Category: Blog

Need to know more about Scoliosis? Sign up for our free information series!

Posted on February 1, 2023 by - Blog

At the UK Scoliosis clinic, one of our primary goals is to help educate people about Scoliosis, the symptoms it causes, how to spot its signs and most importantly, how we can treat it. With this in mind we’re always looking for effective ways to bring usable and easy-to-access information about scoliosis together for those who need it. This week, we’re pleased to launch our new information series, which you can now receive for free, via email.

 

Get the facts, for free!

Our new Scoliosis information series is aimed at those just learning about Scoliosis – whether you’re a parent who has just learned your child has Scoliosis, a young adult who has just been diagnosed, or an older individual experiencing the effects of degenerative or de-novo Scoliosis, the aim of this series is to help you learn the essential facts about the condition and what you can do about it.

 

What is Scoliosis anyway?

Scoliosis is a condition of the spine which, left untreated, can be a life-limiting condition which will often worsen and may require major spinal surgery. Thankfully, today there are a number of effective non-surgical options for treating scoliosis.

Like many conditions, scoliosis is much easier to treat when it is spotted early [i] and the best way to spot it early is to help people understand what to look for. It’s for this reason that scoliosis screening is considered a beneficial stage of treatment amongst the Orthopaedic community, as reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)[ii].  Indeed, numerous studies have suggested that school screening can reduce the number of cases which eventually require treatment – despite this, school screening has still not been implemented in UK schools, although in some countries screening is now widespread. Similarly, most people in the UK have never even heard of Scoliosis, much less the more modern approaches to treating it which exist today.

 

What you’ll learn

Over the course of this easy-to-access series you’ll learn:

  • What Scoliosis is, and what causes it
  • The types of Scoliosis, and who they affect
  • How you can screen for the signs of scoliosis, at home, in less than 5 minutes
  • How we can treat Scoliosis, and how treatment has improved over time
  • What the best treatment for Scoliosis is
  • The answers to the most frequently asked questions we hear about Scoliosis

Finally, we’ll let you know how to get in touch with us if you’re concerned about Scoliosis, or just need more information.

 

How to sign up

You can access this totally free series by signing up here

Please feel free to share this page with any friends or family – the more awareness we raise about Scoliosis, the more people we can help!

5 Tips to Help Reduce Scoliosis Pain

Posted on January 14, 2023 by - Blog

For most of the history of Scoliosis treatment, the widely held view has been that Scoliosis does not cause pain. It’s certainly true that many Scoliosis patients present at our clinic with no pain nor discomfort – but recent research, as well as our experience, has shown that in many cases Scoliosis can be painful.

At least one research study suggests evidence of a possible 35-42% prevalence of lower back pain in adolescents with idiopathic scoliosis[1] (AIS), in another study of 2400 patients with AIS, 23% reported back pain at their initial contact[2]. Chronic non-specific back pain (CNSBP) also seems to be frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[3]  – in addition, patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[4]

In patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[5] and Scoliosis patients have between a 3 and 5-fold increased risk of back pain in the upper and middle right part of the back[6].

While this does not mean that everyone with Scoliosis will experience pain – in fact the numbers roughly support about a 50/50 chance – there are still a significant number of individuals for whom the management of Scoliosis & pain is a factor. At the UK Scoliosis Clinic, we utilise a number of approaches to help manage the pain associated with scoliosis – but there are also some steps you can take yourself.

 

1 – Keep active, Keep fit

Being physically active and reducing the amount of time spent in sedentary positions is very important, not only for pain management but for your overall health and well-being. While it’s true that Scoliosis can make some activities more difficult, and there are some exercises (especially “one-sided” activities, like racket sports) which we might advise against – there’s no reason why Scoliosis should stop you from being as active as possible. If pain is already a significant issue, low-impact activities such as Yoga or Pilates  can be an excellent way to keep moving, and may even provide some additional pain relief. Swimming, once thought to treat Scoliosis (sadly, based on current research, does not[7]) is nonetheless an excellent way to stay fit with almost no risk or injury.

 

2 – Improve your posture.

