Why Does Back Pain Tend to Recur?

chiropractor wayne and paoli Why Does Back Pain Tend to Recur?In a recent Consumer Reports survey, 88% of more than 14,000 subscribers who had lower back pain indicated that it had recurred during the prior 12 months. While other academic studies suggest that recurrence may be somewhat less widespread—perhaps affecting between a third and half of all back pain sufferers—it’s very clear that many people experience back pain as a recurring problem.

Professor Doune Macdonald and fellow researchers at the University of Queensland in Brisbane were interested in learning why some people experienced a recurrence of their back pain while others did not. Their investigation found an association between recurrence of low back pain and altered muscle activity in the deep muscle fibers of the lumbar spine. These muscles are also referred to as your “core” muscles, the ones that are most targeted in Pilates training. Your core muscles give strength, balance and stability to the back, and consist of muscles in the lower back, abdomen and pelvis.

The most important of the core muscles for the stability of your back are the multifidus. These run along the length of the spine and help to take some of the pressure off the vertebral discs so that weight is more evenly distributed along the length of the back. When working properly, the multifidus muscles are activated even before any movement takes place, so as to protect the spine against injury from a sudden load of weight (such as when lifting a heavy box or bending over to tie your shoes).

According to a study published in the journal Pain in 2009, Macdonald and colleagues found that the multifidus muscles showed later activation in those with recurrent low back pain than in the backs of healthy subjects. Any delay in muscle activation can be a potential problem, as a sudden loading of weight on the spine when it is unprepared can lead to abnormal bending and twisting of the spine, increasing the risk of injury.

Possessing strong multifidus muscles is one of the obvious solutions to preventing the occurrence of low back pain. However, part of the problem is that once this set of muscles has been injured, the multifidus tends to atrophy due to disuse while the patient is healing. Prolonged bed rest is one of the worst ways to recover from low back pain because it encourages the multifidus to atrophy even further.

Chiropractic care that includes rehabilitation exercises and spinal adjustments has been shown to improve the function of the multifidus muscles. Your chiropractor can suggest exercises you can do at home that will strengthen your core muscles in between adjustments. The adjustments themselves will align your spine so that it functions properly and will not put excess strain on the supporting multifidus, thus reducing the likelihood of a recurrence of low back pain.

Why Do My Joints Ache When it’s Damp or Cold?

chiropractor wayne and paoli Why Do My Joints Ache When it’s Damp or Cold?It is common for people with chronic joint pain to feel more pain and stiffness when the weather turns damp or cold. While it might be tempting to be skeptical when an elderly relative says his or her joints are predicting that it will rain tomorrow, it turns out they may be right. Essentially, our joints sometimes act as human barometers.

Researchers believe it’s not actually the cold, snow or rain that causes an increase in joint pain, but rather a change in barometric pressure. Robert Jamison, PhD, a professor at Harvard Medical School and chief psychologist at the Pain Management Center at Brigham and Women’s Hospital in Boston, and several colleagues performed experiments with chronic pain sufferers to investigate this phenomenon. The resulting study reported that “67.9 percent of the people surveyed responded that they were sure changes in the weather had an effect on their pain. Most of the patients reported that they can feel a change in their pain before rain or cold weather occur.”

Jamison likens the joints to a balloon. “When a balloon is inflated, it has the maximum inside and outside pressure. High barometric pressure that pushes against the body from the outside keeps tissues from expanding.” But when the weather changes, the barometer drops, reducing atmospheric pressure and allowing tissues to swell. This can put increased pressure on the nerves that send pain signals. “It doesn’t take much expansion or contraction of tissue to affect a pain trigger,” Jamison adds.

Moving to a warmer climate unfortunately will not help the problem in most cases. Jamison says “There’s no heaven on earth. If you have awful back or neck pain … there’s a good chance that that pain will travel with you.” According to Jamison’s research, there is no area of the country where people experience less pain. The patients with chronic pain who lived in San Diego reported just as much pain as their counterparts in Boston. Jamison says, “I think as mammals, we kind of adjust to our climate.”

So what can be done to manage joint pain that comes and goes with the weather? Experts suggest a few possible strategies you can take:

  • Support your joints – Use joint supports (such as elastic knee bandages or support gloves for your hands) to keep tissues from expanding with the change in weather.
  • Keep warm – Dressing warmly and applying a heating pad or hot water bottle to painful areas will help to relax your muscles, easing pain.
  • Keep moving – Much as you may long to stay curled up under the duvet in bad weather, moving around will help keep your joints from stiffening. Try doing some gentle yoga and stretching exercises.

