Neck Pain and Falls Risk

Neck Pain and Falls Risk

Neck Pain and Falls Risk

Neck Pain and Falls Risk

Neck pain is very common throughout the world.1 Up to half of all people around the world suffer from neck pain at some stage each year.2-5 For some people, one big problem with neck pain is that it just keeps coming back, or becomes chronic, and may even increase their risk of suffering from a fall.2 4 6 7

Scientists know that your brain uses sensory information from your muscles and joints around your spine to help control your balance and posture and to make sure you’re moving properly.1,2 When  your brain takes sensory information and uses it  to  help guide movements and  control  muscles  we  call this sensorimotor function.8 One particular study looked at whether neck pain has an impact on proper sensorimotor function in older people.7 In this study, the researchers ran a whole lot of tests of sensorimotor function, like how well the study participants controlled the movement of their eyes and how good their balance was, and they took into account their age and other conditions that they suffered from.7

They found that older people with neck pain were worse than those without neck pain at most of the tests that they performed.7 For example, the people with neck pain couldn’t control their eyes as well and their balance wasn’t as good as people who had no pain.7

The researchers thought that in the people with neck pain they had poor communication between their neck and their brain,  which meant that they weren’t as good at controlling their balance and other types of sensorimotor function.7 Remember that your brain uses sensory information from your muscles and joints around your spine to help control your balance and posture, and to make sure you’re moving properly.9-13 So, if that information from your spine isn’t very good, your brain will struggle to control what’s going on in your body.

The scientists who did this study were saying that the altered information from the neck of these older people who had neck pain was disturbing their brains’  ability  to make sense of other sensory information. This in turn potentially affected their balance and increased their risk of falling.

Chiropractic Studies

We know from many research studies that for people with neck pain, chiropractic care is an effective care option, and it’s also cost-effective and safe compared to other common treatments for neck pain.14-18 But there’s more to chiropractic care than just helping people with their pain.

Researchers from New Zealand have published research studies over many years that suggest that chiropractic care improves the accuracy in the communication between your spine and brain, which makes it easier for your brain to accurately tell what is going on in and around your body.1 And that the spinal dysfunction does not need to be so bad that you are in pain for your brain to be disturbed,11 or for gentle spinal adjustments to help improve your brain’s ability to accurately know what is going on.11

These scientists have even shown that chiropractic care for older adults improves specific forms of sensorimotor function that are very relevant to falls risk.19 In one study, they looked at the effects of 12 weeks of chiropractic care on sensorimotor function in older adults. The types of sensorimotor function they looked at were important measures of brain/body communication that were related to balance and falls risk.  What they found was that chiropractic care in these older adults improved how accurately their brain knew what their ankle joint was doing even when their eyes were closed.19 They found that the older adults could take a significantly faster step after receiving chiropractic care and it also helped their brains to process information from their eyes and ears at the same time.19 In this same study, they also  showed that not only did the older adults who were receiving chiropractic care function better, they felt better too.19

Although chiropractic care does help people with neck pain,20 it also has so much more to offer,21 even if you don’t have neck pain. Chiropractic care is all about improving the communication between your brain and body so you can function at your optimal potential.22 So, whether you suffer from neck pain or have loved ones that do, or you just want to have a tune-up of your brain/body communication, go and see your family chiropractor and have your spine tuned up so you can function at your best.

References 1. Hoy D, March L, Woolf A, et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014;73(7):1309-15. 2. Cote P, van der Velde G, Cassidy JD, et al. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 2008;33(4 Suppl):S60-74. 3. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006;15(6):834-48. 4. Bussieres AE, Stewart G, Al-Zoubi F, et al. The Treatment of Neck Pain-Asso- ciated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther 2016;39(8):523-64.e27. 5. Cote P, Wong JJ, Sutton D, et al. Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J 2016;25(7):2000-22. 6. Bryans R, Decina P, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther 2014;37(1):42-63. 7. Uthaikhup S, Jull G, Sungkarat S, et al. The influence of neck pain on sensorimotor function in the elderly. Arch Gerontol Geriatr 2012;55(3):667-72. 8. Abbruzzese G, Berardelli A. Sensorimotor integration in movement disorders. Movement Disorders 2003;18(3):231-40. 9. Brumagne S, Cordo P, Lysens R, et al. The Role of Paraspinal Muscle Spindles in Lumbosacral Position Sense in Individuals With and Without Low Back Pain. 2000;25(8):989-94. 10. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol 2012;22(5):768-76. 11. Haavik H, Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. J Manipulative Physiol Ther 2011;34(2):88-97. 12. Lackner JR, DiZio P. Vestibular, Proprioceptive, and Haptic Contributions to Spatial Orientation. Annual Review of Psychology 2004;56(1):115-47. 13. Pickar JG, Wheeler JD. Response of muscle proprioceptors to spinal manip- ulative-like loads in the anesthetized cat. Journal of Manipulative and Physiological Therapeutics 2001;24(1):2-11. 14. Wong JJ, Shearer HM, Mior S, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J 2016;16(12):1598-630. 15. Leininger B, McDonough C, Evans R, et al. Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain. Spine J 2016;16(11):1292-304. 16. Michaleff ZA, Lin CW, Maher CG, et al. Spinal manipulation epidemiology: systematic review of cost effectiveness studies. J Electromyogr Kinesiol 2012;22(5):655-62. 17. van der Velde G, Yu H, Paulden M, et al. Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J 2016;16(12):1582-97. 18. Jevne J, Hartvigsen J, Christensen HW. Compensation claims for chiropractic in Denmark and Norway 2004-2012. Chiropr Man Therap 2014;22(1):37. 19. Holt KR, Haavik H, Lee AC, et al. Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial. J Manipulative Physiol Ther 2016. 20. Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther 2010;15(4):315-33. 21. Hawk C, Khorsan R, Lisi AJ, et al. Chiropractic Care for Nonmusculoskeletal Condi- tions: A Systematic Review with Implications for Whole Systems Research. J Altern Complement Med 2007;13(5):491-512. 22. The Rubicon Group. Definition and Position Statement on the Chiropractic Subluxation. [Online] Available at: http://www.therubicongroup.org/#/policies/: The Rubicon Group, 2017:4.


