https://youtu.be/R9sFYl-g0So

Neil Whiteside of Cambridge 105 Radio chats to Ed Groenhart from Cambridgeshire Family Chiropractic Centre in Linton about how our busy lives affect our posture. If the above link isn’t working, go to the Cambridge 105 Radio podcasts page.

Yes, you read it right: Meghan Markle, recently announced pregnant (and married to Prince Harry), is having a geriatric pregnancy. Or at least from a obstetrician’s point of view. Any mother over 35 (Meghan is 37) is still, even in this day and age, considered to be “too old” to be a new mum, and therefore pregnancy is a risk to her health. And to make matters worse, she’s even gone on holiday during her pregnancy: heaven forbid! (I just hope she’s read our hints and tips).

I jest. NHS figures released last year showed the number of women over 40 giving birth in England and Wales has tripled since the 1980s. Whilst a lot of this has to do with career objectives and possibly even house prices, there is still no reason to use this derogatory phrase, and it is derogatory talking about a geriatric at any age (in this chiropractor‘s humble opinion it’s the life in your years, not the years in your life, that counts). Whilst there is a statistical increase in the chances of genetic disorders such as Down’s Syndrome, there is also an increased chance of your child having a higher IQ and being fitter. Care has to be taken around birth due to increased complication risks, such as pre-eclampsia, but a good midwife and/or doula can help a lot in these circumstances to support you and your partner.

So what can we take from this high profile pregnancy? First of all, you are not alone if you are having a baby later in life. There will be many after you being told they are having a geriatric pregnancy (argh, that’s it, no more mention of that phrase). It’s good to know that you have navigated some of life’s complicated times, and still have the memories to share with your little ones. You also have more stability and resources to help with bringing up a baby, and less worries that maybe by having a child now you are missing out on anything. Remember that successful pregnancy is a subjective term, and preparing mentally as well as physically is really important. Your support network will probably already include mums who can share their experience (just choose carefully who’s stories you listen to!) and like anything in life we never stop learning.

If you want to start off on the right foot, please read our pregnancy blog articles, and if you have any further questions, or need any help, contact us. Jo and I have over 25 years’ combined experience of seeing mums-to-be, and also have two children of our own. They’re young enough for us to still have the memories (both good and bad) fresh in our minds regarding the pregnancy and childbirth journey.

The documentary Overfed and Undernourished, the story of an obese child and his journey back from the brink of health problems, is one that all parents need to watch to see what even a fraction of this kind of lifestyle can do to our little ones. It’s a tough watch at times, but we feel its impact is what will keep healthy living at the forefront of our parenting minds. It’s being shown at our place, 4 The Woodlands, Linton, at 8pm on 20th November. Book on eventbrite or call 07870568548.

According to new research^[1] teenage back pain may predict poor overall health, and risk of chronic disease throughout life. The New Zealand Chiropractors’ Association (NZCA) is concerned that chiropractic care is an underused option in the management of back pain and spinal health among teenagers, and believe it could minimise the use of unnecessary pharmaceutical usage^[2]and help establish a better foundation for adult wellbeing.

Chiropractor and NZCA spokesperson Dr Cassandra Fairest explains: `This new study in the Journal of Public Health indicates that adolescents who experience back pain more frequently are also more likely to smoke cigarettes, drink alcohol, and report mental health conditions like anxiety and depression. But too few of them are seeking chiropractic care, which was recently cited in a major call to action by the Lancet as a drug free approach to the management of back pain’.

Teenage back pain shouldn’t be ignored

The authors of this study point out that during adolescence, the prevalence of musculo-skeletal pain in general, particularly back pain rises steeply. Although often dismissed as trivial and fleeting, adolescent back pain is responsible for substantial health care usage, school absence, and interferes with day-to-day activities in some children.’

Researchers used data collected from approximately 6500 teenagers. The proportion of participants reporting smoking, drinking, and missing school rose incrementally with increasing frequency of pain. For example, 14-15 year olds that experienced pain more than once a week were 2-3 times more likely to have drunk alcohol or smoked tobacco in the past month than those who rarely or never had pain.

Similarly, students that experienced teenage back pain more than once a week were around twice as likely to have missed school during the previous school term. The trend with anxiety and depression was less clear, although there was a marked difference between the children who reported no pain, and those who reported frequent pain.

Dr Fairest says: `The researchers found that back pain and unhealthy behaviour not only occur together, but also persist into adulthood. In addition, the developing brain is susceptible to the negative influences of toxic substances, and use in early adolescence may increase the risk of substance abuse and mental health problems in later life.’

