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Täby Kiropraktorklinik: En helhetssyn på hälsa

Aktuellt

Vi är experter i ryggrads relaterade problem

Hur kommer ni bäst i kontakt med oss?      

 Enklaste är att boka på hemsidan via länken ”BOKA TID”, alternativt ringa på telefon 08-6380668.  Vissa dagar kan det vara svårt att komma fram till receptionen. Du kan boka online via länken på hemsidan (boka tid) alternativ skicka en email så hör vi av oss så fort vi kan: sue@kirotaby.se, bjorn@kirotaby.se

Välkomna!

Vad ska jag göra när jag får ont i ryggen eller nacken?

Advice for acute low back pain.

Det beror förstås på vad som orsakat problemet men generellt kan man säga att man skall undvika de aktiviteter som gör ont samt minimera sittandet. Man ska undvika att böja, vrida och luta sig. Känns det ok att gå eller promenera kan man göra det i små doser. Man kan lägga sig och avlasta ryggen av och till under dagen kombinerat med kylbehandling(se instruktioner längre ner). Använd inte värme på ryggraden.

Varför ska man använda kyla när man har fått ont i rygg eller nacke?

Kyla är nästan alltid rätt alternativ. Vid akut smärta på grund av allt från att slå sig på tummen med hammaren eller ryggskott är kyla att föredra. Kyla har en avsvällande samt smärtlindrande effekt. Kylbehandlingen skall vara kortvarig och återkommande. Längden på kylbehandlingen är 5-15 min beroende kroppsdel o ålder på patienten. Kylbehandlingen upprepas med ca 90 min intervall. Det skall alltid vara ett tunt lager tyg mellan kylan o det skadade området. Vid nackbesvär, placerar man kylan som en krage i övergången mellan nacken och axlar. Vid akuta trauma som t.ex. en stukad fot är kompression förstahandsalternativet gärna i kombination med kyla. Värme ökar blodgenomströmningen i området o är lämpligt att ta till vid muskelömhet efter belastning (träningsvärk).

I den akuta fasen försök att jobbar med korrekt hållning förutsatt att det inte ger ökad smärta.

  • sträck på dig
  • spänn magen mot ryggen
  • dra ner skulder partiet och lyft bröstbenet

Konsultera oss innan du börjar med vanlig träning. Att träna för tidigt eller för hårt leder ofta till återfall. Känn efter före! Stelhet och eller smärta på morgonen efter träning/aktivitet indikerar att träningen eller aktiviteten har varit för belastande.

Ju snabbare man får hjälp med besväret desto kortvarigare blir det!

Nya forsknings resultat från Karolinska Universitet:

FÖREBYGGANDE BEHANDLING MINSKAR LÄNDRYGGSBESVÄR

Patienter som kom regelbundet till Kiropraktorn i förebyggande syftet under 12 månader hade mycket mindre besvär än patienter som kom när de hade besvär.

Eklund, A. https://journals.plos.org/plosone/article/metrics?id=10.1371%2Fjournal.pone.0203029

World Spine Day 16/10  stresses the importance of self-help for back pain

World Spine Day is organised by the World Federation of Chiropractic on behalf of the Global Alliance for Musculoskeletal Health and this year highlights the global burden of spinal pain and disability. This year’s theme, Love Your Spine, emphasises the importance of self-help in the management of back pain.

Low back pain is the biggest single global cause of years lived with disability. At any time, it is estimated that over 1 billion people around the world are suffering with low back pain, with 4 out of 5 adults experiencing at least one disabling episode during their lives. It can profoundly affect work life, home life and social life, and low back pain can lead to other health issues.  People suffering with persistent back pain are three times as likely to suffer mental health issues such as depression.

This year’s World Spine Day focuses on how people can look after their spine and help prevent episodes of back pain. Under 1% of all back pain is caused by serious underlying problems, such as cancer and infection, yet people are often fearful of exercise and daily activities because they think it will make their condition worse. This is a myth, says World Spine Day Global Coordinator, Dr Robyn Brown.

”The old-fashioned advice to rest or lie on a board has never been supported by evidence. To the contrary, prolonged rest can often lead to muscle wasting and stiffness and make the problem worse. People with back pain need to know that in the vast majority of cases, getting out, moving and continuing to live a normal life is the best treatment.”

Evidence has shown that low back pain can affect people across the life course, from schoolchildren to the elderly. A long term study in Denmark involving 1400 schoolchildren showed that over a 3 year period 55% of schoolchildren aged 5-15 suffered at least one episode of spinal pain. Although this was usually short-lived and trivial, one in five children was found to be suffering with three or more episodes per year.  Seventeen (17%) percent of episodes lasted more than 4 weeks. Worryingly, child back pain sufferers are more likely to become adult back pain sufferers.

