back pain

5o Shades of Pain

Jul 30, 2012
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50 Shades of Pain

Pain is pain, right? Wrong!  Pain can come in a variety of situations, can feel very different and can be slight or severe.  One person’s experience of pain is often very different from another’s.  There are many factors that affect how a person experiences and reacts to pain ranging from their previous experiences of pain to their psychological state at the time they are suffering.

Different structures in the body cause different types of pain.  For example, pain of a muscular origin will behave in a fairly predictable way.  We are all familiar with muscular pain after a long walk or a hard session at the gym and we know that the pain and stiffness is often worse the second day but that it is then likely to ease quickly after that.

Most people will be able to differentiate stomach ache from back pain and neck pain from a headache but there are some types of pain that are hard to tie down.  People often struggle to put their finger on exactly where the pain is in certain shoulder problems.  They know it hurts but can’t quite work out exactly where.

We have all bashed our funny bone at one time or another (which is actually our ulnar nerve, not a bone) and have therefore experienced radiating pain.  Once the nerve is irritated we experience pain, tingling and some numbness in the little and ring fingers despite the fact that nothing has happened to those fingers.  This is because the nerve impulses are interrupted at the elbow and the signals that arrive in the brain are interpreted as pain and altered sensation.

We can also experience referred pain from organs that are suffering in a completely different place to where the organ is.  People who have heart attacks experience pain in their left arm and their throat neither of which overlie the structure of the heart.  The gallbladder, which sits just underneath the liver, can refer pain to the tip of the right shoulder and problems with the function of the lower back and pelvis can be mistaken for knee pain or groin pain.

Often symptoms we see in the clinic are made up of several different aspects and types of pain.  For example, many people we see complaining of lower back pain find they have quite a sharp pain in a very specific area of their back but also have a constant ache in a larger, more diffuse area and stiffness when they try to move.  This may well be because the affected joint in the back is inflamed and therefore causes acute pain when the joint moves whilst the muscles surrounding the area are very tight from trying to protect the joint and cause the aching pain and stiffness.

By finding out which pain is which we can create a much better understanding of the problem and in doing so provide much better and accurately targeted treatment to get rid of the pain.  Once the pain is gone you are free to do … whatever you want with your body!

Breaking News….Exercise is Good for you …. Imagine That!

Jul 19, 2012
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Breaking News …. Exercise is Good for You … Imagine That!

In the news today new research is telling us that inactivity is responsible for almost as many deaths each year as smoking!  That’s about 5.3 million deaths worldwide per year.

We have always known that exercise is good for us.  Plato said “Lack of activity destroys the good condition of every human being while movement and methodical physical exercise save it and preserve it”. But too often we hear excuses for not doing exercise such as not having time or enough money.

I suspect that also people have become scared of exercise, that is to say that when they think of exercise they think of gyms, Lycra and top class athletes that they must emulate.  They see themselves and think “I can’t be like them, I’m so unfit that I couldn’t possibly even get started!”

But we don’t have to run for miles, pump iron in the gym, join a triathlon club or buy a step machine.  If we look at the current health guidelines we should be doing two and a half hours of moderate intensity, aerobic and muscular strengthening exercise.  That equates to less than 26 minutes per day spread over the week.

Exercise can mean anything that raises the heart rate and gets you a bit out of breath.  Walking the dog, going up stairs, gardening, playing with children and even sex all count as exercise.  In fact for human beings exercise as we know it these days is quite an alien concept.  After all sitting still whilst driving several miles to the gym then running on the spot on a treadmill going nowhere for half an hour is completely nuts if you think about it!

According to the Lancet it is about using the body that we have in the way it was designed, which is to walk often, run sometimes, and move in ways where we physically exert ourselves regularly whether that is at work, at home, in transport to and from places, or during leisure time in our daily lives.

So let’s try to think about exercise in a different way.  What if you went for a walk in the evening for twenty minutes, ten minutes from the house and back?  Throughout the working week you would have done an hour and forty minutes exercise already.  Add to that walking up the stairs in the car park rather than taking the lift on Saturday afternoon in town and a bit of vigorous weeding in the garden on Sunday and you are just about there.

People often see exercise as a way to lose weight or get fit for the summer but let’s start to see it for what it should be – for health.  Exercise helps to make your heart stronger, helps to prevent many cancers, tones up muscles preventing back and neck pain and can really help to relieve stress and depression and ultimately helps you live a longer, healthier life.

So let’s all get outside a bit – especially if the weather is about to get better as they promise.  Make a small change and see the benefits – you can always make more changes later.  Let’s get healthier!

