maintain this in the location of my 4 practice premises. In March 1990 I started my first practice at 18 Ewell Road, Surbiton, where I had a single room and I lived upstairs. Many patients will remember the ginger cat that we had at the time who liked to climb into any cars parked on the front and go to sleep. On many occasions he had to be retrieved from distant jaunts when he was discovered by an unsuspecting patient. In June 1990 the Medical Research Council published it’s findings comparing Chiropractic treatment for lower back pain and Physiotherapy. These were very favourable to chiropractic and it must have been a slow news day because the story made the front page of several daily papers and it was also the lead item on the BBC news. The practice quadrupled over night. In October 1993 the practice moved to 1 Surbiton Crescent where Mark Kennedy and Pernille Larsen joined us. In 1996 the chiropractor on the Hook Road, Jasper Dokkedal, died and we were asked to amalgamate his practice. In 1999 the Chiropractic Act was passed and it became illegal to call yourself a Chiropractor without being registered with the General Chiropractic Council. Chiropractic had become legitimate. In 2003 the practice moved to 29a Surbiton Hill Road where Zane Hall joined. Zane brought expertise both in Chiropractic manipulative therapy and prescriptive rehabilitation exercise to the practice which has since proved to be the future of spinal care. Reflecting on 24 years of practice there are a couple of things that really strike me. First the change in relationship between Chiropractors and GPs has been dramatic. In the 1980s if I got a referral from a GP I would call my friends and brag about it- now it is a daily occurrence. Second, the emphasis has shifted from lower back disorders to neck related disorders. I am sure that this is related to the increasing use of computers over the 20+ years and the ergonomic battlefield that we are now exposed to. In June 2011 the practice moved in with Kathy and Oliver O’Callaghan-Brown at Ace. The future looks exciting with Osteopaths ad Chiropractors working together for the first time to bring the best approach for all patients old and new. Those of you who know the geography of Surbiton will have realised that all 4 practices have been in a line from 304 Ewell Road for about 2 miles towards Kingston. I have been accused of taking this business of alignment too far. Ace Osteopaths ™ Complementary Health Centre ™ Update ™ Volume 3 ™ Issue 2 ™ May 2008 04 Ace Osteopaths Complementary Health Centre www.ace-osteopaths.com What is Chiropractic and what do we know about its history? By Zane Hall, Associate Chiropractor, Kingston Chiropractic Plus I have been a chiropractor since 2002 and practising in the UK since 2004. I have been asked to pontificate on the subjects outlined in the title. He also said it was ok for me to get on my soap box now and then, so here goes. regarding a range of other, related conditions. As with most official statements they try to be everything to everybody. In this case I think the extracts above will satisfy most people. Officially the General Chiropractic Council defines chiropractic as concerned with the framework of bones and muscles that support the body (the musculoskeletal system (MS system)). Some problems of the MS system can be caused by accidents, stress, lack of exercise, poor posture, illness and everyday wear and tear. These problems may cause pressure on the nerves in the body. Depending on your condition the chiropractor may manipulate parts of your spine or joints and give you advice on exercise, self-help, diet and lifestyle. Some chiropractors also offer rehab programmes. The history of chiropractic is a more problematic topic. Basically in about 1880, a gentleman who might have been hard of hearing was cleaning the consulting rooms of a ‘magnetic healer’ who noticed somehow that he’ had a bone out of place’ in his neck. Incredibly he ‘relocated’ the bone and the gentleman could hear again. The healer theorised that the displaced bone had altered the nerve flow and as such was the origin of the disease. Soap Box time! Various chiropractic organisations have alternatively been trying to deify these ordinary people into quasi-religious totems or drag the profession out of the mis-information and mysticism of the time. To put it into perspective, ‘modern medicine’ at the time was not aware of bacteria and as a result tens of thousands of people dies after ‘procedures’ just for the want of clean hands! I feel that this is a dis-service to the patient and the profession - and its practitioners – need to apply the latest understanding of disease/pain/inflammation to better serve our patients! If anyone is particularly interested in the history of chiropractic, do an internet search for DD Palmer and proceed from there. I think we will all be better served by forgetting about the various idealised stories from the past and applying ourselves to diagnosing our patients accurately, improving their knowledge of their ailment, providing effective treatment solutions and empowering them with strategies to maintain their health. To do this we need to actively seek new knowledge and should let the past stay in the past. Manipulation involves precise handling and movements of joints or parts of the spine, sometimes moving them further apart than they would normally go. Similarly, the British Chiropractic Association states that Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves, especially related to the spine. Chiropractic treatment mainly involves safe, often gentle, specific spinal manipulation to free joints in the spine or other areas of the body that are not moving properly. Apart from manipulation chiropractors may use a variety of techniques including ice, heat, ultrasound, exercise and acupuncture as well as advice about posture and lifestyle. Although chiropractors are best known for treating back and neck pain, which they do very well, patients also consult chiropractors 05 Ace Osteopaths Complementary Health Centre www.ace-osteopaths.com GET FIT, LIVE LONGER Exercise is the vaccine to chronic disease by Oliver O’Callaghan-Brown This is a pet topic of mine and it is also a