+ WHAT IS CHIROPRACTIC?
Chiropractors are specialists in the diagnosis and management of spine and spine related conditions. The most common conditions that people consult a chiropractor for are back pain, neck and shoulder pain, and headaches; however, these are not the only conditions that respond to chiropractic care.
People are sometimes surprised that a chiropractor is interested in their hip, knee, ankle, shoulder, elbow or wrist, but as a practice with a sports injury focus, these are areas that we assess and work with every day.
Chiropractic means ‘done by hand’ and, as a manual therapy, is famous for its manipulative techniques (adjustments) for the spine and pelvis, peripheral joints and soft tissues. Whilst these skills are highly effective and largely unique to the profession, they are not the only approach that modern chiropractors use.
We promote active care and prefer a collaborative approach with our patients. Accordingly, we advise on topics such as exercise prescription, stretches, posture and ergonomics.
+ WHAT IS THE DIFFERENCE BETWEEN CHIROPRACTIC, OSTEOPATHY & PHYSIOTHERAPY?
The spine is a complex structure that requires unique expertise to effectively diagnose and manage the many conditions that may affect it. Choosing a healthcare practitioner for the spine can be a daunting task, particularly when in pain or distress. There are many professions, practitioners and approaches to spinal care, each with its own unique characteristics and techniques.
All healthcare professions share data from a common pool of scientific research and it is this knowledge base that forms what is known as the evidence base, from which all good treatment approaches should lay their foundation. There is good evidence for many different approaches to spinal pain, which is one reason why there is so much variance between providers.
Spinal manipulation is a powerful tool, and well supported by the scientific community, however for best results it needs to be performed by an expert. Chiropractic adjustments set the benchmark for spinal manipulation and chiropractors undergo many years of training in order to maintain this high standard.
+ WHY CHOOSE US?
Choosing a healthcare provider for your musculoskeletal health isn't easy, but ideally, your practitioner should perform a thorough examination, explain the results of their tests, give you a working diagnosis and prognosis, as well as outlining their treatment and exercise recommendations.
We do all of this and more.
+ CAN A BONE REALLY GO OUT OF PLACE?
People often report that their back is ‘out’. While this is a common misconception, a bone going ‘out-of-place’ in your back is fortunately, quite rare. A true ‘bone out of place’ is a dislocation or subluxation (partial dislocation), which only happens as a result of severe trauma and requires hospitalisation.
Historically, chiropractors have used the word subluxation to describe the less severe (and most common) cause of spinal dysfunction that we treat on a daily basis. Unfortunately, this has created confusion and helped perpetuate the myth that we ‘put bones back in to place’. As such, this term is being used with less frequency.
+ IS A COURSE OF TREATMENT NECESSARY?
In most cases, you will need a short course of intensive treatment. When a joint injury takes place, adaptations and reversible changes will happen to the tissues involved in and surrounding that joint. It usually takes a number of visits to relieve pain and rehabilitate the structures that normally act to provide support to the injured area.
When our manual approach is combined with tailored exercises we provide you, our results are enhanced, such that we can see a strong and stable body that can handle the challenges that you choose to throw at it.
Research has shown, time and again, that chronic pain is usually associated with poor motor (muscle) control. Re-educating the motor control system is important in getting long standing results from your care. Put simply, motor control is governed by your central nervous system and relies upon good sensory information coming in, and appropriate motor responses going out.
Many of our patients choose to have periodic check ups in order to ensure optimum performance; address the minor niggles before they become major pains, and minimise the likelihood of time off work. Self-employed people, athletes and “weekend warriors” often prefer this type of care, as do some of our more elderly patients who use our services to maintain the best quality of life that they can.
However long you choose to benefit from chiropractic care is always up to you.
+ WHAT SHOULD I BRING WITH ME AND WHAT SHOULD I WEAR?
You should bring along with you the results of any imaging studies or other tests you have had that may be pertinent to your presenting condition and also the images themselves if you have access to them. A list of current medications is also very helpful.
To make things comfortable, wear loose, comfortable clothing that is not bulky. Loose pants that roll up above the knee easily are ideal. Tracksuit pants or shorts are ideal and may also be worn under a gown. Your modesty is of utmost consideration and is preserved at all times.
+ DO I NEED A REFERRAL FROM A GP?
No. A referral is not required, though we always welcome open communication between our practice and your GP. With your permission, we may contact and work with your GP to gain a more efficient outcome in your case.
More GPs are referring to chiropractors under the new Enhanced Primary Care (EPC) plan under Medicare, although only certain patients qualify for a rebate. Check with your GP to see if you qualify.
+ DO YOU TREAT ON THE FIRST VISIT?
As a general rule, if your history and physical examination suggests you are a chiropractic case, we can get started straight away.
