We recently started talking about positional plagiocephaly, and how one of the common causes involved was a restriction in range of motion in the neck that can be caused by a number of different factors. These are usually mechanical in nature, inter-uterine, at birth or postnatally. (1-3)
While there is little argument for the benefits of the involvement of physical therapy in the outcomes for plagiocephaly, one of the lesser explored complications of plagiocephaly is the potential for developmental delays.
The research is talking about a correlation between positional plagiocephaly and motor function, neurodevelopment, language and cognition. They are also highlighting the connection between the severity of the plagiocephaly and risk of developmental delays. (4-6) What all this means Is essentially that the palgiocephaly or flat heat In the past was seen as mostly a cosmetic or appearance issue, now research is showing correlations with all types of development mentioned above.
Again, like we showed in the last blog, the integration of physical therapy, like chiropractic, into the management of plagiocephaly is prudent, especially where there is restriction in range of motion and joint dysfunction identified. (1-3)
The asymmetrical tonic neck reflex (ATNR) is a primitive reflex that babies exhibit in the first 6 months of life and it is an integral part of neural development. Persistence of an ATNR in school-aged children may be associated with poor handwriting, poor written expression, eye tracking issues (reading), difficulty crossing the midline and poor hand-eye coordination.
A study by McPhillips and Sheehy (2004) looked at the correlation between reading level and ATNR reflex persistence. The study put the children into 3 groups based on reading level (top, middle and lowest) and looked at the correlation between that and ATNR persistence.
It was found that the lowest reading group had a significantly higher average level of ATNR compared with the middle reading group and the top reading group. It was also found that there was a significant difference between the lowest reading group and the top reading group on a standardised test of motor ability. This study highlights the high levels of primary reflex persistence in children with reading difficulties and it provides further evidence of the association between reading difficulties and movement difficulties in young children.
A cross-sectional study by McPhillips and Black (2007) found that persistence of an ATNR was associated with lower core literacy skills in younger children. This study suggested that children with difficulties in reading, spelling and nonword reading showed high levels of ATNR persistence compared to the children without difficulties.
The findings of both of these studies are significant as it provides evidence of the association between reading difficulties, movement difficulties and literacy skills in young children with and without a retained ATNR.
If you have any concerns about your child’s reading, movement or literacy skills, give our Practice a call and we can assess your child to see if they still have a retained ATNR and give further recommendation to help manage this.
McPhillips, M. and Sheehy, N., 2004. Prevalence of persistent primary reflexes and motor problems in children with reading difficulties. Dyslexia, 10(4), pp.316-338.
McPhillips, M. and Jordan-Black, J.A., 2007. Primary reflex persistence in children with reading difficulties (dyslexia): A cross-sectional study. Neuropsychologia, 45(4), pp.748-754
Joint pain can be related to many issues and firstly important causes such as fractures, infections and tumours need to be ruled out. We commonly see joint issues also due to muscle and nerve issues. Low back pain and neck pain are common things we see and help a lot of people with, however something you may not be as aware of is that joint pain can also be associated with inflammation from your diet.
Did you know that Osteoarthritis (OA) is the most prevalent type of arthritis in Australia, and it affects about 1.8 million Australians which is about 8% of the total population? Obesity increases the risk of developing OA by 2 fold to 10 fold in the knee joints but OA of the non-weight bearing joints of the hands is also increased in obese patients, clearly indicating that other factors are involved in the relationship between obesity and OA! (1).
By Diet we are specifically focusing on the part here that pertains to the types of fat intake. Sugar also has its issues but we will leave that discussion for another day.
Fatty acids (FA), as part of molecules or acting individually, have diverse functions in cells that range from structural “building blocks” of cell membranes to suppliers of energy and signalling molecules. The FA in cells derive either from outside your body sources or from within the body’s own synthesis. Some organisms require some essential FA compounds that either cannot be synthesized, or cannot be synthesized in sufficient quantities (2).