Older Adults

Older Adults

Some of the challenges of getting older include memory loss and difficulty in carrying out tasks of daily living such as dressing, bathing, or cooking. Due to the decline in nervous system function that often accompanies ageing, many older people also experience an increased rate of falls.1 And although getting old may appear like an inevitable downward progression, there is actually something you can do about it – it’s called healthy ageing.

What is healthy ageing?

Healthy ageing focuses on maintaining mental and physical health and avoiding disease so that you can maintain independence and quality of life. Healthy ageing can feel like a big investment in your health, but the returns are rewarding and can restore some control over your health and life. Chiropractic care can support older people with healthy ageing by helping them maintain and improve their overall function.2 3 So let’s review some of the chiropractic research that is particularly relevant to older adults.

Why try chiropractic?

Many research studies have shown that chiropractic care helps the brain become more accurately aware of what is going on inside your body and the world around you.2 4 This is probably why older adults who receive chiropractic care maintain their ability to carry out their activities of daily living, maintain their ability to live independently and look after themselves.3

Chiropractic may help prevent falls in older people

A recent study focused on whether chiropractic care may help older adults improve their function in a way that could decrease their risk of falling.2 This randomised controlled trial compared 12 weeks of chiropractic care to a usual care control in 60 older adults. After 12 weeks the group who received chiropractic care had become better able to know where their ankle joint was when they closed their eyes. They were able to take a step much faster than the control group, they could simultaneously process visual and auditory information more accurately in their brains, and they also felt better than the control group after 12 weeks of chiropractic care. This means they were better able to control and move their bodies in response to potential hazards which may reduce their risk of falling. On top of that, they felt that their quality of life had improved after the chiropractic care as well.

Functional Ability

Functional ability refers to a person’s ability to carry out basic tasks of everyday life.5 These can be divided into basic activities of daily living, which include bathing, dressing, eating, grooming, transferring, and walking across the room; and instrumental activities of daily living, which include taking medications, using the phone, handling finances, housekeeping, cooking, shopping, and using transportation.1 Due to an age-related decline in physical and cognitive function for many people it can become difficult to carry out these tasks as they get older.3 Slowing the rate of functional decline in older adults preserves their autonomy and well-being and reduces the threat of institutionalisation.3 This is very important for older adults because a loss of independence and functional decline are often associated with frailty and ultimately hospitalisation and mortality.6

Researchers have compared the effects of chiropractic care to standard medical care on health outcomes in over 1000 older adults with back conditions over a two year period.3 They measured their general health status and tracked their ability to carry out their activities of daily living like bathing, shopping, and cooking.

The people who received chiropractic care maintained their ability to carry out their activities of daily living and self-rated health status over a two year period compared to the people who received medical care.3 This means that the chiropractic group maintained their ability to live independently and maintained their health instead of it declining as it did in the medical group. So the chiropractic group were healthier and better able to look after themselves at the end of the study period. But keep in mind that it’s possible that the people who chose to see chiropractors were fundamentally different to those who didn’t and it’s also possible that other factors, besides the chiropractic care, influenced health outcomes between assessments.

Research also suggests that patients who are managed by chiropractors compared to those managed medically take fewer drugs, require less surgery, and are less likely to be hospitalised.7 In a study published in 20077 Researchers compared seven years of health claims from chiropractors to a similar group of health claims from medical doctors. What they found was a 60% decrease in hospital admissions, 62% decrease in outpatient surgery and procedures, and an 85% reduction in pharmaceutical costs for the patients managed by chiropractors compared to the conventional medical management. This may mean that chiropractic care for older adults will result in fewer drugs and less medical intervention and its associated adverse effects.

The research reviewed in this article suggests that chiropractic care slows the decline in functional ability associated with ageing,3 which may reduce the need for potentially harmful medical interventions and drugs.7 It also suggests that chiropractic care enhances sensorimotor function associated with falls risk.2 Chiropractic care can help older people to be more active, more independent, more healthy, and to feel better.2 3 For some older people chiropractic care can truly give them their life back!

Tinetti & Kumar. JAMA 2010;303(3):258-66. doi: 10.1001/jama.2009.2024 2. Holt, et al. JMPT 2016 doi: 10.1016/j.jmpt.2016.02.003 3. Weigel, et al. JMPT 2014;37(3):143-

doi: 10.1016/j.jmpt.2013.12.009 4. Haavik & Murphy. JMPT. Feb 2011;34(2):88-97. 5. Wiener, et al. J Gerontol 1990;45(6):S229-37. 6. Milte & Crotty. Best Pract Res Clin Rheumatol 2014;28(3):395-410. doi: 10.1016/j.berh.2014.07.005 7. Sarnat, et al. JMPT 2007;30(4):263-9. doi: 10.1016/j.jmpt.2007.03.004


Pain is created in the brain

Pain is created in the brain

Pain is created in the brain

Pain is created in the brain

Did you know that scientists now know the feeling of pain is something your brain decides you should experience if it believes there is some tissue damage in your body?1 In fact, your brain can decide that you should feel pain even if it only thinks there is a potential threat of tissue damage!!!2-5

It may seem strange, but it’s totally up to your brain to decide whether you should feel pain or not. Your brain may decide you should experience pain even if you have no actual tissue damage yet,6 or your brain may not create the feeling of pain for you when tissue damage has actually occurred!7 8

This is called the “pain paradox”. It means that the pain you feel does not always reflect the severity or even the location of your problem – if there is a problem at all. Science has shown beyond a doubt that pain is created in your brain!2 4 9 10

Sometimes pain can be very helpful and informative.1 Our brains create the experience of pain to let us know something is not ok.1 Maybe we are overexerting ourselves, or maybe we have had an injury that we need to be careful with to allow our body to heal. The pain can let us know what not to do while our body heals the problem.1 This pain is helpful and informative.1 If we listen to our body these pain experiences can be a good thing.

