This is what their web site looks like:

We already offer a discount to service personnel but I think this has formalised the arrangement for us a bit further and we hope we can add something to support this lot who have given in many cases more than we can imagine.

We are looking forward to seeing how the campaign develops, I suspect it’ll be a popular one.

As usual, the classes will consist of four, weekly sessions geared primarily towards relaxation, stress relief, boosting positivity and the promotion of better sleep. The sessions will last 30 minutes and each one will be attended by a small group of four people. They are beneficial if you would like to deal with generalised anxiety or stress, low mood or sleep problems or if you are looking to get yourself into the right mindset to make changes in your life like lose weight, change career etc.

Each session will be informal, friendly and, above all, deeply relaxing and what is usually a very welcome chance to switch off. Previous clients have reported they have slept better as a result of the sessions, felt calmer and have even received positive feedback from others on their improved demeanour!

Two sessions will be run, one at 12.15 to 12.45pm and one at 1pm to 1.30pm, on a Thursday lunchtime. The charge for a block of sessions will be �30 (payable upfront and non- refundable).

Details:

The first classes will be on Thursday 3rd February (running until 24th January) at C1 Chiropractic Health Centre.
Places are booked on a first come first serve basis; if you are interested or have any more questions please do get in touch by calling me directly on:
07966 094 979
or via the clinic on 0117 922 1542; alternatively you can book via e-mail.

If you’re looking to kick start your year these sessions will be for you!

Many thanks for your consideration,
-please note, if you are interested in holding sessions at your place of work, limited time slots are also available.

Zofie
Clinical Hypnotherapist
DHP.HPD.MAPHP.MNCH
CBT Trained

Carpal tunnel syndrome (CTS) is an injury caused by a compressed nerve in the wrist, resulting in pain and numbness in the index and middle fingers and weakness of the thumb. The carpal tunnel gets its name from the eight bones in the wrist, called the carpals, which also form part of the “tunnel” which the passes leading to nerve leading to the hand.

What you should expect to feel:
Some signs and symptoms of CTS include the following:

Night-time painful tingling in one or both hands that frequently cause sleep disturbance.
A sense that fingers are swollen, even though little or no swelling is apparent.
Daytime tingling in the hands, followed by a decreased ability to squeeze things.
Loss of strength in the muscle at the base of the thumb.
Pain shooting from the hand up the arm as far as the shoulder.

We commeonly treat CTS at the clinic – C1 Chiropractic Health Centre. The methods we, and most chiropractors, use to treat CTS include manipulation of the wrist, elbow and upper spine.

And there are some good studies that support the use of chiropractic treatment for CTS.

In the first study, 25 individuals diagnosed with CTS reported significant improvements in several measures of strength, range of motion and pain after receiving chiropractic treatment. Most of these improvements were maintained for at least 6 months.

A second study compared the effects of chiropractic care with conservative medical care (wrist supports and ibuprofen) among 91 people with CTS. Both groups experienced significant improvement in nerve function, finger sensation and comfort. The researchers concluded that chiropractic treatment and conservative medical care are equally effective for people with CTS. Now this one is the most significant bearing in mind the damage ibuprofen can do to you.

And the good news is that most people’s symptoms clear up within a few months with conventional treatment. If left untreated, CTS in advanced stages can become quite serious, involving a loss of sensation, muscle deterioration and permanent loss of function.

If you need to ask us more contact us at: info@c1healthcentre.co.uk

or have a look at: www.c1healthcentre.co.uk
And here’s the supporting research:

Banner R, Hudson EW. Case report: acupuncture for carpal tunnel syndrome. Can Fam Physician. 2001;47:547-549.

Bonebrake AR, Fernandez JE, Dahalan JB, Marley RJ. A treatment for carpal tunnel syndrome. J Manipulative Physiol Ther . 1993;16(3):125-139.

Bonebrake AR, Fernandez JE, Marley RJ, Dahalan JB, Kilmer KJ. A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. J Manipulative Physiol Ther . 1990;13(9):507-520.

Branco K, Naeser MA. Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies — an open protocol study. J Altern Complement Med. 1999;5(1):5-26.

Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. J Manipulative Physiol Ther . 1998;21(5):317-326.

Is there evidence for chiropractic treatment for sciatica?