You may not be able to avoid weather-related pain entirely, but rest assured that an eventual improvement in the weather will likely bring some pain relief as well.

What Are “Posture Aids” and When Should You Consider Them?

chiropractor wayne and paoli What Are “Posture Aids” and When Should You Consider Them?Many people spend hours each day sitting at a desk, which has led to large parts of the population developing bad posture and subsequent back and neck pain.

Poor posture is actually the most common cause of low back pain, and there’s no doubt that sitting for prolonged periods is a major contributor. However, unless you plan to quit your desk job in favor of more active employment, it’s probably up to you to consider ways in which you can improve your posture while working at a desk. There are a number of different posture aids on the market, some more effective than others.

Back braces – Although a back brace is intended to keep your spine straight, research suggests that in the majority of cases it ends up being worse for your back. A strong brace can be particularly bad. If your back muscles do not need to work in order to keep you upright, they will slowly atrophy and leave you with a weaker back than before, making it subject to increased risk of pain and injury. The weaker back braces become ineffective within 10-15 minutes of putting them on, as your body adapts to the brace and returns to its slumped position. Support braces for the lower back can be useful if worn for only short periods of time while you are recovering from a low back injury. These should be used in combination with exercises to strengthen the muscles of the lower back.

Ball chair – Whether you use a specially-designed “ball chair” or a standard exercise ball, the idea is that sitting on a ball will give the muscles that support your back more of a workout. Stronger back muscles mean better posture. However, a study performed by Canadian researchers at the University of Waterloo found that “prolonged sitting on a dynamic, unstable seat surface does not significantly affect the magnitudes of muscle activation, spine posture, spine loads or overall spine stability.” In fact, the study subjects reported increased discomfort while sitting on the ball as opposed to a standard office chair. If you have a job where you sit for only short periods of time, using a ball chair may help improve your posture.

Kneeling chair – The “kneeling chair” consists of a seat fixed at a 30-degree angle, with a padded support for the knees and upper shins. Sitting at this angle does help to keep the back straight, and if measured to the proportions of the owner, can be used for short periods of time. However, it is not advised that you replace your normal office chair with one of these. It can be hard on the knees and shins with prolonged use and does not allow for movement of the legs as you sit. It can also reduce blood flow to the legs.

Experts stress that the best way to improve your posture is to perform regular exercises that strengthen your “core” muscles (muscles in the low back, hips and abdomen), which are the ones that are used to support your spine and keep you upright. This, combined with the use of an ergonomic office chair that has a back support and which can be adjusted to adapt to your leg and arm height is the best way of maintaining good posture, allowing you to remain free of neck and low back pain.

What is a “Slipped Disc”?

chiropractor wayne and paoli What is a “Slipped Disc”?A slipped disc is the common term for a prolapsed or herniated spinal disc. These discs are set in position between the vertebrae and do not “slip”. Instead, the disc’s outer, fibrous ring tears, thereby allowing the soft, inner portion to extrude through the tear and press against the spinal nerves. Inflammatory chemicals may also be released as a result of the tear and may cause significant, long-term pain.

Depending on the location of the slipped disc, the individual may experience numbness and tingling sensations in the extremities, sciatica and even erectile dysfunction, in addition to the localized pain.

Diagnosis can be performed using a number of methods (X-rays, computed tomography, discography), but a magnetic resonance imaging scan (MRI) is usually the most effective, as it can provide highly detailed three-dimensional images of the affected area. These methods, however, are generally reserved for those cases where natural recovery has failed to improve the symptoms.

A physical examination is commonly performed prior to imaging tests and can include the testing of reflexes, sensations and muscle strength in the extremities and the patient’s ability to walk. These tests may include the straight-leg raising test where the patient slowly raises each of his or her legs individually while lying down. A slipped disc usually induces pain and/or numbness in patients as they raise their legs beyond two-thirds of their normal range.

Treatment for the majority of slipped discs generally consists of the patient practicing gentle exercises and taking prescribed painkillers (if there is significant pain) while the disc shrinks of its own accord. Your chiropractor may also perform spinal adjustments to correct the subluxations that are causing the herniated disc.