But for some people, pain can persist even after the initial injury that caused it has healed.9 11 12 And for some people, the pain can spread to other areas that are not injured at all.6 For these people, the pain has become non-informative and non-helpful. 9 11 12 The pain itself has become a problem. The brain has learnt to be in pain.9 11 12

The way the brain does this is very similar to the way the brain learns anything. It’s called neural plasticity – or brain adaptations.9 11 12 Brain scientists now know that what you focus on drives the way your brain will change.13-15 This can be a problem if you are focusing on your pain because it may make your pain worse. So, even if you’re in pain, try to focus on the good things in your life instead of your pain. Focus on what is working well. Focus on what makes you happy. This alone can help you!1

Chiropractic and Pain

Brain scientists who have studied the effects of chiropractic spinal adjustments have discovered that adjustments may change brain function.16 Chiropractic has a neuroplastic effect on the brain.16 In particular, adjustments change function in a part of your brain called the pre-frontal cortex.17 This part of your brain is actually the part of your brain that’s very involved in pain becoming chronic. 8 18-21 This might be why getting chiropractic care early on when you have a problem has better long-term outcomes.22 It might also be that chiropractic care can prevent pain from becoming chronic.22

Neuroscientists believe that chiropractic care most likely helps reduce your feeling of pain by helping your brain ‘turn down’ or ‘switch off ’ the perception of pain in your brain.23

This means chiropractors may or may not adjust your spine exactly where you feel that it hurts. They are looking for parts of your spine and/or body where there is a lack of proper movement and they will adjust you there – so don’t worry if it’s not where you feel the pain.

Remember that the feeling of pain that you experience is created by your brain and does not mean it’s where the problem actually is.24

Chiropractors are very good at finding the parts of your spine and body that need to be gently adjusted.25 Research studies have shown that adjusting your spine may helps your brain know more accurately what is going on in your body,26 27 so it can more appropriately respond to what is going on and control your body better. It improves your brain-body communication.26 27

If you want to make sure your brain-body communication is as accurate as possible so you can feel great and function at your optimum potential, check in with your chiropractor and see if they can help. For more information, go see your family chiropractor so you can sort the pain in your brain.

References and Disclaimer

This information is provided for educational purposes only. It is not intended to be professional advice of any kind. Haavik Research Limited encourages you to make your own health care decisions based on your own research and in partnership with a qualified health care professional. 1. Seymour B. Pain: A Precision Signal for Reinforcement Learning and Control. Neuron 2019;101(6):1029-41. 2. Koyama T,  McHaffie JG, Laurienti PJ, et al. The subjective experience of pain: Where expectations become reality. Proceedings  of the National Academy of Sciences 2005;102(36):12950-55. 3. Hadjistavropoulos TD, S; Goubert, L.; Mogil J.S.; Sullivan, M.J.L.; Vervoort, T.; Craig K.D.; Cano, A.; Jackson, P.L.; Rainville, P.; Williams, A.C.; Fitzgerald, T.D. A Biopsychosocial formulation of pain communication. Psychological bulletin 2011;137(6):910- 39. 4. Wager TD. Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain. Science 2004;303(5661):1162-67. 5. Ploghaus A. Dissociating Pain from Its Anticipation in the Human Brain. Science 1999;284(5422):1979-81. 6. Curatolo M, Arendt-Nielsen L, Petersen-Felix S. Central Hypersensitivity in Chronic Pain: Mechanisms and Clinical Implications. Physical medicine and rehabilitation clinics of North America 2006;17(2):287-302. 7. Fenton BW, Shih E, Zolton

