KZN SPINE CARE – PRACTICE PROFILE: DR J. SHAIK

Dr Shaik is a well-respected academic and clinician in the field of chiropractic in South Africa. His expertise in musculoskeletal health include musculoskeletal radiology; diagnosis and treatment of low back pain, neck pain and extremity (shoulders, knees, hips, etc.) pain; headache; and sports medicine (he also has a Master’s degree in Sports Medicine).

The details of his two practices are shown below. Both practices are part of the KZN Spine Care group. All consultations are by appointment. Parking is available on-site at both practices. Kindly contact Dr Shaik now to make an appointment.

Practice details of Dr J. Shaik

	Sydenham/Overport	Verulam
Physical address	Randles Road Medical Centre, 468 Randles Road, Sydenham, 4091 (next to Nu Shifa Hospital); practices with Dr KD Sood.	8 Fairview Road, Brindhaven, Verulam, 4339 (directly opposite the Engen Garage (formerly Caltex Garage)
Landline telephone	031 207 5252 (ext. 6)	032 541 6028
Cell number (call or WhatsApp)	078 655 6299	078 655 6299
Email address	jshaik.kznspinecare@gmail.com	jshaik.kznspinecare@gmail.com
Website	Facebook.com/kznspinecare	http://dr-j-shaik.business.site

KZN Spine Care

Quality Health Management

Doctors treating back pain- change in approach

Drs J Shaik, KD Sood, SR Maharajh

According to a recent review by the University of Sydney, general practitioners have changed their approach towards managing uncomplicated low back pain- and this represents a substantial shift in thinking that should see changes to practice worldwide!

What was the old approach?

• Pain medications such as paracetamols & anti-inflammatories were previously the go-to treatment for most forms of low back pain.
• Injections, and often surgery as well
• Recommending bed rest and staying away from work was central to the approach

So, what has changed?

Major international back pain management guidelines, as of 2017. The old recommendations were in place for decades! General practitioners are now unlikely to recommend pain medication for uncomplicated back pain.

Why the change?

• The escalating opioid (pain medication) crisis
• A whole lot of unfavourable research on pain medication

What is the new recommended approach?

Avoid medication initially and discourage any invasive treatments i.e. injections and surgery. Some of the recommended approaches include:

• For pain of recent onset: spinal manipulation, soft-tissue therapy, acupuncture. Note that most patients with recent-onset back pain will improve over time regardless of treatment
• For long-standing back pain: This often requires a more multi-modal approach. Thus, the recommendations include exercise, multidisciplinary rehab, spinal manipulation, cognitive behavioural therapy, mindfulness-based stress reduction and yoga.

It is recommended that doctors and patients should consider nonsteroidal anti-inflammatory medications as first-line therapy when the above approaches don’t provide adequate relief. Certain pain medications should be considered as second-line therapy only if the potential benefits outweigh the risks for the individual patient- and only after discussion of these potential risks & benefits with the patient.

However, there are some challenges!

Health systems in most industrialised countries aren’t currently set up to fund the most appropriate care for low back pain e.g. a course of treatment with a physiotherapist, chiropractor or psychologist. It’s easier & cheaper to simply prescribe pain medication. Low-admin, fast-acting relief! Thus, policy changes are needed to allow GPs to follow current best practice – these boil down to improving affordability of the recommended forms of care. Not only would this make the lives of GPs far easier, it could significantly impact the lives of those suffering.

 

For further advice or assessment, please contact us at KZN Spine Care.

Dr KD Sood: 031 207 5252 (ext. 6) or 083 556 7949 (Sydenham/Overport)

Dr J Shaik: 032 541 6028 or 031 207 5252 (ext. 6) (Verulam and Sydenham/Overport)

Dr SR Maharajh: 084 888 8308 (Greyville)

Frequently-Asked Questions Part I

Drs J Shaik, KD Sood, SR Maharajh

As chiropractors, we get asked a lot of different questions by patients and by the public. As such we have decided to include some of these questions on our blog so that it may be of benefit to our followers. For now, we have just briefly touched on each of these topics to shed some light on them.

Is there a cure for arthritis?

Unfortunately, there is currently no cure for arthritis. There has been some promising work using stem cells but this is a long way off from being implemented in general healthcare. Currently arthritis (depending on the course) is managed conservatively, medically or surgically. So far none of these can promise 100% relief of symptoms. Often a combination of the three is required for alleviating the symptoms.

What is frozen shoulder?