While it’s not true that poor posture causes Scoliosis – poor posture can cause pain, both for Scoliosis sufferers and those without Scoliosis.

A huge part of Physiotherapy based approaches to Scoliosis is increasing awareness of posture – when sitting and standing and to take note of the position of your spine. Are you collapsed to one side or slouching? Try to straighten & lengthen your spine and keep balanced, avoid leaning to one side as this can aggravate pain – instead, try to remain in a neutral or corrected position. Many people with Scoliosis pain find that regular movement helps to reduce pain too.

 

3 – Avoid extended sitting/extended standing

Where possible, avoid extended sitting when working, studying or at school. Regular postural changes/breaks (every 20-30 minutes) are very important and can be as simple as standing up, walking to the other side of the room, or stretching, before sitting back down.

This is, like most of these tips, a good idea to do regardless of your Scoliosis status as long periods of sitting encourage imbalances in muscles and ligaments – in fact, it’s the cause of a huge percentage of back pain cases treated by Chiropractors every year.

 

4 – Light Stretching or Massage

Stretching or Massage, either as a targeted activity or part of something like Yoga can be highly beneficial for Scoliosis suffers –focussing on elongation and decompression of the spine is likely to help relieve pain for many, and can often be performed at home using a tennis ball, foam roller or massager. That being said it’s best to consult with a Scoliosis expert when it comes to stretching or flexibility routines, for example many people with AIS will have reduced spinal curves or flat backs, so it is important that significant hyper-extension/arching backwards is not performed as it may increase the flattening of the back which may in turn progress the scoliosis.

Repetitive one-sided movements, or exercises & stretches leading to excessive spinal rotation may actually worsen pain – due to the 3D nature of scoliosis. Repetitive twisting or one-sided movements can potentially put your spine into an unfavourable position or even counteract an ongoing treatment program, so use with care.

 

5 – The Best Option, Scoliosis Specific Exercise

The best option to address Scoliosis pain is, of course a professional plan. A Scoliosis professional can design a series of Scoliosis Specific exercises, that will help improve posture, manage pain and slow the progression of your condition. These scoliosis-specific exercises, once mastered, can be incorporated into your day-to-day life or form part of an active treatment program.

In some cases, the part-time use of a Scoliosis brace could also be considered – for example, while bracing in adults is not likely to reduce the Scoliotic curve itself, research does indicate that bracing can be effective in reducing chronic pain.[8]

 

 

 

 

[1] Théroux, J., et al.Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review. Chiropractic & manual therapies, 25(1), 1-6.

[2] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[3] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[4] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[5] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[6] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[7] Berdishevsky H, Lebel VA, Bettany-Saltikov J, et al.: Physiotherapy scoliosis-specific exercises—a comprehensive review of seven major schools. Scoliosis Spinal Disord, 2016, 4: 1.

Zaina, F., Donzelli, S., Lusini, M., Minnella, S., and Negrini, S. (2015). Swimming and spinal deformities: A cross-sectional study. The Journal of Pediatrics, 166(1): 163-167.

Gonen Aydin C, Oner A, Hekim HH, Arslan AS, Oztas D, Akman YE. (2020) The prevalence of scoliosis in adolescent swimmers and the effect of swimming on adolescent idiopathic scoliosis. Turk J Sports Med.;55(3):200-6.

[8] Scoliosis bracing and exercise for pain management in adults—a case report Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

Online Booking available now – which consultation is right for you?

Posted on January 5, 2023 by - Blog

As part of ongoing efforts to make accessing services at the UK Scoliosis Clinic easier than ever, we have now introduced an option to book either an online or in-person consultation right here through our website. With two options to pick from you might be wondering which consultation type is right for you?

 

Online consultation

An online consultation is an excellent way to speak to a Scoliosis expert from the comfort of your own home and at a lower cost than an in-person consultation at our clinic. Our online option includes the taking of an essential Scoliosis specific medical history, a review of any x-rays which you may have, movement assessment, a visual postural assessment (if desired) and time for Q & A.

An online consultation generally lasts approximately 20-30 Minutes and takes place via our secure online platform, which means your consultation remains totally private.

