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The Man With His Head In An Invisible Vice 4 September 2014

Posted by davidghallam in Uncategorized.
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A great column by Dr Phil Whitaker in the New Statesman magazine (22-28 August 2014) (just to be clear, the David in the article is not me):

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David was a patient during my earliest years in general practice: an otherwise fit man in his early sixties who needed an operation on his ear. The procedure went without a hitch but afterwards David noticed that he was markedly off-balance and developed dreadful headaches. His description stuck in my mind: he said it was if one side of his skull was being “squeezed and crushed in a vice”. He illustrated this with his hands, clamping and pressing them against his scalp as he tried to explain.

Initially, I hoped it was something that would settle spontaneously: side effects of the general anaesthetic or the painkillers, perhaps, or some deep bruising that would take a while to resolve. After a few weeks without improvement, I organised blood tests and examined everything my training suggested might be relevant. I drew a blank.

My ear, nose and throat (ENT) colleagues were similarly perplexed when he attended his six-week follow-up appointment. The surgery had been successful, they confirmed, and everything was well healed. They were at a loss to explain his new symptoms. (more…)

What is the difference between Chiropractic and Osteopathy? 3 August 2009

Posted by davidghallam in back pain, frequently asked questions.
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This is a question that comes up a lot and it’s one that I find increasingly difficult to answer as I learn more about the wide range of approaches used in my own profession and in osteopathy.

Rotation adjustment

Similarities

There are more similarities than differences between the two professions. Chiropractors and Osteopaths both believe that many health problems are caused by poor posture and misalignment of muscles and joints. They believe that if the structure of the body can be improved and the spine put back into alignment, many problems will be alleviated and the body’s own healing mechanisms will work to restore good health. Misalignment (or ‘subluxation’ to use the chiropractic term) is usually caused by external factors, such as falls or accidents,  stress, or poor posture.

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NICE Guidelines for Low Back Pain 22 July 2009

Posted by davidghallam in back pain, research.
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Assessing the low back

Assessing the low back

The publication of the National Institute for Clinical Excellence (NICE) Guidelines for ‘Early management of persistent non-specific low back pain’ in May 2009 caused something of a stir in medical circles. For the first time, treatments like chiropractic, osteopathy and acupuncture, are included in the recommended approach for tackling low back pain within the National Health Service. I’ve been banging on about the importance of these guidelines to anyone within earshot since they came out.

Who produced these Guidelines?

The NICE Development Group responsible for the Low Back Pain Guidelines was chaired by Professor of Primary Care Research, Martin Underwood, and included various medical doctors, a professor of pain management, a spine surgeon, a physiotherapist, a nurse clinician, a psychologist, patient representatives, an osteopath and a chiropractor.

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Migraine and chiropractic 7 July 2009

Posted by davidghallam in headaches, migraine, research.
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Migraines are painful headaches accompanied by a variety of symptoms such as visual disturbances, sensitivity to light, sound and smells, nausea and vomiting. Migraine attacks may vary in length and frequency: usually lasting from 4 to 72 hours, with most people free of symptoms between attacks.

‘Classic migraines’ are those accompanied by aura symptoms – neurological signs such as visual disturbance, numbness or tingling, dizziness, speech and hearing defects. Some people report memory changes, and feelings of fear and confusion. Other migraines are referred to as ‘common migraines’.

When taking a patient’s history, the chiropractor will be careful to distinguish migraines from other forms of recurring headache such as tension, sinus, eyestrain and cluster headaches.

Chiropractic an effective form of treatment
Most chiropractors approach patients suffering from migraine headaches with confidence because of the beneficial response of previous patients, who often report that chiropractic has given better relief from migraine than other forms of treatment.

Migraine triggers
Precisely how chiropractic may be helping these patients is not yet clear: much research still needs to be done. Migraine is a complex condition whose causes are not yet properly understood by medical science. Different factors are responsible for triggering migraines in different people: eg, stress, bright light, menstruation, hunger, cheese, chocolate, and monosodium glutamate.

Cervical (neck joint) triggers
It has been suggested (Terrett, 2004) that one triggering factor in some patients may be dysfunction in the joints of the cervical spine and/or muscle dysfunction in the neck region (what chiropractors call ‘subluxations’). Chiropractic adjustments can relieve these joint and muscle dysfunctions and thus remove this possible triggering factor in susceptible patients.

Chiropractic research
Four notable research projects have shown that chiropractic care can be effective in reducing the frequency and severity of migraine headaches.

The Wight Migraine Study
87 patients with classic or common migraine received chiropractic treatment over a two-year period. At the end of the two years they were assessed by means of a headache questionnaire. 29 of the 87 subjects (33%) reported a complete cessation of headaches. A further 36 (41%) reported that their headaches were much improved.

The Parker Migraine Study
A randomised controlled trial of 85 migraine sufferers who were treated by chiropractic manipulation, medical manipulation, or physiotherapy mobilisation. The subjects were treated an average of 7 times. The frequency of headache was reduced by 40% in the chiropractic group, 13% in the medical group and 34% in the physiotherapy group. Only the reduction in the chiropractic group achieved statistical significance.

The Stodolny and Chmielewski Study
A study conducted in a Neurology department in Poland of 31 patients with a diagnosis of cervical migraine. All of the patients demonstrated restrictions in neck rotation before the study commenced. After manual treatment, headaches disappeared in 32.3% of the patients. The authors concluded that functional joint restriction in the upper cervical spine plays an important role in the pathogenesis of cervical migraine and elimination of those joint restrictions significantly reduces the intensity of migraine symptoms.

The Tuchin Study
A randomised controlled trial conducted on 123 volunteers aged 10 to 70 years. A diagnosis of migraine was made according to the International Headache Society standard. Subjects were randomly assigned to receive either 2 months of chiropractic treatment or 2 months of ‘placebo’ treatment. Analysis showed a statistically significant improvement in migraine frequency, duration, disability and medication in the chiropractic group when compared to the placebo group. 22% of the chiropractic patients reported more than a 90% reduction in migraines as a result of the 2 months of treatment.

References
The above notes draw heavily on the article ‘Is upper cervical subluxation a triggering mechanism in some migraine susceptible patients?’ by Allan Terrett, Associate Professor at the School of Health Sciences, RMIT University, Bundoora, Australia, published in ‘The Cheiron’ Magazine, Winter 2004.

Wight JS. Migraine: a statistical analysis of chiropractic treatment. ACA J Chiropractic 1978 (Sep); 15 (9): S63-67.

Parker GB, Tupling H, Pryor DS. A controlled trial of cervical manipulation for migraine. Aust NZ J Med 1978; 8; 589-593.

Stodolny J, Chmielewski H. Manual therapy in the treatment of patients with cervical migraine. Manual Med 1989; 4; 49-51.

Tuchin PJ, Pollard H, Bonello R. A randomised controlled trial of chiropractic spinal manipulative therapy for migraine. J Manip Physiol Ther 2000 (Feb); 23 (2); 91-5.