Well, we’ve blogged about sciatica before. Sciatica is a loose, nearly slang term for leg pain originating in the back or buttock.

In the past we have talked about the symptoms, causes, and treatment of this problem; but does chiropractic treatment work? In practice many chiropractors report success treating this symptom, but there is little research that has been done. This makes it hard to know an actual predicted success rate, or compare the success of this to other treatment such as surgery.

Recently there has been more research done into this area, for example in October there was a study published which compared the clinical effect of chiropractic spinal manipulation against microdiskectomy (a type of surgery to remove a disk bulge). This was done in patients with sciatica secondary to lumbar disk herniation – which is when the intervertebral disk herniates, like this:

This causes entrapment and irritation of a nerve leaving the back, which causes leg pain.

They looked at patients who had failed to respond to at least 3 months of other nonoperative management (including treatment with painkillers, massage, and physiotherapy) and found that there was a significant improvement in both those treated with chiropractic and surgery. Sixty percent of the patients with sciatica benefited from spinal manipulation to the same degree as if they underwent surgical intervention (I had to do that in red as it’s a vital piece of information). This is very interesting as most people would like to avoid surgery when possible.

They also found that at 1 year follow up there was no difference in outcome based on the patients original treatment group (chiropractic or surgery), but they allowed patients to swap treatments after 3 months if they wanted to. Of the 40% left unsatisfied after their chiropractic treatment, subsequent surgical intervention had an excellent outcome (it worked as well for them as those who went for surgery straight away).

This study only compared treatment for one cause of sciatica, but this is an important cause, and the findings suggest that patients with this kind of sciatica (due to lumbar disk herniation) should definitely consider spinal manipulation. This may be followed by surgery if there is still no response.

Hopefully there will be more research into this and other causes of sciatica, as these findings are promising, and it is nice for patients to have another option than surgery.

Reference:
McMorland, Suter, Casha et al. (2010). Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study. Journal of Manipulative and Physiological Theraputics, Volume 33, Issue 8, Pages 576-584.

“The main things we see associated with using a laptop are headaches, neck pain and back pain” said Rupert Clements one of the chiropractors at C1 “and it’s starting to become an epidemic.”

Rupert adds: “most people have vague notion that that their computer is the cause of their ailments – but once diagnosed and fully explained they really get the problem. Unfortunately they are often unable to do much about it – if you have to use a laptop for work, you have to use a laptop.”

There are some troubling trends with school kids and students using them to do online home work often sitting in bed, way before they hit the workplace so many of our patients have years of postural abuse to deal with and no wonder its hurting.

“At the conventional computer, you sit at a desk and everything is as good, ergonomically as possible” said Leni Rautenbach who works at C1 “But with a laptop it’s all in one.” Because of their combined structure, Leni said that the problem with laptops comes from people’s extended use with their bodies in a scrunched position. Prolonged use of a laptop with bad posture can lead to issues such as headaches, neckaches, carpal tunnel, tendonitis and back pain.

Some tips to prevent “laptopitis,” or neck and back pain from working on a laptop:
1. Take a break about every 20 minutes, stand up, walk around, maybe even stretch a little.

2. If you’re going to use a laptop, try to sit at a desk or table.

3. If you can, use a desktop computer for those long, gruelling assignments or papers.

4. Switch out your laptop for a desktop. This may seem crazy, but it may prevent long-term damage.

5. If you have pain, see your chiropractor and get some help.

A recent study snappily called:

Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial

By Haas and co-workers was published in the uber serious Spine (The Spine Journal 2010; 10:117-128) which said that chiropractic was good at sorting out headaches.

As we all know, headaches are very common (with up to 16% of the population having one at any one time) and can very disabling (leading to work-days-lost, absenteeism costs and increased medical benefits spend).

Headaches are broken down into primary and secondary. The primary group is made up of:
• migraine,
• tension-type
and
• cervicogenic headache (CGH).

This last lot, CGH, account for a significant proportion of the 16% point estimate of those suffering primary headaches (but Nilson and Sjaastad have estimated the point to range from 0.4%-4.6%). Whatever. They are linked to neck pain and mechanical dysfunction and so, it is theorized, treating neck pain and mechanical dysfunction through manual therapies will help reduce headache symptoms.