Lifting, reaching and sitting for long periods of time during recovery are to be avoided as they often aggravate the condition. However, exercise is important since movement encourages blood flow to the affected area.  Swimming is one of the best methods for exercising during recovery because it releases the compression forces on the spine while promoting blood flow, thereby encouraging the torn disc to repair itself.

Natural recovery can usually be achieved within 4 to 6 weeks, but if the symptoms persist past this point then the imaging tests (i.e., MRI) mentioned above can be applied. Depending on the severity of the tear, the physician may recommend physiotherapy or surgery. Approximately 1 in 10 cases of herniated discs will require surgery due to severe nerve compression, difficulty in walking and standing, symptom severity and/or lack of improvement.

Surgery may consist of open discectomy (where all or a portion of the disc is removed), prosthetic disc replacement (where an artificial disc is inserted to replace the damaged disc), or endoscopic laser discectomy (where the compressed nerve causing the pain is released and part of the disc is removed using a laser and endoscope). Recovery from this type of surgery usually takes 2 to 6 weeks although in some cases, further surgery may be necessary.

As with most conditions, an ounce of prevention is worth a pound of cure. Regular visits to your chiropractor can help nip any subluxation in the bud so that it does not lead to a slipped disc. Engage in regular exercise, avoid sitting for prolonged periods of time, maintain good posture, lift using the proper technique and drink plenty of water (so your discs stay well-hydrated). If you look after your general health and fitness, you will significantly reduce the likelihood of a slipped disc.

Tension Headache Causes and Treatment Options

chiropractor wayne and paoli Tension Headache Causes and Treatment OptionsWhen your head feels like it’s being squeezed in a vise, with pain radiating from the neck, the back of your head or your eyes, you may have what is referred to as a tension-type headache.  Tension headaches are the most common type of headache, accounting for approximately 90% of all occurrences.  Experts estimate that between 30% and 80% of the US adult population suffers from the occasional tension headache.  It is also possible to have chronic tension headaches, but this is experienced by only about 3% of the population.

Unlike migraines, tension headaches do not run in families.  There is no single cause of tension headaches.  Most are due to emotional or physical stress of some kind.  Among some of these causes are:

  • Insufficient or poor quality sleep
  • Losing a job or beginning a new job
  • Having recently had a baby
  • Relationship problems with your partner
  • Sports competitions
  • Studying for school exams
  • Being involved in too many activities
  • Being overweight

Anxiety, fatigue, hunger and poor posture can also significantly contribute to the likelihood of a tension headache caused by tight muscles in the neck and scalp.  Another possible source of some tension headaches may be the frequent or constant clenching of the teeth, which can cause chronic contraction of the muscles in the temples (which is why massaging this area sometimes brings some relief).

Those who suffer from chronic tension headaches tend to be people who suffer from stress on a daily basis.  Women are the most common sufferers of these chronic headaches, which can vary in intensity throughout the day, but which always produce some level of pain.  Chronic tension headaches are classified as those lasting for 15 days or more.  Most commonly, chronic tension headaches last for 60 to 90 days.

Analgesics such as ibuprofen, acetaminophen and aspirin are often used to treat the occasional tension headache.  However, taking these on a long-term basis can cause what are referred to as medication overuse headaches (or rebound headaches), which are the third most common form of headache.

Stress reduction techniques can help prevent tension headaches.  Making lifestyle changes such as getting more sleep, eating healthy food and getting regular exercise can help too.  That said, it’s important to understand that this type of headache is often the result of specific situations in our lives and the way our bodies react to them.  This means that the way we deal with these root-cause situations (potentially including avoiding them in the first place or managing them in a different way) is often the key to making them less frequent or less severe.

What Are “Low-Force Techniques” and When Are They Appropriate?

chiropractor wayne and paoli What Are “Low Force Techniques” and When Are They Appropriate?Most chiropractic manipulation is done using the “high velocity, low amplitude” (HVLA) approach, which consists of quick, short movements to bring the spinal column back into alignment.  However, there are times when other methods may be more appropriate.

Patients who have suffered recent trauma and elderly patients are two common examples.  So are young children and those who are new to chiropractic treatment.  Whenever a patient’s body may be fragile or a patient is particularly nervous about receiving a chiropractic adjustment, low-force techniques reduce the likelihood of accidental injury and may make treatment more effective by minimizing the defensive tensing of muscles.