In Search of Fitness ….. TRX

Jul 5, 2012
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TRX

In Search of Fitness …. TRX
To be honest, I’d never heard of it either and I am told that TRX means Total Body Resistance eXercise (perhaps because its more snappy than TBRE)
I decided to attend the class on a Sunday morning at Phoenix Centre as I knew that the class sizes were small enough to get a good work out and large enough to hide behind others.  Patrizia was the instructor and she quickly got us warming up effectively with various movements and exercises.  After a few minutes of this I was about ready to head home as I realised that my usual running does not really provide a particularly rounded workout.
The TRX is effectively a scaffold with pairs of straps hanging off it.  Each strap has a loop on the end with padded handles.  The idea is that you use your own body weight and lift it to achieve the resistance required.  The good thing though is that by changing the angle or position of your body you can increase or decrease the weight you are lifting.
When I first saw the apparatus I struggled to think of many ways that I could suspend myself from the straps without causing myself some serious injuries but with clear instructions and demonstrations as we went along there were numerous exercise positions used.  These included holding the straps with one or both hands facing forwards, backwards and sideways as well as putting our feet in the straps and doing floor exercises.
Exercises that stand out in the mind are the bicep busting arm curls which involve holding the loops whilst facing the apparatus, leaning away from it and pulling your body upwards.  It feels quite good initially but by the end of the one minute set my biceps were burning with lactic acid.
Also, many people have experienced the Pilates ‘plank’ but imagine doing it with your feet suspended and hovering above the floor where they can swing from side to side!
After 45 minutes of high intensity exercise on the TRX with a period of circuit training in the middle to provide variation I was exhausted.  My muscles felt weak and my legs were most uncooperative when I asked them to allow me to stand up.  I felt muscle fatigue in muscles that I clearly hadn’t used in a very long time and I would happily have stayed lying on the floor for the rest of the day.  However Patrizia was handing around complimentary, freshly prepared protein shakes which would help to reduce the DOMS (Delayed Onset Muscle Soreness) and once I was walking around I began to feel much better, looser and a little smug for having done a really energetic, intense workout.
The next few days I felt some aching in my muscles but nothing too bad.  I found going up stairs felt like hard work but in a funny way it felt good, almost as if my muscles were responding to the workout and becoming fitter as a result.
I enjoyed the class and although it was hard work I did have the option to reduce the workload by altering my body position so I worked as hard as I wanted to.  The class had a really friendly feel and although music was played throughout it helped to keep the tempo of the exercise up rather than being uncomfortably loud.

I did not do this!

Would I do the class again?  Definitely, I feel like this class gives me a good, all round work out, much more than just running or cycling.  Impact is minimal and with guidance from an excellent instructor you know that nothing you do is dangerous.  The class was not daunting in any way and everyone was really friendly.  Anyone would be welcome regardless of their level of fitness or experience.
Booking can be done through the Phoenix Centre on (01403) 800321 and there are several TRX classes through the week to choose from (see www.phoenix-centre.com).  Give it a go – I might see you there.

The Seven Ages of Back Pain

May 30, 2012
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The Seven Ages of Back Pain

The lower back works hard when we lift and we all know that we should be lifting correctly but sometimes it’s just not that easy especially when children are concerned!

1. During pregnancyAs the baby grows your centre of gravity begins to shift and the core muscles get stretched making it more difficult for them to support the lower back during the lifting process.  Extra laxity in the ligaments also means that the lower back and pelvis is in danger of having an acute episode.  Common areas of pain are to one side of the spine or at the top of the buttock.2. With a newbornWhen the baby is small you would imagine that lifting is easy but there is a lot of paraphernalia that goes with a newborn.  The pram, the changing bag, the car seat, not to mention bending to the cot or Moses basket to pick up a distressed child.  Then there is the carrying – all parents will know the subconscious and mildly disturbing rocking that occurs (even when you are not holding the baby).  Holding even a very light infant for prolonged periods of time is very hard work for the muscles of the arms, shoulders, neck and back especially if you are not accustomed to doing so.

3. Pre-toddlers The baby is getting his or her personality and becoming heavier as they are eating more solid food and building their own muscles by learning to crawl and stand.  The lifting required has also changed.  Heavier lifting and often from the floor (or under the table!) means that it may not be possible to get in the correct position to lift making it more likely that your back will suffer.

4. ToddlersEven heavier and now a new challenge … walking and running.  This means you have to keep an eye on them at all times and often have to grab them before they run off in the street or bolt for the hot cup of coffee.  Now your body ends up contorting itself wildly to halt a weighty, fast moving child – recipe for disaster in back terms.