Systematic reviews have been conducted on the usefulness of spinal manipulative therapy (SMT) in the treatment of CGH, however the treatment plans offer great variability: from once per week for three weeks to twice per week for 8 weeks. This, clearly, demonstrates a lack of clinical understanding and consensus in the research. This prevents us from being able to confidently set out the prognosis and expectations with respect to SMT.

The purpose of the study was to determine the efficacy of spinal manipulation in CGH and compare a high-dose and low-dose SMT application to a light massage.

One group received low-dose SMT (8 treatments), high-dose SMT (16 treatments), low-dose light massage (8 treatments) and high-dose light massage (16 treatments). The study showed some interesting things:

• While treatment dose had no effect on the use of medication, those receiving SMT used 1/3 less medication at 24 weeks.

• With respect to the number of cervicogenic headaches experienced, those receiving SMT experienced 2.6 fewer headaches per week compared to those receiving light massage.

• At the end of 24 weeks, those receiving SMT experienced 2.1 fewer ‘other’ headaches per week compared to those receiving light massage.

• While dose effects were small, those who received high-dose SMT experienced a greater improvement in neck pain (-5.9 at 12 wks; -10.6 at 24 wks)

• CGH pain, the number of headaches experienced per week and the amount of medication intake all reduced, with sustained reductions, favouring the SMT group.

• Lastly, by eight weeks, the number of weekly headaches was reduced 50% in those patients receiving SMT and on secondary analysis, a 50% reduction in symptoms (obtained via the outcome measures) was achieved in 80% of those receiving SMT.

The authors point out several key limitations to this study:
• The study design was highly complex and multifactorial.
• There was a small number of patients within each subgroup.
• Multiple headache classifications were present within many patients.

Interestingly, for us as chiros, there was no difference between the two dosages of SMT (though SMT proved to be more effective than light massage, irrespective of dosage.). And, as we’d expect, the differences between the SMT and the light massage group were not only statistically significant, but clinically significant as well.

This study is highly relevant and helpful to clinical practice as it strengthens the use of cervical spine manipulation in the treatment of CGH. It is also helpful as it demonstrates that patients do not tend to be cured by this intervention alone, indicating that CGH may require a combined intervention approach which includes exercise, soft-tissue therapy, spinal manipulation and education.

Have a read and then see why we tell people to get some early care and so avoid this stuff as it just can’t be good for you!

“For Facet Joint Pain, Minimally Invasive Surgery A Good Fit
In pilot study, 30-minute surgery reduces pain, opioid use; multicenter trial to follow

Gabriel Miller

A minimally invasive approach for facet arthrodesis (artificial induction of joint ossification between two bones via surgery – my note) reduces pain as well as chronic opioid use in back pain patients, according to a new study. The procedure — originally developed and used by orthopaedic surgeons and neurosurgeons — also may be performed safely by interventional pain physicians, the study demonstrated.

Although arthrodesis of the facet joints is not a new procedure, experts say a minimally invasive approach — which can be performed by a number of specialties — is novel.

…Like an open surgical approach, the concept behind the minimally invasive arthrodesis is to fuse the facet joint by drilling a hole between the joint walls and tamping an allograft bone dowel into the joint, separating the joint surfaces, locking the facet joint into place and providing a minimal amount of stability. Facet joint disease most often results from degeneration of the cartilage within the facet joint; the joint then becomes unstable and shifts around loosely, causing painful bone-to-bone contact.“ The premise is if you can eliminate the motion that you have between these facet joints, then you can take away the pain,” said Dr. Guiot.

Daniel Bennett, MD, medical director of Integrative Treatment Centers in Denver, and the lead investigator of the pilot study presented at the AAPM meeting [said]: “Because the No. 1 cause of sustained low back pain is joint-related, this procedure is a new tool in the interventional pain specialists’ tool belt.”
The study included 28 prospectively enrolled patients with facet-mediated low back pain, (so, PFS in other words) that was confirmed by intraarticular facet injection. Patients also were required to have previous radiofrequency ablation (RFA) with a return of pain. “We wanted to start with a population that had experienced the current gold standard of care and [had] at least gone through all of the invasive treatments short of surgery,” Dr. Bennett said.

During the procedure, a minimally invasive (!), stab-wound incision is made and Steinman pins are placed between the facet walls. A drill guide is inserted using a spatula and the pins are removed; using the guide, a cortical reamer then bores a Morse taper-shaped canal of bleeding bone, into which the bone allograft is placed. (Minimally invasive, mind!)