An online consultation is ideal for someone who wants to speak to an expert, get a second opinion on a diagnosis or treatment recommendation or is simply seeking some advice about the first steps when learning they have Scoliosis. The major drawback of an online consultation is that we cannot take X-rays nor physical measurements of your spine, nor see you in person – this means that in most cases we cannot formally diagnose Scoliosis during an online consultation, although we can usually give our professional opinion. If you already have X-rays, a web consultation can be an excellent option, although it’s important to keep in mind that our diagnosis and advice in this situation relies on the currency of the X-rays you provide.

Since a web consultation is also cheaper, they’re a good choice for people who want to explore scoliosis treatment, without incurring larger costs – for example, an older person considering bracing to help manage Scoliosis related pain.

Perhaps the biggest benefit of the online consultation option is the fact that you can participate from anywhere in the world – allowing you to access world-class Scoliosis advice wherever you happen to be located. Please note, that we currently offer consultations in English only.

 

In-person consultation

An in-person consultation at our clinic is the most comprehensive option designed to provide not only a formal diagnosis of Scoliosis but also practical advice on treatment steps and the options which would be applicable for you.

Scoliosis consultation at our clinic is the fastest and most efficient way to get answers on Scoliosis. Our consultations can include X-rays (for a additional fee), which are taken here at the clinic enabling you to get a professional diagnosis and a plan to move forward with treatment if appropriate for your case.

Our In-clinic consultation lasts between 1.5 and 2 hours, and includes a detailed, Scoliosis specific medical history, Scoliosis impact assessment, Postural Assessment, Scoliosis measurement and evaluation and a detailed report outlining your case, diagnosis and recommended options for treatment. We can also provide a report to your insurance provider (if required).

Your appointment can include a full set of Diagnostic X-rays utilising our state-of-the-art digital X-ray machine, allowing Scoliosis to be definitely diagnosed and understood. You will also receive a digital copy of your X-rays to take away.

Our in-clinic consultations are most suitable for those who are concerned that they may have scoliosis but do not have X-rays or other documentation to rule the condition in, or out. It’s also ideal for those who know they have Scoliosis and are actively looking to take up non-surgical treatment or are wanting to change treatment, perhaps from another provider.

 

Next steps

All of our consultations are standalone options – meaning there’s no obligation to take up treatment with us after your consultation. In some cases, it might be determined that Scoliosis isn’t the correct diagnosis, or it may be the case that more appropriate treatment can be obtained through another provider – in this case, we’re often able to recommend suitable practitioners close to you.  Where Scoliosis is determined to be an issue for you, an in-person consultation can lead directly into the formation and beginning of a treatment plan should you want to take action as soon as possible.

For those consulting with us from overseas, we work with a network of other Scoliosis treatment providers across the globe and can often recommend a practitioner in your general area – but should you wish to visit our clinic you’ll still be very welcome!

 

 

 

New year, New Opportunities!

Posted on January 1, 2023 by - Blog

As the year comes to a close, it’s time to reflect on all the ups and downs of the past 12 months and look forward to what the future holds. New Year’s Eve is a time for celebration and renewal, a time to say goodbye to the old and embrace the new.

The New Year brings with it the promise of new beginnings, a chance to start fresh and set new goals for the year ahead. Whether you’re looking to improve your health, take on a new challenge, or make positive changes in your personal or professional life, the start of a new year is the perfect time to make a plan and get started.

Here at the UK Scoliosis Clinic we have some exciting new ideas in the works and there will be some fantastic, quicker, easier to use options for one and all coming in 2023. As we finally put COVID behind us were looking forward to helping more people with Scoliosis than ever before!

So as we bid farewell to the old year and welcome in the new, let’s make a commitment to ourselves to make the most of the opportunities that lie ahead. Let’s set goals that inspire us and motivate us to be our best selves. Let’s embrace the challenges and obstacles that come our way, knowing that each one is an opportunity to grow and learn.

From all of us here at the UK Scoliosis Clinic we wish you a happy and prosperous New Year! May the year ahead be filled with joy, success, and all the things that make life worth living. We’ll be back on the 3rd as usual!