5. Pre-schoolHopefully the children will now be a little more obedient and are not so prone to running off and due to their walking ability and weight lifting becomes heavier but more infrequent and of shorter duration.  Up onto the kitchen counter to put a plaster on a skinned knee and up over country gates when required.  Cuddles are done sitting down though hauling a child up onto your lap from the ground can put an enormous strain on the sacro-iliac joints in the pelvis.

6. School YearsLifting of children is seldom required now but there are bikes to get in and out of the boot of the car and play fights to have on the living room floor.  The child is too heavy to lift now apart from the odd piggy back when its really muddy or way past bed time.  There is also more time now to get back into the sports and activities you used to do but remember you have not done them for quite a long time and adjust the intensity and duration of the exercise accordingly.

7. GrandparentsFar from being immune from the pain children can cause to a back the grandparents can be in even more danger if they are not around all the time.  Children grow quickly and if you don’t lift them regularly your back will not be ‘match fit’ and the shock to the back and neck can be significant when an excited child launches themselves at you upon arrival at your house.

Fortunately, at Back to Health we understand the pain being a parent can cause. And we can help you get back to being pain free – as you like it!

Odd Things You Can Do With Your Body # 2

May 16, 2012
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ODD THINGS YOU CAN DO WITH YOUR BODY # 2

Win an Arm-wrestle

When challenging somebody to an arm-wrestle it helps to have an edge.  Try this with somebody who is clearly stronger than you.

It is best to arm-wrestle at a low table for this to work best.  You need to stimulate an acupuncture point on your ankle on the same side as the arm you are wrestling with.  For this example we will assume you are wrestling with your right hand.

With your left hand put your finger tip on the point in the midline on the front of the right ankle in the crease.

Stimulate this point by rubbing firmly with your finger throughout the arm-wrestle.  This should make your right arm very strong and make it much more difficult for your opponent to beat you even if they are much stronger than you.

A word of warning – this does not work when you have been drinking!

The acupuncture meridian point on the stomach meridian (Stomach 41) is the tonification point for that meridian.  This means that all muscles on that meridian will be strengthened by stimulating that point.The muscles used during an arm-wrestle are associated with the stomach meridian and are therefore strengthened by stimulating that point.Meridians also have a sedation point which weakens all those muscles thus making it even easier to beat your opponent …. but that’s another story.

Odd Things You Can Do With Your Body # 1

May 9, 2012
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ODD THINGS YOU CAN DO WITH YOUR BODY # 1
Make your arms float
Standing in a doorway, allow your arms to come away from your sides until they meet the doorframe.  Now push firmly out wards against the frame and keep the pressure up for a minute.  When you release the pressure and walk out of the doorframe your arms will feel like they are floating upwards.
WHY?
The reason for this is that you are performing an isometric muscle contraction with the Deltoid muscle.  That is to say that you are asking the muscle to contract but not letting it shorten.  By holding the contraction you are reinforcing the neural signals to push the arms outwards.  At the same time there is the phenomenon of synergistic muscles which causes one muscle to relax as another contracts.  For example, when you bend your arm at the elbow you need the bicep to contract but you also need the tricep (at the back of the arm) to relax.  If they both contracted together the arm would not move.
THE RESULT!
When you walk out from the doorway the neural stimulation causes the deltoid muscles to continue contracting to a small degree and the synergistic muscles are inhibited making the arms feel as though they are floating upwards.

Deltoid Muscle

Pilates and Back Pain

Apr 25, 2012
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PILATES AND BACK PAIN

Many people that we see in the clinic suffering from back pain, neck pain or any other musculo-skeletal ailment often have an underlying cause for their imbalance.  If the body is not capable of holding itself efficiently then it cannot function properly.  Pilates helps to address the underlying structural imbalances in the body.

We often talk to them about Pilates or Core Strength exercises and can guide them through some simple ways to improve their core strength.  This helps them back to optimal spinal health.

STRUCTURE OF THE CORE

The core is essentially defined by the abdominal wall, the spinal musculature, the pelvic floor and the diaphragm.  In other words, the area below the ribs down to the hips is your core.  There are many muscles that are essential for movement and good posture within this area and Pilates helps you to work on these.

POSTURE

People often talk about posture and think they have poor posture.  What they mean is their ability to align all of the different parts of their body properly.  Good function is more than this though because we don’t often stand still.  We need good alignment or good posture whenever we move.  We need a good dynamic posture.  This allows the body to function normally and allows it to perform daily tasks more efficiently.

