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tension headaches

4 Steps to Assess people with Headaches

If you or someone you know suffers from headaches than this post is for you. 

Below is a video Martin and I made about the steps we take when assessing a client who visits us at Align suffering from headaches. 

There are many different types of headache and not all of them respond to chiropractic care. This is why we go through our 4 step process to determine 

  1. What type of headache you are suffering from,
  2. Are you in the right place and we the right people to help you,
  3. What steps do you need to take to get on top of your headaches.

If you are concerned about your headaches or just sick of dealing with them, contact us at Align and lets find out how to get you on track. 

The video is 3 minutes but for those of you who prefer to read, there is a transcript below the clip. 

 

Hi, Martin here and Kieran from Align Chiropractic and this is a short video to let you know what to expect if you were to come and see us because you've got concerns about your headaches. 

Step One:

The first thing when you have headaches, is you want to make sure that you get the opportunity to tell us all about what's been happening with you. 

There are a lot of different types of headaches and so we're going to be asking you some really specific questions about the type of headache you have, where in your head you get it, the sort of things that make it better or worse and also the things that your headaches are making it harder for you to do in your life. 

This is because while headaches are one part of the problem for, a lot of people the most important thing is to be able to get back to doing the things that they either love to do or need to do in their life. 

So step one we're going to be asking some questions and giving you an opportunity to tell us all about your headaches. 

Step two

When we're assessing somebody who's come to see us with headaches, is to do a palpatory examination. 

A palpatory exam is where we use gentle touch, gentle pressure to assess areas where joints might be restricted in their motion or muscles might have tightened up or there might be areas where there's tenderness that can be part of the trigger for head pain. 

We will also often extend beyond that area, once we’ve got an assessment of the neck and upper back to other related areas so we might be feeling out through the shoulders, palpating the jaw or palpating down through the lower back and rest of the spine. 

Step Three

When we are assessing somebody who has come to see us for headaches is we look at how their spine bends and moves and twists. 

Often when there are imbalances or problems in the way the neck is working it will affect how far you can bend to the left compared to the right. the way that we assess that is to use a process called Inclinometry, which is where we use a precise instrument, called an inclinometer to measure exactly how far you go to the left compared to the right. 

So we can assess all the way, comfortable range of motion one way and then see if going the other way is more restricted. 

Step Four: 

When we are assessing somebody who has come to see us complaining of headaches, is we assess the alignment of their spine. 

Posture is the window that we can use to assess how their how well aligned their spine is and we use specialised software to take a digital photo of them from the front and the side we then digitise that to see if there's any significant alteration in their alignment. 

The way the software works is we first of all take a photo and it uses the iPad to make sure that we have a photo that is absolutely the software then places our grid around exactly where straight up and down is and then we can compare landmarks on you that should also be aligned to see exactly how straight up and down or symmetrical your posture is.

How to set up your desk when you use a laptop in 4 steps

This is a post for people who frequently use a laptop to work on or for longer periods of time. It is especially good for people worried about or who suffer from tension headaches, neck or low back pain, high or sore shoulders, or other postural issues such as forward head posture.

In the video, Martin (using Kieran as the perfect ergonomics model) talks us through the correct ergonomics of how to set up our laptops as a workstation.

Please enjoy the quick video, for your convenience, the ergonomics demo has been transcribed below. 

This video will show you what you need to do to set up your desk when you are using a laptop.

Hi, this is Martin and Kieran from Align Chiropractic, we're here today to give you a quick video that will answer one of the most commonly asked questions that we get in the practice every day.

How should you have your desk set up so that you can look after your spine and your posture when you're spending time at your computer?

The first example we're going to do today is how to set it up for a laptop. Laptops are always a little bit more of a compromise than a desktop because you can't separate the screen but we’re going to go through how you can set it up so that your posture is in as close to the optimal position as possible. 

Step 1: Seat Height

The first point that we want to address is make sure, we can't see this but just take my word for it, Kieran's feet are flat on the floor. 

So we don't want crossed legs because it’s going to create twisting and torsion through our pelvis and lower back and create tension there. 

We want to make sure that the height of the chair, if you've got a gas lift chair, is up high enough so that your hip is either level with your knee so that we've got a straight line there, or you want the hips slightly higher than the knees.

What you don't want, because it's going to create a real curve in your back is knees higher than hips. 

So first point; set up the gas lift so that you're at that height. 

Step 2: Keyboard and arm position

we also want to have when we've got a hand on the keyboard there we want to make sure that we have pretty close to a 90 degree angle here. 

The main thing you don't want to have is to have the keyboard a lot lower, so this is particularly important for shorter people. 

If you have the chair too low then you're in a position where you start having to bunch up and create a lot of tension in your shoulders to be able to keep your hands on the keyboard. 

We want the set up so that we have hands easily on the keyboard with elbows roughly at about that 90 degrees or slightly more open. 

So we want to move our chair in or out so that with our hands comfortably on the keys we've got our hip and shoulder lined up because what we're really wanting to do here is have the big weight of the chest balanced over our hip.