World Spine Day reaches around the globe and has attracted over 500 partner organizations globally, from hospitals and clinics to schools to government agencies, all committed to raising awareness and educating the public. On World Spine Day, activities will take place around the globe to engage people around the #LoveYourSpine theme.

Earlier this year, The Lancet published a series of papers on low back pain. The papers were picked up by media around the world, and resulted in an explosion of social media attention, with over 15 million tweets alone. The findings of the authors were stark –  disability due to low back pain has increased by over 50% since 1990, especially in low and middle-income countries – yet access to effective services remains poor and many myths and misconceptions remain.

Dr Brown adds: ”We know that back pain is complex and that it’s not just made worse by physical factors. Attitudes and anxiety around back pain as well as social factors also play a part. We call this the biopsychosocial model of back pain. One of the biggest challenges we face is that other than in a small proportion of cases it’s not possible to identify exactly what’s causing the pain.”

”We do know that certain groups are more likely to report low back pain than others,” continues Dr Brown. ”People with physically demanding jobs, people who have other physical and mental health issues, smokers and obese people are at the greatest risk of reporting low back pain.”

How do we prevent back pain and best advise people how to #LoveYourSpine?
The latest and best evidence does not support the use of drugs and surgery. The Lancet papers recommend education and self management strategies. Advice to get back to normal activities as quickly as possible and to exercise was seen to be most effective with psychological programs added to those with persistent symptoms.

The guidelines recommend limited use of medication, surgery and imaging, such as x-ray and MRI. In particular, inappropriate use of opioids and spinal injections for back pain came in for strong criticism. Chiropractic care has been shown to be effective in treating acute and chronic back pain with maintenance care reducing recurrent episodes of low back pain.

Dr Brown says: ”The most effective strategies are those that get people back to work early and educate them about the reality of back pain, that movement is medicine and that effective collaborations between patients and their health care teams of spine care professionals work best. See someone who will help you to help yourself ”

D Vitamin tillskott behövs nu från september i Scandinavian!
sunshine calendar

In Scandinavian behöver man ta tillskott av D vitamin redan i september, vi är så långt borta från solen nu att vi inte längre kan producera D vitamin själva. Under fliken näring och hälsa har jag inkluderat Kanadensiska riktlinjer för D vitamin intag.

A Swedish study shows that avoiding sun exposure is as dangerous for health as smoking. Both healthy women and those who have malignant melanoma benefit from sun exposure. Life expectancy increases with active, healthy sun exposure habits. (Lindqvist et al., 2016. Avoidance of sun exposure as a risk factor for major caues of death).

 

pad nacke

Även Barn får Ont i Nacken
In children the size of the head is proportionally larger in reference to the body until puberty. Injuries sustained to the head and neck in infancy will affect a different area of the spine than during later childhood. The weight of the head is a strain on the neck. With that said a key message for children is to reduce strain on the neck by avoiding looking down for extended periods of time. We are seeing a rise in the incidence of screen related neck problems in children and adolescents which in Swedish is called ”Padnacke”. The message here is to keep screens at eye height, observe how your children use the different media and help them find a position where the sit up straight and have their head over their shoulders, gaze straight ahead. It may a help to use pillows in the lap to rest the arms on to raise screen height so the neck is not under strain. Check out the picutres on this site under ”ergonomi”. Another group of children who experience neck pain are those who are avid readers, play instruments and/or have prolonged static activities with their arms stretched out and unsupported. Sitting properly at a desk which is ergonomically adapted for the size of the child is important as well when doing homework. We recommend using the TV for films to reduce static strain on the eyes and the neck. Besides the neck, eyesight in children has been shown to be affected by prolonged periods of time looking at screens. Children are not looking using the eyes to look up and away nearly as much which has resulted in an increased incidence of myopia. The most vulnerable to neck pain are those who have had an injury early on to the head or neck. They tolerate less well when the neck is bent forward for sustained periods of time, over books or a screen. Good ergonomics at home and in school are important, but reducing screen time and increasing physical activity is critical for long-term optimal health of children.

CORE träning för spädbarn och infant… Läs mer under spädbarn!

Vitamin D deficiency and Scoliosis

A recent study published by the journal, Spinal Deformities, discovered a high prevalence of vitamin D deficiency in adolescents with scoliosis who are meant to undergo spinal surgery.

A total of 217 adolescents with either neuromuscular or idiopathic scoliosis were included in this study. All patients were scheduled to undergo either spinal fusion or initial growing rod placement surgery. Prior to the operation, the researchers recorded data regarding gender, age, body mass index, race, scoliosis type, spine surgery procedure and season of the year. Additionally, all individuals had serum blood draws in order to determine vitamin D status.

