3 Myths about Low Back Pain that are stopping your recovery

So far in this 3 part series (of which this is part 3) looking at the PAIN = DAMAGE myth, we’ve come to understand that:

  • Pain is not an accurate indicator of tissue damage
  • Pain is an output of the brain that is projected onto your body
  • The experience of pain is greatly influence by context, such as the language we use to describe our pain
  • Misinformation and untrue beliefs about our health and bodies can lead to an increase in pain

And so if you’re dealing with long-standing pain, then let me give you 3 truths to combat this myth and help you with your own pain:

  1. Your body is fundamentally strong – A lot of you may be familiar with the statistics that come up in Health and Safety and Work, that say when you’re sitting with bad posture or lifting a heavy box with bad posture double the amount of pressure is put on your back. The original research for these statistics was conducted on cadavers – that is people who have donated their bodies to science for experimentation after their death. And so this study confirms something very obvious to me – that dead bodies shouldn’t sit in chairs or lift heavy boxes. Your living tissues are actually remarkably strong and resilient and it’s harder than you think to cause serious damage. And, importantly from that piece of research, even the highest amounts of pressure measured in those cadavers were well within tolerance levels for a living spine. You are not a fragile structure.
  2. Don’t fear movement – it’s a common misconception that bending is bad for your back. And we hear all the time that we have to hold our spine really straight and brace our core before any movement in our back. But honestly, stiffening your back like that is a really unnatural thing to do. On the other hand, there is strong evidence of the many benefits of staying active to reduce pain. In fact keeping mobile, and for many people this would involve staying in work, results in less pain and a faster recovery. So don’t fear movement – “motion is lotion”, as they say.
  3. Your body is healing – think back to last time you had a cat scratch or a paper cut. How long did it take to get better? Would you be surprised if, after a year, it was still bleeding? We are so used to our skin healing and repairing itself, but we often don’t have the same faith in the bits we can’t see, like our joints. But the same immune cells that heal your skin and working all the time to repair all your insides too. And they’re constantly at it – healing and protecting, healing and protecting. So you can have some faith – you are always repairing and getting better.

Now I think that this topic is so incredibly important because a misunderstanding of pain and a fear of our bodies can be a huge burden for the individual. Patients tell me all the time that they’ve stopped doing things that are important to them, because they just don’t trust that their bodies will cope. One patient told me that she felt she had no choice but to have an abortion because of the unbearable strain that a pregnancy would put on her back.

But the impact is not just felt at the individual level. Low back pain and neck pain are both leading causes of time off work in Britain. And the UK, like most other European countries, spends between 2% and 3% of GDP on its treatment. In fact the treatment of persistent pain costs more than diabetes and cancer… combined.

Imagine how this would change if we threw out the pain = damage myth. If instead of spiralling into inactivity and fear we remembered that we are strong and capable of healing. How liberating would it be if we remembered that movement will build our bodies and not break them. And how empowering would it be if we recognised the ability of our brains to control our pain.

Pain – All in Your Head?

Last week we explored the PAIN = DAMAGE myth and saw that:

If the brain feels there is credible evidence of a threat, it will create the experience of pain to protect you. Like that fire alarm sensing smoke or heat, it will sound the alarm. This in essence means that pain is not something that exists IN the body, it is created by your brain and projected ONTO your body.

Now, I just want to pause here and deal with a thought that many of you are having right now. You might be thinking “Are you saying that for some people their pain is in their head?” No. I’m saying that for all of us, 100% of the time, pain is in our heads.

But don’t mis-understand me. What I mean by that is that 100% of the time pain is an output of the brain. What I’m not saying is that, if your pain isn’t driven by tissue damage, then it’s not “real” pain.

If we return to our fire alarm analogy, that fire alarm could be sounding because of a house fire or because of burned toast, but the sound it makes in both those situations is the same. Regardless of what is driving pain, the experience of it is just as real.

And for this reason we must move away from the PAIN = DAMAGE myth. Because if we believe that pain is always an accurate indicator of injury or damage in the body, not only is it untrue, it can actually be very harmful. 