The primary end points in the study were pain measured on a 100-point visual analog scale and function measured with the Oswestry Disability Index (ODI), each of which was measured at four, 12 and 52 weeks postoperatively. After complete follow-up, average pain scores decreased from 79 to 23 and functional disability, as measured by the ODI, improved from 33.46 to 8.32 (SD, 5.17).

Narcotic use also was measured before and after surgery, with morphine equivalents as high as 510 mg per day among patients. However, after 12 months, only four patients remained on opioids,

Dr. Bennett said:
“There was a big difference [in opioid use] and at the end of the day, when you look at that with the ODI data, there is a significant improvement in function,” he said.

“Pain management specialists inject facet joints all day long, so they are extremely accustomed to getting into that joint—in fact, much more accustomed than any surgeon would be,” said Dr. Guiot. “Once you are in the joint and you can access that space, that’s the toughest part of the procedure [and] the remaining portion is actually very simple.”

An additional key benefit, Dr. Guiot said, is that a minimally invasive (!) approach, which doesn’t damage or significantly alter surrounding tissue, doesn’t preclude any larger reconstruction procedures at a later date. “The most beneficial aspect is that this really doesn’t burn any bridges,” he said.

Dr. Bennett believes that the diagnostic approach used prior to minimally invasive (!) arthrodesis represents a shift toward treating pain at the source, rather than blunting nerves through ablation or opioids.

“One important thing to point out: This technique only treats the joint,” Dr. Bennett said. Arthodesis may prove more durable than RFA, but in order for it to work effectively physicians have to know precisely where the pain is originating.

“What I’m advocating based on the data is intraarticular facet injections that confirm the pain generator as the joints, not ligament or muscular structures,” he said. “Then you know what you should expect as an outcome when you fuse those painful joints.”

So stapling the joints together reduces the pain. Now this is laudable but no one should get to the point that they need their joints, which are designed to move, to be clamped together. Please get some care into those joints before you need ablating (!), opiods which I’m sure my mother warned me about or a minimally invasive (!) arthrodesis.

Overview
LLD is typically divided into two broad categories:

1. Structural discrepancies. These occur when either the thigh (femur) or shin (tibia) bone or both bones in one leg are different lengths to the corresponding bones in the other leg. Small discrepancies between the length of bones on each side of the body are common; the problem occurs when the difference in length is more pronounced (usually .5 to 1 inch difference is considered within normal limits). A structural LLD also is called a true leg length discrepancy and is considered a true discrepancy because the cause is an actual physical length difference in the lower extremity bones. Structural LLD is usually as a result of genetic conditions, nutritional deficiency or traumatic cause such as fracture or disease loss of bone. A fuller guide is shown below:

a. Previous injury to bone. A broken bone can cause an LLD if the bone heals in a shortened position. This typically occurs if the bone fractures into several shards and is more likely in an open fracture. Remarkably, broken bones in children can lead to overgrowth of bone few years after healing, resulting in a longer than normal bone. Overgrowth commonly occurs in young children with femoral fractures. However, if the break runs through the growth centre near the end of a bone and damages the cells responsible for growth of the bone, this may cause slower growth, resulting in a shorter leg.

b. Bone diseases. Bone disease such as osteomyelitis, can also injure the growth plate, where growth in length occurs, so that a discrepancy occurs gradually over time. Others include neurofibromatosis, multiple hereditary exostoses and Ollier disease. Bone tumours and the treatments designed to eradicate them can also be related to leg length discrepancy. Tumours, like an infection, can invade the growth plate and treatments, like chemotherapy, can also damage the plate.

c. Bone infection. Bone can occur in children while they are growing can cause significant LLD, especially if the infection happens in infancy. Inflammation of joints during growth, such as juvenile arthritis, can cause LLD.

d. Hemihypertrophy (one side too big) or hemiatrophy (one side too small) are rare limb length discrepancy conditions. In these conditions, the arm and leg on one side of the body are either longer or shorter than the arm and leg on the other side of the body. There may also be a difference between the two sides of the face.

e. Other causes. Other causes include inflammation (arthritis) and neurologic conditions.

f. Idiopathic difference. Sometimes the cause of limb length discrepancy is unknown. These conditions are usually present at birth, but the leg length difference may be too small to be detected. As the child grows, the limb length discrepancy increases and becomes more noticeable.

