Chiropractors from The Chiropractic Association (Singapore) at Kampong Chai Chee

The day was 9th July 2011. The time was 2 pm on a Saturday at the Kampong Chai Chee Community Centre in Bedok and the residents of the surrounding area had turned up in full force for a health care screening offered by The Chiropractic Association (Singapore) organised jointly with Kampong Chai Chee.

The organisers had not expected so many to be interested in attending the activities that afternoon which included a cooking demonstration on healthy dishes, a kickboxing demonstration, spinal screening by the chiropractors of The Chiropractic Association (Singapore) and a talk in Chinese by myself on common spinal conditions and tips on self-help.

The many elderly there were treated to movie screenings followed by a cooking tour etc. We were told to expect about 150 participants and the hall was full. Four tables were set up where chiropractors from our association assessed posture and answered questions minus the machines commonly used in mall screenings.

Those who came did come with real spinal complaints. A woman asked me where our hospital was located so she could go there. Another asked me if she needed to see a doctor for help. I indicated that we did not have a hospital where they could go to. And this I said with a heavy heart. I did not know if we would see them again, or how they could get the help they might be needing. I tried to tell them again of our website where they could locate a chiropractor but many did not know how to use a computer.

The day's event closed with the Minister of Kampong Chai Chee, Minister Lee Yee Shyan, presently the Minister of State for Manpower and Trade and Industry, giving away lucky draw prizes. He had graced the day's activities with his presence mingling amongst the crowd.

Many residents were still present in the hall at the close of the day's programme. I left wondering if we had done enough for the residents of Kampong Chai Chee.

Integration of TCM into Mainstream Healthcare

Malaysia's Minister of Health, YB Dato' Sri Liow Tiong Lai, at the International Medical University's (IMU) official opening of the Chiropractic Centre and Chinese Medicine Centre on 4 December this year, announced the critical step IMU was taking in integrating medicine, dentistry, chiropractic and now also Chinese medicine in IMU. He discussed Malaysia's use of traditional medicines in the Chinese, Indian, Malay and Islamic cultures, mentioning the strong base the population has in traditional and complementary medicine. The plan is to continue to expand the integrated hospital concepts into more areas in Malaysia besides the six they currently have.

A local study revealed that 69.4% of Malaysians use traditional and complementary medicine. The Ministry of Health are hoping to combine mainstream with traditional chinese medicine to reduce the side effects experienced by patients on drug therapy. China will be providing training, research and development in Malaysia's Salak Tinggi to create a new centre of excellence.

The open approach towards complementary medicine was refreshing and exciting. A survey in our practice showed 17.3% of first time patients/clients had tried Chinese tuina. Malaysian medical doctors attending the IMU two day Complementary Medicine seminars and workshops as part of the CPD programme had the opportunity to voice concerns over integration as well as watch a Chinese doctor use acupuncture needles with skill and finesse.

To find out more about the developments of traditional complementary medicine in Malaysia, these links may be helpful:
http://www.mmail.com.my/content/56880-traditional-complementary-medicine-bill-be-tabled-early-next-year "The Malay Mail, Dec 4th 2010"
http://www.youngmps.org/?p= 775 "East meets West in Holistic Healthcare for All"

Back pain and the tendency to favour one side when standing

Our work within our clinic have shown through observation that people who come in with what looks like a lumbar curvature will surely stand leaning towards one side. In some cases, the tendency to lean on the one leg disappears in just one session of treatment but in other cases the leaning persists even after a few sessions of correction. We found it significant if the difference in weight was 4 kg or more side to side when they stood on two weighing balances at the same time. Also, for those who continued to stand on one side after treatment, they were more likely to have an anatomical leg length difference, or a structural lumbar curve or scoliosis. For those whose centre of gravity was restored almost immediately, their lumbar curvature was compensatory or functional. Adjusting the pelvis was an effective way of restoring balance to the body to those with a functional lumbar curve. More gradual improvements over time were seen with those suffering from structural problems.

We gathered data from a recent Mind Body Spirit Festival held at Fort Canning, 24th - 25th October 2009, where 40 people were invited to take their weight on the weighing scales. 60% of the people volunteering were females. The mean age was 43.3 years. 21/40 people or 52.5% of those who came forward reported previous episodes of back pain. This figure is lower than that reported in the United States where 8/10 Americans claim to have suffered from at least one episode of back pain previously.

19/40 of the people surveyed or 47.5 % measured a difference of 4 kg or more side to side when they stood on the scales. This may or may not be representive of the population of Singapore at large as the people who volunteered probably suspected a back problem when they approached our booth at the festival. Of these, 73.7% admitted to having back pain before, a higher number as expected than for a random sample of people who may or may not be standing leaning to one side.