I mentioned last week that this myth could be considered a leading cause of long-standing low back pain. One of the reasons for this is because the language we use when talking about low back pain is often quite scary. When we talk about a slipped disc, a twisted pelvis, a weak core or a spine that’s “out” these can be scary-sounding things, even though they are not life-threatening things at all. What often results from this kind of language is that people become frightened of their own bodies. Thinking back to what we learned last week about pain, we know that stress hormones and your beliefs about your health and your body play a big role in the creation of the pain experience. And so, we see how a vicious cycle could begin. People are frightened, feel more pain, and because they feel more pain they become more frightened.

So an obvious thing that I would ask is that if you’re a healthcare professional, especially if you’re in the manual therapies, stop scaring your patients. We don’t have good evidence that weak cores or twisted pelvises exist in the way that we describe them, much less that they cause pain. But we do have good evidence that the language we use can make patients feel fragile and broken. And this absolutely does contribute to their experience of pain.

Hurt doesn’t always mean Harm

I’m here today to tell you about a huge myth. This myth is about pain and it could be considered a leading cause of persistent low back pain.

Here it is – are you ready?: PAIN EQUALS DAMAGE

On so many levels this feels right to us, doesn’t it? You get an injury, nerves carry pain signals to the brain and you feel pain. But the research has shown us that the experience of pain is so much more complex and nuanced than this and actually it isn’t just about damage at all.

We now know that you can have AN INJURY WITH NO PAIN

Many of us will have had experience of spotting a bruise on our arm or leg and thinking “where did that come from?”. That’s an obvious sign of (albeit minor) tissue damage which didn’t hurt at the time of an injury. I used to see it pitch-side all the time when I was doing first aid at football games. Players would be so involved in scoring that they wouldn’t notice gashes, sprains, strains, or sometimes even fractures, until they actually looked a few moments later. Or how about nosebleeds? They often don’t hurt but they are caused by a ruptured blood vessel in the nose.

Moreover, if you took 100 people with no back pain and scanned them in an MRI machine, 50% of them would have a disc bulge and/or osteoarthritis that is producing no symptoms and absolutely no pain.

We also know that you can have PAIN WITH NO INJURY

Why do we describe the loss of a loved one as heartache? Isn’t it because we get a tangible feeling of pain in our chest in grief? Or if you want a more medical example how about migraines? The pain from migraines is usually very severe. But there’s no damage or injury with a migraine and within a few hours the person has usually fully recovered. So what was all that pain about?

We even know that you can have PAIN WITH NO BODY PART

Some of you may be familiar with phantom limb pain, where a person experiences pain in a limb that isn’t there. Most commonly this is due to amputation but there are actually cases of people born without limbs still experiencing sensations from a limb that never existed. Not only that, but this can be replicated in non-amputees too. In certain research conditions, a person can be made to feel pain in someone else’s body or can be made to feel that kind of deep tingly sensation you get with acupuncture, when acupuncture is performed on a prosthetic limb. Even if they’ve never had acupuncture before.

 

So if you can have an injury with no pain, pain with no injury, or pain without even a body part, then our experience of pain CANNOT just be about tissue damage. 

 

We actually now know that many things contribute to the creation of pain, and it’s all to do with complex interactions of the nervous system. But because neuroscience is complicated I like to think of it like a fire alarm. Because fire alarms don’t actually respond to fire, do they? Their sensors respond to heat and smoke. In the same way there are no pain signals, pain nerves or pain pathways in the body. Receptors on the nerves are sensitive to pressure or stretch, to temperature, to certain chemicals. Now, these things might imply that there was some damage in the area but actually the brain takes a lot of other things into account too. It will take information from sight and sound to work out where you are and what you’re doing. It will assess your mood and the levels of any stress hormones in your blood. It will call on your memory bank to ask if you’ve had this pain before. And it uses your personal beliefs about your body and your health. And using all this information your brain asks one question: “Do I need to protect myself?” 

 

If the brain feels there is credible evidence of a threat, it will create the experience of pain to protect you. Like that fire alarm sensing smoke or heat, it will sound the alarm. This in essence means that pain is not something that exists IN the body, it is created by your brain and projected ONTO your body.

(Stay tuned for the next instalment next week)

Is BMI broken?

Let me tell you about two conversations (and one rude remark) I had recently:

I was discussing an upcoming knee replacement with a neighbour. He is about 5′ 5”, very rotund and in his late 60s, and he said

“They won’t do the surgery until my BMI is lower. They want it below 40. But the thing is, when I was 20 I used to play rugby, and I just don’t think they’re taking into account the muscle on my legs from back then.”