The neurobiology of pain perception in normal and persistent pain. Pain management 2015;5(4):297-317. 8. Mitsi V, Zachariou V. Modulation of pain, nociception, and analgesia by the brain reward center. Neuroscience 2016;338:81-92. 9. Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011;152(3 Suppl):S49. 10. Atlas LY, Bolger N, Lindquist MA, et al. Brain Mediators of Predictive Cue Effects on Perceived Pain. 2010;30(39):12964-77. 11. May A. Chronic pain may change the structure of the brain. PAIN® 2008;137(1):7-15. 12. Costigan M, Scholz J, Woolf CJ. Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage. Annual Review of Neuroscience 2009;32(1):1-32. 13. Draganski B, Gaser C, Busch V, et al. Changes in grey matter induced by training. Nature 2004;427(6972):311-12. 14. Kolb B, Whishaw IQ. BRAIN PLASTICITY AND BEHAVIOR. Annual Review of Psychology 1998;49(1):43-64. 15. Ungerleider L. Imaging Brain Plasticity during Motor Skill Learning. 2002;78(3):553-64. 16. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol 2012;22(5):768-76. 17. Lelic D, Niazi IK, Holt K, et al. Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study. Neural plasticity 2016;2016:3704964. 18. Apkarian AV, Thomas PS, Krauss BR, et al. Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain. Neuroscience Letters 2001;311(3):193-97. 19. Seminowicz DA, Moayedi M. The Dorsolateral Prefrontal Cortex in Acute and Chronic Pain. The Journal of Pain 2017;18(9):1027-35. 20. Kang D, McAuley JH, Kassem MS, et al. What does the grey matter decrease in the medial prefrontal cortex reflect in people with chronic pain? European Journal of Pain 2019;23(2):203-19. 21. Loggia ML, Berna C, Kim J, et al. The lateral prefrontal cortex mediates the hyperalgesic effects of negative cognitions in chronic pain patients. The Journal Of Pain: Official Journal Of The American Pain Society 2015;16(8):692-99. 22. Eklund A, Jensen I, Lohela-Karlsson M, et al. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain-A pragmatic randomized controlled trial. PLoS One 2018;13(9):e0203029. 23. Haavik H, Niazi IK, Holt K, et al. Effects of 12 Weeks of Chiropractic Care on Central Integration of Dual Somatosensory Input in Chronic Pain Patients: A Preliminary Study. 2017. 24. Dalton PA, Jull GA. The distribution and characteristics of neck-arm pain in patients with and without a neurological deficit. The Australian journal of physiotherapy 1989;35(1):3-8. 25. Holt K, Russell D, Cooperstein R, et al. Interexaminer reliability of a multidimensional battery of tests used to assess for vertebral subluxations. Chiropr J Aust 2018;46(1):101-17. 26. Haavik H, Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. J Manipulative Physiol Ther 2011;34(2):88-97. 27. Holt KR, Haavik H, Lee AC, et al. Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial. J Manipulative Physiol Ther 2016.


Safety

Safety

Some people are worried about seeing a chiropractor because they think that chiropractic adjustments might be harmful or dangerous. However, the research relating to chiropractic care shows us that it is remarkably safe,1 and it’s effective2 and it’s associated with high levels of patient satisfaction.3 Chiropractic care actually has an enviable safety record compared to most other healthcare interventions.1, 4

There must be some risk?

Virtually all forms of healthcare are associated with some risk.5 With the sort of manual or ‘hands-on’ procedures that chiropractors use in everyday practice, it’s logical that there is at least some risk that on rare occasions some people may suffer from an adverse event after seeing their chiropractor.

A number of researchers have reviewed all the published literature relating to the safety of chiropractic care.6-8 According to these reviews, serious adverse events are very rare and most of the time the scientists weren’t sure if the chiropractic care actually caused the event or not.6-8

Because serious adverse events are so rare following chiropractic care, it’s virtually impossible for researchers to accurately estimate how often they actually occur.6 So, there are only rough estimates for serious adverse events. And these estimates range from one in 20,000 to one in several million chiropractic visits.4 But let’s put this into perspective; another study has shown that people who have to go to hospital have as high as a one in three chance of suffering from an adverse event.9

What is more common with chiropractic care is that some people can feel a bit stiff and sore after they’ve been adjusted, but this usually goes away by itself.1, 6, 7

So, according to the best reviews of all the science literature on this topic, we know that being seriously hurt from seeing your chiropractor is extremely rare.4, 8, 9 In fact, the statistics tell us that you are about 10 times more likely to be seriously injured driving to and from your chiropractor’s office than you are from being seriously injured while seeing your chiropractor.10

Stroke

Despite all of these studies showing how rare adverse events are with chiropractic care, there are still some people who are worried a chiropractic adjustment could cause a stroke. This has also been studied very carefully.8, 11 In two separate studies researchers looked at extremely large patient databases from insurance plans in Canada and America and compared over 2600 patients who had actually suffered from a stroke involving arteries in their neck and they compared them to people who hadn’t had a stroke.8, 11 They looked to see whether the people who had suffered a stroke were more likely to have seen a chiropractor or a medical doctor before suffering from the stroke.

What they found was that people who had suffered from one of these strokes were no more likely to have seen a chiropractor than a medical doctor before the stroke occurred. In some groups, they were actually more likely to have visited a medical doctor than a chiropractor before the stroke.

What does this mean?

These studies suggest that patients who suffer from a stroke after seeing a chiropractor probably went to see the chiropractor because they had neck pain or headaches that  had  been  caused by the early stages of the blood vessel damage that ultimately caused the stroke. So, the stroke had already started before they went to see the chiropractor. It also means that there is no greater risk of suffering from a stroke if you choose to visit a chiropractor compared to the risks from visiting a medical doctor.

So, if you or someone you know is worried about seeing a chiropractor, you can rest assured that chiropractic care is associated with very low risk of causing serious harm.6, 7 The risks are so rare that they cannot accurately be estimated,5, 11 and of the risk estimates that have been made, most suggest that serious adverse events associated with chiropractic care happen perhaps every several hundred thousand visits.5, 6 Like any healthcare intervention, some adverse events do of course occur with chiropractic care5, 6 and these adverse events are generally minor and go away by themselves5, 6 and don’t take away from the high levels of patient satisfaction associated with chiropractic care.3 So, despite what some people think, chiropractic has an enviable safety record and you can rest assured that if you go see your chiropractor, you’re in safe hands.

Disclaimer and References

This information is provided for educational purposes only. It is not intended to be professional advice of any kind. Haavik Research Limited encourages you to       make your own health care decisions based on your own research and in partnership with a qualified health care professional.  1. Rubinstein SM. J Manipulative  Physiol Ther 2008;31(6):461-4. 2. Coulter ID, et al. Spine J 2018;18(5):866-79. 3. Gaumer G. J Manipulative Physiol Ther 2006;29(6):455-62. 4. Rafter N, et al. QJM : monthly journal of the Association of Physicians 2014. 5. Jevne J, et al. Chiropr Man Therap 2014;22(1):37. 6. Gouveia LO, et al. Spine (Phila Pa 1976) 2009;34(11):E405-13. 7. Thiel HW, et al. Spine (Phila Pa 1976) 2007;32(21):2375-8; discussion 79. 8. Cassidy JD, et al. Journal of Manipulative and Physiological Therapeutics 2009;32(2, Supplement 1):S201-S08. 9. Makary MA, Daniel M. Bmj 2016;353:i2139. 10. Administration NHTS. Washington, DC: National Highway Traffic Safety Administration, 2013.


