In 2018 I started a masters in musculoskeletal neuroscience, focusing on my research on pain, dizziness and balance. The timing wasn’t great, we had just moved house, were building our chiropractic clinic in Woking and my first son was born 2 weeks later. Trying to balance work and life is tricky at the best of times and I knew this would be a challenge. However, I also knew I’d regret it if I delayed it.
From a young age my father often told me ‘if I could only teach you one thing it would be to think for yourself’. As a result I question everything, especially in healthcare. There is so much information available and unfortunately a huge amount of misinformation. It’s incredibly difficult to know what is really true. “New research shows…” is a phrase you’ll see in the news everyday, however, although the headline might be interesting often the quality of the research is poor.
I’ve attended thousands of hours of seminars dedicated to pain, dizziness and balance. I’ve read thousands of articles about the back pain, neck pain, shoulder pain, BPPV and headaches and as I learnt more I started to notice contradictions and assumptions. I found learning discouraging, “you can prove anything with research” is the often toted phrase. I hate that phrase but it was proving true. That’s why I wanted to do my second masters. I wanted to really learn how to tell what is most likely true from what is probably opinion or a twisting of facts.
Our chiropractic clinic in Woking is different to most because we have a special interest in neurological conditions. This means that most of our patients consult us for chronic back pain/neck pain/shoulder pain, dizziness, poor balance and headaches. Many have had a concussion, whiplash or surgery. Sadly, many have experienced emotional trauma causing anxiety. I’m focusing my study on how to diagnose and treat these conditions. This means that our chiropractic clinic uses the most current research to optimise care.
Over the last year I’ve learnt more about the variations of BPPV, including subjective BPPV which is often misdiagnosed. I’ve learnt that the recurrence rate of BPPV is 20% and that the average number of treatments needed to resolve it is two. However, some people will require up to five Epley manoeuvres before their symptoms fully resolve, usually spread over a month.
I’ve found that anxiety can cause dizziness and dizziness can cause anxiety. I’ve learnt that PPPD is far more common that I previously thought and treat although difficult is possible. It requires a comprehensive treatment plan focused on improving balance, building confidence and managing anxiety.
I know more about why people with back pain have bad balance, something I have observed for many years but never fully understood. I also found information about the changes in muscular control that occur in chronic low back pain. As a result I’ve also learnt how best to assess and treat back pain. I had always used vibration therapy as part of treatment but it had played a minor role. My research has found that vibration therapy is a highly safe and effective way to reduce back pain and improve strength and coordination.
Pain may occur when you sprain or strain a muscle or ligament. We expect most mild cases to resolve within a few weeks to a few months. However, some people develop chronic pain. This occurs when changes in the nervous system mean that pain is felt more easily, this happens at the site of injury but can spread into non-injured areas. You may have hurt your shoulder but start to feel pain in the neck, spreading down to your elbow. Many know this as referred pain and it can be quite dramatic. My biggest study so far has been to look at how to predict and detect when someone is starting to develop chronic pain, regardless of whether it is related to low back pain, neck pain shoulder pain or headaches. This has proven invaluable as it plays a strong role in the development of a treatment plan.
So far my research focus has mainly been on the diagnosis and understanding of different conditions. In particular I’ve learnt to observe and reflect on my experiences in practice. This has allowed me to question things I have taken for granted and see things in a new light.
Over the next year I will focus more on treatment options and effectiveness for low back pain, neck pain, dizziness and headaches. Many patients consult me for their post-concussion syndrome/TBI. I’ve spent time in the USA and Netherlands working with the Carrick Institute and I’ve seen some incredible results. I’ve seen many patients will chronic neurological symptoms improve greatly with specific, non-invasive treatment and exercise. I will learn more about how effective this approach is and how to predict which patients will respond well.
I’ll keep learning and keep passing that information on.