As much as the condition suggests that the shoulder gets cold, this does not happen. It refers to the gradual loss of movement at the affected shoulder joint. Initially, there is severe pain and limitation of movement, followed by a decrease in pain and increase in limitation of movement. This is usually due to tightening of the ligaments of the shoulder joint (i.e. the capsule). The condition may take up to two years to resolve.

When should I have x-rays taken?

Although x-rays are painless and easy to do, they are not without risks as the patient is exposed to radiation (generally safe doses). However, there are times when an x-ray (also called a radiograph) is necessary. These include any trauma (fall or car accident), severe pain not responding to treatment or getting worse, severe limitation of movement, any chest pain, pain that’s worse at night, unintentional loss of weight and severe pain during rest. This list is not comprehensive; your healthcare provider will advise you on when & why you require x-rays. Also, refer to our previous article on red flags.

In future blog posts we will expand on each of these topics a bit more. In the meantime, send through some of your own questions that you would like answered.

 

For further advice or assessment, please contact us at KZN Spine Care.

Dr KD Sood: 031 207 5252 (ext. 6) or 083 556 7949 (Sydenham/Overport)

Dr J Shaik: 032 541 6028 or 031 207 5252 (ext. 6) (Verulam and Sydenham/Overport)

Dr SR Maharajh: 084 888 8308 (Greyville)

2017 Video Refresher- Daily Habits

We trust you all enjoyed the festive season and are all ready for a great year ahead! To kick-off 2018 we thought we would do a basic recap of the key take-homes from the videos posted last year. For ease of reference and a more detailed overview, we’ve included links to these videos.

Some good daily exercises:

• Chin tucks, seated or standing (1)
• Neck Push backs – seated or standing (1)
• Interlock hands behind head, tuck chin in (1) & (2)
• Push elbows back, bring shoulder blades in together (1) & (2)
• Arms outstretched towards ceiling (2)
• Point toes downwards, rotate ankles (2)
• Bring knees towards chest, rotate hips to either side (2)

1. Video 1
2. Video 2

Routine bedroom, bathroom & kitchen habits:

• Basic 1-minute routine before getting out of bed (1)
• Avoid rushing out of bed and rounding the back & neck (2)
• Get up in stages, using arms for support while maintaining neutral spine (2)
• Don’t use laptop on bed- shift to a desk (5)
• Stand as close as possible and square up to the sink (3) & (4)
• Bend at the hips so as to keep the back straight (3) & (4)
• Use a rinse cup (3)
• Place one foot at the threshold so as to keep straight (4)
• Carry pots close to you, raise counter-tops by using cutting boards etc. (4)

1. Video 1
2. Video 2
3. Video 3 
4. Video 4
5. Video 5

Optimal driving ergonomics (6):

• Glide seat forward/back as required
• Tilt back-rest to appropriate upright angle
• Adjust steering column as needed
• Make use of head-rest
• Take short breaks during long trips

Video 6

Seated at your desk (7):

• Sit right up against the back-rest
• Tilt the pelvis forward
• Tuck your feet under the chair
• Raise your laptop
• Tuck the chin back

Video 7

Hope you found this refresher useful and can put most of it into practice right away. In our next video series we’ll demonstrate some common chiropractic adjustment/treatment techniques used.

 

For further advice or assessment, please contact us at KZN Spine Care.

Dr KD Sood: 031 207 5252 (ext. 6) or 083 556 7949 (Sydenham/Overport)

Dr J Shaik: 032 541 6028 or 031 207 5252 (ext. 6) (Verulam and Sydenham/Overport)

Dr SR Maharajh: 084 888 8308 (Greyville)

SCOLIOSIS: PART II

The Bent Spine

Drs SR Maharajh, J Shaik & KD Sood 

In Part I of our article on scoliosis, it was mentioned that the cause of scoliosis is often unknown (idiopathic).  In Part II, we highlight the risk factors associated with scoliosis, as well as the effects that it has on the individual and the different treatment options that are available.

What are the risk factors associated with scoliosis?

• Age: Young individuals, especially adolescents, are at risk of developing scoliosis during the growth spurt which occurs just before puberty. Scoliosis in the elderly may be due to advanced spinal degeneration (spondylosis)
• Gender: Females have a higher risk of developing a scoliosis. The may be due to the effects of the hormone leptin on the nervous and musculoskeletal systems.
• Genetics:  One is more likely to develop scoliosis if one’s blood relatives (e.g. parents) already have scoliosis.
• Poor posture: Poor spinal posture contributes to the development of scoliosis

What are the symptoms/effects of scoliosis?