Many of these people we saw during that weekend will continue to stand and walk with their weight on one side resulting in possible tissue damage to the areas under stress, most likely the lumbosacral and hip joints.

Malaysia to offer first chiropractic programme in South East Asia

Patients have frequently asked me over the past few years whether I had earned my degree in chiropractic from Singapore. In fact, there are no chiropractic degree courses offered in South East Asia at all. The closest university one would have to travel to is Australia. In America sits the highest concentration of chiropractic colleges globally. In England, Ireland and Wales, there are two accredited colleges offering chiropractic. Two more are located in Europe --- France and Denmark.

I greeted the news that Malaysia may well be on its way to setting up a chiropractic programme commencing February 2010 with a mixture of exhilaration, wonder and amazement (Malaysian Business, August 16th 2009). The Malaysian government would recognize chiropractors under Malaysia’s Traditional and Complementary Medicine Act. No such provision exists in Singapore.

Forty students are expected in the first batch of students at the International Medical University, Kuala Lumpur. As of 31st October, ten Malaysians have enrolled but more are expected towards the end of the year. Currently, they are hoping for students to complete the first two or two and half years of the degree locally, followed by a further two years in an overseas establishment to complete the Bachelors of Science (Hons) chiropractic degree.

The implications of the successful implementation of this programme are far reaching. The profile of chiropractic in the region would be raised. Those of whom who have been deterred from the study of chiropractic in the past for financial reasons may now find it easier to pursue this course. With a steady supply of chiropractors in South East Asia, the need to import overseas talent may decrease in the near term.

To know more about the developments of chiropractic in Malaysia:
IMU President, Tan Sri Abu Bakar Suleiman
President of Chiropractic Association of Malaysia, Dr Vishwadeep Singh Sandhu
Principal Assistant Director of the Practice and Registration Section, Traditional and Complementary Medicine, Ministry of Health, Dr Shamsaini Shamsuddin
Head of Chiropractic programme, IMU, Professor Michael Thomas Haneline

Getting your neck adjusted - how worried should we be?

In response to The New York Times article "Little risk of stroke from neck adjustments" published yesterday on September 4th in "Mind Your Body", as a chiropractor, I have just something to add.

"The claim: Manipulating your neck could lead to a stroke."
Could it? There have been people who suffered a stroke after neck manipulation. It mentions forceful twisting of the neck by chiropractors. However, the forceful twisting of the neck has also been performed by barbers, bonesetters, osteopaths, manual therapists, yoga instructors ... People have also been known to have suffered a stroke after a visit to the hair salon for a hairwash. Rare incidents of strokes have been reported of people who looked at the sky or over their shoulder. Placing your neck in a vulnerable position (kind of at the sky straight up then turn your head slightly) could very well just do it even without force.

These are triggering events that led up to the unfortunate event in a person already predisposed to stroke.

Is there any sure way of ascertaining who might be more at risk from stroke after neck manipulation? No. Persons who are worried may ask their doctor if they are in the first place at risk from a stroke.

The results of a ten year study by the The Bone and Joint Decade 2000 – 2010 launched in Geneva in January 2000 during a World Health Organization (WHO) conference on “The Burden of Musculoskeletal Conditions at the Start of the New Millennium” should put some issues to rest.

There are people at higher risk of developing strokes due to lifestyle factors like smoking and drinking. They may be genetically more predisposed to suffering from a stroke, or may already suffer from high blood pressure or heart disease. The integrity of the blood vessels in their neck may be compromised and since there is no effective way to screen them, perhaps those with a medical history suggesting a higher risk of stroke should be aware that a neck adjustment has a remote chance of bringing on a stroke in these people. Having said that, people who have visited a GP for a headache or neck complaint are not less likely to suffer from a stroke thereafter (see significant findings of the Bone and Joint Decade).

With any clinical procedure, the benefits of an adjustment has to be weighed against the perceived risk. An adjustment skillfully performed, involving minimal rotation, carries very little risk to the vertebral arteries.

Ask your chiropractor about the Activator method, mobilisation, manual traction, soft tissue work, myofascial releases, which can all help with a bad neck. There are more ways than one. Chiropractors are well known for their neck adjustments called "cervical spinal manipulation". Hopefully, we can deliver similarly spectacular results using non-force techniques ... but they usually require more time.

"Watch Your Back" by Kalis Koh

Watch Your Back Besides the perils of a shrinking bank account, the price women pay for fashion extends even to their health.

Looking chic comes with a price for Miss Tay Yayin, 22.