I was telling a friend of mine, who is a personal trainer, about this conversation. His background is in boxing and martial arts, having been county champion about 3 years ago. He now trains athletes and is in excellent shape himself. He’s over 6′ tall and in his early 20s, and he said:

“I went to the GP recently about some symptoms I was having and he said that with my BMI being technically overweight, my issues were down to being too fat. I asked if he was kidding so he asked what I ate. I told him that, because of how I train, I have to eat around 6000 calories a day to maintain my muscle, and he told me I should cut it down to 2000.”

Now for the rude remark. I was telling my mum about both of these conversations and an extended family member, who is roughly half my height but weighs more than me and recently had open heart surgery, interrupted and said

“These two stupid women…”

(that’s right, she called me and my mum stupid, to our faces)

“…talking about BMI. As long as you’re fit and healthy that’s all that matters.”

I had all these conversations in the space of a week, and it wound me right up!

What is BMI?

BMI stands for Body Mass Index, and it’s calculated using your height and weight. Essentially, it’s a ratio that, depending on your height, will give you an idea of what a healthy weight is for you. This is usually expressed as a range, rather than a fixed number; a BMI of 18.5-25 is considered healthy. Anything under 18 is considered underwieght, above 25 is overweight and above 30 is obese.

These ranges have been shown to be predictive of the risk of developing certain conditions. For example, a higher BMI is associated with a higher risk of osteoarthritis in the lower limbs, insulin resistance, hypertension, diabetes and cardiovascular disease. It is also associated with poorer control of asthma and poorer sleep quality. A lower BMI is associated with a higher risk of fractures, especially in female athletes and the elderly. Both a high and low BMI reduce fertility in different ways.

But, given the conversations above, it seems that no-one trusts BMI any more. Why might this be?

When I was in high school I remember learning about BMI and being told that it didn’t work in sports people, because of their muscle mass. When I was at university I remember a class-mate (who did Power Lifting as a hobby and was extremely muscular but very short) saying that because of his height his BMI didn’t really reflect how heavy he was. I remember at chiropractic college training alongside an Olympic sprinter (who went on to run in the relay team against Usain Bolt) whose BMI technically made him obese. We can all think of examples like this.

What are the limitations of BMI?

When BMI was first devised it was, by necessity, easy to do. In the 1830s there was no easy access to computers or calculators and so clinicians needed a simple formula to quickly assess a patient. There is an argument now that the formula could be updated to make it more complex, but more representative and realistic.

One limitation is the effect of extremes of height. Because weight is divided by height, people who are very short tend to have BMIs that “exagerate thinness”, whilst very tall people will be more likely to be shown as overweight.

Another limitation is that BMI doesn’t take into account what is making up the weight. Muscle is three times denser than fat and not associated with the same health risks we mentioned above. This is why BMI tends to show athletes as overweight when they clearly have low body fat. To a lesser extent bone-density can also affect BMI readings as the quality of the skeleton can’t be assessed in this calculation.

Another limitation that is important, but often overlooked, is that BMI is designed for people who are skeletally and sexually mature, ie. adults. Children need a different measure altogether and for this most healthcare professionals will use a growth chart for height, weight and head circumference.

Can we make BMI better?

Each of these limitations can be addressed to make BMI more accurate. The new formula described below takes into account the effects of extreme height or shortness, to give a more balanced picture:

BMI (metric) = 1.3 x weight (kg) / height (m)2.5

or

BMI (imperial) = 5734*weight(lb)/height(in)2.5

You can try it here.

In order to take into account muscle mass, you can pair BMI with another reading, like body fat %, caliper readings, DXA scanning or waist circumference. Of these, waist circumference is thought to be the most useful, as bulk in this area is much more likely to be fat (or in some cases water) than muscle. It also correlates very highly with disease risk, such as metabolic disorders and cardiovascular disorders. In fact, many scientists argue that a waist-height circumference might be more predictive of cardio-vascular disorders than BMI or waist circumference alone.

However, it’s worth mentioning that if your BMI is over 35, then pairing them with an additional measure has been shown to have no added benefit when it comes to predicting health. If you’re in this category, known as “morbidly obese”, it’s not because of muscle, water or being tall and taking those things into account won’t change the stats on your health.