The Lancet, one of the world’s most prestigious medical publications, has said in a series of articles that healthcare system changes are crucial to changing behaviour and improving delivery of effective care for back pain.  It recommends integrating and supporting health professionals from diverse disciplines to provide patients with consistent messages about mechanisms, causes, prognosis and natural history of low back pain, as well as the benefits of improved spinal health, physical activity and exercise. Chiropractic is ideally placed to play a pivotal role in this development.

A pill may not be the best solution

Dr Fairest says: `We do have to ask ourselves why some teenagers are still being prescribed pain medication which may cause side effects when chiropractic care may be just as, or even more effective, and offer better long term outcomes? Chiropractors are uniquely placed to provide care that specifically focuses on the health of the spine and the relationship between the spine and the nervous system, both of which are clearly relevant to this populations presentations. It seems that there’s a disconnect between patient choices and evidence-based guidelines for low back pain based upon what is actually happening within our healthcare system. Too many GP’s are encouraging people to rely on medication and are only considering chiropractic care after pharmaceutical treatments have failed instead of making a referral to a chiropractor a first-line treatment option, as per the research.’ We also have to remember that encouraging teenagers to take a pill to “feel better” may not be the best example for them to be seeing, as illicit drug use can often be seen as a similar “solution”.

If you know someone who has a son or daughter with teenage back pain, let them know how to contact us today.

Source (edited from): https://www.firstchiropractic.co.nz/adolescent-back-pain-may-herald-lifetime-of-ill-health/

1. ^[1]S J Kamper, Z A Michaleff, P Campbell, K M Dunn, T P Yamato, R K Hodder, J Wiggers, C M Williams. Back pain, mental health and substance use are associated in adolescents. Journal of Public Health, 2018; DOI: 10.1093/pubmed/fdy129

 

^[2]Low back pain: a call for action Lancet Volume 391, No. 10137, p2384–2388, 9 June 2018https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext

There are plenty of opinions when the subject of children and chiropractic care comes up. The decision to bring your child in for chiropractic care is one that needs support, from family and other caregivers. It’s not necessary to defend your decision of how you wish to have your child looked after, but sometimes a bit of evidence to support your decision is reassuring. Apologies for the evidence-overload, but then again this at least demonstrates the weight of evidence supporting your decision.

1. Chiropractic care for children is dangerous:

   Cranial and activator techniques are preferentially used in this population http://bmccomplementalternmed.biomedcentral.com/…/1472-6882…
   “This study shows that for the population studied, chiropractic manipulation produced very few adverse effects and was a safe form of therapy in the treatment of patients in this age group.”
   http://www.jmptonline.org/ar…/S0161-4754(08)00175-9/abstract
   “Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare. The 3 deaths that have been reported were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date.”
   http://www.jmptonline.org/ar…/S0161-4754(14)00178-X/abstract (Adverse incidents involving children and chiropractic are exceedingly rare; compare this to medical incidents)

2. Chiropractors are seeing children for conditions outside of their scope:

   “This study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. ”
   http://www.jmptonline.org/ar…/S0161-4754(12)00062-0/abstract
   “Chiropractic and osteopathy is primarily used for back and neck pain, which is increasing in prevalence in children. Teens are more likely to use it than are younger children.”
   http://online.liebertpub.com/doi/abs/10.1089/acm.2011.0268
   “Of the indicated specific clinical presentations, musculoskeletal complaints were the most common followed by non-musculoskeletal conditions of childhood.”
   http://www.sciencedirect.com/…/article/pii/S1479235409000078

3. There is no evidence to support the idea of a chiropractor treating a child

   This large prospective study demonstrated that controlled manual stretching is safe and effective in the treatment of congenital muscular torticollis when a patient is seen before the age of one year.
   http://jbjs.org/content/83/5/679.abstract
   There is reason to suspect that infantile torticollis may be related to breastfeeding difficulties
   http://jhl.sagepub.com/content/22/3/328.short
   “Infants with unilateral sternocleidomastoid tension and associated craniofacial, spinal, and hip asymmetries may feed poorly”
   http://jhl.sagepub.com/…/20…/01/23/0890334414568315.abstract
   “On follow-up, 93% of mothers reported an improvement in feeding as well as satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding.”
   http://chp.sagepub.com/content/21/2/85

   