What we don't want to be is so far back that we start to do this kind of thing, where there's a lot more tension on both the lower back and shoulders. Similarly, we don't want to be leaning all the way forward because it's going to tire out our back. 

Step 3: How do you manage the screen position?

So, a nice comfortable position of the chair, then this is the bit where we always have the little bit of a compromise with the laptop where we want to get your head balanced over your shoulder, but if you're looking down at a screen on a laptop, then that's always going to be a little bit tricky. 

The idea with the laptop is, make sure that you realise that you're always going to have a little bit of your head posture forward rather than balance the weight of your head over your shoulder so it’s really important to take micro breaks. 

Step 4: Micro Breaks

There are programs you can get that will remind you every 20-25 minutes to just stop for a minute, relax your arms way aside have a little micro break, turn your head all the way to the left, all the way around to the right, just drop your shoulders up and down a little bit and then you can get back to work.

So there it is, a couple of key points that you can use to set up your desk or your laptop in the optimal position, thanks.

 

What is the best way to sit?

"How should I be sitting?"

We often get asked this by our clients and on the surface it sounds like a pretty simple and straight forward question but when you think about it, its a much broader subject than it first appears. 

If you subscribe to the theory that the researchers at QI are correct about pretty much everything (and let's face it, who doesn't?) then this video will explain to you a little about the *ideal* way to sit, but what do they mean by the BEST way to sit?

For instance, it could be argued that what you are sitting FOR might actually dictate how you could best attempt to sit. Then again, there are some people who argue that we shouldn't be sitting for more than just short periods at all! 

In this post I wanted to discuss a few different types of sitting and when you might want to use them.

But Kieran, what do you mean by different types of sitting?

I'm glad you asked! there are a few different ways in which we position our bodies when we sit and each has its own set of pros and cons. 

In the video above, they make reference to sitting with an angle between your low back and your hips of roughly 30 degrees. They don't specify this in the video but sitting with an angle like that refers to research for the best sitting position to ease pressure on your lower lumbar vertebrae and disks, hopefully reducing the risk of low back pain or injury including disk bulges. 

When I was studying biomechanics as part of my Bachelor of Applied Science (Chiropractic) at RMIT, (back then, the course was an undergraduate degree and a Masters by course work instead of the 5 year Bachelor degree Chiropractors currently undertake...also Youtube was only 1 year old...thats not relevant to that last point other than it gives you an indication of how old I must be) we learned that the ideal angle to sit was indeed NOT sitting up straight but between 100-110 degrees. Definitely within the ball park of what this episode of QI suggests.

So why are we always trying to sit up straight?

It seems strange doesn't it that despite scientific evidence to the contrary, that we should still be obsessed with sitting up straight. 

I can't find any rational reasoning for this but I posit that it's due to our societal awareness of posture in reference to our shoulders and head forward positions, rather than any awareness of our spinal health at large. 

Well then...which is it? Posture or low back health?

To be completely honest, I do not believe that there is one answer to this question. 

Firstly, if you know you have, or at risk of a low back injury, then it is reasonable for you to, as much as possible while sitting, attempt to have an appropriate angle of between 10 and 30 degrees beyond sitting up straight. I would also add, if you have or believe you are at risk of a low back injury, please contact us at Align Chiropractic to see what ELSE you can do to get on track beyond remembering how to sit. 

Secondly, if you don't have a specific reason or concern in reference to your low back, then as stated earlier, perhaps it is best to remember the context in which you find yourself sitting. 

If you are going to be at a computer for most of the day, then a focus on correct sitting posture. 

A couple of quick reminders are:

  • Key board - Positioned more directly in front of you, so you aren't reaching for it or turning your     wrists to get the correct angle.
  • Screen - Directly in front of you,at a height where your eyes are aimed directly in the middle just about the centre of the screen.
  • Chair - Adjusted to a height where your feet can easily touch the floor with your hips at or just past 90 degrees to your torso.
  • Mouse - Just to the side of the keyboard, easy to reach in a way that keeps your arm bent, not reaching for it.
  • Alignment - Sitting up straight, don't slouch and don't let your head and shoulders slump forward. 

Always remember to keep what you need to use IN FRONT OF YOU in an easy position to use.

Computers and equipment was designed to fit US, not the other way around!

Your other best line of defence is to try utilise a standing desk for at least some part of the day!

However, the above video raises an interesting point, If sitting more casually, i.e. watching a movie etc, then sitting up straight as if you are using a computer doesn't really feel like it makes much sense. Lets face it, it doesn't matter who you are, no one can sit up straight for extended periods of time. 

It makes sense to do it while working, where we can get up from the desk to stretch, get water or to stop our body from fatiguing, but if you're planning to sit and enjoy Casino Royal, re watch the Back to the future trilogy or binge The Sinner, then you can hardly annoy everyone you're watching with and interrupt the show with incessant stretching. 

This is where finding that 10 to 30 degree angle for your low back really comes to the fore.