Best use of BMI

All this is to say that a human body is very complex. Reducing a person to a number without taking the bigger picture into account will never produce good healthcare outcomes. However, there seems to be a mistrust of BMI as a health statistic in the general public which I feel is quite unfounded. BMI does have it’s limitations, true, but these are:

  • generally small
  • only apply to extremes of the populations (elite athletes, the unusually tall or short)
  • can be corrected for with the updated formula mentioned above
  • outweighed by the overwhelming correlation with serious health risks

Let’s not throw out the baby with the bath water. If you’re one of the 95% of people out there who doesn’t fall into an extreme category then BMI won’t tell you everything you need to know about your health – but it’s a darn good place to start.

Your back isn’t “out”

Sometimes as chiropractors we can be so lazy. Especially in how we explain things to patients. We say things like

  • Your spine is out of alignment
  • Your back is too flat/curved
  • Your neck is stuck
  • Your hip is out
  • Your pelvis is tilted
  • One leg is longer than the other
  • Your arches have collapsed
  • Your disc has slipped (see previous post for a big rant on this one!)

As often happens in a healthcare profession (HCP), we’ve developed our own little language to talk to each other about the things we treat. And because we’ve all gone through the same training, we understand what these short-hand terms mean and the implications of them.

But sometimes we make the mistake of assuming that patients know what we mean by this. But some interesting research over a decade ago demonstrated that the use of medical jargon, or even just a poor explanation, can lead to patients getting a very different idea of what is wrong with them. In this study, doctors gave a diagnosis to a patient, and then the patient was asked by researchers afterwards to recall as much as they could about the diagnosis and describe what they thought it meant. Doctors who used the word “neurological” in the explanation (which means anything to do with the nervous system – the brain, spine and nerves in the body) gave patients the impression that their condition was progressive (ie. would only get worse and not better). Patients who heard the word “chronic” (meaning lasting longer than 3 months) interpreted it as “incurable”.

But the real danger in this scenario is not just that the patient mis-understands their condition. The real risk we run is that patients will change their lives based on the information that HCPs give them, and they can end up much worse-off as a result.

We are the problem

Let me tell you about a patient of mine – we’ll call him Paul*. Paul was in his mid-30s when he came to see me. He had been seeing a chiropractor I knew well in another part of the UK, who had recommended he continue his care with me when he moved to Cheshire. When I asked him about his previous treatment, this is what he told me:

“I got some pain in my back while I was running a 10k. When I went to see the chiropractor, he told me both my hips had dislocated and he put them back in again. Since then I’ve had regular treatment and he keeps putting my hips back in place. I’ve stopped running because I don’t want them to dislocate permanently, but my back isn’t really much better.”

As I said before, I know the chiropractor who treated him. He’s a competent, evidence-based and ethical chiropractor. And I know there’s absolutely no way that he told Paul that both his hips were dislocated, but this is what Paul heard from his explanation. As a result, Paul stopped exercising.

A multitude of research tells us that exercise is the best thing you can do for your back and inactivity will almost certainly make back pain worse. Not only that, just think about the impact on Paul’s life when he stopped running. Doubtless his fitness decreased; perhaps gained weight; he may have spent less time in fresh air and nature; and maybe he doesn’t even see his friends from his running group any more.

So there is a real danger when we mis-communicate a diagnosis like this that we change the trajectory of a person’s health. We actually can be the cause of serious problems down the line. If Paul had continued the way he was, he may have put himself at increased risk of cardiovascular disease, diabetes, osteoporosis, several types of cancer and mental health problems.

Chiro-translate

So, returning to that list above, let me give you a translation of what your chiropractor really means! (And you might also want to look at the video explanation on my Facebook page here)

Broadly speaking, the statements fall into 2 categories:

