For clarity, there are two forms of acupuncture. The traditional Chinese medicine form of acupuncture used for general health benefits such as improving organ function. This form of treatment is not supported by data, so it is regarded as being non-evidence based and is not something that we offer.

The other form of acupuncture, often called dry needling, is where needles are placed into painful muscles to bring about pain relief. This works in much the same way as massage. This is the form of acupuncture referred to in this article and is the one we offer in our clinic.

The NICE Guidelines do not recommend the use of acupuncture for Chronic Non-Specific Low Back Pain. This is the type of low back pain that around 91% of people with back pain have. However, over the last 15 years acupuncture has found itself going on and off the NICE Guidelines. So, it is likely that it is largely 50/50 and only works for a select group of people under certain circumstances. When researching this topic, I found this viewpoint was largely confirmed.

What are the benefits?

Two high-grade studies from 2020 and 2024 found that acupuncture seems to reduce pain in the short term, but this improvement is only short lived. So, it’s unlikely to provide long term benefits.

On that basis though, including it in the early phases of treatment as one part of a wider plan for someone who is in a lot of pain is not a terrible idea.

Another study found that when combined with other treatments, dry needling gave short term reductions in pain levels for people who had long term (chronic) low back pain, but not when used alone.

We probably shouldn’t be surprised that dry needling alone doesn’t really help people with chronic back pain much. In fact, the NICE Guidelines only recommend one treatment for chronic low back pain that can be used without also adding exercise to it – that treatment is exercise itself!

Multiple factors

Non-specific low back pain normally has multiple driving factors behind it, such as obesity, smoking or low exercise levels. It doesn’t matter how many sessions of acupuncture you have, it won’t increase your exercise levels.

In respect of sciatica, when compared against painkillers, acupuncture seemed to provide some relief. However, there are currently no high quality studies in this area, so we can’t make any strong conclusions.

So, that still poses the question, should a patient receive acupuncture/dry needling when they have Non-Specific Low Back Pain or sciatica?

Well, I think the most well-rounded answer would be “maybe”. Acupuncture seems to provide decent short-term improvements in pain levels for some people when combined with exercise. The cynic in me is there to point the finger back towards the clinician in instances like this.

Yes, you could have acupuncture if you want it. But it’s important not to hang your hat solely on that to provide you with the long term improvements you want, because the research (and common sense) tells us that you will require a more extensive treatment plan.

When treating patients with Non-Specific Low Back Pain we must acknowledge that mental health plays a big role in the onset of pain a well as occupation, lifestyle, general health and sleep routine.

So, if your clinician is simply putting some needles in your low back, manipulating it and booking you back in for next week without giving any attention to lifestyle, environmental and your broader health status, you are unlikely to be getting the gold standard treatment.

Using acupuncture alongside physical rehabilitation and a wider approach considering the whole of the patient is the most appropriate way for someone to receive acupuncture.

This article by Rob Bailey first appeared in the Diss Express in September 2026.

I see a lot of patients with tendinopathies who have been to other clinicians that have tried lots of different approaches, such as stretching, massaging and even manipulation. But the patient is still in pain.

This is because the only treatment that tendinopathies respond well to is exercise. More specifically, it seems that tendon problems largely respond best to strength training.

I’m aware that I probably seem like an exercise salesman with how much I bang on about it – it’s essential in the recovery of virtually EVERY musculoskeletal problem. So if you need to exercise your tendon to get it to stop hurting, what exercise should you be doing?

Evidential studies

A study from 2023 found that more challenging strength exercise performed at a low frequency outperformed lighter strength exercises performed more frequently. So working hard but less often seems to be better than the “little and often” approach.

Another more recent study also found that exercise was superior to other forms of treatment, such as steroid injections, which they found only provided small short-term improvements. These results are confirmed by an older study which found that steroid injections were worse than other treatments for longer term improvement.