Palpation is a technique which uses the hands to assess the degree of tension and range of motion in a patient.  In many cases, the chiropractor will take the joint to the furthest end of movement but by then it may already be causing pain.  Chiropractors practicing low-force palpations feel for the first barrier to movement and stop there, which is gentler for the patient.

Similar to low-force palpation, low-force adjusting begins slowly in order to find the minimum force needed to make the desired adjustment rather than immediately using full force.  Low force adjustments do not give the same “buzz” to patients as HVLA techniques (which often cause neural receptors in the joint to fire), but this is not always a bad thing.  This is especially true for those who are especially sensitive or already in a state of nervous tension or excitement.

Low-force techniques also include soft tissue methods such as post-isometric relaxation, which involves gently contracting a target muscle for a short time (5-10 seconds) while the patient resists it.  Following the resisted contraction there is a 10-15 second period in which contraction is “switched-off” and the muscle can be manually lengthened with little resistance.  Myofascial release is another low-force technique that is routinely used by chiropractors and other manual therapists to passively relax and lengthen muscle tissue through palpation and massage.  Trigger point therapy, which focuses on identifying and stimulating specific points of muscular tightness to produce a relaxation response and release of tension, is also low in force but still very effective.

Although low-force techniques are particularly appropriate for patients who have recently experienced trauma and for patients who are especially sensitive, nervous or excited, there also may be other times when they are preferable to HVLA adjustments and other full-force techniques.  If you’re wondering whether chiropractic care may be right for you or have questions about our approach to care, please call or visit our office.  We’ll be happy to help!

How Well Does Chiropractic Care Relieve Back and Neck Pain?

chiropractor wayne and paoli How Well Does Chiropractic Care Relieve Back and Neck Pain?If you have never considered going to a chiropractor to treat the pain in your neck or back, maybe you should.  There are an increasing number of studies that confirm the effectiveness of chiropractic care in the treatment of back and neck pain, particularly in comparison with pain-relieving drugs.

According to a report published in the September 2011 issue of Consumer Reports, chiropractic treatment outperformed all other methods for treating back pain, including prescription medication.  Of those reporting that a treatment “helped a lot” in the management of their back pain, 65% listed chiropractic (the highest rated treatment) as the most effective, as opposed to 53% for prescription medication.  Other natural therapies were also useful (e.g. deep tissue massage helped 51% of patient a lot, yoga/pilates–49%, acupuncture–41%), but none approached the effectiveness of chiropractic care.  Similar results were found for the treatment of neck pain (chiropractic–64%, prescription medication–49%).  Results were based on the Consumer Reports National Research Center’s 2010 Annual Questionnaire, analyzed by researchers from the Natural Medicines Comprehensive Database.

In a study performed by researchers at Minnesota’s Northwestern Health Sciences University, chiropractic care was more effective for treating neck pain than medications such as aspirin, ibuprofen or narcotic pain relievers.  The study, published in The Annals of Internal Medicine, followed over 270 people with neck pain for about three months.  These people were divided into three different treatment groups.  The first group received chiropractic care, the second group was prescribed exercises to do at home and the third group was prescribed painkillers or muscle relaxers.  Approximately 57% of the chiropractic group reported experiencing a reduction in pain of at least 75%, compared with 33% of those in the medication group.

Author of the study, Dr. Gert Bronfort, a research professor at the university, said that of the positive changes that had resulted from chiropractic treatment, “These changes were diminished over time, but they were still present.  Even a year later, there were differences between the spinal manipulation and medication groups.”

Another downside that the medication group experienced was that it was necessary to keep taking the painkillers.  Dr. Bronfort said, “The people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later.”  One of the great benefits of chiropractic care is that it treats the source of the problem, leading to long-term pain relief, in comparison with painkillers that just mask the symptoms.

Research has found that the most benefit in the relief of neck and back pain comes from a combination of chiropractic care and exercises you do at home.  Your chiropractor can suggest effective exercises that you can do at home in between adjustments that will work synergistically with your chiropractic care so that you can experience long-term relief from your back and neck pain.

What We Can Learn From How Other Countries Eat

chiropractor wayne and paoli What We Can Learn From How Other Countries EatWhen it comes to world cuisine, there’s broad agreement that the “modern” Western diet is one of the worst for our health.  Fast food cooked in hydrogenated oils and snacks that are laden with salt and sugar make up much of the typical American’s diet.  The way many of us eat has been a major contributor to high rates of diabetes, heart disease and cancer.