  1. Statements about movement – These are comments about joints being “stuck”, “fixated” or “restricted”, and it might also include comments about joints being “out of alignment”. What is actually happening, is that the joint no longer has a full range of motion so instead of moving 100% of it’s normal motion, it actually moves something like 50-80%. The joint does still move, so it’s not “stuck” or “fixed/fixated” in one placed, and in every other respect the joint is perfectly healthy and does still function, but it probably feels a little stiff. Manual therapy (like the treatments chiropractors do) has been shown to be really effective for restoring movement in these joints. But sometimes we make the patient feel like their spine is fused at that spot, and always will be.
  2. Statements about shape/symmetry – These are comments about spines being too curvy or flat, feet having fallen arches or collapsed arches or high arches, one hip or shoulder being higher than the other, etc. The first thing to say about these measurements is that they’re not very easy to define. For example, there is a huge variety in the shape and size and combination of the 3 arches in a person’s foot. But there isn’t really a fixed definition of how high is too high for an arch. So it falls into the category of the “expert eye”/”looks a bit high/low/flat/collapsed to me” – which can be very different between healthcare professionals. This is sometimes helped by comparing side to side – as in the case of one shoulder or hip being higher than another. The second thing to say is that, when we make statements like this as chiropractors it is VERY rare that we are actually talking about the shape of your skeleton. A lot of times we might just be talking about your general posture, how you hold yourself, or muscle tension in an area making it look bulkier or higher than it actually is. But we run the risk of making patients feel like their skeleton is going to be permanently mis-shapen and lead them to worry unnecessarily.

But the most important thing to say about these 2 categories is that neither of them IN AND OF THEMSELVES are predictive of pain or poor function. When assessing a patient a chiropractor needs to take into account medical history, family history, occupation, hobbies, accidents/injuries… as well as a lot of non-physical factors like the patient’s past experience of healthcare, their beliefs about their pain and their mental health. And after this, the postural and motion assessment forms just one part of a thorough examination.

You know what I mean?

There really is no excuse for HCPs to be lazy in their approach to communicating with patients. So if your chiropractor or physiotherapist or doctor says something you don’t understand, please feel no embarrassment in interrupting and asking them to make themselves clearer. A clinician worth his salt will not be offended at you attempting to understand your condition better – good ones would welcome it.

Discs Don’t Slip

The intervertebral discs sit between the bones of the spine. They’re composed of a gel-like material (in the picture below this is called the nucleus pulposus) surrounded by a mesh of fibres (the annulus fibrosus). Whenever there’s any movement through the spine, the discs act like little shock-absorbers, to dissipate the force and protect the bones of the spine from any impact.

On either side of the disc, attaching each surface to the adjacent bone, is a cartilagenous endplate (ie, a flat circular structure made of cartilage) This not only firmly anchors the disc to the bone, but also acts as a membrane for water and nutrients to pass from the blood vessels in the bone into the disc. This keeps it hydrated and nourished.

And on top of this, there are a multitude of ligments that run over the spine and the discs. These are made from strong, tough fibres which run parallel to each other, to form a barrier with high tensile strength. These keeps the whole spine sturdy. The picture below shows the multitude of stabilising ligaments in the spine.

Seriously, discs don’t slip

All of this is simply to say that discs don’t slip. They do not slide out of place, or move around in the spine. They are firmly anchored by the end-plate and bound in by ligaments. They simply cannot slip out.

The injury that is often described as a “slipped disc”, is actually a bulge. Sometimes the annulus fibrosus (the outer rings of fibres that hold the gel of the disc contained) can be injured, and this can lead to the softer nucleus pulposus (the gel in the middle) bulging out, usually into the side of the spine. Sometimes this will put pressure on the nerve there, which causes the classic leg pain of sciatica.

Why does it matter?

Surely it’s just terminology? The pain is the same is doesn’t matter what we call it, right?

Actually, that’s not true.

We can’t see our spines. If we hurt our elbow, we would get a lot of visual information about how the injury was progressing. We would see swelling reduce, bruising go down, scratches or wounds healing, etc. In the spine we don’t get this visual information and so we rely a lot on our imagination – we have to visualise in our own minds what we think is happening in our backs. This is how our brain processes and makes sense of an injury.

And so actually the terminology we use has a huge impact on the mental image we draw up of our injury. I have had patients tell me that their “slipped disc” has moved out of their spine and they have no idea where it has gone but it’s left a great big hole in their spinal column.

The downward spiral

Now imagine how a person who thought like this would act. They would avoid anything that might challenge their “unstable”, “weak” or “slippery” spine/discs. They would be less active, they may sit/lie down/rest more. They may stop doing things they love.

All of these are things that are unhelpful to your recovering back. Research shows that movement is important to your spine and bed rest severely slows recovery.