 

Ps. If you have left messages for us over Christmas please know that we’ll be responding to everyone as quickly as possible, it will however, take a few days to catch up!

Happy Christmas!

Posted on December 23, 2022 by - Blog

One of the best things about Christmas is spending time with loved ones. Whether you’re cuddled up by the fire with your significant other, or surrounded by family and friends at a big holiday party, there’s nothing quite like the feeling of being surrounded by those who care about you.

Of course, Christmas wouldn’t be complete without all the delicious food and drink that goes along with it. From turkey and stuffing to eggnog and mulled wine, there are plenty of festive treats to indulge in during the holiday season. And let’s not forget about all the sweet treats like Christmas cookies and candy canes!

But beyond the presents and the food, there’s something truly special about the spirit of Christmas. It’s a time of year when people come together to spread joy and kindness, to give back to those in need, and to reflect on all the things that we have to be grateful for.

From all of us here at the UK Scoliosis Clinic, we wish you a very Merry Christmas! May your holiday season be filled with love, laughter, and lots of festive cheer. We’ll be back in January 3rd – see you then! 🙂

­­­­Scoliosis – some posture tips

Posted on October 26, 2022 by - Blog

Contrary to popular belief, poor posture cannot give you Scoliosis – the known causes of Scoliosis include degenerative changes in the spine (associated with ageing), neurological conditions and some genetic conditions. It’s also possible to end up with Scoliosis as the result of an accident or injury, or perhaps due to complications during surgery for another issue. All other scoliosis cases are considered idiopathic, meaning the exact cause is unknown – however, there is no evidence to suggest that bad posture causes Scoliosis.

 

Nonetheless, posture is an important thing for Scoliosis sufferers to keep in mind – now that it is more widely recognised that scoliosis can cause pain and discomfort, many people naturally wonder if there are ways we can reduce discomfort and support treatment during scoliosis correction. While everyday postural changes designed to correct scoliosis are a critical part of approaches such as Schroth therapy, there are also some small changes which one can make in order to potentially improve their overall quality of life.

 

Sitting and standing

When standing or sitting; good posture uses less energy than poor posture – this is true whether you have scoliosis or not! Some people with scoliosis might find sitting or standing with good posture difficult, either because of the spinal deformity or because of tiredness associated with scoliosis exercise treatment (this is normal!).  Because of this, it’s not uncommon for scoliosis patients to sit or stand with weight shifted more to one side than the other – either trying to overcompensate, or simply leaning on the strong side due to tiredness.

The ideal posture when standing is to have weight evenly spread – the neck should be straight with no tilt, the hips level, and the pelvis neutral (this means not tilting forward or backwards). The knees should be straight or alternatively, one knee straight, the other slightly bent. It can help to check your posture regularly in the mirror or get others to check it for you. Imagine yourself as a puppet with a string attached to the top of your head pulling you straight. The important thing to remember is not to overcompensate – if you lean slightly to one side, try to aim for this neutral posture – but don’t go further the other way!

When sitting, it’s easier to centre yourself correctly – the key is to allow the chair to take your weight evenly, which a normal char will. Try to sit back in a chair with your weight on your buttocks and thighs and your back straight. Try not to sit forward on the edge of your seat and keep the pelvis neutral (not tilting forward or backwards). Try to select a chair that allows your knees to be bent at roughly a 90 – 75 degree angle when sitting so that your knees are level with, or slightly lower than your hips. Keep feet flat on the floor and shoulder-width apart. Try not to sit for too long at any one time. It is best to move every 30 minutes to avoid getting stiff, whether you have Scoliosis or not!  Low soft sofas, chairs without arms, chairs that are too low or too high, bucket chairs and deep chairs can all be especially uncomfortable for those with Scoliosis.

Some patients find that lumbar (lower back) supports, cushions or memory foam can assist with any pain when sitting – for the most part these are safe to use, but t’s worth checking with your scoliosis practitioner if possible.