Understanding Plan

Understanding Plan

Experiencing pain is normal. Everyone experiences pain now and then.1 Pain is supposed to be protective to make you stop doing things that may be dangerous.2 But chronic pain that has persisted for more than 3 months is no longer protective, nor informative.3 So, what is chronic pain and what can you do about it if you suffer from it?

All pain is created by your brain because your brain has decided that you are threatened and in danger and need protecting.4-9 The interesting thing is that you don’t actually have to have any actual tissue damage to feel pain.10 And if your brain is not aware of tissue damage, you may not feel any pain at all, even if you’ve injured yourself.4 6

Sometimes pain persists long after tissue damage has actually healed.11 When  pain  persists  for  more  than  3 months we call this chronic pain.  Chronic  pain  is the second-most common reason people see a doctor and miss work.11 More than one-third of people with chronic pain become disabled by their pain to some degree.12 13 Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating. The pain can be from headaches, joint pain, neck pain, back pain or pain from an injury. Other kinds of chronic pain include tendinitis, sinus pain, carpal tunnel syndrome, and pain affecting specific parts of your body. The common thing with all these types of pain is that the actual feeling of pain is always, 100% of the time, created in your brain.5 8 14 15 This does not mean it’s not real – but understanding that the pain itself is created in your brain is really important for how you can get rid of it. And because pain depends so much on what you think and feel about the pain,2 it’s very important you understand pain properly.

Your pain experience depends on why your brain has decided you need to be protected – why it’s creating the feeling of pain for you in the first place.5 It can, therefore, be very useful for you  to try to figure out why your brain may be creating pain for you. What was happening at or around the time your pain started. What makes it worse? What makes it better?

Why is that important? Because we know that the brain can be retrained,16 so you need to use all the tools available to you to retrain your  brain  to be out of pain.16 Some of the keys to retraining your brain are staying active,17-19 staying positive,20 eating well,21 22 and sleeping well.23

Stay Active

One important way that you can help yourself if you are in chronic pain is to stay active.17-19 Your posture and how you move plays an important role in how you feel and how you experience pain.18 19 Even as little as a short walk every day can help.19 If there are movements you cannot do because of your pain you can still help by imagining these movements.24  We  know from neuroscience research that imagining a movement influences the brain in    a very similar way to actually doing the movement.24 25 This can help retrain your brain to understand that the movement is not dangerous – because imagining doing the movement will not hurt. You can basically trick your brain into giving you back pain-free movement.24 Play with these sorts of things. Make movement fun. Move in different emotional states, like when you are happy or grateful. Move outside – in the sun, in a park with beautiful plants and flowers. Move in the water.

The movement of your spine is also very important.26  Yoga  or simple spinal exercises can be great for this     and chiropractic care may be really important to help you move too.27-29  The main focus of chiropractic care      is to improve  the movement and function of your spine.30-32  This is so important because proper movement     of your spine helps your brain know more accurately what is going on, not only just in your spine, but also elsewhere in your body.33 34 And research tells us that chiropractic care can help people who suffer from back pain,38 39 and headaches.40 This is most likely because chiropractic care helps your brain know more accurately what is going on in your spine and body33 41 and may help your brain to switch off feelings of pain, when they are no longer needed.

So if you suffer from chronic pain do your best to stay positive,20 move often,18 19 eat well,21 22 sleep well,23 and go see your family chiropractor to help retrain your brain to be out of pain.38 39

References:

Katz WA. The needs of a patient in pain. The American journal of medicine 1998;105(1, Supplement 2):2S-7S. 2. Seymour B. Pain: A Precision Signal for Reinforcement Learning and Control. Neuron 2019;101(6):1029-41. 3. Holt K, Russell D, Cooperstein R, et al. Interexaminer reliability of a multidimensional battery of tests used to assess for vertebral subluxations. Chiropr J Aust 2018;46(1):101-17. 4. Fenton BW, Shih E, Zolton J. The neurobiology of pain perception in normal and persistent pain. Pain management 2015;5(4):297-317. 5. Koyama T, McHaffie JG, Laurienti PJ, et al. The subjective experience of pain: Where expectations become reality. Proceedings of the National Academy of Sciences 2005;102(36):12950-55. 6. Mitsi V, Zachariou V. Modulation of pain, nociception, and analgesia by the brain reward center. Neuroscience 2016;338:81-92. 7. Ploghaus