But all this imagery of “slipped” discs will usually make someone more anxious about their back and, as we have discussed before, fear and anxiety about back pain can actually sensitise the nerves and make the back pain worse.

Good news for discs

As we’ve also discussed on this blog, discs DO heal.

So here’s what you should do if someone tells you that you have a “slipped” disc (once you’ve informed them of their mistake and pointed them to this blog – haha!):

  • Don’t put yourself on bed rest
  • Use paracetemol or cocodamol (not both) and/or manual therapy (like a chiropractor, osteopath or physiotherapist) for pain relief and to encourage movement
  • Perform regular gentle movements in the spine in the direction that gives relief (I give my patients the McKenzie exercises)
  • Be patient. Discs do heal but they take time.

Does my disc need surgery?

We’ve talked before on my Facebook page about how discs don’t really slip. But There’s some exciting new research with even more good news for discs!

Disc bulges CAN re-absorb (resorb). That means the bulge can suck itself back in. Spontaneously. With no surgery or treatment necessary.

Here’s a picture from the research to prove it – can you see the disc sucking back in over time?

And not just the little ones. One of the research papers included a lady who had a large disc bulge in her neck and had experienced sudden quadriparesis (noticeable weakness, but not total paralysis, of all four limbs). Her disc bulge and all her symptoms got better by themselves, with no specific treatment, over 28 months.

In fact one study recommends that lateral disc bulges (these are the bulges that go out to the side into the nerve root, rather than backwards into the spinal cord) resolve so frequently that conservative treatment (ie, non-surgical) should be the first port of call. Especially if there is also radicular pain, like sciatica.

So if you are struggling with a disc issue, remember this:

  • Your body is capable of healing
  • Discs spontaneously resorb very frequently
  • Your spine is ultimately very stable
  • You do not need to immobilise your back or put yourself on bed rest

What do gardening, sex and skateboarding have in common?

They all count towards your daily exercise quota!

OK, so technically sex isn’t included in the list of NHS recommended exercises, but I reckon it meets the criteria for aerobic activity (see below)

Why bother?

“Yeah, yeah, another blog post telling me I need to exercise. Whatever.”

The benefits of exercise are profound and wide-ranging

I know I’ve shared this infographic many times before, but I feel this information is so powerful but so little-known. Regular exercise reduces your risk of all causes of mortality by 30%. Or, in other words, by not doing regular physical activity as these guidelines suggest, you increase your risk of premature death by a third.

As well as all the other benefits listed on this diagram, it’s also well-known that an inactive lifestyle is a big predictive factor for a lot of musculoskeletal pain, including back pain, neck pain and knee pain. These conditions are all common and, with 1 in 5 GP consultations being for one of these conditions, are a big burden on the healthcare system.

How much exercise do I need?

If you’re aged 19-64, the most recent research suggests that it’s important to do 2 types of exercise regularly

  1. Aerobic exercise – these are exercises which boost your metabolism. You need 75minutes of vigorous aerobic activity OR 150 minutes of moderate aerobic activity every week. As a rule, 1 minute of vigorous activity will provide the same benefits as 2 minutes of moderate activity. It should leave you slightly sweaty, a little breathless and with a slight increase in heart rate. (See what I mean about sex being a good candidate?)
  2. Muscle strengthening – these are exercises which may or may not leave you short of breath, but will help build strength and endurance in your muscles. It is recommended these are done twice a week, and include all major muscle groups in your body (so not just arms and chest, but also legs and back, etc)

It’s also recommended on top of this that all adults stay generally active throughout the day and avoid periods of prolonged sitting.

What counts?

It’s easy to assume that to exercise you have to attend a gym, or have a personal trainer, or wear lycra. Actually, lots of every day activities could count towards moderate aerobic exercise, such as:

  • a brisk walk to the shops
  • pushing a lawnmower
  • playing tag with your children in the garden or park

You could also include things like skateboarding or rollerblading, or riding a bike on level ground.