So where should we be looking for tips to healthier eating?  The good news is that we can learn a lot from the traditional cuisines in other parts of the world.  Studies have shown that populations in places like Japan, India and countries around the Mediterranean Sea have far lower rates of these diseases, due in part to the health of their cuisine.

By world cuisine, we do not mean the Americanized form that has been adopted by fast food companies such as Taco Bell and Pizza Hut.  Traditional Mexican and Italian dishes can be very healthy and, unlike items on the menu at these restaurants, they do not rely heavily on cheese as a main ingredient.  Following are some of the health benefits of different cuisines from around the world.

Japanese – The Japanese have the lowest obesity rate (3%) and the highest life expectancy in the world.  And this is not due to genetics.  When the Japanese move to the West and begin to consume a Western diet, their obesity rates quickly become comparable to ours.  Their diet is based on rice, lots of different vegetables and fatty fish.  Fatty fish is rich in omega-3 fatty acid, which has been shown to have health benefits for both the cardiovascular system and the brain, warding off diseases such as dementia and Alzheimer’s.

Indian – The greatest advantage to Indian cuisine is its use of spices.  Some dishes are hot, but not all of them.  The blend of spices used in Indian dishes, such as turmeric, ginger and cumin, not only impart incredible flavor and aroma to each dish, but may also provide a variety of health benefits.  Turmeric is perhaps the king of Indian spices—it is a staple in any Indian household in much the same way that salt and pepper are in the Western world.  It has a popular reputation for protecting against cancer and may ease symptoms of arthritis.

Mediterranean – This includes cuisines from Greece, Spain, Italy and southern France.  Its main benefit is that it contains large amounts of fresh vegetables and fruits, along with healthy fats such as olive oil.  Although some would not consider duck or goose fat healthy, the French (who consume more of this fat than anyone else) have among the lowest rates of heart disease in the world.  Mediterranean cuisine also has a greater reliance on fish for protein, rather than meat and cheese, which are eaten in much smaller quantities.  This cuisine is chock full of vitamins, minerals and antioxidants that protect against cancer and heart disease.

Mexican – Real Mexican food combines basic, healthy ingredients that give the body everything it needs nutritionally (beans, rice and corn are the staples).  Many dishes allow for a slow release of carbohydrates into the system, lowering blood sugar and in some cases even reversing diabetes.  Many of the dishes also feature heart-healthy tomatoes and chili peppers.

So pick up a cookbook of traditional recipes from some of these countries and give them a try.  They’ll add some variety to your weekly menu PLUS they may help improve your health!

How Frequently Should I Get Adjusted?

There is not one simple, one-size-fits-all answer to a question about how frequently a person should have a chiropractic adjustment.  Each person’s individual needs and overall health must be taken into account.  That said, a reasonable short answer to this question is “whenever you have developed a spinal misalignment.”  However, knowing when this has occurred (as a subluxation can be completely painless) can be difficult.

For this reason, the best policy is to visit your chiropractor on a regular basis, much as you would visit a dentist to have your teeth cleaned from time to time so as to avoid cavities.  But the frequency of adjustments is primarily based on your health and wellness goals, the severity of any specific issues and how quickly your body responds to treatment.

If you are a person who follows a healthy diet, gets adequate amounts of exercise and has a relatively stress-free life, then some chiropractors suggest a visit between once a month and semi-annually.  This will allow your chiropractor to treat any emerging subluxations and get rid of them before they become a problem.  If you wait until you have pain, it will likely take more chiropractic adjustments to heal the problem than if you had gone in for a periodic adjustment.

Dr. Greg Haitz from Rimrock Chiropractic in Grand Junction, CO, says “I can say from 10 years of experience in this profession that my regular once or twice a month patients rarely have much going on and seem to always be much healthier over all.  They get sick less often [and] don’t catch every bug that goes around.  They have better spinal range of motion and they tend to not have accelerated spinal degeneration on their x-rays.  What we do consistently makes the biggest impact in our health.  [It] doesn’t matter if it’s brushing our teeth, daily exercise and stretching, eating well 85+% of the time or monthly chiropractic adjustments.  Consistency is the key.”