 

Exercise

Exercise is an essential part of everyday health and may well also form part of your Scoliosis treatment – if you are using an exercise-based approach to Scoliosis you will be well aware of the importance of maintaining a balanced and symmetrical spine unless you are specifically performing a corrective exercise.

It’s easy for people with scoliosis to get sore, stiff or tired when using the gym or exercising due to the additional strain which the spine is already under. Similarly, it’s not always a good idea to perform stressful exercises after a scoliosis specific exercise session, as parts of your back will feel tired.

If you do want to perform any kind of weight-bearing exercise, be sure to discuss the best way to do this with your scoliosis practitioner – and always work within your limits, especially during treatment. Very often, low impact and symmetrical exercises, such as swimming are an excellent way to augment scoliosis treatment while keeping fit and with a very low risk of injury or strain.

 

Beds and sleeping

Choosing the right bed is very important as you spend around 8 hours of the day in it. If you are comfortable you are more likely to sleep well. Getting enough is critical for mental as well as physical health.

As with a chair, it’s recommended to have a bed that allows you to sit on it with your knees at or just below 90 degrees – this should make it easier to lie down and get up.

The mattress should not be too hard or too soft. It needs to support your weight without sagging or giving way at the hips and shoulders – many Scoliosis patients find that a memory foam mattress is more supportive for them – don’t forget that these can be bought separately and added to your bed!

Some patients, especially those with Lumbar curves can experience discomfort when sleeping and laying in bed – this is, in fact, the case for many people, scoliosis sufferer or otherwise, since sleeping flat on your back with your legs straight can put a strain on the lumbar spine. Sleeping on your back, with your knees bent, on your side with your leg bent forward or on your side with a pillow between your legs or under your knees for better support can all help to relieve this discomfort. While not a universal rule, we also find that most scoliosis patients find sleeping on their front somewhat uncomfortable – so you may want to avoid this!

 

Paul at the ScoliCare Online Symposium, 2022

Posted on October 15, 2022 by - Blog

After attending several fantastic events this year as an attendee, Paul was thrilled to be invited to present some results and cases from the UK Scoliosis Clinic at this year’s ScoliCare Annual Online ScoliCare Symposium.

 

ScoliCare Symposium 2022

As we’ve often said, one of the most critical factors when it comes to improving outcomes from Scoliosis treatment in general, and bracing in particular, is staying involved and up to date on the latest research. At the UK Scoliosis Clinic, we’re constantly evaluating research into innovative approaches to scoliosis treatment, with a view to integrating promising methods into our own programmes.

ScoliCare’s Annual Online ScoliCare Symposium brings together global healthcare leaders to provide an update on the latest in scoliosis treatment -being an online event it’s possible to incorporate a very wide variety of views and case studies to allow attendees to benefit from cutting-edge research from around the globe.

The Symposium was a jam-packed six hours of content from non-surgical scoliosis clinicians, researchers, surgeons and exercise rehabilitation providers. Some of the topics covered included:

  • The latest scoliosis research from around the world
  • Complex scoliosis management insights
  • Sagittal balance in scoliosis focus
  • Scoliosis-specific exercise overview
  • Scoliosis and sport
  • Adult bracing
  • The surgeon’s perspective
  • Wide range of case studies

Paul was thrilled to present some fantastic case studies from the UK Scoliosis Clinic as part of the Session: Neuromuscular Scoliosis and Suspension Bracing.

 

Case study

The case presented arrived at our clinic at the end of October 2018 with a 42° right thoracic curve, having no pain and being otherwise healthy. Although the signs of Scoliosis had been observed, the surgeon advised “watch & wait”.

The UK Scoliosis clinic designed a treatment plan designed primarily to stop the progression of Scoliosis and avoid surgery, with the secondary desire to reduce the curve if possible. The plan for this case included full-time brace wear of 21-23 hours/day, Corrective PSSE, Mirror image over corrective exercises, SEAS self-correction and General core stability exercises and calisthenics – rather than focusing on just a single approach, we opted for a combined plan which aimed to address each of the core aspects impacted by Scoliosis.