As a result of their anti-inflammatory actions, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may have therapeutic efficacy in inflammatory diseases. These are some of the oils found in fish oils. Work with animal models of Rheumatoid arthritis (RA), colitis (abdomen pain) and asthma has demonstrated efficacy of fish oil and of mediators derived from EPA and DHA. There have been many clinical trials of fish oil in patients with inflammatory diseases. Many trials in RA report clinical improvements (e.g. improved patient assessed pain, decreased morning stiffness, fewer painful or tender joints and decreased use of NSAIDs), and when the trials have been pooled in meta-analyses, statistically significant clinical benefit has emerged (3,4). A few human trials, supported by findings from animal models, indicate that EPA and DHA have a role in stabilizing advanced atherosclerotic plaques, which could reduce cardiovascular events and mortality (5). Mice studies show that diets higher in specific types of polyunsaturated fatty acids decreased progression of OA and synovitis (joint inflammation).
If you would like to know more about Fatty Acids and joint pain we would love to see you in our practice.
(1)Sekar, S., Crawford, R., Xiao, Y. and Prasadam, I., 2017. Dietary fats and osteoarthritis: insights, evidences, and new horizons. Journal of cellular biochemistry, 118(3), pp.453-463.
(2)De Carvalho, C.C. and Caramujo, M.J., 2018. The various roles of fatty acids. Molecules, 23(10), p.2583.
(3)Fortin, P.R., Lew, R.A., Liang, M.H., Wright, E.A., Beckett, L.A., Chalmers, T.C. et al. (1995) Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis. J. Clin. Epidemiol. 48, 1379–1390 doi:10.1016/0895-4356(95)00028-3
(4)Goldberg, R.J. and Katz, J. (2009) A meta-analysis of the analgesic effects of ω-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain 129, 210–223 doi:10.1016/j.pain.2007.01.020
(5)73 Calder, P.C. (2017) New evidence that ω-3 fatty acids have a role in primary prevention of coronary heart disease. J. Public Health Emerg. 1, 35 doi:10.21037/jphe.2017.03.03
Shoulder pain and rotator cuff injuries are very common to see in clinical setting, as well as our day to day life. 70% of people at some point in life get shoulder issues!! This is huge! 40–60% of individuals with shoulder pain experience it for a duration of a year or more.(1) Increase of age, repetitive overhead movement and history of trauma has been shown to relate to damaging the rotator cuff muscles.(2)
The rotator cuff is composed of four different muscles that predominantly allows free movement of the arm while maintaining a certain level of stability. Shoulder supporting structures such as the scapula, shoulder muscles and neurovascular components are overlying on each other and extremely complex. Diagnosis of shoulder pain can vary from common inflammatory conditions e.g. osteoarthritis, tendonitis, bursitis to cervical radiculopathy and even apical lung cancer.(3) Therefore, clinicians often combine a medical history and perform orthopaedic testing, ultrasound or MRI to pinpoint a diagnosis and provide appropriate treatment options.
Since a lot of rotator cuff injuries are asymptomatic and reportedly undiagnosed, it is vital to pick up subtle signs early to avoid further damage to the shoulder.(2) One quick test to assess one of your rotator cuff muscle is called the “empty can test”. It is very easy to do at home and you will need a friend to help.
“Hold your arm straight and 45 degrees away from midline. Imagine you are holding a can and trying to empty it. Ask your friend to gently apply a downward pressure from your wrist.”
If you are unable to hold against a gentle pressure, or feel pain in your shoulder, it is suggested that a full shoulder assessment with appropriate professionals be undertaken.
Chiropractic has a strong musculoskeletal base incorporating spinal and upper extremity joint management for shoulder pain. A clinical trial has shown chiropractic manipulative therapy provides short term benefits from shoulder pain sufferers.(4) Management and care plan will always be made on a case by case basis and more research is suggested for chiropractic care and shoulder pain.
Give our practice a call if you failed the test and have concerns! Sprouting health team are here to help and we will always redirect you if we can’t.
1. Minkalis AL, Vining RD, Long CR, Hawk C, de Luca K. A systematic review of thrust manipulation for non-surgical shoulder conditions. Chiropractic & manual therapies. 2017;25(1):1.
2. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. Journal of Shoulder and Elbow Surgery. 2010;19(1):116-20.
3. Whittle S, Buchbinder R. Rotator cuff disease. Annals of internal medicine. 2015;162(1):ITC1-ITC16.
4. Munday SL, Jones A, Brantingham JW, Globe G, Jensen M, Price JL. A Randomized, Single-Blinded, Placebo-Controlled Clinical Trial to Evaluate the Efficacy of Chiropractic Shoulder Girdle Adjustment in the Treatment of Shoulder Impingement Syndrome. Journal of the American Chiropractic Association. 2007;44(6).