Occasionally, we may choose to withhold certain treatment approaches until we have received further confirmation of our working diagnosis from imaging studies or scans that we may refer you out for.
Many of our balance, dizziness or vertigo patients are not treated on the first visit however, as depending on the nature of their condition, it may be advisable for them to avoid driving immediately after treatment and these considerations cannot be made without an appropriate examination.
+ IS CHIROPRACTIC SAFE?
Yes. Your safety is our primary concern, and that begins with our initial examination and our working diagnosis. We need to make sure that we know as much as we can about the state of your health, and also make a working diagnosis on the likely cause of your pain before we start.
The safety and effectiveness of chiropractic spinal manipulation (adjustment) has undergone considerable scrutiny from individuals and organizations within the health care and scientific communities, as well as from chiropractors themselves. Few health-care interventions have been assessed as extensively.
The result of this extensive study is a significant body of evidence surrounding the efficacy of chiropractic care. Over the last 25 years, at least five formal government studies from around the world have found spinal adjustment (manipulative) therapy to be safe, effective and cost-effective.
Complementing the government inquiries are numerous scientific and clinical studies (including randomized controlled trials) assessing the appropriateness, effectiveness and cost-effectiveness of chiropractic spinal adjustment.
+ DO ADJUSTMENTS HURT?
Typically, not at all. In fact, a lot of patients enjoy the sensation.
+ WHAT MAKES THE POPPING SOUND?
Frequently, an adjustment is associated with a ‘clicking’ or ‘popping’ sound as a sudden decrease in pressure within the joint allows gas to escape from the fluid that lubricates the joints.
This phenomenon is analagous to the release of pressure when you open a bottle of soft-drink, or pop a champagne cork.
Although this harmless noise can be a little disconcerting for some people, it is perfectly safe and nothing to be alarmed about.
+ AM I TOO OLD FOR CHIROPRACTIC CARE?
Not at all. More and more people are consulting chiropractors in their later years. With growing concerns about the long term risks of anti-inflammatories and other analgesic medications, natural approaches such as chiropractic are viable alternatives for increasing mobility and improving quality of life.
+ WHAT ABOUT OSTEOARTHRITIS?
Osteoarthritis is very common in the weight bearing joints as we age and the spine is no exception. In fact, structural changes of the spine are expected as we age, much like grey hair or wrinkles.
Whilst chiropractic care cannot undo the structural changes that have taken place over the passage of time, chiropractic care can make a big difference to a persons mobility, pain sensitivity and quality of life.
+ WHAT ABOUT DISC BULGES?
Disc bulges are a contentious cause of back or neck pain. Disc changes are very common in the general population, and the correlation between visible changes on scans such as CT or MRI and a persons symptoms is very low.
Though spinal discs are most definitely a potential source of back pain, it is entirely possible to have a disc bulge that causes no symptoms whatsoever.
+ IS IT SAFE TO SEE A CHIROPRACTOR WHEN I'M PREGNANT?
Absolutely. Pregnancy commonly causes low back pain due to the changes in posture and weight bearing, as well as hormonal changes that take place in the final trimester of pregnancy.
As a therapy that primarily deals with care of the structure and function of the human frame, chiropractic is well suited to manage the various discomforts that may arise during pregnancy. Techniques are modified to suit the changes your body is going through and are perfectly safe. Reducing pain and maintaining optimal functioning of the pelvic girdle may contribute to a less stressful delivery.
+ WHAT CAUSES LOW BACK PAIN?
There are many causes of low back pain, and each of them needs to be managed differently. The most common of these are local inflammatory processes as a result of irritation or minor damage to the spinal facet joints, the outer fibres of the intervertebral discs, or pelvic joints.
Many times, people aren’t even sure how their back came to be sore in the first place, or complain that it started after the most trivial of movements (such as bending over to pick up a small object).
Traditionally, these types of injuries have been considered to be the result of cumulative micro-trauma that eventually exceeds tissue tolerance. Whilst this is true in some situations, in most cases, the real reason your spine may become painful after a simple movement is as a result of poor movement control (motor control). Though strength, endurance and flexibility are important factors in maintaining a healthy musculoskeletal system, motor control has consistently shown to be the most important factor associated with spinal pain.
The human spine is an extremely complex and highly mobile structure that requires precise control of movement to maintain appropriate joint stability and alignment. Just like the regulation of your heart rate or pupil size, this motor control system is largely outside of conscious control, and takes place reflexively via our many complex postural reflexes. This is referred to as reflex motor control.
Interestingly, one of the effects of joint manipulation is stimulation of the reflex control centres of the spinal cord and central nervous system to help them perform better and allow you to maintain your own joint stability better. These effects are likely to be relatively short acting, however, so for best results we recommend following the tailored exercises we provide to help you maintain the improvements that we make whilst you are in the clinic.
+ WHAT IS CORE STABILITY?