  1. Dissociating Pain from Its Anticipation in the Human Brain. Science 1999;284(5422):1979-81. 8. Wager TD. Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain. Science 2004;303(5661):1162-67. 9. Wiech K. Deconstructing the sensation of pain: The influence of cognitive processes on pain perception. Science 2016;354(6312):584-87. 10. Costigan M, Scholz J, Woolf CJ. Neuropathic Pain: A Maladaptive Response of the Nervous System to Damage. Annual Review of Neuroscience 2009;32(1):1-32. 11. St Sauver JL, Warner DO, Yawn BP, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American popu- lation. Mayo Clinic proceedings 2013;88(1):56-67. 12. Webb R, Brammah T, Lunt M, et al. Prevalence and Predictors of Intense, Chronic, and Disabling Neck and Back Pain in the UK General Population. Spine 2003;28(11):1195-
  2. 13. Mallen C, Peat G, Thomas E, et al. Severely disabling chronic pain in young adults: prevalence from a population-based postal survey in North Staffordshire. BMC Musculoskeletal Disorders 2005;6(1):42. 14. Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011;152(3 Suppl):S49. 15. Atlas LY, Bolger N, Lindquist MA, et al. Brain Mediators of Predictive Cue Effects on Per- ceived Pain. 2010;30(39):12964-77. 16. deCharms RC, Maeda F, Glover GH, et al. Control over brain activation and pain learned by using real-time functional MRI. Proceedings of the National Academy of Sciences of the United States of America 2005;102(51):18626-31. 17. Geneen LJ, Moore RA, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017;4:Cd011279.
  3. Booth J, Moseley GL, Schiltenwolf M, et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal care 2017;15(4):413-21. 19. O’Connor SR, Tully MA, Ryan B, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil 2015;96(4):724-34.e3. 20. Schutze R, Rees C, Slater H, et al. ‘I call it stinkin’ thinkin’’: A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing. British journal of health psychology 2017;22(3):463-80. 21. Masino SA, Ruskin DN. Ketogenic diets and pain. Journal of child neurology 2013;28(8):993-1001.
  4. Silva AR, Bernardo A, Costa J, et al. Dietary interventions in Fibromyalgia: a systematic review. Annals of medicine 2019:1-29. 23. Burgess HJ, Burns JW, Buvanendran A, et al. Associations Between Sleep Disturbance and Chronic Pain Intensity and Function: A Test of Direct and Indirect Pathways. The Clinical journal of pain 2019. 24. Bowering KJ, O’Connell NE, Tabor A, et al. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. The journal of pain : official journal of the American Pain Society 2013;14(1):3-13. 25. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. Journal of neural transmission (Vienna, Austria : 1996) 2007;114(10):1265-78. 26. Laird RA, Keating JL, Ussing K, et al. Does movement matter in people with back pain? Investigating ‘atypical’ lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors. BMC Musculoskelet Disord 2019;20(1):28. 27. Eliks M, Zgorzalewicz-Stachowiak M, Zenczak-Praga K. Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art. Postgraduate medical journal 2019;95(1119):41-45. 28. Li Y, Li S, Jiang J, et al. Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine 2019;98(8):e14649. 29. Galindez-Ibarbengoetxea X, Setuain I, Andersen LL, et al. Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Car- diovascular Outcomes: A Review. J Altern Complement Med 2017;23(9):667-75. 30. Brown RA. Spinal Health: The Backbone of Chiropractic’s Identity. Journal of Chiropractic Humanities 2016;23(1):22-28. 31. Hart J. Analysis and Adjustment of Vertebral Subluxation as a Separate and Distinct Identity for the Chiropractic Profession: A Commentary. J Chiropr Humanit 2016;23(1):46-52. 32. The Rubicon Group. Definition and Position Statement on the Chiropractic Subluxation. [Online] Available at: http://www.therubicongroup.org/#/policies/: The Rubicon Group, 2017:4. 33. Haavik H, Murphy B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. J Manipulative Physiol Ther 2011;34(2):88-97. 34. Korakakis V, Giakas G, Sideris V, et al. Repeated end range spinal movement while seated abolishes the proprioceptive deficit induced by prolonged flexed sitting posture. A study assessing the statistical and clinical significance of spinal position sense. Musculoskeletal science & practice 2017;31:9-20. 35. Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015(9):Cd004249. 36. Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther 2010;15(4):315-33. 37. Bryans R, Decina P, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther 2014;37(1):42-63.
  5. Goertz CM, Pohlman KA, Vining RD, et al. Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: a systematic review. J Electromyogr Kinesiol 2012;22(5):670-91. 39. Ruddock JK, Sallis H, Ness A, et al. Spinal Manipulation Vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis. J Chiropr Med 2016;15(3):165-83. 40. Bryans R, Descarreaux M, Duranleau M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011;34(5):274-89. 41. Holt KR, Haavik H, Lee AC, et al. Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial. J Manipulative Physiol Ther 2016.


Do you suffer from headaches?

Headaches

Do you suffer from headaches, or do you know someone who does? If you do, know that you are not alone. The head is actually the most common site of pain in the body. Headaches can range from a mild pain that comes and goes, through to constant intense pain that’s so bad you have to crawl into bed with a bucket in case you throw up!

Headaches, like any pain in your body, are a sign that something is not quite right. Your brain will create for you the sensation of pain if it thinks there is something wrong or if it thinks there is a potential problem. For example, your brain will give you a headache if you have taken too much medication – letting you know there is some chemical toxicity going on! And some headaches are a warning of life-threatening illness. But for most people, headaches are not a sign of life-threatening illness and are more the consequence of lifestyle and daily behaviour.

We know now, from a lot of neuroscience research studies, that when your spine is not moving properly, this changes the way your brain perceives what is going on in and around your body, the way it integrates other sensory information, and the way it controls your body.1-3 The movement of your spine is, in other words, very important for your brain to know where you are in space, and since you cannot see your spine with your eyes, your brain relies on the information it receives from the small muscles closest to your spine and skull.

If the segments of your spine are not moving properly… what chiropractors call being subluxated… this may, for some people, manifest as headaches. Others may experience back pain. It’s possible that problems in the spine may even lead to some babies experiencing colic or some kids may not be fully aware of their bladder at night and end up with bedwetting.

Research has shown that when a  chiropractor then gently adjusts these subluxations, it helps the brain to more accurately ‘see’ what is going on in and around the body. So, when you get adjusted by your chiropractor, if your spinal dysfunction was manifesting as headaches, these may improve. If your spinal dysfunction was manifesting as back pain, then this may get better. If it manifested as colic or bedwetting then these symptoms may improve, and so on and so on.