   Your children are perfect, we want them to grow up to realise their potential

4. Chiropractors don’t have the necessary quality research in this population:

   “Our practice-based research observational study reports a rate of that <1% of the patient population or 1 in 1046 patient visits resulted in minor adverse events. All reported aggravations (from chiropractor and parent survey) were minor, self-limiting and did not require hospitalization or medical attention.”
   http://www.sciencedirect.com/…/article/pii/S1876382009000985
   “The application of modern chiropractic paediatric care within the outlined framework is safe. A reasonable caution to the parent/guardian is that one child per 100 to 200 attending may have a mild adverse event, with irritability or soreness lasting less than 24 h, resolving without the need for additional care beyond initial chiropractic recommendations.”
   http://www.sciencedirect.com/…/article/pii/S1479235411000903

5. There is no need for children to see a chiropractor:
   

   “In summary, Low Back Pain in children and adolescents, as in adults, is a common condition: some have shown a lifetime prevalence as high as 70–80% by 20 years of age”. This pain has been shown to produce limitations in performance of daily activities. (NOTE: Back pain in a child should always be considered as a serious symptom indicating assessment by a trained health professional)
   http://adc.bmj.com/content/90/3/312.short
   “Prevalence rates ranged substantially, and were as follows: headache: 8–83%; abdominal pain: 4–53%; back pain: 14–24%; musculoskeletal pain: 4–40%; multiple pains: 4–49%; other pains: 5–88%.”
   http://www.sciencedirect.com/…/article/pii/S0304395911004751
   “The estimated overall mean prevalence of headache was 54.4 % (95 % CI 43.1–65.😎and the overall mean prevalence of migraine was 9.1 % (95 % CI 7.1–11.1).”
   http://link.springer.com/article/10.1007/s11916-013-0341-z
   There is reason to suspect that psychological factors play a big role in low back pain in school children (http://link.springer.com/article/10.1007/s00586-002-0385-y). As experts in conservative management of spinal syndromes and their various sequelae, chiropractors are well positioned to decrease this burden by performing a thorough assessment and implementing an active management approach to help decrease catastrophizing. Children and chiropractic care are a perfect fit!

The following blog is by one of my colleagues who I’ve been lucky enough to learn a lot from over the years, Dr Glenn Maginness. Dr Glenn is a chiropractor who sees only children as patients. He graduated in 1986 and runs one of the largest family practices in Australia. Glenn completed a 3 year postgraduate Masters Degree in Chiropractic Paediatrics in 1998 and has held over 40 paediatric focused seminars throughout Australia, New Zealand, South Africa and the U.K, over the last 15 years. With the launch of his Online Paediatric CE Program in 2013, Dr Maginness’ wealth of knowledge is now available 100% online. The program addresses all aspects of the paediatric experience, including the assessment, adjustment and management of the paediatric patient. He can be contacted at chiro@netspace.net.au

Even with over 30 years practice experience, and the knowledge that comes from the thousands of babies and children that I have adjusted over those years, occasionally I am reminded in practice the very important fact that we never stop learning.

Some time ago I learnt something really important from a 10 year old boy who had presented with a two month history of worsening lower back pain.

I am always a little concerned when I have a paediatric patient present with any sort of ongoing musculoskeletal pain. I am always wary of those differential diagnosis’ that are potentially more serious. Back pain in this age group should always be a red flag for you. So you should always rule out the ‘potential nasties’ first.
Anyway, this child had been through the ‘medical merry-go-round’. He had seen a number of GP’s, been referred to a neurologist, had an MRI (which was unremarkable), and he had also seen a physio. As a result of all of this he had had all the potentially serious diagnosis’ ruled out. The various diagnosis that he did receive ranged from muscle strain, disc inflammation, posture problems, and even a ‘back virus’. The parents attended my practice at the suggestion of a local GP who had essentially, in his own words, ‘run out of suggestions’.

At the time of presentation, neither the parents nor the child could recall any incident which may have precipitated the onset of the child’s back pain.
On examination I was quite surprised at the extent of the biomechanical dysfunction present in this child’s lower back region. I really felt that a major incident/accident was likely the cause, but as I have said, no such incident could be recalled by the patient or the parents.

Essentially there was noticeable dysfunction at the L3/4/5 spinal level, with extensive muscle guarding and general lumbar stiffness. ROM was decreased by more than 50% in all directions.
The physio had strapped his upper back to improve posture – (really??). This had not made any impact on the pain or discomfort. A GP had recommended a ‘course of pain killers’. This offered short term relief only- big surprise!

So I commenced care for this child, initially focusing on manual adjustments and deep soft tissue work, confident that we would see a change relatively quickly, despite the apparent chronic nature of the condition. My expectations were that within a few visits we would start to see a change in pain and discomfort, as the biomechanics improved.

