Bones and joints make up our basic framework and are frequently the source of trouble. Verne Maree looks at some options in Singapore, to help you deal with back pain, stiff necks as well as hip and knee problems.
1. Aligning the spine
Ask around, and you’ll find a high proportion of people who either suffer from back pain right now or have done so in the past. US studies show that up to 80 percent of the population experience lower back pain (LBP) at some point. Similarly, two-thirds of the UK population will suffer neck pain during the course of their lives.
Given the spine’s central role in our physical structure, health and wellbeing, it’s not surprising that there’s a health discipline that focuses entirely on spinal alignment: chiropractic.
Until I talked with chiropractor DR MATT KAN, however, I had no idea that seemingly unrelated issues like teenage bed-wetting, or severe chest pain, could be caused by vertebral misalignment or degeneration – and, therefore, treated by chiropractic manipulation.
You can imagine how concerned the parents of Dr Kan’s 13-year-old patient were when he suddenly started wetting the bed, and how demoralised the lad himself must have felt. “The source of the trouble was the nerve between vertebrae L4 and L5, which controls the bladder, explains Dr Kan. “It was simply a neural problem. By adjusting those two vertebrae, we started to see significant improvements in just a couple of weeks.”
It’s a basic physiological fact that the nervous system controls and coordinates all the organs and structures of the human body – you’ll find that in Gray’s Anatomy. So, it follows that any misalignment of the vertebrae and discs may cause irritation to the nervous system, through the nerves that radiate out from the spinal cord.
For example, headaches, migraine, insomnia, high blood pressure and more can be related to the C1 vertebra, right at the top of your spine. That’s because the nerve that emerges from C1 is responsible for blood supply to the head, and for the pituitary gland, the scalp, the inner and middle ear, and more. These conditions can be related to whiplash injuries, says Dr Kan, which often happen to children sleeping in a moving car.
Suffering from a stiff neck or a chronic cough? It may be due to misalignment of your C6 vertebra, whose related nerve controls the neck muscles, shoulders and tonsils. “We often have patients with neck and shoulder problems related to flying, and usually find that their C5, C6, C7 and T1 have been put out of alignment by sleeping slanted to one side for long periods,” he explains. Lugging bags is another no-no. “Always use a trolley – and never carry anything on the shoulder. That’s just asking for trouble.”
Further down the spine, the nerve emerging from T2 is responsible for the heart. Dr Kan frequently see patients referred to him by cardiologists, in cases where their chest pain is related not to a cardio-pulmonary problem, but instead to the degeneration of their mid-back vertebrae.
And so it goes on. Each of the 24 spinal vertebrae, as well as the sacrum and coccyx bones at the base of our spines, controls the healthy functioning of various specific organs, muscles and other tissues.
Do his expat patients tend to suffer from a particular set of spinal problems? To a degree, says Dr Kan. Don’t underestimate the damage that can be done in the process of settling down in a new country, he adds: “Unpacking and moving stuff around is extremely demanding on the body, so don’t be surprised if you develop neck and shoulder problems soon after your arrival here – or find that existing problems have worsened.”
Frequent travel – whether for relocation, work or leisure – adds its own set of stressors. No wonder we sometimes come back from a long-haul vacation feeling so tired that we could do with a few more days off!
Though certainly not limited to his expat patients, workplace injuries are something else that Dr Kan sees quite often. That’s because so many of us sit for far too long in front of the computer, or on our laptops or tablets, devices that are not ergonomically synchronised to the structure of the body.
Generally, you go to a medical doctor to get treatment for a particular condition, often in the form of a prescription for one or more drugs. Chiropractic detects and corrects the root cause of your health problems by “removing vertebral subluxation”, says Dr Kan – its holistic approach aims to prevent disease and promote ongoing wellness without the use of drugs or surgery. That’s of special benefit to everyone, especially people who are active in sports that tend to cause injuries.
“Our aim as chiropractors is to return you to full function,” Dr Kan emphasises. “That’s very different from another discipline that might advise someone with a knee problem to stop running, or someone with a back problem to stop playing golf.”
So, what happens at your initial chiropractic appointment? First comes a very thorough examination to establish the reason for your pain, says Dr Kan. It’s most important to know whether the pain is primary, secondary or compensatory.
“Let’s take knee pain, for example. If you’ve injured your knee, your knee pain is a primary problem. Or it may be that your pelvis is misaligned, causing one leg to be shorter, which puts strain on the knee; here, your knee pain is a secondary problem. Finally, you could have an ankle or a neck problem that’s affecting your gait and thereby causing the knee pain; that would make it a compensatory problem.”
This full examination includes going for x-rays and possibly scans; checking your posture, spinal motion and gait; and investigating in detail your nerve-related organ function, your history of problems and injuries and your current daily activities.
It’s not always possible to return the spine to its totally normal state, unfortunately. It depends mainly on how advanced the vertebral subluxation (degeneration) is, which is directly related to how longstanding the damage has been. This doesn’t refer to how long you’ve been in pain, explains Dr Kan – the damage may go back to long before you started feeling pain or discomfort.
From the x-rays and possibly MRI scans, he can clearly show you the current state of each area of your spine, and the level of degeneration, if any.
Pre-emption and Consistency
Prevention is of course better than cure. Most of us, however, only pay attention to our body when it reacts to ill treatment with sickness or pain.