Chiropractic may help

But what does the research say about chiropractic care and headaches?

Researchers have reviewed all of the randomised controlled trials that have looked at the effects of chiropractic care or spinal manipulative therapy on headaches.4-6 In these studies, they have compared chiropractic care to sham care or other interventions.

The results show that chiropractic care does really help some people with headaches and migraines!

In one study,7 the researchers looked at the effects of two months of chiropractic care in 127 people suffering from migraines. After two months, they found that the people in the study who received chiropractic care got better compared to the control group with all the migraine outcomes that they looked at. They actually found that for about 1 in 5 people, their migraines almost went away completely after two months of chiropractic care! And for half of the study participants, their migraine frequency significantly reduced. The results of this study suggest that a large number of migraine sufferers respond well to chiropractic care! We don’t know for sure who will respond well, and we don’t know how much of an influence the placebo effect has, but for some people, when they get under chiropractic care, their migraines may almost completely resolve within just a couple of months.

In another study,8 80 patients with chronic headaches that were due to a problem in their neck, called cervicogenic headaches, received 8 weeks of chiropractic care and another similar group of 80 patients received 8 weeks of light massage. What they found in this study was that the patients receiving chiropractic care improved significantly compared to the control group that received massage. Pretty much all of the pain and disability scores they looked at were better in the chiropractic group. The chiropractic patients also had fewer headaches and took less medication by the end of the study. The chiropractic patients in this study were actually over 3 times more likely to have a significant improvement in their headache symptoms compared to the patients receiving a light massage.

These studies suggest that chiropractic care may really help some people suffering from different types of headaches. So, if you experience headaches, why don’t you consider chiropractic care and make sure your spine is functioning well so you can operate at your best!

Credit:
Dr. Kelly Holt – BSc, BSc(Chiro), PGDipHSc, PhD
Dr. Heidi Haavik – BSc(Physiol), BSc(Chiro) PhD
Disclaimer and References
This information is provided for educational purposes only. It is not intended to be professional advice of any kind. Haavik Research Limited encourages you to make your own health care decisions based on your own research and in partnership with a qualified health care professional. 1. Uthaikhup S, Jull G, Sungkarat S, et al. The influence of neck pain on sensorimotor function in the elderly. Arch Gerontol Geriatr 2012;55(3):667-72. 2. Haavik H, Murphy B. The role of spinal manipulation in addressing disor-dered sensorimotor integration and altered motor control. J Electromyogr Kinesiol 2012;22(5):768-76. 3. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Man Ther 2008;13(1):2-11. 4. Bryans R, Descarreaux M, Duranleau M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011;34(5):274-89. 5. Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat 2010;18:3. 6. Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ 2017;357. 7. Tuchin PJ, Pollard H, Bonello R. A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migrane. J Manipulative Physiol Ther 2000;23(2):91-95. 8. Haas M, Spegman A, Peterson D, et al. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J 2010;10(2):117-28.


Heart Rate Variability

Heart Rate Variability

Heart Rate Variability

Heart Rate Variability

Did you know that your nervous system controls your heart rate? It is one of the many smart things that your body does without you having to or put any thought into it. Your nervous system will increase or decrease your heart rate based on the needs of your body, and this is called heart rate variability.

Most people know that having a healthy heart rate is important – you don’t want it too fast, and you don’t want it too slow. It is providing your vital organs with blood and oxygen that you need to survive. However, your heart rate is not at a constant steady 70 beats per minute all day every day; it changes based on whether you are resting or exercising, whether you are happy or angry, nervous or relaxed. These changes in heart rate can be measured by something called heart rate variability or HRV.

HRV is controlled by your nervous system (made up of your brain, spinal cord and all the nerves that go to every tissue and cell in your body), specifically the part of your nervous system that is automatic, that we don’t have to think about, like breathing. A good HRV (a high one) is thought to reflect a healthy heart and a body that can respond and adapt to its environment and needs.

It is important that your brain knows what is going on in and around your body so that it can know when to increase or decrease your heart rate, and it needs to do this quickly. For example, if you get a fright, or suddenly need to run really fast, your nervous system will quickly need to increase your heart rate so it can pump enough blood to your muscles so you can run. However, when you are sleeping or relaxed, you don’t want your heart rate to stay beating that fast as this is not good for you, so your brain will sense this and then decrease your heart rate.

We know now, from a lot of neuroscience research studies, that when your spine is not moving properly, this changes the way your brain can sense what is going on in and around your body and the way it controls your body.1-3 If the joints of your spine are not moving properly (what chiropractors call being subluxated) this may affect how well you can sense what is going on in and around you and how well you can react to your environment. Research has shown that when a chiropractor then gently adjusts these subluxations, it helps the brain to more accurately “see” what is going on in and around the body. So, when you get adjusted by your chiropractor, it might help you to be able to respond and adapt to your environment better and keep you balanced and healthy.

Chiropractic may help

What does the research say about chiropractic care and heart rate variability (HRV)? Researchers have looked at a lot of the studies that have been done on the effects of chiropractic care on   HRV and summarised them.4 The results show that chiropractic care does affect HRV, and in particular, it seems to increase the healing and calming side of our autonomic nervous system, the parasympathetic nervous system!

In one study,5 the researchers got 96 different chiropractors to measure HRV before and after adjustments on 8 different patients and after 4 weeks on 2 of their patients. Altogether, 539 adults had their HRV recorded before and after their adjustments, and 111 adults had their HRV recorded across four weeks of chiropractic care. They found that in both of these groups of adults, there were improvements in their HRV measurements and that in the group that received adjustments over four weeks, these improvements remained constant over that time.