Much to my surprise (and frustration), there was no appreciable change in the child’s symptoms. I persevered for several weeks, seeing the child three times per week. I modified my adjusting, utilising a variety of different techniques, all the time waiting for (and expecting) the child to report an improvement in symptoms. While biomechanically there certainly was a (slow) improvement in the child’s condition, by the 6th week there was still no change to symptoms at all!?

Now at this point I have to admit that I was very tempted to refer this child to ‘someone else’, perhaps a different health practitioner with a fresh approach. However, deep down I really did feel that with perseverance the child’s symptoms had to start to improve in time. So this belief, mixed with the confidence conveyed to me by both of the parents of how sure they were that I was going to make a difference, and that they were in the right place, resulted in us persevering.

All the way through this process, I would constantly discuss with the parents what I was thinking, always being open and honest with them, including my concerns about the apparent lack of progress. At the same time however, I would demonstrate the ‘before and after’ aspects of the care that demonstrated quantifiable changes, including improvement in the biomechanics, from visit to visit – the ROM, muscle guarding, etc.

These parents had ‘been everywhere else’ (their words) and continued to communicate to me that they had total confidence in my management strategy, and wanted to stick at it. By this stage I had also incorporated flexion-distraction therapy and an exercise program, to help to improve the lumbar spine biomechanics. I can’t ever remember utilising this type of therapy with one so young, but I was basically trying everything. But I would have to admit that as each week went by, my confidence started to wane.

If I was to be 100% honest, if it wasn’t for the parents absolute confidence in me, I actually think there is a chance that I may have referred this child to someone else before the end of that 6th week. I am an impatient person. I am an impatient chiropractor. Because of the potential of chiropractic to make such amazing changes to the health of kids, so quickly, that is what I have come to expect. And when it doesn’t happen, my belief in what I am doing (in my management strategy) starts to then be tested. This is not necessarily a bad thing. It is important to continually question what you are doing so that you can always be confident and comfortable that you are achieving the very best clinical outcome for every patient that you see.

In the 7th week, there was a very slight change in symptoms. The child reported he felt ‘a little better in the mornings’. That gave me some hope.
Now it was around this time that the mum announced (somewhat sheepishly) that because of my continued insistence that this had to be due to an accident of some sort, they finally recalled an incident which ‘may have contributed’ to the back pain. The incident was 5 months prior to the onset of the back pain, and hence the connection was not immediately made.
The parent related that the child had spent an afternoon at ‘Gravity Zone’, (which is a warehouse full of trampolines and foam pits etc. Very popular for parties of kids of this age group). The child recalled an incident where he had bounced on a trampoline and on landing had hyperextended his spine and at the same time he heard a ‘crack and a squelching noise’, followed by intense back pain. This pain persisted for a few days and then went away. The mother too remembered this when the son talked to her about it. There was no further pain or discomfort until 5 months later, which is when they initially visited the GP.

So for me, all of a sudden things became a little clearer. I had felt all along that there must have been an accident of some sort to create the mess I was dealing with in the lower back. And there it was!

From that moment there was a steady improvement in the back pain. By the 12th week the child was almost totally symptom free. The parents were so happy that they persevered. I now see this patient monthly, and at his monthly visits he reports no pain or stiffness at all. So a great outcome was achieved.

So what did I learn from this patient?

Quite simply, that sometimes (certainly with chronic conditions), it can take time for the body to heal. While as chiropractors we pride ourselves on our ‘miracle quick fixes’, sometimes it is just plain hard work. This child had what I believe was a significant injury to his lower back region. Without the confidence and encouragement of the parents I would have potentially ‘given up’ on him early, which then would have then placed them potentially back on the merry go round looking for a miracle cure. And the really sad thing is there is every likelihood that he would most likely still be in pain, because the parents may have decided that they had ‘tried chiropractic ’ and that it didn’t work, and therefore may have been reluctant to see another chiropractor.
This experience has reminded me to be patient… something I am not very good at. Give the body time to heal. Give the body time to recover.
However, the unfortunate fact is that often you will not even be given the opportunity to be patient. If you have a parent who demands the quick fix with their child, you may not even be given a fighting chance to help a child in pain.

So this experience has also served to remind me of the importance of educating the parents. These parents were chiropractically educated through our healthcare class, and as such were educated and informed about the amazing potential of the chiropractic adjustment. I am sure that this is what gave them the strength of conviction to book their child in 3 times a week for so many weeks. Never missing one appointment. Never deviating from their schedule.
Now those who know me will know that this a very unusual schedule (3 x week) for me to recommend for a child. (I only work two days a week so the third visit was with another chiro in my practice). But always my advice to parents is ‘if this were my child, this is what I would do?’ My belief at the time was that this child needed the care 3 times per week, so that’s what I conveyed to the parents. You should always tell the parents what you believe, not what is perhaps easiest for them to hear.
This simply further highlights to me that no matter how experienced you are, regardless of how many letters you have after your name… you never stop learning.