In fact, a study from 2021 found that NO treatment was better than exercise! (I’m definitely sounding like an exercise salesman now)

So, if you have a tendon problem and your therapist is doing anything other than giving rehab and self-management advice, it’s likely your problem will not resolve.

Generally, you’re at higher risk of developing tendon problems if you are older, have diabetes, are overweight or have had a tendon problem in the same area before.

How do I exercise?

So, if we know you need to exercise tendon problems and that strength training is best, what would a recovery programme look like?

The way to structure an exercise programme for these problems is to start doing strength-based exercise around 3 times per week. We get patients to start off with very simple exercises so we can get a basic understanding of how much stress the tendon will tolerate. If they are rehabbing their achilles tendon I may start with some heel raises. If the heel raises don’t make the pain worse, I will likely then get the patient to repeat this holding a weight at the same time. I then progress the amount of weight they are holding in order to create ongoing improvement.

If the pain gets worse, we simplify the exercise in some way to make it easier and less demanding, or we might just try a different exercise altogether. If nothing happens to the patient’s pain levels, we will progress the difficulty of the exercises.

The only caveat with exercise for tendon problems (and it’s probably the main reason that people struggle with them so much) is that you need at least 48 hours between rehab sessions. The reason is that tendon pain can get worse post-exercise for up to 48 hours and it doesn’t mean you did the wrong thing. The only reason that elevated pain after exercise would suggest that you’ve aggravated the tendon is if the pain persists for MORE than 48 hours. If this happens then we get the patient to exercise again but just at an easier level.

It all sounds like a very simple solution but in practice it can be more complicated, but by regularly relying on exercise we give our patients the best chance of recovery.

This article by Rob Bailey first appeared in the Diss Express in August 2026.

Hip pain affects around 10% of the population, increasing to around 14% of those over the age of 60. Depending on what part of your body you define as your hip it can have a different cause.

Finding the true source

Some patients point to the base of their low back as the area of concern. Pain here is likely coming from the sacroiliac joint or peripheral nerve irritation. Other patients describe their hip as being the bony bit on the outside of their upper leg, with pain here likely being caused by irritation of the gluteal tendons or the iliotibial band. The final problem area is into the groin. Pain into the groin is likely caused by problems within the hip joint itself, such as osteoarthritis or damage to the cartilage.

In summary, the hip has different regions to it and the region of the pain dictates the most likely cause of the problem. This, in turn, determines the type of treatment that is required.

For example, if a patient has a hip pain that can be traced back to a problem with their sacroiliac joint, the best course of action is to provide short term pain relief. This could be in the form of administering hands-on treatment, followed by rehab to progressively load the joint up again.

Alternatively, if the patient has lateral hip pain coming from gluteal tendon irritation, then the best course of action is to engage in a strength-focussed rehabilitation programme. This could involve using weights or resistance bands, starting at lower weights and then building up slowly over time, with the patient performing this around three times per week.

Finally, if the pain is coming from problems within the ball and socket joint itself, then it’s important for the clinician to determine whether they believe an x-ray or MRI is necessary. For milder cases of osteoarthritis, a scan is unlikely to provide the clinician with any extra information that would alter the course of treatment.

In this instance, it is appropriate for the patient to receive some hands-on treatment and an exercise programme. If the clinician suspects there is a labral tear or extensive osteoarthritis present that is causing the pain, then a scan would be necessary to gain further information. It is important to decide whether invasive treatment, such as steroid injections or surgery, is necessary for recovery.

Early treatment gets results

Two long term studies found that hip problems are particularly recurrent and persistent with many participants in the studies experiencing ongoing problems past one year from onset.

If you’re suffering from hip problems, it’s important to visit your doctor or chiropractor in order to decipher the cause of pain and engage in early intervention. However, if invasive treatment such as surgery is not necessary, then the treatment you receive must include exercise.

A research paper fairly recently found that positive long-term outcomes for osteoarthritic hip problems were only achieved from exercise. So, getting an exercise programme that will help you recover and self-manage the problem is of the utmost importance.