Low back pain is one of the leading causes of disability globally (1). In the US military, it is the most common reason members seek medical care (2). For many, it can cause limitations to daily function and can have a big impact on mental health (3). Do you or a loved one experience low back pain? This is an important article that can make the world of difference to you.
“The direct cost of back pain in the US in 2010 were $34 billion” (4)
Common medical therapies for low back pain, which include the use of nonsteroidal anti-inflammatory drugs, opioids, spinal fusions, and epidural steroid injections, have been demonstrated to have limited effectiveness (5-7). About 30% of adults in the US with spinal pain have used chiropractic care (8), but can it help manage low back pain and are there benefits?
In a recent research literature, where they were looking at changes to pain and disability among US service members with low back pain, 750 members were enrolled for the study. The members were put into 2 groups, one group only received the usual medical care for low back pain, while the other group received the usual medical care along with chiropractic care as well. The group which also received chiropractic care resulted in moderate short-term treatment benefits in both low back pain intensity and disability and led to high patient satisfaction and perceived improvements (9). This study did have some limitations as it only followed up with the participants for 12 weeks, so it was relatively short term, and further research is needed to assess longer term outcomes. But it can be seen that chiropractic may be of benefit along with the usual medical therapies to help manage low back pain.
If you want to find out if chiropractic may help manage low back pain for you or your loved ones, have a chat with one of our chiropractors to see how they can assist.
“Improving your overall function and pain levels is important for your overall quality of life”
1.Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, Charlson F. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;9995:743-800.
2. Clark LL,Hu Z. Diagnoses of low back pain, active component, U.S. Armed Forces,2010-2014.MSMR.2015;22 (12):8-11.
3. Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, Fossum C, Underwood M. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskeletal Disord. 2014;15:50.
4. Gaskin DJ, Richard P.The economic costs of pain in the United States.JPain.2012;13(8):715-724.
5. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain:time to back off? JAmBoardFam Med. 2009;22(1):62-68.
6.Manchikanti L, Knezevic NN, Boswell MV, Kaye AD, Hirsch JA. Epidural injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and meta-analysis. Pain Physician. 2016;19(3):E365-E410.
7. Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis. 2017;76(7):1269-1278.
8. Weeks WB, Goertz CM, Meeker WC, et al. Public perceptions of doctors of chiropractic: Results of a national survey and examination of variation according to respondents’ likelihood to use chiropractic, experience with chiropractic, and chiropractic supply in local health care markets. J Manipulative Physiol Ther 2015;38:33–544.
9. Goertz, C.M., Long, C.R., Vining, R.D., Pohlman, K.A., Walter, J. and Coulter, I., 2018. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: a comparative effectiveness clinical trial. JAMA network open, 1(1), pp.e180105-e180105.
There are many reasons why parents bring their children in to see a chiropractor. One of the more significant reasons with infants is plagiocephaly. Plagiocephaly simply put is asymmetry of the head. There is more than one type of this asymmetry, for the purposes of this, we are looking at positional plagiocephaly. (1-3)
Positional plagiocephaly typically occurs from mechanical factors applied over time, which can occur in utero, at birth or postnatally. In this condition there is flattening of one side of the occiput. The region of occipital flattening relates to the side that the head is toward when in the supine (on back) sleeping position. (1)
In 1994, the Back to Sleep campaign started, which saw the risk of sudden infant death syndrome (SIDS) drop by 40-60%. There was, however, an unfortunate side effect that was positional plagiocephaly, which increased by up to 600%. It has been suggested that this has exacerbated a lack of tummy time. (2)
This is where we as chiropractors come in. The research is showing that physical therapy is beneficial in increasing the range of motion for a child’s neck, which has been shown to be present in almost all cases of plagiocephaly. The cause of this is not fully understood, but is appear to be associated with multiple factors (as mentioned above) which restrict range of motion and joint dysfunction. Ultimately, this highlights that having a physical therapist, such as a chiropractor, in the treatment team may well help manage this type of plagiocephaly in your child. (1-3)
Sports-related concussion (SRC) rates in children has doubled during the last decade so here is some really important information that you need to know!