Overall the case was a fantastic success, between October 2018 and April 2022, the Scoliosis reduced from 42 to 21°, ATR reduced from 17 to 13°, Grown in height from 3cm from 172.5cm to 175.5cm was observed, along with Improved aesthetics.

 

 

 

 

 

World Spine Day, 2022!

Posted on October 11, 2022 by - Blog

The theme emphasizes diversity of spinal pain and disability as part of the global burden of disease and addresses the need for access to quality essential spinal health services worldwide. With an estimated 540 million people in the world suffering with low back pain at any one time, it remains the leading cause of years lived with disability.

 

What is World Spine Day?

Taking place on October 16 each year, World Spine Day highlights the burden of spinal pain and disability around the world. With health professionals, exercise and rehabilitation experts, public health advocates, schoolchildren and patients all taking part, World Spine Day is celebrated on every continent.

World Spine Day highlights the importance of spinal health and well being. Promotion of physical activity, good posture, responsible lifting and healthy working conditions will all feature as people are encouraged to look after their spines and stay active.

An estimated one billion people worldwide suffer with spinal pain. It affects people across the life course and is the biggest single cause of disability on the planet. Effective management and prevention is therefore key and this year’s World Spine Day will be encouraging people to take steps to be kind to their spines.

Populations in under-served parts of the world often have no access to conventional healthcare resources to care for spinal pain and disability. Dedicated spinal health professionals do not exist in many parts of the world, helping people to self-manage their conditions is important. Even in high-income countries, back pain afflicts many millions of people, resulting in an enormous impact on industry and the economy.

Organized by the World Federation of Chiropractic, World Spine Day has over 800 official organizational supporters worldwide.

 

The Campaign for 2022

Each year, World Spine Day is marked on October 16th – it’s a unique and important opportunity to recognise the importance of spinal health!

This World Spine Day, Complete Chiropractic, in association with World Spine Day participants everywhere, is calling for action to focus on the global burden of spinal disorders while emphasizing #EVERYSPINECOUNTS, highlighting the diverse challenges of living with low back pain in all regions, cultures, backgrounds, and across the life course; prioritizing a condition that is more prevalent than cancer, stroke, heart disease, diabetes and Alzheimer’s Disease combined.

This year’s campaign – #EVERYSPINECOUNTS  – will focus on highlighting ways in which all people can help their spines by staying mobile, avoiding physical inactivity, not overloading their spines, and adopting healthy habits such as weight loss and smoking cessation.

Believed to be the largest global public health event dedicated to promoting spinal health and well-being, World Spine Day is observed by health professions and public organizations concerned with spine care throughout the world.

At the UK Scoliosis Clinic, our objective this year is to educate our community about the importance of their spine and posture and the benefits of Chiropractic and an active lifestyle.

As part of this effort, we are offering a number of special promotions within the clinic – watch this space!

Clinic closed – September 19th 2022.

Posted on September 14, 2022 by - Blog

Dear all – just a quick update to let you know that the UK Scoliosis Clinic will be closed on September 19th as we mark the Funeral of Her Majesty, Queen Elizabeth II.

The official state funeral of Her Majesty The Queen will take place at Westminster Abbey on Monday 19th September at 11 AM, and we will take this opportunity to give thanks for her commitment to our commonwealth, and reflect on her life’s work.

After this, We’ll reopen as normal on September 20th.

On the passing of Queen Elizabeth II

Posted on September 10, 2022 by - Blog

With great sadness at her passing, we at the UK Scoliosis Clinic wanted to take the opportunity with this weeks blog simply to thank the late Queen Elizabeth II for her record service as our monarch, and champion for the commonwealth.

Elizabeth II was Queen of the United Kingdom and other Commonwealth realms from 6 February 1952 until her death, and therefore was our longest serving Monarch, with a reign of 70 years and 214 days.

While most in the UK will remember her for her appearances at important national events in and around London, it’s important to remember that Elizabeth served as queen regnant of 32 sovereign states during her lifetime, and 15 at the time of her death. This of course includes Australia, from where our very own Paul Irvine originates.

We will update all our patients on any changes to opening hours which arise as a result of the period of national mourning which will follow