2. Functional discrepancies. These occur when the leg lengths are equal but the symmetry is altered usually somewhere above the hip which in turn disrupts the symmetry of the legs. Functional LLD is more common than the structural form, however the causes can be harder to determine. In functional LLD it appears that one leg may be longer than the other, but there is no significant difference in the length of the lower extremity bones. Instead, a postural distortion above the hip joints has caused one lower extremity to appear longer or shorter than the other.

The causes of functional LLD are numerous with the most common set out below:

a. Sacroiliac joint dysfunctions leading to pelvic obliquity – and I think the most common, at least in my clinic. This is one of the key findings from a massive study carried out by one of our co-authors, Augusto Manganiello was that just a small LLD can lead to significant pelvic torsion and further sine biomechanical problems.

b. Hip joint dysfunction causing compensatory alterations by the joint and muscles that move the joint. Congenital (present at birth) problems that alter alignment of the hips, such as coxa vara and developmental dislocation of the hip fall into this category.

c. Neuromuscular problems, such as cerebral palsy, which causes problems with alignment and posture can also lead to a functional discrepancy.

d. I am told that a growth in muscle mass itself may lead to LLD. Apparently, the Vastus lateralis muscle seems to push the iliotibial band (ITB) laterally leading to femoral angle compensations to maintain a line of progression during the gait cycle. This is bound to be misdiagnosed as ITB syndrome and subsequently treated incorrectly.

e. And the internal rotators of the lower limb being chronically short or in a state of contracture though I hate this sort of diagnosis as there’s never a decent answer to the why?

f. And apparently, failure or incorrect loading of the Back Force Transmission System (the longitudinal-muscle-tendon-fascia sling and the oblique dorsal muscle-fascia-tendon sling). See the proceedings of the first and second Interdisciplinary World Congress on Low Back Pain.

g. And one I found last week with a patient who has uber lax ligaments and has developed one hyperflexed knee leading to a subsequent low hip on that side.

It is important to distinguish between the two as they are treated differently.

Incidence
One study reported that 32% of 600 military recruits had a 1/5 inch to a 3/5 inch difference between the lengths of their legs. In a study by a bloke called Knutson, who is no slouch, he concluded:

“Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1). The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches ~ 20 mm (~3/4″).
Conclusion
Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.”

The most accurate way to identify a structural LLD is with a lower extremity radiograph that allows a comparison of bone measurement with the other limb. If this is not an option, a comparison of the measurement between bony landmarks on each side with a tape measure is another option, although it is somewhat less accurate.

Treatment
Structural discrepancies
For structural LLD the therapeutic goal must be to flatten the pelvis. Treatment of structural LLDs depends on the severity of discrepancy and the requirements of the patient. Treatment is done in the following ways:

1. Orthotics: A shoe lift can be used to treat discrepancies up to 2 cm. The lift should be large enough to allow the patient to walk normally.

2. Shortening procedures: The following procedures, used to shorten the longer leg, may be recommended for some children, in cases where the leg length discrepancy is expected to be between 2 and 6 cm at maturity. Shortening is considered safer and results in less complications than lengthening procedures:

a. Epiphysiodesis – This procedure slows the rate of growth of the long leg, allowing the short leg to catch up. The operation involves the creation of bony ridge, usually by repositioning a block of bone in the region, that tethers the growth plate, preventing future growth. The disadvantages of this procedure include shortened stature, surgery on the unaffected extremity, and the irreversibility of the procedure.

b. Epiphyseal stapling – This operation is performed to slow the rate of the growth temporarily. Staples are surgically inserted on each side of the growth plate. Once equalization has been achieved, the staples are removed.

c. Bone resection – This operation, removal of a section of bone to equal out the discrepancy, can be performed in adults or adolescents who are no longer growing.

3. Lengthening procedures are usually reserved for discrepancies that are more than 4 cm. While one of the obvious advantages of lengthening is the achievement of height, it is not always the method of choice because the process used is technically difficult and has a significant rate of complications, discussed further below.