• A bulge on one side of the (back of the) chest (known as the rib hump)
• Shortness of breath and chest pain as a result of compression of one side of the chest.
• Impaired function of the heart or lungs in severe cases, if left untreated.
• Chronic back pain and pain in the hips and knees.
• Psychological – anxiety or depression as individuals become concerned about their appearance.
• Interestingly, one study found that right thoracic and double curves in girls and right lumbar in boys were significant factors for curve progression.

How is scoliosis treated?

In mild types of scoliosis, and functional scoliosis, muscle rehabilitation and postural correction can be used to correct the curvature. Chiropractic treatment including spinal manipulation can be helpful in alleviating pain and stimulating the appropriate muscles of the spine. In severe idiopathic scoliosis, more aggressive forms of treatment are indicated. These include bracing of the spine, which holds the spine in a straight position, and has been shown in some studies to prevent worsening of the curve (an example is shown in Figure 1).  In some severe cases, where the progression of the curve cannot be prevented using braces, surgery may be indicated. This is decided by the spine surgeon after thoroughly assessing the spine. The surgery involves the use of screws and rods to correct the curve of the spine (Figure 2). In adolescents, the rods are lengthened every 6 months in order to allow proper correction over time as normal growth occurs.

 

Figure 1: An example of a brace for scoliosis treatment

Figure 2: An x-ray showing pre- and post-surgical correction of a severe scoliosis

At KZN Spine Care, we are committed to helping you achieve optimal spine and musculoskeletal health. We welcome your comments and queries. We will answer some of your questions in a series of short videos. For further advice or if you need consultation please contact:

Dr KD Sood: 031 207 5252 (ext. 6) or 083 557 7949 (Sydenham/Overport)

Dr J Shaik: 032 541 6028 or 031 207 5252 (ext. 6) (Verulam and Sydenham/Overport)

Dr SR Maharajh: 084 888 8308 (Greyville)

SCOLIOSIS: PART I

The Bent Spine

Drs KD Sood, J Shaik & S Maharajh

Normally, when you look at someone from the back, you notice that the spine runs straight down the middle. With scoliosis, however, there’s an abnormal sideways curvature of the spine, which usually appears in the shape of an ‘S’ or ‘C’ (Figure 1). Scoliosis is not a disease, but it may be caused by a pathological condition. Sometimes the curve is mild and hardly noticeable while in other cases it may be severe and even disabling. Surprisingly, most often the cause of the curve cannot be identified – this is termed idiopathic scoliosis. Where a cause is identified it is divided into structural and functional curves; the management for each is different.

Scoliosis can be found in very young children; in adolescents and in adults. It is more common in females and can run in families (familial). Only around 10% of those affected will have a curve that progresses beyond mild.

Figure 1: Child with scoliosis as viewed from the back (left) & front (right)

What are some of the common causes? 

Functional scoliosis involves a temporary and reversible change in the spine. The most common causes are differences in leg length and paraspinal muscle spasms.

Structural scoliosis is irreversible and has an underlying structural cause. This type affects 3% of the population. The most common causes are congenital (failure of formation of a part of the vertebra), trauma (spinal fractures), spinal tumours, and diseases which result in muscle wasting.

How is scoliosis assessed?

This is done by a clinical and radiographic (x-ray) assessment by spinal experts (orthopaedic spinal surgeons and chiropractors).

What signs can we look out for?

Back pain that does not respond adequately to treatment or tends to recur soon after treatment could be due to underlying scoliosis.                                                                                                                         Things you may notice include:

• Head not centred over body 
• Body leaning to one side
• One shoulder or hip higher than the other 
• One shoulder blade sticks out more than the other 
• Uneven waist height
• Walking unevenly 
• Clothes hanging unevenly or fitting awkwardly            

Here’s a short video to help guide you in screening your child at home

Figure 2: An illustration of some visible features of scoliosis

Even if a minor curve is noticed, it’s best to get it checked out by your chiropractor or physiotherapist. Scoliosis is easier to treat when detected early, as curves that start in childhood may progress as the child grows.

In Part II of this article we’ll discuss the effects and multidimensional impact of scoliosis on the body as well as the various treatment options and approaches

For further advice or assessment, please contact us at KZN Spine Care. Over the years we have seen several cases of varying forms of scoliosis.  In an upcoming blog we’ll share some of our experiences with you, so do make sure to follow this thread.