This is what the researchers found:

  • Approximately 75% of the participants were considered vitamin D deficient (<20 ng/ml; <50 nmol/l).
  • African Americans were more likely to be vitamin D deficient than Caucasians (p < 0.0002).
  • Those who were preparing for spinal fusion also experienced a greater risk of deficiency compared to those undergoing an initial growing rod placement (p < 0.03).
  • Low vitamin D status was most common during winter compared to any other season (p < 0.005).
  • Those with neuromuscular scoliosis had significantly higher vitamin D levels compared to those with idiopathic scoliosis (p < 0.0002).

The researchers concluded,“Low [25(OH)D] levels are reported in pediatric patients with scoliosis preparing for corrective spinal surgery. Population subsets most at risk for deficiency in this limited study include African American children, those presenting for spinal fusion surgery, and patients admitted in winter season.”

Reference:

Mayes, T. et al. Prevalence of Vitamin D Deficiency in Pediatric Patients With Scoliosis Preparing for Spinal Surgery. Spinal Deformities, 2017.

Läs mer om Tongue tie och vad jag gör som kiropraktor för att hjälpa till under fliken spädbarn. Även vuxna kan ha besvär från ett kort tungband. Ett kort tung band påverkar huvudposition och käken. Huvudvärk, käk besvär och näck besvär är inte ovanligt som följd. Det finns situationer där man klipper tungbandet, men även om man inte gör det, behandlar man tungan, käken och nacken. Här har vi kunskap att bedöma om tungband eller läppband behöver behandling eller klippning.

Scoliosis (Skolios)

Scoliosis is defined by having abnormal curves in the spine. It can be a curve side to side forming an “S” when both the mid back and low back are involved, or a “C” curve when just the upper or lower spine is involved. Scoliosis is also used when there are excessive curves front to back. A kyphosis describes a strong curve in the mid back while excessive lordosis describes a strong sway back curve in the lower back.

Scoliosis can be functional or structural. A functional curve is a curve that is due to a condition and can be corrected. An example of this is a short leg which causes a tipping of the pelvis and a resultant scoliosis of the spine. A scoliosis from the bottom up.

A structural curve is one due to the way the spine and skeleton develops. There can develop during different time frames

Some curves start inutero when the developing fetus is positioned in a way that allows for uneven development of the cranium and face (plagiocephaly and unilateral microcephaly), and eventually a torticollis. This is called infantile scoliosis and there is an increased risk for hip dysplasia in these infants. This left untreated can result in a scoliosis. Some infants, those in a breech position or facial or brow presentation at birth can have asymmetry between the front and the back of the body. They usually have the head in a strong position of extension (looking at the ceiling), arms back, difficulty lying on the stomach. Besides physical treatment of the joints, ligaments and muscles, it is critical for the parents to learn how to train with the infant. Babies that are asymmetric already inutero will usually develop a favorite side, often disregarding one side. In the breech baby this may present as not having contact with the front of the body, or with the top and bottom half of the body.

Being asymmetric in infancy affects the integration of sight and balance with movement interfering with normal development of the core musculature.

The condition left untreated results in asymmetry in the developing child.

When we discuss scoliosis, there are two aspects to consider. One is that scoliosis develops and the other is the scoliosis that progresses. There are different theories as to why some children develop scoliosis; there is not a single cause. There are different theories why a scoliosis becomes aggressive and progresses into a more deforming condition. More to come on this.

What is important in the treatment of scoliosis is evaluation of the curves, optimizing function of the spine and working with exercises to reduce the curves and gain core strength and stability. Each child gets an individual program which is based on how their curve has or is developing. Another important aspect of managing scoliosis is nutritional supplements. Certain nutrients, D vitamin in particular, are critical for the developing spine. There is a higher risk for scoliosis in Scandinavia due to the northerly latitude. Under the section “näring och hälsa” are recommendations for supplementing D vitamin, both how much to take and during which months of the year.

New Guidelines for the Treatment of Low Back Pain

The American College of Physicians (ACP) has presented guidelines for the treatment of lowback pain based on the scientific evidence and provides clinical recommendations on noninvasive treatment of low back pain. The study has evaluated outcomes such as reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects. The recommendations for all physicians treating patients with lowback pain, whether acute or chronic conditions, was to avoid prescription of pharmacological agents and instead recommend spinal manipulation. For patients with chronic lowback pain, besides spinal manipulation, other nonpharmalocgial recommendations are appropriate exercise training to activate the core muscles, acupuncture, mindfulness, relaxation techniques among others. As a chiropractic physician, treatment of lowback pain varies depending on the diagnosis. Critical to all patients is learning what is neutral posture, how to activate the core to support it and then appropriate exercises to slowly strengthen the core with out straining it. Techniques vary for treatment from deep soft tissue, gentle mobilising, activator technique (an instrument used apply a graded force to a joint, particularly when low force techniques are indicated) and manipulative joint techniques appropriate to the patients size and condition. Choose a Chiropractor whose education provides skills in diagnosis so the cause of the problem is treated and not a symptom.