In preparing for a natural birth, we recognize two things: the mother’s autonomy in childbirth and the supremacy of normal physiology. A mother-tobe has many resources to draw from in preparation for birth, the greatest being her own innate capacities. Learning about how the body is designed to give birth can lend tremendous understanding and support for the whole birthing process. The words “optimal positioning” signify that the mother and baby have aligned in a way that is complementary for a natural, empowered birth.

The most desirable position for the baby in birth is when the baby’s head is down, with the back of the head (occiput) and spine facing the mother’s front left side. During birth, from the mother’s superior view, the baby’s body rotates clockwise, aligning the occiput with the mother’s symphysis pubis. Then the baby’s head emerges. Once the head is out, the shoulders continue to rotate in that same clockwise motion so they, too, can fit through the mother’s pelvis.

Appearing in Issue #53. Order A Copy Today

If the baby’s occiput is facing the mother’s right side, in order for the head to get into the most desirable position, the baby must do a “long turn” in the clockwise direction within the mother’s entire pelvis to arrive at her symphysis pubis. Frequently, the baby will stall with his occiput up against the mother’s sacrum. This is called an occiput posterior presentation. It may lead to a longer and more difficult labor and delivery, or even to interventions that prevent a natural birth from happening.

Babies move freely throughout pregnancy. Between 35–37 weeks, they settle into what usually becomes their position for birth. Obstetricians perform an ultrasound at 37 weeks, but how can a mother determine her baby’s position earlier? And what about mothers who choose not to have ultrasound? One way to learn your baby’s position is with belly mapping. You can read about belly mapping on page 56 in this issue of Pathways.

But the biggest question is, why do babies choose a less than optimal position to begin with? Many mothers are not aware that their pelvic balance throughout pregnancy affects their baby’s position in birth. Increasing your awareness of your posture and movement will support your baby’s ability to find his optimal position for a safe and natural birth.

Structure Determines Function

Malpositioning in labor may occur partly because of the modern, sedentary lifestyles that thwart optimal positioning during pregnancy. Especially while seated, we often compromise our spinal alignment and optimal positioning. Easy chairs, couches and car seats force us into a slouch position. Even when sitting in straight-backed chairs, we can find ourselves slouching, compromising our pelvic balance. Slouching misaligns the pelvis in such a way that it makes it more comfortable for the baby to turn posterior or breech.

If, instead, you sit with your pelvis tilted forward, your lower spine curves forward. Your pelvis will be open and the baby can choose the most ideal position for birth.

Be conscious of your posture as often as possible, especially when you are sitting. Sit with your hips rocked forward and your knees always lower than your hips. Cease slouching, leg-crossing, or sitting on your legs. Sitting toward the front edge of your chair will help overcome negative sitting habits. Wellinflated birth balls and the Swedish kneeling chairs make it easy to keep your knees lower than your pelvis.

When taking long car rides or when sitting at work, take breaks often and move your body. Spend time throughout the day moving your hips in a figure-eight-type motion. You can use the back of a chair to lean on to do this movement. This keeps the joints in your pelvis flexible and better able to maintain a balanced state. These positions also lean the uterus forward and encourage the baby to settle into the anterior position, an ideal position for birth.

Another beneficial movement is pelvic rocks. To start, get on all fours and arch your spine. This strengthens and tones your lower back muscles. Then allow your spine to arch forward. This motion opens up the pelvis, relaxes the uterus and gives ample room for the baby to move. Also, you can exercise by crawling on the floor to optimize positioning.

If you have an occupation that is restrictive to movement or has you maintaining a one-sided posture for long periods of time, it is important that you aim to change postures regularly so you can support pelvic balance. For example, chiropractors and massage therapists may spend their entire day on one side of their table. In this case, maintain pelvic balance by adopting alternate stances.

If you are frequently holding an older child during pregnancy, and you elevate your hip for added support, know that this repetitive torque to your pelvis can cause structural imbalances that may adversely affect your baby’s positioning in utero. This was the case for me when I was pregnant with my sixth baby. Having held my fifth child on my left side consistently, my baby was led into a posterior occipital presentation for labor.

It might seem inconvenient to balance out your daily positions, but your awareness and effort to do so throughout pregnancy can make a significant difference in your birth experience.