KZN SPINE CARE COMMEMORATES WORLD AIDS DAY

Drs J Shaik, KD Sood and S Maharajh

In the early 1980s, doctors were puzzled by an increase in a rare type of pneumonia and skin cancer especially in homosexual men. At that time nobody knew what was causing this phenomenon. In 1983, two scientists, Robert Gallo and Luc Montagnier, (independently of each other) discovered a virus that was responsible for the rise in opportunistic infections and tumours. This virus was later named human immunodeficiency virus (HIV).  It was found that there were three main routes of transmission viz. unprotected sexual contact, through contact with contaminated blood or blood products and mother-to-child transmission. It is now known that all people whether homo- or heterosexual; young or old; male or female; of all races and backgrounds can be infected by HIV. Since 2013, there are at least 30 million people with HIV/AIDS worldwide. In 1987, James Bunn and Thomas Netter decided that a day should be set aside to create awareness of HIV/AIDS and recommended December 1 as World AIDS Day. This date has since been adopted by the World Health Organisation.

While considerable literature exists on the clinical presentation of HIV/AIDS (especially those relating to the lymph nodes, skin rashes, diarrhea, lung infections), not many people are aware of the musculoskeletal (bones, joints and muscle) and neurological (nerves, brain, spinal cord) manifestations of HIV/AIDS. These include:

• Muscle pain due to inflammation (polymyositis)
• Arthralgia (joint pains) which can be severe
• Arthritis especially Reiter’s syndrome which is a type of sexually transmitted infective arthritis and psoriatic arthritis (associated with the skin condition known as psoriasis)
• Bone pain and pathological fracture from tumours such as Hodgkin’s lymphoma
• Pain in the foot and ankle due to inflammation of the plantar fascia and tendons of the foot and ankle
• Severe headache
• Seizures
• Meningitis
• Spinal cord compression

People present to chiropractors and other therapists mainly for musculoskeletal or neurological conditions. It is, therefore, important for both patients and healthcare practitioners (GPs, chiropractors, physiotherapists and others) to be aware of these clinical presentations and institute the appropriate investigations and treatment plans. It is important to know that not all these features occur at once, and in some cases, the diagnosis may be delayed. This is one of the reasons it is important to truthfully disclose your health status to your healthcare provider when he or she is taking a medical history from you.

We, at KZN Spine Care, are committed to educating the public on HIV/AIDS and in the fight against this disease. Please feel free to share this information with your family, friends, neighbours and colleagues. If you require any advice or information please do not hesitate to contact us.

The Flat Back Syndrome

Drs J Shaik, KD Sood and S Maharajh

 

Introduction

In our last post we spoke about round back syndrome. In today’s blog, the flat back syndrome will be described. Previously, we mentioned the curvatures of the spine which are essential for countering the effects of gravity thus allowing us to have a balanced upright posture. While the round back syndrome mainly affects the thoracic spine (mid-back), flat back syndrome can affect both the thoracic and lumbar (lower back) spine.

What is it?

Flat back syndrome refers to a loss of the normal kyphotic (outward) thoracic curve or normal lordotic (inward) lumbar curve or both. This results in the back having a flattened appearance when viewed from the side (Figures 1a & b).

Figure 1a: The flat back syndrome (thoracic)

Figure 1b: The flat back syndrome (lumbar)

How does it come about?

One of the main causes of flat back syndrome is spinal surgery. Metal rods are sometimes inserted to fuse the vertebrae (i.e. spinal fusion surgery) and the surgeon may find it difficult to bend these rods to match the normal spinal curvature. Sometimes a laminectomy (a type of back surgery) is done to decompress the spinal nerves. This can lead to a loss of the inward lumbar curve.  Excessive muscle spasm of the paraspinal muscles (those found in the back alongside the spine) and weak abdominal muscles can lead to a (painful) flat back. Another common cause is degeneration of the intervertebral discs especially in the lumbar spine. The spine tilts forward as the intervertebral discs degenerate. Vertebral fractures, especially in osteoporotic spines, may lead to a flattening of the curvatures.  In ankylosing spondylitis, the thoracic spine curve increases but the lumbar curve decreases.

How is it diagnosed?

The condition is diagnosed by clinical assessment of the patient and through the use of spinal x-rays.

What are the effects of this condition?

The main features of this condition are neck, mid-back and low back pain. Sometimes patients will lean their neck forward (excessive forward head posture) in order to maintain their head in a position to see forward. Patients may have difficulty keeping their upright balance. This is an important consideration in the elderly where the risk of fractures due to a fall is higher. There may be pain in the thighs and calves due to shortening of the hamstrings and calf muscles.