CORE STRENGTH

The muscles which are largely forgotten are often the most important.  Many of us wish we didn’t have a flabby tummy but instead wish we had a flat “six pack”.  This leads us to hold our tummies in using our six pack muscles (rectus abdominis).  Unfortunately, the muscles we should be using are much deeper than this and cannot readily be seen. Developing core strength allows the correct muscles to be strong and work together well.  It allows them to work to their optimum level at the right time.

FLEXIBILITY

By increasing the efficiency of the body’s movement and reducing the strain on the spine and joints we give our body the chance to become more flexible.  It no longer has to work to hold you back from potential injury but can stretch confidently, in the right direction, supported correctly by the other muscles and can achieve better flexibility.

BACK PAIN

Because we sit for hours in front of computers or do lots of lifting in our jobs we put a great deal of strain on our body without providing it with the strength to be able to cope with those demands.  We also ask it to perform tasks outside of work that are totally different to the ones it is used to doing.  For example, commonly people sit at the desk all week then go and dig the garden at the weekend.  Consequently many people suffer greatly with back pain.

Pilates is a brilliant way to give your body the strength it needs so you can have the freedom to function efficiently.

Trolley Dash to the Osteopath

Apr 19, 2012
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TROLLEY DASH TO THE OSTEOPATH

Recent conversations with patients have alerted us to the fact that many people may be putting unnecessary strain on their backs whilst doing the weekly shop.  The problems, apart from lifting heavy items into and out of the car stem from the way they push the trolley.

If you watch most people in the supermarket they will haul the trolley around to the side when they get to the end of the aisle.  This involves planting both feet on the floor and rotating the trolley to the right or left until it is pointing in the right direction whilst trying to maintain forward momentum and avoid people coming the other way.

This rotational movement puts a lot of strain through the sacro-iliac joints in the lower back/pelvis region and strain of these joints can produce severe, one-sided pain in the lower back.  This is a very common complaint amongst our new patients and fortunately osteopathy can be very helpful in relieving this type of back pain.  However, this can be eliminated by stopping, revolving the trolley on the spot until it is pointing in the right direction then moving off again.

In order to help avoid making your shopping trip more painful here are our top tips for pain free shopping;

  1. 1. Use the trolley correctly – when you get to the end of the aisle stop the trolley and walk around it holding the handle until you are pointing in the right direction then push off again.  This will avoid putting too much strain on the lower back.
  2. 2. Distribute the weight better – Most of us fill the far end of the trolley with fruit and vegetables first (as they are usually at the front of the supermarket).  This means that the trolley will be harder to manoeuvre.  Try putting the fruit and veg in the middle of the trolley, leaving space at the near end for heavy items and space at the front for lighter things.
  3. 3. Buy heavy things online – If your weekly shop includes pre-packaged heavy items, get them delivered.  Typical examples include bottles of water, tinned products and alcohol.  When you next visit the supermarket you will only need to buy the light, fresh products and may only need a small trolley.
  4. 4. Ask for assistance – most large supermarkets would be happy to provide a member of staff to help you pack your shopping and help you to the car with it if you are having difficulty.  If you have back pain or you feel it is very heavy ask the cashier if they would get someone to help.
  5. 5. Spread the load – when you get home in the car get family members to help unload the car.  They may not like it but it’ll get done much more quickly!

By following these tips we can’t guarantee you will enjoy the weekly shop but hopefully you will avoid back pain.

