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Täby Kiropraktorklinik: En helhetssyn på hälsa

Vuxna Patienter

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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 learnig 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 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.

As Biomechanical specialists, we examine all the joints of the body (except the inner ear…).
What are common problems that we treat in our office?

We start at the feet. We evaluate the function of the feet and by improving the mobility of all the small joints many problems causing discomfort can be addressed. Some causes of pain or discomfort actually originate in the low back, so we are always considering this as a possibility of why a patient has foot pain. Some of the different types of problems are heel spur (hälsporre), Achilles tendonitis, Morton’s neuroma, hallux rigidus, hallux valgus, plantar fasciitis among others. In some cases we tape the foot for a period of time to address instability. Our role is to improve function by mobilizing or manipulating different parts of the foot. Once function is improved, exercises to stabilize the foot and appropriate foot wear are recommended.

The knee is a hinge joint. When function is impaired this leads to instability and strains primarily the surrounding joints. In some patients knee pain reflects a primary problem in the hip and must be differentiated. We have these important skills in differential diagnosis. Understanding the origin of the problem is the first step in the assessment of the patient. Only then can adequate treatment be performed and proper rehabilitation recommended. The goal with treatment is to restore normal function in the joint and to recommend exercises to stabilize the joint. In some cases a brace to stabilize the knee is needed.

The hip joint is a ball and socket joint that is part of the pelvis, it is a very stable. Reduced mobility in this joint directly strains the joints of the pelvis and lumbar spine. This responds well to mobilization and stabilizing exercises.

A common problem area is the pelvis, low back and hip complex. Having skills in differential diagnosis is critical to differentiate a hip problem from a pelvis or low back problem. Clinically, it is very common that a patient has been told they have a hip problem when a thorough examination reveals a problem stemming from the low back. The lumbar spine sits on top of the pelvis, in particular the sacrum. The spine is like a chain with many small parts that should be mobile. In the lumbar spine the joints are formed to move sideways and forward and backward. This area is injured most often when bending forward, twisting and lifting.

As we move up the spine to the thoracic spine, (or bröstryggen), the vertebrae are formed differently and move most easily sideways, forward and backward and in rotation. The ribs attach to the vertebrae (costovertebral joints) making up the chest and they attach in the front of the body to the sternum with the costosternal joints. The rib cage is susceptible to injury during heavy lifts and certain twisting movements. When the costovertebral joint is sprained, it can be difficult to take a deep breath or twist the upper body. This area is most commonly injured while lifting heavy things with outstretched arms. When the ribs are involved, the pain can travel around the rib and/or through the ribcage. Some people think they are having a heart or lung problem. Examination of this injury or dysfunction requires specialty education in biomechanics. We commonly treat this and show exercises which are necessary to stabilize the injured area.

The cervical spine (halsryggen) sits on top of the shoulders and bears the weight of the cranium. The cervical spine glides sideways, forward and backwards with the majority of rotation at the junction of the uppermost vertebrae and the cranium.

When parts of the “chain” or vertebrae are not moving as they should, there is a strain on the adjacent areas. The goal with treatment is to restore normal functioning and recommend exercises to make the area stable.

The shoulder complex is made up of the clavicle, the shoulder blade and the head of the humerus (top of the arm). The glenohumeral joint or the moveable part of the shoulder is rather unstable compared to the hip. It is more easily injured and requires very specific training to avoid long term problems with the shoulder. The clavicle and shoulder blade are less often injured, but may not function optimally with a shoulder injury. These are addressed in treatment and rehabilitation.

The elbow and wrist are common areas of complaint. The elbow is a unique joint which bends and can rotate. Depending on the type of injury or overuse syndrome which presents treatment addresses joint function and muscles that support the joint. The wrist has many small bones and the joints here must function perfectly to avoid pain and discomfort. In recent years complaints have increased with the monotone use of the arms at the computer. Good ergonomics are critical for avoiding overuse and appropriate information is an important aspect of rehabilitation.
Pain in the shoulder, arm, elbow, wrist or hand can reflect a problem in the neck.

Our skills in differential diagnosis can determine where the problem comes from, whether it is a problem amenable to chiropractic care, or whether another specialist should examine the patient.

 

Under 2010 har ledare i neurologi, medicin och forskare i kiropraktik samlat ihop vetenskaplig bevis angående kiropraktik även kallat manuell medicin och hur effektiv den är. De har funnit att efter de högsta kraven när det gäller vetenskapliga bevis kan man nu säga att kiropraktisk behandling med manipulation/mobilisering är effektiv behandling för:

  • ont i ländryggen, båda den akuta och mer kroniska fasen av besvär
  • migrän och huvudvärk som kommer från nacken
  • yrsel som orsakas av nacken
  • ont i nacke, båda den akuta och mer kroniska fasen av besvär. Nya bevis inom vetenskaplig forskning.
  • problem med leder i armar och ben (axel, armbåge, handled samt höft, knä, vrist och fot)
  • plantar fascit, carpal tunnel syndrom, rotator cuff syndrom

Rapporten visar att det finns positiva bevis för behandling av en del andra problem än rygg o nacke, både det som gäller övrig muskulatur och leder men också andra besvär .

Stukad vrist, ont i svanskotan, ischias, käkleds besvär (TMJ), spänningshuvudvärk samt PMS, mensvärk och lunginflammation hos äldre. Patienter som svarar positivt på behandling har ett problem med funktionen i lederna, och symptomen lindras när man återställer funktionen i de drabbade leder. Det finns även indikation att behandling kan vara effektivt vid astmabesvär.