“We believe it’s important to educate and empower our patients, so that we don’t only see them in an emergency situation,” says Dr Kan. That goes for children, too. “Some people bring in their children for preventive treatment – just like brushing your teeth.”
Speaking of children, infants could benefit from chiropractic, he says. Babies who undergo a breach delivery or are born by Caesarean section often have neck and shoulder issues that go untreated. “If your baby isn’t sleeping well, isn’t eating well and cries a lot, a series of chiropractic adjustments over several months will likely solve the problem.”
In cases where the damage is so bad that the baby’s skull is actually slanted, he will do a cranial alignment over a few months to a year to gradually shift the skull back into shape.
Finally, consistency counts in the gentle art and science of chiropractic. It’s those small spinal adjustments over a period of time that keep you aligned and on the path to good health for the long term.
2. The ABC’s of MRI
Only a vague idea of what MRI is? You’re not alone. Consultant radiologist DR KENNETH SHEAH of Orthopaedic & Hand MRI spells it out for us.
What is MRI and what does it do?
MRI stands for magnetic resonance imaging, and it is used as a diagnostic tool in conjunction with x-rays, ultrasound, and CT scans. Unlike a CT scan, MRI is safe during the latter part of pregnancy because it doesn’t use x-rays and therefore involves no ionising radiation. Instead, it uses radio waves and a powerful magnetic field to produce clear, detailed cross-sectional images of the inside of the body.
MRI can tell fat from muscle, blood vessels from nerves, and ligaments from tendons. So, radiologists interpreting the scans are able to tell with precision what part of the body is injured, what is involved, and how badly it is injured. In summary, MRI is a safe medical investigation for musculoskeletal injuries.
What’s its role in orthopaedics?
MRI is important in the diagnosis of injuries to bones and joints, including knee, ankle, elbow, shoulder, hip and spinal problems. The new MRI machines are also able to visualise fine structures – including some ligaments that are only 2mm thick!
Any advice for our readers?
Appropriateness criteria published by leading professional bodies are a good starting point to decide if an MRI is any good for your condition. Where possible, have the scan reported by a radiologist with a subspecialty interest in musculoskeletal radiology.
Worried about claustrophobia?
Depending on your injury, you may be able to avoid going into a narrow, claustrophobic tunnel and lying very, very, still. Private medical facility MRI Center for the Extremities offers compact MRI diagnostic imaging equipment that allows knees, ankles, feet, elbows, wrists or hands be scanned in isolation, with no need to involve the entire body. It’s ideal for a wide variety of injuries, especially sport injuries. You recline comfortably in an armchair, your arm or leg rests in the scanner, while music plays through noise-cancelling headphones to keep you entertained!
Case 1: After breaking her fall on an outstretched hand, a 40-year old woman had swelling and pain around the wrist. An MRI scan confirmed a scaphoid waist fracture (one of the wrist bones), synovial thickening within the wrist joint and sprains of the intrinsic ligaments of the wrist. The wrist joint was eventually casted and allowed to heal naturally.
Case 2: An avid weekend basketballer in his 30s was doing a pivot manoeuvre when he felt a sharp snap in his planted knee, which quickly swelled up. MRI confirmed a tear of the anterior cruciate ligament, one of the major stabilisers of the knee, together with a lateral meniscal tear.
Case 3: While chasing a football, a patient rolled or twisted his ankle. This stresses the outer part of the joint, injuring the important lateral collateral ligament structures. MRI could see through the acute swelling, showing ligament damage and bone bruising, serious injuries that require crutches and a stabilisation boot.
3. Healing support
Joint pain doesn’t just affect your quality of life, it can literally be crippling. Of all the chronic ailments that can strike us as we age, hip or knee pain are two of the most common. Orthopaedic surgeon DR CHIN PAK LIN of The Orthopaedic Centre is a hip and knee specialist. Life is movement, and movement is life should be our mantra, he says; there is no elixir of life apart from a healthy lifestyle. And most of the literature on the subject agrees that exercising our joints will extend their longevity.
Proper diet and weight management are an integral part of a holistic approach to joint health, he says, and can help you avoid developing the kind of painful, stiff and dysfunctional joints that can destroy your quality of life.
Judicious use of painkillers, such as acetaminophen or NSAIDS (aspirin, ibuprofen and so on), can provide relief in moderate cases.
Supplements that purport to save your joints do not have Dr Chin’s support, however; he finds the evidence for their claims to be feeble and questionable.
Good orthotic joint supports can help provide support to sore joints, or to off-load pressure from them, especially in the early stages.
Modern medical innovations are able to offer good solutions, including minimally invasive techniques, computer-aided and robotic surgery in joint reconstruction and rescue surgery. You don’t have to live with pain. If it persists, seek help from an appropriate professional.
4. Brace yourself!
Twisted your ankle on the MacRitchie trail? Elbow annoying you after a day on the golf course? Or maybe your knee starts niggling halfway through your tennis match? And now you’ve been told to stop playing, to stop moving, to sit on the bench. For someone who’s active and loves their sport, that’s terrible news.
Bauerfeind Sports is a line of high-quality supports for ankles, knees, wrists, ankles, backs and more, from a German company that produces medical aids to help people regain mobility and wellbeing. Its range of knee supports, for example, is made of a light, airy and comfortable yet highly elastic knitted fabric, which carefully regulates the level of compression and is designed to enhance both recovery and performance. Or choose an individually adjustable knee strap with a special pad to relieve the patellar tendon.
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