Many children with SRC will experience symptom resolution within 2 weeks, however 33% of these children will experience other ongoing issues including somatic, cognitive, physiological and/or behavioural symptoms. When these symptoms persist longer than 28 days, they are referred to as “persistent post-concussion symptoms”1.
Persistent post-concussion symptoms can have serious adverse effects on children and can result in school absenteeism, impaired academic performance, depressed moods, loss of social activities and lower quality of life1.
Return to exercise at the level prior to concussion is the primary determinant of physiological readiness to return to sport. Exercise can exacerbate symptoms after concussion so the “Rest-is-best” approach is commonly prescribed for anyone who experiences a concussion, however there is research out now that looks into concussion recovery in a different way.
A 2019 study looked into the effect of using rehabilitative exercise vs. static stretching to treat children with concussion symptoms that had lasted more than a month. This study found that moderate level exercise after the first 48 hours following concussion could safely speed recovery and decrease symptom scores more rapidly, although this did not reach clinical significance. Given the burden of social and academic problems during prolonged recovery in children, this reduction in delayed recovery for some participants was significant.
Aerobic exercise training has beneficial effects on autonomic nervous system regulation, cerebral blood flow regulation, cardiovascular physiology and brain neuroplasticity.2 However more research is needed to assess the mechanisms of aerobic training and persistent post-concussive symptoms.
If your child has experienced a concussion or significant bump to the head, give our practice a call so we can assess and help manage your child to a speedy recovery.
Ankle pain can be commonly related to back issues due to our bodies compensatory mechanisms, it also of course may be a result of injury. A common diagnosis of ankle pain is Achilles’ tendinopathy which is located at the back of your foot. The Achilles tendon is the largest and strongest tendon in the body, and serves as the conjoined tendon for the calve muscles consisting of the gastrocnemius and soleus muscles.(1)
Causes are multi-factorial, with both extrinsic and intrinsic risk factors likely contributing. Extrinsic risk factors include training errors, increased training volume or physical activity, environmental variables or improper footwear. Intrinsic risk factors to consider include abnormal ankle dorsiflexion range of motion, abnormal subtalar joint range of motion, decreased ankle plantar flexion strength, increased foot pronation, increasing age, and genetic factors. Co-morbidities of obesity, hypertension, hypercholesteremia, and diabetes can also contribute, and the presence of systemic inflammatory disease.(2)
In a recent study completed this year, the application of lumbar spine manipulation may help manage improvements in Achilles’ tendinopathy. Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation.(3)
Beyond strictly manipulating a location of dysfunction, it was believed that improving lumbar mobility would improve gait mechanics by decreasing proximal compensation. The patient was able to perform more heel raises with less pain reported, and with improved pain values noted at the Achilles tendon.
Joint mobilization and manipulation were utilized in addition to eccentric exercise, with immediate improvements in symptoms and function noted, which were maintained at discharge (12 weeks) and follow-up (nine months). Healing may take several months in chronic conditions and may partially be due to the lack of vascularity to the tendon. Initial conservative treatment measures should begin with relative rest and activity modification to provide pain relief and time for the tendon to heal.(2)
According to recent literature Chiropractic mamangement appears to be a safe and effective intervention in the rehabilitation of chronic tendinopathic dysfunction.(1)
1. Jayaseelan DJ, Kecman M, Alcorn D, Sault JD. Manual therapy and eccentric exercise in the management of Achilles tendinopathy. J Man Manip Ther. 2017;25(2):106-14.
2. Papa JA. Conservative management of Achilles Tendinopathy: a case report. J Can Chiropr Assoc. 2012;56(3):216-24.
3. Savva C, Kleitou M, Efstathiou M, Korakakis V, Stasinopoulos D, Karayiannis C. The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report. Journal of bodywork and movement therapies. 2021;26:214-9.
Do you feel weak in your lower limbs?
People with musculoskeletal pain, whether its knee, hip or low back pain can present with weakness in the muscles. Muscles that are weak may fatigue faster which could be problematic if you spend most of your day standing. There is growing evidence that spinal manipulation may increase muscle strength in healthy people and people with musculoskeletal and neurological disorders (1).