For this procedure, a customized apparatus that encircles the leg is surgically attached to the limb that will be lengthened by pins. Limb lengthening correction works on the principle of bone regeneration (osteogenesis) as segments of the bone are pulled apart (distracted). To achieve this, a bone is first cut in two during surgery. Days after surgery, the two ends of the bone are very gradually pulled apart through continual adjustments that are made to the apparatus, usually at a rate of 1 mm per day. This gradual distraction leads to formation of new bone between the two ends, at the site of lengthening. After the process is complete, and the bone is given a chance to harden, the apparatus is surgically removed. A cast or brace may be required for some time for further protection. Common complications associated with lengthening procedures include pin tract infection, wound infection, hypertension, partial dislocation of the hip and knee, a delayed union of the bone and fatigue fractures after removal of the lengthening apparatus.

4. Prosthetics: These devices, which are typically used to treat a child who has had to have an amputation, may be satisfactory for some patients with very large discrepancies, who would not benefit from other lengthening or shortening procedures

But, any structural LLD <20 mm and LLD caused by supra-pelvic muscle hypertonicity may interact in a standing posture, but not in an prone or supine posture as they are unloaded postures. So, any LLD due to suprapelvic muscular hypertonicity should be eliminated before any necessary treatment of structural LLD starts.

The lateral flexion of the lumbar spine was assessed in a group of subjects 10 years after structural LLD caused by femoral fracture that occurred after they were skeletally mature. Despite the compensatory lumbar scoliosis, these subjects had symmetrical lumbar lateral flexion, prompting the authors to comment that the “…acquired leg-length discrepancy produced little permanent structural abnormality in the lumbar spine…”. So, significant anatomic LLD acquired after skeletal maturity does not result in adaptive structural changes within a 10-year period.

However, another study from the same orthopaedic centre looked at the effects of significant (so about 3 cm) structural LLD acquired prior to skeletal maturity in mature subjects (so between 17–38 years old). In this group, there was considerable asymmetry of lumbar lateral flexion after placing a lift under the short leg to level the pelvis. This indicates that the body had permanently compensated to the structural changes in the spine/pelvis.

This type of permanent compensation in preskeletal maturity LLD was also found in subjects with pelvic obliquity. Young et al. found that placing a lift under the foot of a subject with no pelvic obliquity resulted in greater lumbar lateral flexion towards the now high iliac crest side. In subjects with pelvic obliquity, when the lift was put under the foot on the side of the low iliac crest in order to level the crest, lateral flexion was increased towards the formerly low crest side. If the body remodels and adapts to the pelvic obliquity or torsion caused by anatomic LLI, then by putting a lift under the side of the “low” iliac crest, one is actually raising what the body has adapted to as level. In other words, the unlevel pelvis of those with anatomic LLI has been adapted to and is now “normal”, and putting a lift under the low side has the same effect as putting a lift under the leg of an even pelvis!

“Back pain relief in just five minutes a day

If you suffer from back pain and have received professional help, the chances are that you have been told that you need to strengthen your ‘core’. Studies into the causes of back pain have identified weak musculature of the low back and ‘core’ as a common factor in many cases of chronic back pain. So, what is this term ‘core stability’ which is being bandied about and where is this elusive core?

The core muscles are located around the abdominal region, back, pelvic floor and hips. These muscles are responsible for balance, posture, trunk stability and are the foundation for movement. If they are weak, other muscles have to compensate, which is where poor posture and back pain come in.

Core stability isn’t about having a six-pack. Your six-pack muscle (the Rectus Abdominis) is a superficial muscle and, although it does form part of the core, we are more concerned with strengthening the smaller, deeper muscles for maximum stability.

So, now you know where the muscles are, we can work on identifying them in your own body in order to effectively strengthen them.
Below are four core strengthening exercises. During each exercise, you need to employ these muscles and maintain the contraction throughout. If you’ve done Pilates before, you may have heard this referred to as ‘zipping and hollowing’ or ‘pulling in’. Once you’ve mastered this technique, apply it to everyday life. Contract your core when lifting, running, even getting out of bed to keep your spine protected.