Longstanding Imbalances

Previous physical trauma may cause issues in optimal positioning as well. Can you recall falling, tripping, or being in a car accident? Maybe a sport you played, such as hockey or lacrosse, had you repeat a one-sided, twisting motion? These traumas, regardless of how long ago they happened, may have affected your spinal alignment, and therefore your pelvic balance may be compromised for birth.

When the pelvis is out of alignment there is often tension in the attached ligaments. Because these ligaments also attach to the uterus, an uneven pulling can cause the uterus to rotate, making it difficult for the baby to assume his ideal position.

Chiropractic care throughout pregnancy is a safe and effective way to balance pelvic misalignments. Doctors who are certified in the Webster technique use gentle and specific adjustments to realign the pelvis and restore function to the nerves, muscles, and ligaments associated with pregnancy and birth.

Movement

Restrictive and repetitive movements and postures, along with old injuries in our spine and pelvis, create further restrictions in our joints. These restrictions affect muscle, ligament, and nerve function. In pregnancy and birth, we want the joints in the pelvis to open and move. We want the muscles, ligaments and nerves to be working for maximum strength and optimal function. Movement throughout pregnancy is essential. Certain movements during pregnancy support joint mobility and at the same time help establish optimal positioning.

Pelvic rocking. Get on all fours, arch the back up and down. If the baby has settled into a less than ideal position, pelvic rocking can provide the motion and space for a baby to move.

Figure eight. Lean against the back of a chair, and while you are leaning forward, gently and evenly move your pelvis in a figure-eight-type rotation to keep your pelvic joints uniformly balanced.

Hip shimmy. As you lean forward (over a birth ball or a chair, or on all fours), your birth assistant holds each side of your hips and rocks them back and forth. In this way, the baby responds to the movement as your hip joints mobilize. The combined support and motion to the hips feels great!

Belly sifting. Get on all fours. Have a partner wrap a scarf or shawl under your belly, then pull up and gently jiggle right and left.

Pelvic sifting. Lie on your back. Have a partner put the scarf under your pelvis and, while lifting, jiggle your hips. Depending on the baby’s position this ancient technique helps encourage baby movement.

Dystocia

There are three causes of dystocia in birth, per the Williams Obstetrics textbook. The first relates to the power of the uterus and its ability to function as designed. The uterine muscle needs proper nerve supply in order to function correctly. Pelvic imbalance puts undue stress on uterine nerves and ligaments, affecting their optimal function.

The second cause of dystocia relates to the passageway, or the alignment of the mother’s pelvis. If the pelvic bones are not balanced correctly, it will be more diffic ult for the baby to move through the pelvis.

The third cause of dystocia relates to the passenger, or the baby’s movement through the mother’s pelvis and birth canal. Again, pelvic misalignments put undue tension on
uterine muscles and ligaments, which in turn pull on the uterus and impair the baby’s ability to optimize its position and movement.

Preliminary clinical studies indicate that regular chiropractic care throughout pregnancy may, in fact, address these three causes of dystocia.

 

Movement During Labor

Even if the baby is in an optimal position at the onset of labor, new positions may arise. If these new fetal positions slow labor down or even stall labor (a condition called dystocia), unnecessary interventions may ensue.

Movement is key in all labors, and all mothers should be encouraged to get into any positions that they feel are necessary. During my sixth labor, it became apparent that my baby was in the occiput posterior position.

This was likely due to carrying my fifth son exclusively on my left hip during pregnancy. By the end of labor I experienced very intense back pain and became exhausted. Although I do not usually choose to lay down for birth, that little voice inside of me prompted me to go to my bed. Giving in, I laid down on my left side and drew my right knee upwards. No sooner than I had done this my baby did a 180 degree rotation, moving from occiput-posterior to occiput-anterior. As soon as the rotation was complete, she came sliding right out!

Labour is a dance between the mother and baby. Together they find the ideal movements and positions that allow for a safe and easier natural birth experience. Listening to our inner voice and literally moving with it is the essence of this dance. It can make the difference between a safer, easier birth and one filled with intervention.

Simple things, such as standing upright if you have been lying down, walking if you have been stationary, rotating the hips, and other movements in labor, can help this dance unfold. All of the techniques shown above for pregnancy can be used in labor as well. Some are more suited to certain cases, and all have the possibility of balancing the pelvis and helping the baby descend into the birth canal for a safer, easier birth.

It’s important for moms to realize how to support their own physiology and trust that their body and baby knows what is best for their birth.

Thank you to midwife Amy Hoyt for the inspiration to write this article.