For vigorous aerobic exercise, you probably need to make more of an effort than you would in every day activities. This could include things like:

  • A bike ride over hills
  • Jogging or running
  • Sports like tennis, hockey, netball or football (but not like golf)
  • Gym classes like aerobics
  • Some martial arts (but not tai chi)

To strengthen muscles, activities could include:

  • lifting weights
  • working with resistance bands
  • doing exercises that use your own body weight, such as push-ups and sit-ups
  • heavy gardening, such as digging and shovelling
  • yoga
  • pilates

These exercises are counted in reps and sets, and to get the benefits you need to do at least one set of 8-12 reps, using a weight that makes the last rep a challenge.

Lots of sports actually count as both aerobic and muscle strengthening, such as running, football, rugby, netball and hockey.

The power of small changes

One thing to remember is that there’s little or no benefit to “one-off workouts” or short-term health kicks. To have the incredible benefits we discussed earlier, exercise really needs to become part of your lifestyle and be performed regularly. Therefore, you could argue that the most important factor for any exercise you do is that it be enjoyable. After all, you need to stick at it long term.

So don’t be afraid to try new things until you find something that you’ll love to do for exercise. Like being outdoors? Join a walking club. Hate the machines at the gym? Try a class instead. Love music? Start salsa lessons! Like being part of a team? Join a local sport club. Fancy something sociable? Pick up a friend and go for a hike. Preparing to grow your family? Pregnancy yoga. There’s something out there for everyone.

If you need some ideas, Julia has lots of links to local groups and events that you might like to try, so just mention it at your next session for inspiration!

Trapped Nerves

Most of us would be familiar with the term “trapped nerve” but can just any nerve get trapped? How do you tell if you’ve got a trapped nerve? And what should you do about it?

What do nerves do?

Nerves are responsible for carrying information all over the body and simplistically speaking this information falls into 2 categories:

  • Information about MOVEMENT – this is signals being taken from the brain to the muscles of the body. And not just your skeletal muscles which control your voluntary movement. This would also include the muscles that push food through your digestive system, the muscles that squirt saliva from the salivary glands into your mouth and the muscles which make the pupils of your eyes smaller or larger, depending on the light.
  • Information about SENSATION – this is signals being taken from the body to the brain, carrying information about sensations in the skin, stretching in the muscles, heat or inflammation in the tissues and more

When a nerve gets trapped, you would expect to see problems with the carrying of all this information to and from the affected nerve.

  • The muscles would not be getting information about movement, and so they may seem weaker than usual. Sometime this can even make the affected area feel heavy or more effort to move.
  • The sensation signals travelling from the area will be affected, so the area may start to feel tingly with pins and needles, or even numb
  • The compression on the nerve would send signals back up to the brain, causing sharp pains along the course of the nerve. This means you could get pain very far away from the original nerve compression, such as in sciatica, where there is pain in the leg but the original compression occurs in the back.
Whilst the nerve is compressed in the spine, the pain of sciatica is felt in the leg

Where do nerves get trapped?

Nerves are usually very mobile structures, and most of the time they have lots of space and “wiggle room” to accommodate movement or change in the tissues around them.

Nerves are most at risk of getting trapped at points where they run through narrow tunnels in the body, because they have less “wiggle room”. The space around them is restricted. The nerves are usually able to glide through these tunnels. But now imagine if that tunnel became squashed or inflamed. The nerve would start to feel the pressure of that and would not be able to glide smoothly.

The most common place for a nerve to get trapped in a tunnel is in the IVF (intervertebral foramina – a posh word for spinal tunnels), where the nerve first exits the spinal cord. When this happens, you will hear people say they’ve trapped a nerve in their neck or back. But there are other tunnels all over the body, particularly in the arms and legs.

  • the Carpal Tunnel, in the wrist, where the nerve runs underneath a stiff ligament
  • the Tunnel of Guyon, on the outside edge of the lower palm, where the nerve runs under the pisiform bone
  • The Olecranon Fossa, where the nerve runs close to the bones of the elbow
  • The Deep Gluteal Space, where the nerve runs underneath or through the piriformis muscle
  • The Thoracic Outlet, where the nerve bundle runs on top of the ribs and under the muscles of the neck and chest
  • and many more
The median nerve runs through the carpal tunnel under a stiff ligament, which may compress it

Why do nerves get trapped?