Shin Splints

Apr 4, 2012
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SHIN SPLINTS
Shin splints can be a very painful and very common reason why people have to reduce their training or stop altogether.  We have seen several people in the clinic recently training for Brighton Marathon with these symptoms.
WHAT CAUSES SHIN SPLINTS?
Shin splints (also known as Medial Tibial Stress Syndrome or Medial Tibial Periostitis) is caused by overstrain on the membrane around the tibia bone resulting from excessive strain placed on it by muscle attachments.  It often occurs in people who do a lot of exercise and who over-train or rapidly increase their training. Running on hard surfaces and doing a lot of stopping and starting are also reasons why people suffer from shin splints.
Having poor trainers or having poor foot mechanics especially when the foot rolls inwards during running (over pronation), weak ankles and tight calf muscles are also factors that can contribute to shin splints.
INITIAL TREATMENT FOR SHIN SPLINTS
  1. 1. Firstly you need to stop the exercise that is causing the problem.  Two weeks is usually a minimum.  This allows the irritation to stop while the cause is addressed.
  2. 2. Use ice treatment – apply ice packs for ten minutes per hour for a few hours to reduce inflammation and therefore reduce the pain.  Repeat as necessary.
  3. 3. Check your training shoes – if they are worn on the sole under the big toe or ball of the foot in that area there is a good chance you over pronate and this needs to be addressed with different trainers and/or orthotics in the shoes.
  4. 4. Continue training using non weight bearing exercise such as swimming or cycling to maintain fitness.
  5. 5. Stretch your calf (including gastrocnemius, soleus and tibialis posterior) and shin. See the stretching page on our website.
LATER TREATMENT FOR SHIN SPLINTS
  1. 1. Strengthen your muscles using;
            1. a. Calf raises
            1. b. Toe raises
            1. c. Toe/Heel walking
            1. d. Resisted foot dorsiflexion
  2. 2. Begin your training again slowly and build up gradually
  3. 3. Warm up and stretch the calf and shin prior to exercise
  4. 4. Consider wearing compression socks which allow heat to be retained and provide support to the calf muscle (they don’t look great but a lot of top athletes wear them!)
  5. 5. Get better trainers.  Go to a shop that assesses your running gait properly. We suggest Run in Hove or Tortoise and Hare, Cranleigh
WHAT CAN WE DO FOR YOU?
  1. 1. We can assess your muscular and biomechanical function of your foot and leg
  2. 2. We can release the muscles effectively
  3. 3. We can ensure you are doing the correct stretching
  4. 4. We can strap your leg to take strain off the shin
  5. 5. We can ensure that your pelvic mechanics are working properly thus reducing the chance of secondary problems such as back pain and hip pain.
  6. 6. We can help to get you running again!

Avoiding Neck Pain, Shoulder Pain and Arm Pain at Work

Mar 28, 2012
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HELPING TO REDUCE NECK ARM AND SHOULDER PAIN AT WORK
In response to a question we received on Facebook here are our 5 top tips for avoiding neck pain, shoulder pain and arm pain whilst at work.
1. Ensure your workstation is set up correctly.
You should be sat directly in front of your computer rather than at an angle and have your arms comfortably to your side. Your forearms should be horizontal and your eyes should be just above the level of the top of your monitor. Keep your shoulders relaxed and make sure your mouse is not too far away from you. Make sure your seat is at the right height and you have a small gap behind your knees between the knee and chair.  Put your buttocks right back in the seat so that when you sit up you have a good lumbar curve.  Keep your back against the back of the seat but don’t lean back on it.  Ensure your feet are flat on the floor.
Look at this diagram to ensure you have the right position.
Guidance can also be found on the HSE website (self-assessment guides) at http://www.londonmet.ac.uk/services/safety/computer-workstations-self-assessments-dse-risk-assessments.cfm
2.            Get the mouse right.
There are several ways you can use your mouse to minimise strain on your arm and forearm.  Try using the other hand or alternate your left and right hand.  Position the mouse closer to the keyboard to avoid having to turn your arm out to reach it.  Slow down the mouse and reduce the number of clicks required by adjusting the settings in the control panel of your computer.  Try using keystrokes instead of the mouse for certain actions (this can be done by looking in the tools menu).
Use different mouse devices and rotate them so you change them regularly.
3.            Get the right hardware.
There are various ergonomic designs of mouse and keyboard on the market so think about having a trip to a computer shop to try some out.  Talk to your employer if you think you may benefit from a different type of device – you never know they might even buy one for you!
4.            Take regular breaks from the screen.
Every 15 to 20 minutes you should look away from the screen to avoid your eyes getting dry and strained.  Try looking to a different part of the office and blinking repeatedly for a few seconds (though its best to avoid looking at a colleague whilst doing this as they may get the wrong idea!)
5.            Stretch
Stretch your forearms regularly by holding your arms out in front of you and pulling your hand towards you first palm up, then palm down. 
Hold the stretch for 30 seconds each.
Clasp your hands together and push them away from you whilst pushing your spine backwards.  This will give a good stretch across your back.  Complement this by pushing left, right, up and down also.
Stretch your head in each direction and allow the weight of the head to stretch the muscles of the opposite side.
Keep an eye on the website for upcoming guidance on stretching.
Follow these tips to help avoid pain and discomfort in your neck, shoulders and arms whilst at work.
  • Not sure if osteopathy is for you?

    If you have any questions regarding osteopathic treatment prior to booking an appointment, please do not hesitate to let us know and one of our osteopaths will be happy to discuss these with you. If you are still not sure we offer a Free Assessment. Just ask when you call.