Here’s how to do it…
Lie face up on the floor with your legs bent and feet flat on the floor. Locate the top of your pelvis [on each side directly above where your pockets are] and walk your fingers diagonally down to[wards the top of your zip at] the front [each hand] by about 5cm.
Keep your fingers there, now cough. As you cough you’ll feel a contraction in the muscles under your finger. This is your core ‘firing up’.
This is the contraction you want to establish and maintain throughout the exercises so practice doing this by coughing again and trying to hold the contraction for at least 30 seconds.
If you find you’re holding your breath, try counting out loud.
It does take a bit of practice to get the hang of this but once you’ve got it you’ll have no problem holding the contraction while exercising and breathing at the same time!

So, to the exercises…

Roll down
This will mobilise your spine and provide a good stretch down your back. Stand with your feet hip width apart and your knees slightly bent. With your core contracted, put your chin on your chest and slowly roll down through your spine. Keep your knees slightly bent.
Think about articulating one vertebrae at a time, feeling the stretch down your back until you’re bent over with your neck relaxed and your arms hanging down, like a rag doll. Then roll back up, stacking one vertebrae on top of the other. Bring your head up at the very end to finish the exercise.

Leg raises part one
Lie face up with knees bent and feet flat on the floor hip distance apart. Contract your core and raise one leg off the floor until the knee is above your hip-joint, keeping your knee bent.
Be careful not to lose the natural curve of your spine. If your back starts to ache, chances are your back is arching and your pelvis is tilting away from you.
Avoid this by holding the contraction thigh and tilting your pelvis towards you by pushing your spine toward the floor.
Note I said pushing ‘towards’ the floor, not ‘into’ the floor. You don’t want to lose the natural curve by pushing the spine into the floor.

Leg raises part two
In the same starting position as the previous exercise, contract your core and raise one leg then straighten it out in front of you, keeping a bend in the knee. Raise as high as you can without losing the natural curve in your spine, then, making sure you’re still holding in your core, press your low back into the floor and tilt your pelvis in towards you. This time you want to lose the curve. Hold, then return to your starting position and repeat the other side.

Front support hold
Often referred to as ‘the plank’ this is a great one for your core. On your front, with your core contracted, prop yourself up on your elbows and raise onto your toes so your entire body is off the floor (apart from your elbows and toes, obviously – if you learn how to do it otherwise, please let me know).
You’re aiming for a ‘dish’ position, so rather than having your back dead straight, you want to tilt your pelvis forwards to achieve a slight upward curve, like a bridge. This takes pressure off your back and works the core harder.
See for illustrations and further guidance. If you can spare five minutes each day to do these four exercises, you’ll be giving yourself a good start to achieving core stability and reducing back pain. ”

Not at all bad advice and if you look at our web site:
www.c1healthcentre.co.uk
you’ll see these shown on our page to boot.

http://www.telegraph.co.uk/health/expathealth/7718976/Back-pain-relief-in-just-five-minutes-a-day.html

For years, employees who suffer from chronic low back pain have been treated with a transcutaneous electric nerve stimulation (TENS), a portable device that applies a mild electrical current to the nerves through electrodes. The theory behind the treatment was that nerves can only carry one signal at a time. Physicians believed that transcutaneous electric nerve stimulation confused the brain and blocked the real pain signal. However, according to a guideline issued by the American Academy of Neurology, this method is not recommended.

Research on TENS transcutaneous electric nerve stimulation for chronic low back pain has produced conflicting results. For the guideline, the authors reviewed studies for low back pain lasting three months or longer. Acute low back pain was not studied. The report concluded that transcutaneous electric nerve stimulation does not help chronic low back pain.

Researchers noted that all but one of the studies excluded people with known causes of low back pain, such as a pinched nerve, severe scoliosis (curving of the spine), severe spondylolisthesis (displacement of a backbone or vertebra), or obesity. In the study that looked at low back pain associated with known conditions, transcutaneous electric nerve stimulation was not shown to be effective.

“The strongest evidence showed that there is no benefit for people using transcutaneous electric nerve stimulation for chronic low back pain,” said Richard M. Dubinsky, lead author of the guideline and a fellow of the AAN.

“Doctors should use clinical judgment regarding transcutaneous electric nerve stimulation use for chronic low back pain. People who are currently using transcutaneous electric nerve stimulation for their low back pain should discuss these findings with their doctors.”

The guideline determined that transcutaneous electric nerve stimulation can be effective in treating diabetic nerve pain, also called diabetic neuropathy. However, researchers said more and better research is needed to compare transcutaneous electric nerve stimulation to other treatments for this type of pain.