Consultation with the World Health Organization recommending non-pharmacological alternatives for infants and children

As an expert in paediatrics and a faculty member for the European Academy of Chiropractic (EAC) within the European Chiropractic Union (ECU), I have worked to formulate a contribution to the EU consultation on paediatric regulation for the World Health Organization (WHO). The goal is to promote specific research and trials for drugs prescribed for children, rather than, as were the practice, extrapolating data from experiments on adults. Children and particularly infants are not miniature adults; most of the medications prescribed are not adequately researched for them. They differ in anatomy and physiology, so the response to medication depends on the maturity of their developing systems. This is why medication doses cannot just be downsized.

Our contributions have focused on alternative non-pharmacological interventions to be tried before medication is prescribed. We have seen examples of this with exercise being prescribed as medication. Last week the guidelines for physicians were published for treatment of low back pain and the headlines are: non-pharmacological, alternative treatment is recommended for back pain, among which is spinal manipulative therapy or chiropractic care. Chiropractic care is not just a quick maneuver, it is a package of care first assessing the problem as the spinal care specialist; treating biomechanical dysfunctions with any of a variety of techniques; instructing the patient in self-care, proper posture and ergonomics; and instructing in appropriate exercise to stabilize the injury.

This type of approach to a patients’ biomechanical health is appropriate at all ages and is part of the solution to avoiding chronic pain. The infant with a biomechanical problem due to in-utero constraint or a difficult delivery needs this type of early intervention to avoid permanent changes in how the brain interprets pain. For the geriatric patient’s quality of life, they need a biomechanical assessment and treatment to optimize functioning and learn exercises to keep them functional and prevent falling. Optimal biomechanical functioning is important for good health in all age groups.

Some of the suggestions recommended for addressing the cause of the problem and reducing unnecessary medication and the risks for adverse effects for the infant and child are as follows:

• Before pain medication is prescribed for otherwise healthy neonates, infants and children, an assessment by a spinal care expert should be performed to rule out the possibility of pain due to a biomechanical dysfunction that would be amenable to treatment. A short trial of care is appropriate with positive findings.

• For the otherwise healthy neonate, infant or child with persistent crying and/or any of the following symptoms: recurrent vomiting, stomach pain, eczema, audible mucous or coughing during expiration or constipation: a 3 week trial of milk protein free and soy protein free diet (for the breastfeeding mother and/or child).

• These milk, soy and gluten free formulas should be made available for families over the counter and at a comparable price to regular formulas.

For the following conditions:
• Treatment of GORD or reflux in the infant: before a trial of medication with proton pump inhibitor, the infant should have a 2 week trial of milk protein and so protein free diet to see if symptoms resolve.

• For children not meeting their growth curves: A 4 week trial of milk protein and soy protein free diet. For Scandinavian children and children testing positive for HLA-DQ8(2) positive, a 3 month trial of a gluten free diet should be tested.

• Constipation in the infant or child: a 3 week trial of milk protein and soy protein free diet be assessed before prescribing medication.

• In otherwise healthy children, presenting with back pain, neck pain or other joint pain, an assessment by a spinal expert and a trial of chiropractic care should be made available and assessed before prescribing medication.

References:
Lifschitz & Szajewska. Cow’s milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr (2015) 174:141–150 DOI 10.1007/s00431-014-2422-3.
Dobson D, Lucassen PLBJ, Miller JE, Vlieger AM, Prescott P, Lewith G. Manipulative
therapies for infantile colic. Cochrane Database of Systematic Reviews 2012, Issue 12. Art.
No.: CD004796. DOI: 10.1002/14651858.CD004796.pub2.
Ndetan H, Evans MW, Hawk C, Walker C. Chiropractic or osteopathic manipulation for children in the United States: an analysis of data from the 2007 National Health Interview Survey. J Altern Complement Med. 2012 Apr;18(4):347-53. doi: 10.1089/acm.2011.0268. Epub 2012 Mar 2.

Årets Kiropraktor 2015!
Har av medlemmarna i Legitimerade Kiropraktors Riksorganisation blivit utvald till Årets Kiropraktor.
För att hon genom sina insatser ökat kunskapen om muskuloskeletala besvär hos barn och ungdomar genom sin utbildning och arbete med riktlinjer.

Dr Sue A. Weber BSc, DC, MSc
Chiropractic Paediatrics

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