Too often when I see patients with hip problems, they’ve been told the only solution is a hip replacement. The research that I have laid out in this article suggests that hip pain has many different causes and requires a different treatment dependent on that cause. Most of the time that treatment must include exercise, with research showing even arthritic hip pain can be managed using ongoing exercise.

This article by Rob Bailey first appeared in the Diss Express in July 2026.

Yet if those magazines were completely honest, they’d probably recommend the same thing every issue…walk more!

It may not be glamorous, but walking remains one of the simplest and most effective things you can do for your health. It’s also one of the best ways to help manage and prevent low back pain.

Despite having greater access to health information than ever before, around one in three adults still doesn’t get enough physical activity. The World Health Organisation recommends at least 150 minutes of moderate exercise each week, which works out at around 20-25 minutes of brisk walking a day. It’s a surprisingly small investment for a habit that can deliver huge benefits.

Regular walking helps improve cardiovascular health, supports weight management, boosts mood and energy levels, and reduces the risk of many long-term health conditions.

Less widely known is its role in keeping your back healthy. Low levels of physical activity are a recognised risk factor for developing episodes of low back pain; in other words, simply moving more can reduce the likelihood of your back causing problems in the first place.

When back pain does strike, many people assume they need a complicated rehabilitation programme. While targeted exercises certainly have a place, research suggests that recovery doesn’t always have to be complex. A 2019 study comparing core-strengthening exercises with a walking programme found that both approaches reduced back pain, with neither proving clearly superior.

Even more encouraging is the evidence showing that walking can help prevent future flare-ups. A major Australian study published in 2024 found that people who received education alongside a personalised walking programme experienced fewer episodes of back pain than those who didn’t follow a walking plan.

That’s not to say you should swap the gym, swimming pool or cycling club for a daily stroll. If you enjoy those activities, keep doing them. The message is simply that walking deserves far more credit than it gets. As a tool for improving health and managing back pain, it performs remarkably well.

There’s another advantage too: walking is free. No memberships, specialist equipment or expensive classes required. All you need is a comfortable pair of shoes and a little time. It’s also one of the most accessible forms of exercise. Almost anyone can do it, regardless of age or fitness level. Better still, it can be social. A regular walk with friends often feels less like exercise and more like a catch-up, making it easier to stick with.

In my experience, the most effective health habits are usually the simplest. Walking is easy, accessible and costs nothing. Sometimes the best solution really is right outside your front door.

This article by Rob Bailey first appeared in Village People magazine.

What I mean is the beautifully curved spine, the head at the top of the spine with the chin tucked, shoulders back and toes pointing squarely forwards. I am describing the image we all picture when someone thinks of a good posture.

The fundamental issue I have with this is the lack of research about its importance.

For example, when I was at university during physical examination classes, we were taught to check the heights of a patient’s pelvis. We were told that differences in height could be significant for a patient’s pain. Some chiropractors still insist that this must be ‘corrected’ immediately.

Unfortunately for these posture enthusiasts, a 2023 study of 300 adults found 78% had some form of pelvic asymmetry. This means that it is more normal to be asymmetrical than it is to be symmetrical. Viewing a patient from the front with a noticeably uneven pelvis may mean they look a bit lop sided, but it turns out it is completely normal. This goes entirely against the ‘good posture’ model we’ve been discussing.

In fact, the issue is worse because having one leg longer than the other is a likely cause of pelvic asymmetry and leg length discrepancies are present in around 90% of the population.

Another study from 2019 of 202 women found that over 75% of them had one shoulder higher than the other. This study found no correlation when pain levels were compared to shoulder asymmetry. So, it’s more common than not to have uneven shoulders and it is not related to pain.

Another area I regularly hear chiropractors discuss is that if a patient has too much or too little curvature in their lumbar spine then that could be a cause of their pain.