What can I do to help myself if I have this problem?

Your chiropractor, physiotherapist or general practitioner will assess you and advise you on the best course of treatment. Aerobic and core-strengthening exercises might be useful. Spinal manipulation could also help with pain relief and curve restoration. Stretching the paraspinal, hamstrings, gluteal and calf muscles; physical therapy; non-steroidal anti-inflammatory and muscle relaxant medication are other treatment modalities available. It is also important to do some exercises to improve balance (but always under the advice of a registered practitioner). Spinal surgery may be required for severe cases.

For further advice or assessment please contact us at KZN Spine Care. 

Round Back Syndrome – Part II

Drs J Shaik, KD Sood and S Maharajh

 

Have a look at the second part of our weekly blog. In Part I we explained what Round Back syndrome essentially is and briefly went over the main causes. Now we’ll cover the effects of this disorder, as well as touch on some management approaches.

Is the condition painful?

Some people with round back syndrome are asymptomatic (i.e. they experience no symptoms). However, most people will experience some degree of discomfort or pain. Spinal cancers and ankylosing spondylitis are often very painful. It is important to note that although the curve disorder is in the mid-back region, other areas are also affected and can become painful e.g. neck pain with or without referral down the arms, chest tightness, low back pain and even hip and knee pain. Prolonged increase in the thoracic/mid-back curve also predisposes an individual to early degenerative changes in the spine (spondylosis) and other joints resulting in chronic pain and disability.

What are the other effects of round back syndrome?

A severely exaggerated/increased curve can lead to difficulty in breathing as the lungs and heart are squashed in the chest. A rounded or hunched back can also result in low self-esteem and other psychological problems. An upper crossed syndrome results from tight pecs and neck muscles in the back; and weak muscles in the front of the neck and mid-back (Figure 3).

Figure 3: The upper crossed syndrome

What could be done to address this?

The most important thing is to identify the cause; for this you can consult your chiropractor, general practitioner or physiotherapist for a proper assessment. Recommended approaches could include:

-Specific exercises to strengthen the back muscles

– Postural re-training (Biokineticists are ideal for this)

– Stretching the pec and related muscles

An ergonomic assessment of your office, home and car could also help to identify aggravating or perpetuating factors. In severe and painful curves, surgery may be required. A psychologist could also assist in addressing self-esteem and other issues.

For further advice or assessment please contact us at KZN Spine Care. 

Round Back Syndrome – Part I

Drs J Shaik, KD Sood and S Maharajh

 

Introduction

Did you find our last article on excessive forward posture useful and informative? In keeping with spinal curves, we’ll now move on to the mid-back or thoracic region. This section of the spine is located between the neck and low back (lumbar) regions. As you can see from the figure below, the thoracic spine (when viewed from the side) curves in the opposite direction to the lumbar and cervical spine (Figure 1). This mid-back region is prone to changes in its curvature viz. increased curve (round back syndrome); decreased curved (flat back syndrome); and side curvature (scoliosis). In this two-part article we’ll briefly describe the round back syndrome. Flat back syndrome and scoliosis will be discussed in articles to follow.

Figure 1: Curves of the spine

What is it?

Round back syndrome refers to an increase in the thoracic/mid-back curve, which results in a hunchback-type appearance (Figure 2). The key features are:

– an increased thoracic curve

– excessive forward head posture

– rounded shoulders

Figure 2: The round back syndrome

 

How does it come about?

There are several causes, the most common being poor posture where the back muscles are weak and there is tightness of the pectoralis (pec) muscles. Also, a decrease in bone density (osteoporosis) can result in increased thoracic curve. This is common in the elderly, those with Cushing’s syndrome, vitamin D and calcium deficiencies and in certain types of cancers (e.g. myeloma). A condition called Scheuermann’s disease can occur in some adolescents. Essentially, they develop changes to the shape of the vertebrae (spinal bones) and the spinal discs which increase the curve. Trauma to the spine which results in vertebral fractures can also increase the curve. Ankylosing spondylitis, a painful inflammatory arthritis, can lead to a permanent increase in the thoracic curve.

Can this condition be corrected?

It depends on the cause. Where structural changes have occurred e.g. vertebral fractures, the increased thoracic curve is usually permanent. Postural training can improve round back syndrome but requires a dedicated effort from the individual.

In Part II of this article we’ll briefly discuss the effects of this condition as well as what you can do to address it. We’ll also post a couple of videos on it to take you through it visually & practically.

For further advice or assessment please contact us at KZN Spine Care.