regular theme is the British Journal of Sports Medicine. The following train of thought featured in the May edition. sedentary lifestyle is a bigger risk factor for mortality than mild to moderate levels of hypertension. Since few doctors would give up measuring blood pressure as a vital sign why would they choose to ignore measuring activity levels? There is a chronic issue in the public domain or obesity and inactivity that is leading a lot of people towards the premature onset of chronic diseases and death at a younger age. Medicine has moved on so much that people who died of heart attacks in the 70s would now be saved and would live for many more years. However this does add a significant burden to the NHS and leads to a service that struggles from the very numbers that require its help. But there is now significant evidence that shows a direct relationship between physical activity and health – those who maintain an active and fit way of life live longer healthier lives and will require less medication and NHS treatment as they enter old age. Those who are unfit and sedentary very predictably develop chronic diseases like heart disease and diabetes. This association between activity level and health status exists irrespective of gender, ethnicity or age. All benefit from exercise, all suffer from inactivity. One could argue that asking patients about their activity levels does not ensure that they make changes but explaining the benefits allows them to make an informed decision and at minimum everyone should be informed of the benefits. If adults are not doing 150mins/week and children are not doing 420mins/week then they should be flagged as being at risk and advised of the importance of being more active. They are more likely to take up exercise if it is connected to a disease they are currently dealing with or that they are at risk of. It should be the doctor’s responsibility to make connections with the fitness industry, to identify those fitness professionals who can help although ideally this should be done centrally. Surely this would be more beneficial to patients than having to refer to a medical or surgical specialist? To be honest the reluctance of the medical profession and the lack of impetus from above results in people like Robert Salis, the author of the piece in the BJSM and me standing on a soap box and encouraging the patients to mobilize their doctors. But if enough of you are aware of the benefits of exercise and pester your doctor for more exercise prescription the more likely this will sink in and force the hand of the medical profession to get off their own backsides and think about the health of their patients, not just their disease. Exercise is medicine that every patient needs to take. Its clinical benefits should not be denied to anyone especially those with chronic diseases like hypertension, heart disease and diabetes to name but three. Also anyone who is at risk from these should consider exercise as a ‘vaccine’ that greatly lowers the risk of illness and certainly extends life. It is readily available to everyone and thus the exercise habits of every patient that should be assessed at every visit to the doctor; there is no excuse not to. (Acknowledgements to Robert Salis Br J Sports Med May 2011 Vol 45 No 6.) But the medical fraternity seems to want to resist this, prefering to continue to provide more time-consuming, uncomfortable and even more dangerous therapy. Would you readily take insulin shots, have chemotherapy or undergo surgery by choice if there was a less risky solution? I am sure the answer to that is no and yet everyday many thousands of people do just that because they believe that it will help and the system is set up to administer these treatments. If a similar system was in place to administer exercise prescription surely patients would be more likely to consider that treatment option. An essential first step is for doctors to establish the exercise habits of their patients, treating the question and answer as a vital sign since there is no better indicator of a person’s health and likely longevity than the min/week of activity they engage in. It makes more sense to stop taking blood pressure at every visit than to ignore exercise habits because a 06 Ace Osteopaths Complementary Health Centre www.ace-osteopaths.com Acupuncture can reduce period pain (dysmenorrhoea) By Victoria Busk A review by Australian authors has concluded that current evidence suggests the use of acupuncture to reduce menstrual pain. The authors looked at ten trials reporting on 944 participants. The results were positive, showing that there was an improvement in pain relief from acupuncture compared with a placebo control or with Chinese herbs. In two trials acupuncture reduced menstrual symptoms (such as nausea and back pain) compared with medication, in one trial acupuncture reduced menstrual symptoms compared to Chinese herbs, and in one trial acupuncture improved quality of life compared with usual care. Interestingly acupressure fared well with improvement from pain relief compared with a placebo and in a second trial acupressure reduced menstrual symptoms compared with a placebo control group. This is good news for anyone suffering with this debilitating condition. Dysmenorrhoea, indicating pain before, after or during menstruation, can affect woman at any time during their menstruating years. According to Chinese medicine, the aetiology of period pain can be due to emotional strain such as anger, frustration and resentment, excessive exposure to cold and dampness, overwork or chronic illness and excessive sexual activity and childbirth. Acupuncture treatments focus on the patient as each individual is unique and the treatment is tailored to the particular condition and circumstances. A thorough consultation is taken as well as taking the pulse and looking at the tongue that are important indications as to what is happening within the body. If this is something that you suffer with and would like to find out more information please get in touch. Acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev. 2011 Jan 19;1:CD007854 Ace Osteopaths ™ Complementary Health Centre ™ Update ™ Volume 3 ™ Issue 2 ™ May 2008 07