For the past two months, the pharmacy technician has been enduring pain in her neck and upper back owing to an oversized tote bag she bought from Zara. On days when her bag is heavier than usual, she takes a longer time to arrive at her destination as she has to stop for a few times to take a rest.

“All along, I suffer from occasional backache because of a crooked spine, but the frequency of pain has increased ever since I started carrying a heavier bag,” she said.

Voluminous bags are proving to be a health hazard due to their potential in inflicting back and shoulder injuries on their users.

According to The Straits Times, clinics and physiotherapy practices are receiving a steady stream of patients seeking treatment for pains in their upper backs and necks as a result of the heavy loads they are lugging.

“If they (women) have a car or arrive in cabs, it doesn’t really matter, but if they have to walk long distances, then it begins to matter especially if they have an existing injury,” said Dr Serene Ng, 36, a chiropractor from Integrative Chiropractic.

One shoulder can become bigger than the other due to an uneven distribution of weight, she said. Carrying your bag on one shoulder strengthens the trapezius muscle there, which causes one side of the muscles to become bulkier than the other. Over time, it can result in a lop-sided body position.

Carrying heavy bags in your hands can create a traction force which pulls your joint further apart, increasing the laxity in your wrist joints, added Dr Ng.

Dr Ng warns that the situation is worsened when you clutch your handphone to your ear while carrying a heavy bag. The muscle puts up with increased pressure, which may result in cervical radiculopathy, a condition characterised by the damage of nerve function.

Despite the health repercussions, some users are undaunted by the dangers of oversized bags.

Madam Ho Wai Kuin, 38, a homemaker, said, “Having a big bag is convenient. I can easily dump things inside and it’s good to know that the bag is filled up even though my shoulder aches when I carry it for too long.”

Miss Chan Sing Ying, 19, a student at the Nanyang Technological University, said a capacious bag “is necessary” since she is staying in the school hostel. The ample space allows room for her “dirty clothes, laptop, books and other necessities” when she returns home at the end of each week.

“More importantly, you would rather want to be seen toting around a fashionable bag than to carry a haversack,” she added.

For those whose penchant for big bags is unwavering, Dr Ng recommends investing in one that is made of a soft and flexible material with wide straps.

“When your bag is hard and rigid, it doesn’t allow much body movement. A pliable bag, on the other hand, accommodates the shape of your ribs and allows proper trunk rotation movement, hence preventing you from swaying more to one side,” she said.

She encourages users to carry different bags from time to time. The varying depths of dissimilar bags can result in one bag feeling heavier than the other even though equal weight has been placed in both bags.

“If your bag isn’t made very well, when all your items sink to the bottom of your bag, it feels very heavy. However, if you place all your items into another bag that is more shallow, it will feel lighter as the items are more evenly spread out and [they] are contained flat-packed in your bag,” added Dr Ng.

By doing so, the body is not loaded in the same position with the same weight all the time.

To ensure the weight of your bag is distributed evenly across your body, you should carry your bag as close to your body as possible and utilise all the pockets, said Dr Ng.

A local healthcare company, EzyHealth Holdings, suggests that users engage in low impact activities such as yoga. Exercising strengthens the back muscles which reduces back pain.

The Daily Mail warns against carrying your bag in the crook of your arm. This may relieve some pain momentarily, but it actually puts more strain on your body as your bag is further from your body’s centre of gravity.

Anti-inflammatory medications, massage, ice packs and hot packs can help to alleviate backache temporarily, according to the Health Promotion Board. Avoid long periods of bed rest as they will weaken the muscles, lengthening the time needed to recover. But more importantly, a correct posture should be maintained at all times.

Everybody pays a different price for following fashion fads, but if you are experiencing acute pain, you should heed your body’s warning and seek medical attention.

Despite the health warnings, it seems that many are not going to ditch their supersized bags until the trend dies down.

“It’s all about the fashion aspect. People see the bag, but not the pain,” said Ms Tay.

Riddled with acne --- the drug free approach

Some ideas for teens who want to move away from drugs and chemical based lotions:-

Have you tried the following:

1. Diet - make the sacrifice, avoid the foods you know cause you breakouts

2. Cleanse from the inside - see what having brown rice for breakfast can do for your digestive system and your skin

3. Cleanse externally - try using dead sea mud soap

4. Supplement - take digestive enzymes just before a meal every meal

5. Therapy - thought of having lymph drainage done by trained therapists on the face, neck and upper trunk of the body to improve the condition of your skin?

6. Manage stress - we all know what this does to your sleep, skin and immune system

The condition of your skin tells your chiropractor something about you and your lifestyle.