Linton chiropractor Ed Groenhart has joined a national campaign to make people more aware about the importance of a having a healthy spine. The Alliance of UK Chiropractors (AUKC) says the spine, and nervous system function, is key to overall health, not just the back and neck, because it houses and protects the central nervous system that connects the body to the brain. The organisation brings together the United Chiropractic Association (UCA), McTimoney Chiropractic Association (MCA) and the Scottish Chiropractic Association (SCA).

Ed’s Linton practice is among the practices taking part in the AUKC’s Spinal Awareness Week campaign on 14-20 May. He explained why the spine is so important: “If we look at the spine purely as a structure, it holds us upright, but it also houses the spinal cord, protecting our delicate nerves from interference”.

 “Chiropractors find the bits in it that aren’t working as well as they can, and with our hands or specific tools, safely and gently mobilise them, in what we call an adjustment. So, by adjusting the spine, we enable itto function better.

“We hypothesise that if the spine is functioning poorly, then our nervous system will be functioning poorly too, because the spine is the gateway for most of our nervous system. With a poorly functioning nervous system our body simply can’t work as well as it should, and we may get warning signals in the form of health complaints.”

He says we can be lulled into a false sense of security about our health: “We all think we’re fine, if we feel good or we look good. But if you ask anybody who has ever survived a heart attack how they felt the day before, they will say they felt fine. In reality, their heart attack didn’t just come out of the blue. So, it’s not just how you feel, it’s how you function.”

The AUKC has produced a video to explain how a healthy spine is essential for good overall health. Jonathan Clarke, an executive member of the UCA, said: “Our health is dictated by our body’s ability to adapt to external stress.

 

“The analogy we’re using is that if we see our body as a kitchen sink, we can deal with a certain amount of stress without adverse effect, because we have a natural ability to deal with some stress and we have this big sink that we can fill.

“But the tap continues to pour in external stresses and it will never turn off completely, so we’ll always be facing chemical, emotional and physical stress; thoughts, toxins and traumas. There are things we can do to turn the tap down and therefore limit our exposure to these stresses, but they never go away.

“The other tool in our kit is the plug-hole, the drain. If we keep a nice wide drain, then we’re constantly draining the stress away by appropriately adapting to this stress. The things that control the drain are what we call the ‘Five Pillars of Health’ – nutrition, exercise, rest, attitude and the function of our spine and nervous system. With those five in play, we are better able to adapt to the stresses that we all face throughout our life.”

The message of Spinal Awareness Week 2018 is: ‘It’s not just how you feel, but how you function’. The aim is to encourage people to make lifestyle choices that will enable their body to work well, keep their nervous system functioning at its best, and to cope better with stresses that can often lead to health complaints both physically and mentally.

“Chiropractic isn’t the solution, but, by utilising the Five Pillars of Health, it is part of a solution,” says Ed.

If you’d like more information about how chiropractic care works, contact Ed or Jo at Cambridgeshire Family Chiropractic Centre on 07870568548 or feel free to arrange to pop in for a chat.

In 1993 a report was written by Pran Manga and colleagues. The Manga Report was commissioned by the Canadian Government of Ontario to ascertain the effectiveness and cost-effectiveness of chiropractic, specifically for lower back pain. The report is summarised below, with particularly striking comments in bold: how much relevance do they have to UK health issues today? You decide. Either way, this is a ringing endorsement for chiropractic care.

The Manga Report was a major study to assess the most appropriate use of available health care resources, reported in 1993 by the Ontario Ministry of Health. The report overwhelmingly supported the efficacy, safety, scientific validity and cost-effectiveness of chiropractic for low back pain 

EXECUTIVE SUMMARY

Introduction

The serious fiscal crisis of all governments in Canada is compelling them to contain and reduce health care costs. It has brought a new and unprecedented emphasis on evidence-based allocation of resources, with an overriding objective of improving the cost-effectiveness of health care services.

The area of low-back pain (LBP) offers governments and the private sector an excellent opportunity to attain the twin goals of greater cost-effectiveness and a major reduction in health car costs. Today LBP has become one of the most costly causes of illness and disability in Canada – a phenomenon which does not appear to be generally appreciated or understood in medical and government circles in Canada. Studies on the prevalence and incidence of LBP suggest that it is ubiquitous, probably the leading cause of disability and morbidity in middle-aged persons, and by far the most expensive source of workers’ compensation costs in Ontario – as indeed in most other jurisdictions.

Much of the treatment of LBP appears to be inefficient. Evidence from Canada, the USA, the UK and elsewhere shows that there are conflicting methods of treatment, many with little – if any scientific evidence of effectiveness, and very high costs of treatment. Despite this, levels of disability from LBP are increasing.