Rapporten visar att behandling är både ofarlig och lämplig för alla ovan nämnda problem.

Utan tvekan kan man nu säga att manipulation/mobilisering utförd av kiropraktorer med utländsk godkänd utbildning (se www.LKR.se för svenskar med lämplig utbildning) är viktig i behandling av rygg och nackbesvär samt ont i huvudet.

Studier bekräftar vad vi har sett i praktiken sedan länge. Behandling av patienten i sin helhet förbättrar kroppens funktion och förmåga. Normal funktion of knä och höfter gör att ländryggen fungerar optimalt. När man börjar förlora rörlighet i de leder, sliter man på ländryggen och skynda de degenerativa förändringarna. Behandling av knä och höft problem så att de inte förlorar sin rörlighet minskar risken för ländryggs besvär.

Ergonomics at home and in the work place
Here is a group of pictures showing good ergonomics at home and in school. The basic principles are to vary standing and sitting. Standing is better for you body as long as it feels good. The screen should be at eye height until you use progressive eyeglasses, when the screen is slightly lowered. Avoid tilting your head to look at a screen. This protects your neck. The angle at the elbow should be 90 degrees and the lower arm resting and pivoting on the desk. This relieves shoulder and neck tension. Depending on the angle of the spine, it can be comfortable to have one foot on a stool, stand wide based with good posture.

For more information and pictures follow the link Ergonomi
Idrottare

taby chiro 019 taby chiro 091

En idrottare är allt från barn som lär sig en sport, ungdomar som tränar, vuxna som tävlar till vuxna och äldre som håller sig igång. Som ung är det viktig att träningen är anpassad efter ålder, detta för att minimera risken för skada. Björn är engagerad som tränare och kiropraktor för barn från sex åringar och uppåt i ålder i båda hockey och fotboll och har utbildning som fokuserar på förebyggande av skada och ålders anpassade träning. Senaste forsking från Danmark visar tydligt att barn klarar sig bättre från allvarliga idrottsskador genom att inte specialisera sig för tidigt. Helst ska man träna olika sporter medan kroppen utvecklas.

Behandling av den skadade idrottaren sker i flera steg. Först måste man ha kunskap för att diagnostisera problemet, vilket betyder att man måste förstå vad som är fel. Behandlingen har som mål att återställa funktionen, främja läkningen av den skadade vävnaden och sedan lära ut övningar som stabiliserar området. Stabilitet i bålen är grunden till balansen och kontroll i hela kroppen. Stabilitetsträning av bålen hör till träningen i alla åldersgrupper och alla sporter. För de som redan har haft nack- eller ryggbesvär är råd om lämplig träning viktig så man inte överanstränger det skadade området. Det är viktigt att titta på hela idrottaren. Förutom rygg eller nackbesvär är det vanligt med axel, arm, handled, höft, knä, fot eller ljumsksmärta hos idrottare. Det är viktigt att titta på hela individen och inte bara symtom området. Vid knä besvär eller lårmuskelproblem är det även viktigt att titta på bäcken, höft o ländrygg, (se nedan). När hela kroppen fungerar optimalt, kan man prestera maximalt. Råd om kost och näring är viktig för alla som tränar flera gånger i veckan.


Referenser:

Qaseem A, Wilt T, McLean R, ForcieM. 2017. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine; 166(7):514-530.

Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, Faber-Dobrescu M, Andres C, Graham N, Goldsmith CH, Brønfort G, Hoving JL, LeBlanc F. 2015. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev.;9:CD004249. doi: 10.1002/14651858.CD004249.pub4.

Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. 2014. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap;22(1):12. doi: 10.1186/2045-709X-22-12.

Bronfort G, Haas M et al. (2010). Effectiveness of manual therapies: The UK evidence report. Chiropractic & Osteopathy.18:3. Doi:10.1186/174601340018-3.

Haldeman S, Underwood M. (2010). Commentary on the United Kingdom Evidence Report about the effectiveness of manual therapies. Chiropractic & Osteopathy.18:4. Doi:10.1186/174601340018-4.

Hondras MA, Long CR, et al. (2009). A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low-back pain. JMPT;32:330-43.

Senna MK, Machaly SA (2011) Does Maintained Spinal Manipulation Therapy for Chronic Non-Specific Low-Back Pain Result in Better Long Term Outcome? Spine DOI: 10.1097/BRS.0b013e3181f5dfe0.

Haldeman S, Chapman-Smith DA, Peterson DM eds (1993) Guidelines for Chiropractic Quality Assurance and Practice Parameters. Aspen Publishers, Gaithersburg, MD.

Henderson D, Chapman-Smith DA, Mior S, Vernon H eds (1994) Clinical Guidelines for Chiropractic Practice in Canada Suppl to JCCA 38(1).

Bigos S, Bowyer O, Braen G et al. (1994) Acute Low-Back Problems in Adults. Clinical Practice Guidelines No. 14. Rockville, Maryland: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services AHC PR Publication No. 95-0642.

Murata Y, Takahashi K, Yamagata M, Hanaoka E, Moriya H. 2003. The knee-spine syndrome: Association between lumbar lordosis and extension of the knee; J Bone Joint Surg [Br];85-B:95-9.

Offierski CM, Macnab I. 1983. Hip-spine syndrome. Spine;8:316-21.

Chaibi , Russel M, Tuchin P. 2011. Manual therapies for migraine: a systematic review. J Headache Pain;12:127–133.