 A study from 2025 of nearly 36,000 test subjects found enormous variations in spinal curvatures, with lots of differences linked to age, gender and race. So, if everybody has different levels of spinal curvatures and it’s due to factors outside of our control, it would be an enormous leap to suggest that it’s linked to pain or is abnormal.

As a final example I will discuss forward head carriage. This is when a person’s head sits slightly in front of their shoulder line when viewed from the side (if you poke your chin forwards you will see what I am describing).

I’ve lost count of the number of times I have heard practitioners blame the position of a patient’s head for their neck pain. A 2019 research paper reviewing lots of other high quality research found no correlation between neck pain and forward head carriage.

Musculoskeletal pain is a complex and unpleasant physical experience, made up of factors from our biology, lifestyle, environment and mental health. It’s impossible to put a patient’s back, neck or shoulder pain down to simple postural asymmetry, it’s a hugely reductionist way of viewing the body and it won’t lead to effective management of their problem.

 Moreover, any practitioner who claims to be able to alter these asymmetries with hands-on treatment is likely ill-informed and not working from a best practice, research-backed model.

 When seeking a healthcare practitioner to help you manage pain, you are better off to find someone who listens intently, provides you with a clear explanation that encompasses the broad spectrum of causes for pain (not just presenting you with a list of your physical asymmetries), and then creates a tailored care plan that involves hands-on treatment, exercise rehabilitation, education and lifestyle management.

We are all different shapes, sizes and have a wonderful array of asymmetries; they’re all normal!

This article first appeared in the Diss Express in July 2026.

Unfortunately, the growth of social media platforms have given an enormous boost to non-research backed explanations of how treatment works such as ‘re-aligning the spine’ or ‘breaking down scar tissue’. Sometimes you get even whackier explanations from those who think it’s ‘helping to remove interference from your nervous system’, as though there is some sort of malign force interfering with your health that only they can remove.

What’s really happening?

Low back pain is an alarm system. It happens when your brain receives signals that it believes are threatening to you, so it turns on the alarm, or pain, to protect you. An example of this would be that if you go to lift something heavy, you strain a muscle in your back. That muscle sends a danger signal to your brain called nociception. Your brain turns on the alarm system to provoke a response from you.

When people who have pain seek manual therapy, they often find a short-term benefit from their treatment. This is because it has temporarily helped to modulate how the brain is processing the danger signals it has received. It is not strictly because of something physical happening at the site of the pain as a result of the treatment. So, when your clinician treats the site of your pain, they are actually affecting your brain.

 The best explanation of what I’m doing when I am treating people is that I am de-sensitising their nervous system; temporarily reducing the amount of pain you feel by affecting how your brain is processing information.

Some would say that muscles relax and joints move better after treatment. It’s true that the treatment has a physical effect on their body but it’s not because the treatment has affected that joint, but because the protective response in that part of the patient’s body has been dulled.

Bodies are not fragile

 It’s very important for patients not to view their bodies as fragile. Some believe their spines can pop out of alignment and then be realigned by someone manipulating it back into place. We know that people who hold this opinion about their bodies actually experience more pain than people who view their bodies as strong and robust.

Hands-on treatment can reduce your pain in the short term by affecting how your brain processes the information it is receiving from your tissues. It’s important that you use that time where you have less pain to partake in activities that help to manage your symptoms better long term, such as physical rehabilitation.

There’s no specific cure for pain in your body because it’s an arguably normal protective function of your nervous system. It’s a way of preventing injuring yourself further. About 70% of people with an episode of low back pain right now will have another episode within 12 months.

So, it’s important to shift your thought process from thinking treatment does something magical to your tissues, to thinking about treatment as one part of an approach for managing your back pain more effectively. Having treatment to help keep aches and pains at bay is fine, providing you also use the short-term relief to stay active, get plenty of sleep and manage stress effectively.

If the clinician treating you is claiming to put your spine back into alignment or that they are ‘removing interference with your nervous system’, then you may be better off trying a different therapist – particularly if they are not putting enough emphasis on your own self-management of your problem.