In the Province of Ontario LBP is managed mostly by physicians and chiropractors, with physiotherapists also playing a significant role. While medical services are fully insured under Medicare, chiropractic care services are only partially covered. LBP patients incur the highest out-of-pocket expenses for chiropractic services. Virtually,no out-of-pocket expenses are incurred for medical treatment, with the exception of drugs, and out-of-pocket expenses incurred for physiotherapy services fall somewhere in between the two.

Medical physicians, chiropractors, physiotherapists and an assortment of other professionals together offer about thirty-six therapeutic modalities for the treatment of LBP. In this study we focused principally on the effectiveness and cost effectiveness of chiropractic and medical management of LBP.

FINDINGS

F1.
On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate.

F2.
There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low-back pain.

F3.
While it is prudent to call for even further clinical evidence of the effectiveness and efficacy of chiropractic management of LBP, what the literature revealed to us is the much greater need for clinical evidence of the validity of medical management of LBP. Indeed, several existing medical therapies of LBP are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by non-chiropractic professionals.

F4.
There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management. We reviewed numerous studies that range from very persuasive to convincing in support of this conclusion. The lack of any convincing argument or evidence to the contrary must be noted and is significant to us in forming our conclusions and recommendations. The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care.

F5.
There would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions annually. 

F6.
There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician [GP] management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favoring chiropractic management of LBP.

F7.
Despite official medical disapproval and economic disincentive to patients (higher private out-of-pocket cost), the use of chiropractic has grown steadily over the years. Chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians.

F8.
In our view, the constellation of the evidence of:

(a) the effectiveness and cost-effectiveness of chiropractic management of low-back pain.

(b) the untested, questionable or harmful nature of many current medical therapies.

(c) the economic efficiency of chiropractic care for low-back pain compared with medical care.

(d) the safety of chiropractic care.

(e) the higher satisfaction levels expressed by patients of chiropractors, together offers an overwhelming case in favor of much greater use of chiropractic services in the management of low-back pain.

F9.
The government will have to instigate and monitor the reform called for by our overall conclusions, and take appropriate steps to see that the savings are captured. The greater use of chiropractic services in the health care delivery system will not occur by itself, by accommodation between the professions, or by actions on the part of the Workers’ Compensation Board and the private sector generally.

RECOMMENDATIONS

R1.
Current policy discourages the utilization of chiropractic services for the management of LBP. There should be a shift in policy to encourage and prefer chiropractic services for most patients with LBP.

R2.
Chiropractic services should be fully insured under the Ontario Health Insurance Plan, removing the economic disincentive for patients and referring health providers. This one step will bring a shift from medical to chiropractic management that can be expected to lead to very significant savings in health care expenditure, and even larger savings if a more comprehensive view of the economic costs of low-back pain is taken.

R3.
Chiropractic services should be fully integrated into the health care system. Because of the high incidence and cost of LBP, hospitals, managed health care groups (community) health centres, comprehensive health organizations, and health service organizations) and long-term care facilities should employ chiropractors on a full-time and/or part-time basis. Additionally such organizations should be encouraged to refer patients to chiropractors.

R4.
Chiropractors should be employed by tertiary hospitals in Ontario. Hospitals already employ chiropractic in the United States with good effect. Similar recommendations have been made recently by government inquiries in Australia and Sweden, and following government funded research in the U.K. and other countries. Unnecessary or failed surgery is not only costly but also represents low quality care.

R5.
Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities relevant to their scope of practice and patients’ needs.

R6.
Chiropractors should have access to all pertinent patient records and tests from hospitals, physicians, and other health care professionals upon the consent of their patients. Access should be given upon the request of chiropractors or their patients.

R7.
Since low-back pain is of such significant concern to workers’ compensation, chiropractors should be engaged at a senior level by Workers’ Compensation Board to assess policy, procedures and treatment of workers with back injuries. This should be on an interdisciplinary basis with other professional, technical and managerial staff so that there is early development of more constructive relationships between chiropractors, physicians, physiotherapists and Board staff and consultants. A very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the Workers’ Compensation System in Ontario.

R8.
The government should make the requisite research funds and resources available for further clinical evaluation of chiropractic management of LBP, and for further socioeconomic and policy research concerning the management of LBP generally. 

R9.
Chiropractic education in Ontario should be in the multidisciplinary atmosphere of a university with appropriate public funding. 

R10.
Finally, the government should take all reasonable steps to actively encourage cooperation between providers, particularly the chiropractic, medical and physical therapy professions.