There is a lot of buzz in gymnasiums, and in the general media about the need to strengthen our ‘core’ and improve ‘core stability’ or joint stability in our spine and pelvis, but what does this actually mean?
As we interact with the environment, we constantly experience forces acting upon our bodies. To interact with these forces without injury, a given joint must have enough stiffness to cope with the forces encountered. Joint stiffness is the ability to provide resistance to a change in shape or position and is the first line of defence when an external force is applied to a joint (ligaments and connective tissue structures providing the last line of defence).
Joint stiffness is largely dictated by the level of muscular contraction of the muscles surrounding that joint. A contracted muscle resists lengthening and thereby resists joint movement. Obviously, too much contraction and stiffness impairs all movement, and one cannot move fluently or efficiently with muscles held tight all of the time.
Instead, our muscle tone is carefully monitored and finely controlled from moment to moment, and matched to the demands placed on the body by the external environment. This allows for efficiency of movement and should allow for appropriate stiffness for a given task, and thus joint stability. This context dependent, reflexive, dynamic motor (muscle) control system is finely tuned and as stated above, is largely outside of conscious control.
As an example, science has repeatedly demonstrated that when moving an arm or leg, our ‘core’ muscles normally contract to brace and stabilise the spine BEFORE the arm or leg moves. This occurs outside of conscious control. This normal pattern of movement does not occur in the same way in people with low back pain. It is therefore inferred that their spines are less stable, as the supportive core muscles are slower to activate than normal, and do not provide the same level of stability or support.
Generally speaking if you have pain, you will have a problem with motor (muscle) control. If there is a problem with motor control, you not only need to address the pain, but also the motor control system. This is true not only of the spine, but of the shoulder, hip and most other joints of the body.
+ WHAT ABOUT DIZZINESS OR VERTIGO?
Vertigo, or dizziness, is a very common condition that becomes more prevalent as we age. It is responsible for almost as many visits to physicians as back pain or headaches. Vertigo is estimated to effect just over 40% of the population aged over 16, at some point in their life.
Symptoms of vertigo may arise from a wide range of diseases or conditions, only some of which may be treated in our office.
To break it down, approximately:
- 50% of all cases of vertigo are due to disorders of the inner ear (vestibular system).
- 15% of cases of vertigo are caused by anxiety disorders.
- 5% of cases are caused by medical causes such as low blood pressure, infection, hypoglycaemia, heart problems, or from medications used for controlling epilepsy or blood pressure.
- 5% of cases are due to brain based conditions such as migraine, stroke, multiple sclerosis, brain tumour, Parkinson’s disease or certain types of epilepsy for example.
- 25% of cases, unfortunately, have no known cause.
Dr Steven Hewitt has undergone postgraduate training in vestibular rehabilitation and the management of common vestibular disorders. As stated above, approximately 50% of all cases of vertigo are associated with disorders of the vestibular (inner ear) system. The great news is this means many cases of dizziness and balance problems can be addressed using an exercise based program of vestibular rehabilitation.
Benign Paroxysmal Positional Vertigo (BPPV) is perhaps the most common form of vertigo in adults, and is usually very straight forward to manage. In fact, the success rate is greater than 95% with one treatment and some simple home exercises.
+ WHAT IS VESTIBULAR REHABILITATION?
Vestibular rehabilitation is an exercise based approach to the treatment of vestibular (inner-ear) problems and their secondary effects. Numerous research studies have demonstrated the effectiveness of vestibular rehabilitation, as opposed to general balance and conditioning programs. Vestibular rehabilitation is considered the most successful management approach for people with balance problems or dizziness associated with disorders of the vestibular system.
There is strong interplay between sensory inputs from our Spine, visual inputs from our Eyes, and vestibular inputs from our inner Ear (S.E.E principle). Any mismatch in sensory cues from these delicately balanced systems will result in a false perception of movement or dizziness. A common example of this is when you are sitting in a stationary train, and an adjacent train moves off and you momentarily have the false sensation of moving in the opposite direction.
Many vestibular disorders result in subtle sensory mismatches such that patients may:
- feel dizzy when looking at moving targets
- experience blurred vision when walking or moving their head
- have impaired balance
- feel unsteady when walking
- have difficulty concentrating or maintaining visual focus
Vestibular rehabilitation incorporates a number of approaches, but most exploit the ability of the vestibular system to adapt and modify its function, as well as utilising the S.E.E principle of sensory convergence between spine, eyes, and ears.
Vestibular rehabilitation approaches commonly used in this office are:
- Re-positioning manoeuvres
- Adaptation exercises
- Substitution exercises
- Habituation exercises
Many patients presenting with vertigo also have neck pain and headaches associated with their balance problems. In fact, some patients present with neck pain and headaches and do not report their balance problems because they do not realise they are often related, or that we are able to treat them.