Complementary Healthcare Services for Wantage and Surrounding Areas

34a Market Place, Wantage, Oxfordshire. OX12 8AH
Telephone 01235 760079


Should you see a chiropractor for low back pain?

Robert H. Shmerling, MD
Faculty Editor, Harvard Health Publishing

If you’ve ever seen a doctor for back pain, you’re not alone. An estimated 85% of people experience back pain severe enough to see a doctor for at some point in their life. Yet despite how common it is, the precise cause of pain is often unclear. And a single, best treatment for most low back pain is unknown. For these reasons, doctors’ recommendations tend to vary. “Standard care” includes a balance of rest, stretching and exercise, heat, pain relievers, and time. Some doctors also suggest trying chiropractic care. The good news is that no matter what treatment is recommended, most people with a recent onset of back pain are better within a few weeks — often within a few days.

What’s the role of chiropractic care?
Some doctors refer back pain sufferers to a physical therapist right away. But many people with back pain see acupuncturists, massage therapists, or a chiropractor on their own. Experts disagree about the role of chiropractic care, and there are not many high-quality studies to consult about this approach. As a result, there are a number of questions regarding the role of chiropractic care: Should it be a routine part of initial care? Should it be reserved for people who don’t improve with other treatments? Are some people more likely to improve with chiropractic care than others?

The answers to these questions go beyond any academic debate about how good chiropractic care is. Estimates suggest that low back pain costs up to $200 billion a year in the US (including costs of care and missed work), and it’s a leading cause of disability worldwide. With the backdrop of the opioid crisis, we badly need an effective, safe, and non-opioid alternative to treat low back pain.

A recent study on chiropractic care for low back pain
A 2018 study published in JAMA Network Open is among the latest to weigh in on the pros and cons of chiropractic care for treating low back pain. Researchers enrolled 750 active-duty military personnel who complained of back pain. Half were randomly assigned to receive usual care (including medications, self-care, and physical therapy) while the other half received usual care plus up to 12 chiropractic treatments.

After six weeks of treatment, those assigned to receive chiropractic care:

  • reported less pain intensity
  • experienced less disability and more improvement in function
  • reported higher satisfaction with their treatment
  • needed less pain medicine.
While no serious side effects were reported, about 10% of those receiving chiropractic care described adverse effects (mostly stiffness in the joints or muscles). Five percent of those receiving usual care had similar complaints.

All studies have limitations
And this one is no exception. While this study suggests that chiropractic care may be helpful for low back pain, some aspects of the study make it hard to be sure. For example:

  • It only lasted six weeks. As mentioned, most new-onset back pain is better by then regardless of treatment. For those with more long-lasting back pain, we’ll need more than a six-week study.
  • The differences in improvement between those receiving chiropractic and usual care were small. It’s not clear how noticeable such a difference would be, or whether the cost of chiropractic care would be worth that small difference.
  • The study included a mix of people with new and longer-standing low back pain and a mix of types of pain (including pain due to a pinched nerve, muscle spasm, or other reasons). If this study had included only people with muscle spasm, or only people who were obese (rather than military recruits), the results might differ. So, it’s hard to generalize these results to everyone with back pain.
  • Most of the study subjects were young (average age 31) and male (77%). All were generally healthy and fit enough to pass military fitness testing.
  • Study subjects knew which treatment they were receiving. This creates potential for a placebo effect. Also, the added time and attention (rather than the spinal manipulation) might have contributed to the response. Then again, these factors may not matter to a person who just wants relief.
  • This study only included people who were willing to receive chiropractic care. Even within the two groups, the care varied — that is, not everyone in the usual care group received the same treatment, and this can also be said for the chiropractic group.

If any of these factors had been different, the results might have been different. For example, it’s possible that if an older population of people with chronic low back pain had been studied, “usual care” might have been the better treatment.

Bottom line
This new study lends support for chiropractic care to treat low back pain. But it’s important to recognize the limitations of this trial, and keep in mind that treatment side effects were more common among those receiving chiropractic care. In addition, chiropractic treatments aren’t free (although, fortunately, insurance coverage for chiropractic care is becoming more common).

This won’t be — and shouldn’t be — the last study of chiropractic care for low back pain. But until we know more, I’ll continue to offer it as one of many treatment options.

Follow me on Twitter @RobShmerling

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How can you sleep better and feel refreshed?