These studies suggest that even just one adjustment can influence an important part of our nervous system that controls our heart rate, which represents how well our body can respond to our environment, and is considered to be a measure of someone’s adaptability and general health. Also, very importantly, in the stressful, fast-paced life we often live these days, chiropractic care appears to increase the “healing and calming” side of our autonomic nervous system. If you are interested in good health, adaptability and want to respond better to stress, why don’t you consider chiropractic care? Make sure your spine is functioning well so you can operate at your best!

Credit:
Dr. Kelly Holt – BSc, BSc(Chiro), PGDipHSc, PhD
Dr. Heidi Haavik – BSc(Physiol), BSc(Chiro) PhD
Disclaimer and ReferencesThis information is provided for educational purposes only. It is not intended to be professional advice of any kind. Haavik Research Limited encourages you to make your own health care decisions based on your own research and in partnership with a qualified health care professional. 1. Uthaikhup S, Jull G, Sungkarat S, et al. The influence of neck pain on sensorimotor function in the elderly. Arch Gerontol Geriatr 2012;55(3):667-72. doi: 10.1016/j.archger.2012.01.013 [published Online First: 2012/02/22] 2. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol 2012;22(5):768-76. doi: 10.1016/j.jelekin.2012.02.012 [published Online First: 2012/04/10] 3. Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control.  Man Ther 2008;13(1):2-11. 4. Amoroso Borges BL, Bortolazzo GL, Neto HP. Effects of spinal manipulation and myofascial techniques on heart rate variability: A systematic review. Journal of Bodywork and Movement Therapies 2018;22(1):203-08. doi: https://doi.org/10.1016/j.jbmt.2017.09.025 5. Zhang J, Dean D, Nosco D, et al. Effect of Chiropractic Care on Heart Rate Variability and Pain in a         Multisite Clinical Study. Journal of Manipulative and Physiological Therapeutics 2006;29(4):267-74. doi: 10.1016/j.jmpt.2006.03.010


Chiropractic Mount Pleasant - Dr Helen Leeks - Revitalise Chiropractic

Lower Back Pain

I frequently see people who have suffered lower back pain for longstanding duration. It is surprising how often this can be the result of over-working the core muscles.

The psoas muscles, also known as the core muscles, are frequently targeted as being the muscles that must be worked hard to stay strong.

Although it is important to keep these muscles strong, they do retain a level of fitness in day to day activities such as walking and standing. Overworking them can result in exhaustion and consequent weakness to the muscle, along with damage to the lumbar spine.

It is important to recognise that excessive training of these muscles can be very dangerous to the low back and can in fact result in disc damage. This is because this muscle attaches directly to, not only the vertebral joints from T11/12 to L5, but also to the discs at these levels.

It is very difficult to stretch the core psoas muscles. They attach directly into the diaphragm fascial fibres which encircle the lower thoracic region around the ribcage. They also attach into the iliac muscle fibres on the inside of the pelvic bones. Since these attachments are directly onto bones, to fully stretch the fibres would require the type of flexibility only high-level gymnasts acquire. In my opinion it is not wise to consistently contract any muscle that cannot be easily extended.

 

If you are concerned about whether you are doing damage to your lower back, by overexercising these muscles, my advice is to cease core work until you can ascertain whether the muscles are currently weak or strong.
To determine the strength, or weakness, of the muscles it is best to request a muscle strength assessment. It is also important not to automatically assume they are weak through lack of training as the reverse is frequently true.

If you have had lower back issues, I suggest that caution should be taken when enrolling in any programme that specifically targets these muscles.

I am so passionate about these topics and I hope that this information is helpful to anyone experiencing lower back issues.


Chiropractic Mount Pleasant - Dr Helen Leeks - Revitalise Chiropractic

Meet Our Chiropractor - Dr Helen Leeks

Meet Dr Helen Leeks (Chiropractor)

(B.Sc. B.App Science (Chiro). Dip Teach)

dr-helen_380

For over 20 years Dr Leeks has been serving patients throughout Australia. A 1993 graduate of RMIT in Melbourne, Dr Leeks specialises in providing expert chiropractic care using gentle and effective chiropractic therapy.

Dr Leeks has studied a broad range of chiropractic techniques and is also a kinesiologist, a nutritionalist and craniopath. She has also served as a clinician at Murdoch University training future chiropractors.

Providing Care for a Variety of Conditions

The two primary techniques that Dr Leeks uses are Applied Kinesiology (A.K.) and Sacro-Occipital Technique (S.O.T.). Both techniques allow Dr Leeks to work with her patients to achieve the best results in the shortest time possible.

SOT is a natural and gentle method of restoring normal function and movement to all joints of the body. It is especially helpful in alleviating chronic low back and neck issues.

AK is an excellent diagnostic technique used to identify underlying nutritional and structural issues which may lead to pain in both joints and soft tissue. Dr Leeks uses AK to identify problems in the mobility of all of the joints of the body, not just the spine.

Dr Leeks has also completed Chirodontic training. Chirodontics is designed to assist chiropractors who work with dentists to achieve structural stability for the jaw (TMJ) joints. This can be especially helpful for patients who suffer from symptoms related to extensive dental work. This includes headache, migraine and facial pain and numbness.

Dr Leeks enjoys helping patients with a wide range of problems. She especially enjoys helping patients who have frustrated all other options and have suffered with a chronic, longer term condition. Her approach aims to both the correction of problems and long term stability to prevent reoccurrences.

Some of the conditions that Dr Leeks sees at her clinic include:

  • Joint aches and pains
  • Backache and spinal pain
  • Headache and migraine
  • Jaw tightness and pain (TMJ)
  • Sports injuries
  • Sciatica

Dr Leeks looks forward to welcoming you at your next visit.