This article by Rob Bailey first appeared in the Diss Express in May 2026.

Because of the importance of exercise in a patient’s treatment plan, we always get a clear understanding of what they are already doing prior to them seeing us. Some patients are regular dog walkers, some go to the gym, some are part of our in-house pilates class, while some don’t really do anything at all. We always take time to fully understand what patients do and then we quantify it – how many minutes, how often, the intensity etc.

All this information gives a picture of the patients’ overall physical condition, as well as deciding if their level of exercise is playing a role in their pain – too much or too little.

Take it easy?

I’m always excited when I hear a patient say that they regularly go to the gym and lift weights. Not Weight-bearing exercise increases bone density and ligament tensile strength, and it can be a fantastic tool for managing pain. But most patients who regularly lift weights caveat this by saying ‘but I only go light’. I’m always disappointed when I hear this.

Possibly patients choose to lift light weights because they believe that they can ‘wear out’ their bodies if they work them too hard. This is a commonly held belief not just by patients, but by medical professionals as well.

There is a long history of poor research on this. Many years ago, a Canadian chiropractor conducted a series of research papers on dead animal tissue and found that excessive, repetitive loading led to tissue damage. This research has influenced treatment offered by many healthcare professionals.

The single biggest flaw in his research that renders his whole argument obsolete is that dead tissue does not heal or recover after injury or loading. So obviously repetitive loading of a dead tissue will damage it, but providing you are a living human, your tissues will recover and heal after you have used or injured them.

The heavier, the better

If you go to the gym and put a heavy load through your spine, it will recover and heal afterwards – it will not wear out! The only exception is repetitive injury of a tissue will likely lead to some long-term changes in the tissue structure. However, if you load your tissues progressively and respectfully, they will adapt, become stronger and MORE injury resistant.

I get almost every single patient I see to do some form of weight bearing exercise from bodyweight squats right up to weighted deadlifts. I always recommend they should start light and then progress it over time. The goal being that we want them to lift a heavy weight for a small number of repetitions, several times a week. Whilst we initially use this as a tool to get patients pain under control, we can also use it as a means for long term management of their condition.

Think of times when you need to lift something heavy. Moving furniture, digging the garden, lifting heavy shopping bags. If you’ve already practised these movements with regular weight lifting, these tasks will be physically easier for you to perform and you’ll have a significantly lower chance of getting pain or injury from performing them.

So, if you do go to the gym and lift weights, there is nothing wrong with going heavy. In fact, I would recommend that you do. The only thing that you need to remember is to make sure that you start at a level you’re comfortable with and then increase the weight progressively over time. It really is as simple as that!

This article by Rob Bailey first appeared in the Diss Express in April 2026.

They would, without fail, recommend for us all to walk more. They would remind you every month to ensure you’re getting in your 10,000 steps every day. This is even more true when it comes to recovering from or managing low back pain. Walking seems to be equal to many other forms of exercise for reducing low back pain.

We need to get out more

Unfortunately, in the western world, despite our increasing levels of wealth and knowledge, around one third of adults still do not get enough exercise. The World Health Organisation recommends 150 minutes of gentle or 75 minutes of intensive exercise every week. That’s about 22 minutes of walking each day as part of achieving your 10,000 steps.

This not only makes you healthier and helps to stave off many health conditions, but it also helps with preventing episodes of low back pain. Low levels of physical activity is a risk factor for getting an episode of back pain, so making a simple change to slightly increase your daily steps can have a significant impact on your long-term health.

In terms of low back pain recovery, many different professionals try to sell complex and intricate exercise programmes to aid recovery. It turns out that this is completely unnecessary! A randomised controlled trial from 2019 compared core strength exercises on one hand, against walking on the other, and found that they both reduced back pain.

Not only does walking reduce back pain, but it also actually reduces the recurrence of back pain. Another high-quality study from Australia in 2024 found that education and a personalised walking programme helped to reduce the number of episodes of back pain for the participants, when compared to those who did no walking.