When a nerve sits in a tunnel as described above, it is confined. If something then pushes into that tunnel the nerve becomes compressed. There are a few common things that may push into the tunnel to squash the nerve:

  • DISC – in the spine, discs may sometimes bulge and push onto the nerve
  • ARTHRITIS – in arthritis, the extra bone that grows may sometimes push onto a nerve
  • MUSCLE – sometimes when muscles become tight or shortened, they put pressure onto the tunnel which the nerve sits in, causing the nerve to be compressed
  • SWELLING – if inflammation occurs within the tunnel, the pressure of this swelling would compress the nerve

It is possible to have any or all of these without it compressing the nerve.

There are several other very rare causes of nerve compression such as bleeding (like in Compartment Syndrome) or space-occupying lesions (like a tumour).

A disc bulge is a common cause of trapped nerve in the spine

What can I do about a trapped nerve?

1. Find out what is pressing on which nerve

In this blog, I am usually very hesitant to say “go and see a chiropractor”, because I believe most patients, with the right information, can take care of themselves. However, in this case it’s important to get a diagnosis. The treatment for disc bulges, arthritis and muscle tension are very different and if you target the wrong one you may not feel any relief, or may possibly even make it worse.

2. Take pressure off the nerve

This will mostly be in the form of hands-on treatment from your chiropractor, who will use gentle, specific techniques to decompress the nerve and resolve the underlying cause of the compression

3. Get the nerve gliding again

Once you know from your chiropractor which nerve is affected, you can start doing gliding exercises specifically for that nerve. There’s a different nerve-glide exercise for every single nerve in your body so it’s important to chose the right ones, and your chiropractor can help with this.

4. Support the healing of the nerve

Nerves can heal quite slowly so if you want a full and speedy recovery there are several things you can do (or stop doing) to encourage healing. Nerve healing is hugely slowed down by smoking, and quitting or cutting down significantly will improve your chances. Your nerves will also use lots of B vitamins, magnesium and omega 3 in the healing process, so taking a good supplement with high levels of these 3 ingredients will help. Taking regular gentle exercise during recovery will improve blood flow to the nerves, which will provide all the oxygen and energy needed for repair.

Whiplash

We commonly associate whiplash injuries with car accidents or collisions, but whiplash can occur any time your head moves suddenly, such as a fall where the head is jolted backwards, or as an sporting injury in a contact sport like rugby.

Unlike more serious injuries, like a fracture, the pain of whiplash may not develop for a day or two after the initial injury. But the pain that develops from it can be debilitating, because it often causes severe stiffness, spasms, neck pain and headaches.

Whiplash falls into two categories:

  1. “Simple whiplash” – this is due to sprains and strains in the soft tissue of the neck which happened at the moment of impact
  2. “Stingers/Burners” – where the nerves in the neck and shoulder are also damaged leading to tingling, numbness, pins and needles and/or pain in the arm

For the vast majority of people, the pain from whiplash is manageable and the whiplash will resolve by itself. In these circumstances the best thing to do is get some rest, use gentle heat on the area and take paracetemol.

It’s very important in the immediate aftermath of a whiplash injury to keep the neck moving as much as possible. Under no circumstances should it be immobilised in a brace or collar.

If you remember nothing else from this blog post, remember this. DO NOT USE A NECK BRACE ON WHIPLASH!

Got that? Ok.

DON’T USE A NECK BRACE FOR WHIPLASH INJURIES!

Chronic Whiplash

For some people, however, whiplash can become a chronic condition, where the pain persists even after the initial injury has healed. This can make day to day living difficult, and can even lead to depression due to the chronic pain. In situations like these having some treatment, such as chiropractic treatment, can be very helpful. (You can click here to see the results of a patient I treated after she had pain for 7 years after her whiplash, and has now found significant relief.)

The truth is that we don’t really know what the factors are that predict whether someone will have chronic pain or recover quickly from whiplash, but it seems to be some combination of the following:

  • How emotionally traumatic the original event was
  • How painful the initial onset of whiplash was

But it doesn’t seem to be correlated with:

  • How bad the initial accident was, eg. if the car was rear-ended or rolled into a ditch
  • Whether or not you claimed for your treatment on insurance
  • Whether you had “simple whiplash” or a “stinger/burner”
  • How quickly you got treatment for it

Because of this I usually recommend that you continue with your normal day to day life as much as possible for at least 3 weeks. If your pain or stiffness have not improved at that point, or the headaches become unbearable, or it is affecting your sleep, then make an appointment to see me and we will get right on top of it.