A recent study had shown that spinal manipulation helped improve voluntary force and limb joint position sense that reflects improved sensorimotor integration and processing (2). It reported that participants of the study who were receiving a single session of spinal manipulation or 12 weeks of chiropractic care showed an improvement in their ankle and elbow joint position sense (2). This suggests that manipulation may have an impact on the integration and processing of somatosensory information from the limbs (2) which can improve one’s balance and muscle strength & control.
Another study where an early randomized controlled trial found that quadricep strength was increased after spinal manipulation to the L3-L4 lumbar segments (3). However, this study did exclude people with previously diagnosed pathology which limited the clinical applicability.
Two studies looked at a specific muscle, the Tibialis Anterior (the muscle in front of your calf), and whether there was an increase in strength and motor control after a single session of spinal manipulation. It showed that the maximum voluntary control force increased in muscle strength suggesting that motor control was altered (1).d
The basic science does allow a better understanding of the mechanism behind the effects of spinal manipulation. However, there still needs to be further research on the longer term and potential functional effects on patients who exhibit increased muscle strength and function after spinal manipulation (1,2). Manipulation may be the starting point for a strengthening program that would be best integrated with other therapies for functional and strengthening improvements (3).
If you feel weak in your lower limbs or anywhere in your body, come down to Sprouting Health, we are here to help you!
Whiplash is a well known mechanism of neck injury. Characterised by an acceleration followed by a sharp deceleration, which forces the cervical spine into hyperflexion and hyperextension, most commonly resulting in soft tissue injuries, neck pain, headache, dizziness and fractures.(1, 2)Whiplash was once the most common emergency room treated motor vehicle injury in the USA.(3) Despite the fact that patients with whiplash injury very often suffer from short term neck pain(up to 10 days), a recent study has found 40-50% of whiplash patients develop chronic symptoms.(2)
Whiplash can happen easier than you might think! A simulation using vitro cervical spine revealed 3.5 G-force is considered to be the threshold for neck injuries.(4) “Traffic accident data compiled in Germany reveals that over 90% of whiplash injuries result from rear impacts at speeds of less than 25 km/h”.(4)
Fun fact: Backdated to 1995, the reported incidence of whiplash injuries in the Netherlands has a sharp increase in relation to the rise of seat belt use.(3)
Whiplash symptoms including neck pain exacerbated with movement, headaches, loss of range of motion, pinpoint tenderness at the base of occiput and more..(2, 5) In more significant impacts, whiplash patients may experience neurological symptoms in their peripherals such as weakness in the arm and grip strength.(5) Accidents in sport can also cause whiplash injury, especially with reported higher rates of occurrence in football and indoor soccer players, along with the potential of a concussion.(6)
Most occupants in major car accidents would have undergone a medical assessment to exclude spinal injuries. However, occupants in minor car accidents can often be left alone with neck injuries hoping it will get better over time. A Chiropractor can help manage chronic musculoskeletal pain, including neck pain, for the best possible outcome as mentioned in our blog from last week. Chiropractors are a primary health care provider in Australia which means you do not need a referral to see one of us for an assessment. If you are experiencing pain, give our practice a call and see whether we can help manage your concerns.
1. Chen H-b, Yang KH, Wang Z-g. Biomechanics of whiplash injury. Chinese Journal of Traumatology (English Edition). 2009;12(5):305-14.
2. Al-Khazali HM, Ashina H, Iljazi A, Lipton RB, Ashina M, Ashina S, et al. Neck pain and headache after whiplash injury: a systematic review and meta-analysis. Pain. 2020;161(5):880-8.
3. Ioppolo F, Rizzo R. Epidemiology of whiplash-associated disorders. Whiplash Injuries: Springer; 2014. p. 13-6.
4. Li F, Liu N-s, Li H-g, Zhang B, Tian S-w, Tan M-g, et al. A review of neck injury and protection in vehicle accidents. Transportation Safety and Environment. 2019;1(2):89-105.
5. Seroussi R, Singh V, Fry A. Chronic whiplash pain. Physical Medicine and Rehabilitation Clinics. 2015;26(2):359-73.
6. Albano M, Alpini DC, Carbone G. Whiplash and Sport. Whiplash Injuries: Springer; 2014. p. 127-37.
Blogs by the team at Sprouting Health