Walking is as good as anything

Now I am not saying that people who regularly go to the gym or who swim or go cycling should give that up and start walking instead. What I am actually saying is that as a tool for health and pain management, walking is as good as anything.

We also need to consider the cost effectiveness of interventions when it comes to musculoskeletal pain and walking ticks another box there as well! Walking is free. Joining a gym, buying a bike and going swimming all involve the participant paying a fee. If someone said to you that there was something that you could do to reduce your chance of back pain, improve your health, costs nothing and only takes 20 minutes out of your day, then that really is the pot of gold at the end of the rainbow.

Walking is also incredibly low barrier. You don’t need to be an athlete to participate, and you don’t need to go to a class to learn how to do it. You can even make it social. Making your regular walk a time when you meet up with friends can help to improve consistency because let’s face it, it makes it feel less like exercise and more like a catch up with mates!

From my own experience, the best forms of health interventions are often the simplest and increasing daily steps is probably the most consistent piece of advice that I give to patients. It’s simple, easy and free – what more could you ask for?

This article by Rob Bailey first appeared in the Diss Express in March 2026.

A lot of patients either go to a lot of effort to sleep in a position they find uncomfortable, but someone has told them it is ‘better for their back’. Or they make the mistake of spending £1000 on a brand new mattress that supposedly helps to prevent back pain. Unfortunately, neither of these approaches is recommended by research.

I agree some positions are more comfortable to sleep in than others when you’re suffering with pain, but that doesn’t mean that same position is better for you long term. Moreover, we’re all different shapes and sizes. So, what is comfortable for one person may be uncomfortable for another.

There also doesn’t seem to be any research that agrees on what sort of mattress is best for people with back pain. This is because the firmness of a mattress and what is considered comfortable are highly subjective. If you believe your mattress is uncomfortable, changing it for a new one is a good idea. But bear in mind there may be many other factors contributing to your back pain and a new mattress may only make a small improvement unless you address all other relevant factors.

Buying a new mattress is also the most expensive way to try to reduce your back pain. So, if you’re looking for a good return on your investment, this is not the best place to start. One high quality study from 2018 stated that ergonomic furniture designed to help with back pain (including mattresses) does not have a firm evidence base.

Think about your sleep habits

When we do our initial consultations, we always discuss a patient’s sleep habits. We want to know how well they sleep; how regular their sleep pattern is and how much they sleep.

Why are we so pedantic about this?

Research seems to indicate that a patient’s sleep habits play a role in their recovery. One study from 2018 by Pakpour et al found it is more difficult to recover from chronic pain if you have bad sleep habits before your pain starts. Another study from 2018 by Kovacs et al found that improving your sleep quality can lead to improvements in low back pain during the early phases of care. So, sitting down with your chiropractor and identifying your bad habits can really make a difference.

How do you ensure you get a good night’s sleep?

The simple answer is to use Sleep Hygiene guidelines which can be found on the NHS website. Six rules you can follow daily to get into a good routine, including guidance on making better choices around diet, caffeine usage and creating a calming environment.

Another simple change is the use of a phone before bedtime. Generally, you should avoid screen time right before bed, however that isn’t what I am referring to. Many patients I see make the same mistake in not altering the colour of the backlight.

It’s called Night Shift on iPhones and Eye Comfort Shield on Samsung. What this does is alters the backlight colour tint on your phone screen from white to orange. White light makes your brain think that the sun is up and it releases chemicals to keep you awake. Orange light doesn’t do this. So having the orange backlight set to come on a few hours before bed can help significantly improve your sleep quality.

Whatever approach you try, make sure you try to cover as many parts of your sleep routine as possible and don’t simply buy a mattress that has been ‘specially designed’ to help with back pain, because it probably won’t offer the degree of difference you’re hoping for.

This article by Rob Bailey first appeared in the Diss Express in February 2026.

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