Similarly while driving, I do not expect you to stop every 20-40 minutes on your daily commute for a walk, so keep that position in mind when you set up your car seat (I will post about correct driving position in the near future, but as a general rule, give yourself that slight angle, position the steering wheel so you aren't leaning forward to reach for it and make sure your head isn't being pushed forward by the headrest).

Another question we get asked frequently is should you sit on a gym ball instead? 

My answer is always the same...if your living room or office aesthetics suit the presence of a gym ball as a permanent piece of furniture, then perhaps posture and sitting is NOT the biggest issue you are currently experiencing. 

More seriously though, in my experience, sitting on a gym ball doesn't provide you with a better sitting technique for an extended period. Like anything, our body will fatigue if we ask it to hold a more rigid position for a long time and eventually we all end up slumping. Personally, I believe that a gym ball can actually help you to slump your shoulders forward as it offers you no form of support to relax into a better position. 

If you DO insist on sitting long term on gym ball, always be mindful of when your head slumps forward and your low back has started to curve in the opposite direction. 

Yep, just like any product sold on late night infomercials, the sad reality is, sitting on a gym ball will NOT automatically give you abs. 

The same can be said of ergonomic chairs or those kneeling 'chairs', not only are they usually more of an eyesore than you would hope them to be, they are really about trying to make the most of a crummy situation. They will try place you in a better posture but without adjusting your position, mindfulness of your body and remembering to get up and move frequently, your body will always try to reduce energy expenditure and slack off as soon as you aren't looking. 

So what SHOULD I be sitting on?

For a hint at the type of chairs we at Align DO actually like people to sit in, look at the furniture in our practice. 

The Eames chairs we have in the practice weren't just chosen for how beautiful they are, or how well they stand up to being sat on by hundreds of people, they also allow you to be comfortable in a relatively good position for a reasonable period of time. 

At the end of the day, there really is no substitute for body awareness. 

Listen to your body. Stand up when you need to stand up, move when you have to move, and re-position yourself when your body tells you it needs re-positioning. 

To discuss the best ways to combat bad posture, exercises to improve your ability to sit better, or discuss your concerns about your posture, contact us at Align on (03) 9696 1057, or bring it up during your next visit so that we can discuss your issues specifically and tailor an approach to your and your needs. 

In a slump...Is it time to stand tall and stop your mum from nagging you?

Good Posture...I know, I can feel how bored you are already. I don't blame you. Can you even count how many times you have been nit picked about slouching? 

And why the hell should you care right? I mean, who cares that you slump a little? Plus, its so hard to stop doing! You try so hard to be upright when you first get to your computer but sure enough, 2 hours later you find yourself leaning into the screen of your computer with your shoulders hanging from your ears and a back hunch that would make Mr. Burns envious. 

A man displaying woeful posture...in need of nagging

A man displaying woeful posture...in need of nagging

As a Chiropractor, 2 things happen often in my life. 

The first is that at almost every time I am introduced to a person or group, most people instinctively straighten their backs and sit or stand taller, as if they all instinctively know that 'Good Posture' is important (even if we don't know why) and that its something we only think about when prompted to (even though we know deep down that our posture isn't great in the first place)

The second is that poor posture is one of the leading causes the issues that we see in our practice every day!  

Low back, neck pain, jaw pain, shoulder injury, predisposition to spinal degeneration, carpal tunnel type symptoms, migraines and tension headaches are some of the most common symptoms we see day in and day out and it doesn't take much Googling to find that a lot of these problems are either caused by, or at the least made worse by, poor posture. 

So, how does having bad posture lead to these issues? 

The answer is actually really simple and its actually a major part of understanding what we do as chiropractors:

Nervous system feedback and the body’s position in space

"The deeper layers of muscle are concerned with ‘sensing’ our position in space and relaying this information to the brain. If this function is taken over by muscles... (As a result) the brain gets an incomplete picture. The brain assumes that the body needs to be propped up to counteract the effects of gravity, so it triggers further muscle contraction. This adds to the general fatigue and pain felt by the person with poor posture." - The Victorian Government's better health website 

The issues with poor posture appear to go beyond just the physical mechanics as well! 

If I told you to imitate a person who is stressed out, anxious or depressed, I bet you would tighten and slightly raise your shoulders, pushing your head forward and making you shorter. Sound familiar? 

Some authors discuss that consistently being in this position might actually lead to deepened depression, increases in perceived stress, circulation issues, as well as negatively affecting digestion, breathing mechanics and the we way we are perceived by ourselves and others!

So what can we do about it? Well I'm here to tell you that dealing with posture is both simple AND challenging. 

Simple in that there are very basic ways that we can start to work on and improve how our body holds itself, yet challenging in that as Australian's, we are sitting or lying down for an average of 23 hours and 47 minutes, so we have a lot practice at bad posture to try and work against!

Over the space of a few more blog posts, I am hoping to talk you through some strategies to start tackling this problem, but until then, if you have any questions, or if yourself or someone close to you needs help getting out of their slump, please do not hesitate to contact us at Align on (03) 9696 1057.

 

Kieran