  1. Remove alcohol - whilst it might send you to sleep, the quality of your sleep will be poor
  2. Reduce caffeine to 2 cups per day before 1pm and avoid cola. Caffeine is detoxified very slowly by some people and can still be circulating several hours later.
  3. Have a carbohydrate snack at bedtime. Carbohydrates trigger melatonin our sleep hormone. Ideas could be a couple of oatcakes with a banana or some soaked oats with berries.
  4. Don't treat your bedroom like a cinema, a kitchen or a study - it should be a quiet place with low level lighting at an ideal temperature of 18 degrees
  5. Get off social media, the blue light from devices affects melatonin, and if the phone is in the room put on airplane mode (yes the alarm still works)

How hungry are you? How full are you? Getting hunger levels right makes weight loss easy
In this world of overabundance many people have lost touch with their hunger, and either eat just because it's a meal time (regardless of hunger) which can lead to weight gain, or ignore their hunger because they are too busy, and then overeat at the next meal. This can cause weight gain and make you feel sluggish.

Get used to assessing your hunger. Ideally you want to feel about 5 /6 before a meal. Being a little bit hungry is good for fat burning and nutrient extraction. Food also tastes so much better, but being excessively hungry will make you eat too much and too fast. Eating mindfully and slowly allows you assess how full you are which needs to be 4 or 5 out of 6. There are certain appetite hormones that take longer to register, so only eating until you feel about 80% full will mean that in 20 minutes chances are you'll feel more like 90-100% full, so don't go back for seconds until 30 minutes has passed. If we stuff ourselves we are less likely to feel active and more likely to eat more than we need.

"Blue Zones" areas of longevity. What can we learn?

A number of studies have found that these areas (see below) contain extremely high rates of nonagenarians and centenarians, which are people who live over 90 and 100, respectively. In these areas, people don't try to be healthy, their environment naturally encourages it through food, sunshine, sleep and movement.

Another commonality to Blue Zones is that those who live there primarily eat a natural unprocessed 95% plant-based diet. Although most groups are not strict vegetarians, they only tend to eat meat around five times per month and they only drink moderately if at all. Caloric restriction and periodic fasting are common in Blue Zones. Both these practices can significantly reduce risk factors for certain diseases and prolong healthy life.

Regular exercise and movement is part of their daily life. People in Blue Zones get sufficient sleep. Seven hours of sleep at night and naps of no more than 30 minutes is common.

But one of the most common factors to these area is the close social connections they have, which in some studies supercedes nutrition.

  • Icaria (Greece): Icaria is an island in Greece where people eat a Mediterranean diet rich in olive oil, red wine and homegrown vegetables.
  • Ogliastra, Sardinia (Italy): The Ogliastra region of Sardinia is home to some of the oldest men in the world. They live in mountainous regions where they typically work on farms and drink lots of red wine.
  • Okinawa (Japan): Okinawa is home to the world’s oldest women, who eat a lot of naturally fermented soy and practice tai chi, a meditative form of exercise.
  • Nicoya Peninsula (Costa Rica): The Nicoyan diet is based around beans and corn tortillas. The people of this area regularly perform physical jobs into old age and have a sense of life purpose known as “plan de vida.”
  • The Seventh-day Adventists in Loma Linda, California (USA): The Seventh-day Adventists are a very religious group of people. They’re strict vegetarians and live in tight-knit communities.

How much coffee (caffeine) should I drink?

We live in an increasing cafe coffee culture which has tapped into our busy tired lives and gives us a much needed boost ...... or does it? Coffee is highly addictive, and for people who think they need a coffee to get going, they are actually suffering withdrawal from the substance. Caffeine boosts adrenaline which can cause jittery hyper behaviour in some people which affects productivity and increases anxiety, this is then followed by a crash. Low energy and low mood often mean people reach for caffeine again and so a coffee / coke rollercoaster continues. Coffee can also aggravate heartburn and IBS.

I recommend no more than 2 cups of caffeine per day, and only before 1pm because it can take some people many hours to detoxify caffeine. Be aware of coffee shops, a large coffee in Costa is 4 shots of caffeine!! Decaffeinated is an option for those who love their tea and coffee, but generally this process is carried out using toxic chemicals.

If you are looking for alternatives Redbush (Rooibush) tea is healthy and tasty. You can get coffee alternatives made with barley and chicory. There are a variety of herbal teas, my favourite being the Pukka, though watch too much green tea which is also caffeinated. Make water more interesting with lemon and ginger, or mint and cucumber, or berries. For a comforting winter drink, tumeric latte with some coconut oil is delicious.


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