Certain circumstances, such as an injury or some type of trauma, may call for frequent adjustments at the beginning, gradually tapering off as you heal.  For minor to moderate subluxations, a single treatment may be sufficient to relieve pain.  However, the long-term success of the treatment also depends on how your body reacts to the adjustments.  Some people’s muscles, joints and ligaments are in excellent condition and once a misalignment has been corrected, they can go for months until needing another.  Others, particularly in cases where there is a lot of stress on the body through repetitive motion, bad posture, bad muscle tone, etc., have to train their body to “hold” the alignment through periodic readjustments.

A consultation with your chiropractor can tell you the frequency of chiropractic adjustments that will provide you with the most benefit and will work with you to develop a treatment program that includes adjustments, lifestyle advice and exercises you can do at home to speed the healing process.  Once healing has occurred, it may also benefit you to visit your chiropractor from time to time for a preventative adjustment to help you continue to remain pain-free.

ADHD in the Classroom: What Every Parent (and Teacher) Should Know

Attention Deficit/Hyperactivity Disorder (ADHD) is classified as a psychiatric or neurological behavioral disorder.  It is characterized by a significant inability to concentrate for more than a very short period of time and/or impulsive behavior and hyperactivity.

The number of school-age children affected by ADHD is difficult to accurately assess, since diagnostic criteria vary.  Furthermore, the normal excitability of creative and energetic children can often be mistaken for a mental health problem by parents or teachers unable to unwilling to cope with it.  However, an estimated 1 in 20 children has ADHD, and it is important to note that approximately 70%-80% of referrals and diagnoses relate to boys.  Whether this is due to a real difference in the occurrence of ADHD or the natural tendency of boys to be louder and more impulsive has yet to be established.

Parents commonly worry about whether their child performs well in school.  The disruptive behavior and lack of attention that characterizes ADHD is clearly going to put an affected child at a disadvantage.  Additionally, if the underlying disorder is not recognized, the child may be blamed and stigmatized for being unable to control his or her behavior by both parents and teachers.  The fact that the diagnosis and treatment of ADHD has been the subject of considerable controversy for several decades has not helped to achieve any kind of clarity regarding the condition.  It is important for both parents and teachers to understand that ADHD is not caused by bad parenting, but is a physical disorder with a biological cause.

So, what are the signs of ADHD that parents and teachers need to look for, and what can be done to manage the condition to minimize its disruptive effect on both the affected pupil and his or her classmates?

The presence of either impulsive behavior or inattention that impedes a child’s ability to learn is a genuine cause for concern.  The type of impulsive behavior and hyperactivity observed in children with ADHD is far more extreme than the usual childhood displays of acting up.  The inability to concentrate is more than just boredom with the task at hand, and an ADHD child suffering from inattention may display many of the following signs:

  • Distraction
  • Inability to finish even simple tasks
  • Carelessness and sloppy mistakes in their work
  • Disorganization
  • Avoidance of anything that involves sustained mental effort, such as homework

Discussing these signs with the child (either at home or at school) can help to determine if they feel unable to help themselves and whether ADHD may be the underlying problem.  Teachers may have an advantage here over parents since they are able to compare the behavior and attention span of an ADHD child to what is typical for their classmates.  In contrast, parents without any other reference points may view their child’s behavior and attention span as normal.  In either case, it is important to avoid blame and labeling so that affected children do not feel guilty for behavior and attention lapses that may not actually be their fault.

If ADHD is suspected, then referral to a medical professional is necessary for an accurate diagnosis and to exclude the possibility of other conditions such as Tourette syndrome and learning disabilities.  Approximately two thirds of children with ADHD are also found to have another disorder.  Doctors, psychiatrists and social workers may wish to include visits to the school and home environment in their assessment to see how the child reacts in a range of situations.

Treatment for ADHD may involve strategies for managing behavior for both the child and his or her parents and teachers.  Changes may be made to their learning style and program, and depending on the severity of the condition, medication may be prescribed.  ADHD children have different learning needs and will thrive best if these are met.  These needs may include a structured and regular learning program and an absence of potential distractions.  Pupils with ADHD may need to be seated away from their classmates, with a clear indication that this is being done for their own benefit rather than as a punishment.  Similarly, an ADHD child will work best at home in a calm, uncluttered environment.

As with any learning disability, ADHD is best managed through support of the child rather than using punitive measures to attempt to correct behavior.  Consistency and good communication between parents, teachers and health professionals are also essential for successful treatment.