Top Tips for Knee Pain

All the techniques described below are demonstrated on my Facebook live video about this topic, which you can find here

Knee pain is relatively common in the UK and the good news is that it’s often very easy to treat! Here are my top tips for knee pain.

1 – Hands on!

The most common form of knee pain is muscular, that is, pain caused by tightness, tension or weakness in the muscles of the knee. In 90% of cases it’s the vastus medialis oblique (VMO) muscle which is the culprit, so here’s what you can do to help.

The VMO muscle is responsible for 90% of muscular knee pain

Massage the muscle. You can find it by placing the palm of your opposite hand on the kneecap of the affected knee – the point at which the tip of your thumb lands is the most common area for a knot in that muscle. Grab some lotion and give it a vigorous rub until the knot is reduced and the pain has subsided.

Exercise it. Stand in a high squat leaning against the wall with a soft ball between your knees. Squeeze the ball between your knees and, at the same time, push your bottom into the wall. You should feel your inner thighs tense up. Hold this for 10 seconds and relax. Repeat. If you find this version of the exercise too easy you can sit into a deeper squat or bring your feet closer to the wall.

2 – Move, Move, Move!

The next most common cause of knee pain is osteoarthritis (OA). As we discussed in an earlier post, OA is not in and of itself a painful condition, but sometimes the presence of OA can irritate other structures or make the joint stiff. In this case, the best thing is to move that joint! Motion is lotion!

Underwater exercises can be very effective for knee pain

Walking is great, dancing is great, cycling is great! So if you enjoy any of those, do lots of them! But you’ll probably find swimming is the most effective way to move the knee and reduce pain and stiffness. Not only does being in the water remove some of the weight-strain on the knee, by making you weightless, but the act of moving the knee through the water provides some resistance and helps to strengthen the knee muscles, build up cartilage and improves blood flow. Better still, why not try marching through the water, or cycling your legs as if you were riding an underwater bike?

I would also highly recommend taking a supplement for your joints if you know you have OA – the BioCare Glucosamine MSM Complex and their MegaEPA are an excellent combination. Or, if you don’t like tablets and you prefer a liquid supplement to put in smoothies, BioCare also make a JointGuard solution which has high levels of Glucosamine and Omega 3 oils (and it actually doesn’t taste too bad because it’s got ginger and citrus in!). If you are an existing patient of mine, I have a discount code that you can use on their website too.

3 – Lay down your heavy load

Having a Body Mass Index (BMI) over 25 classifies you as overweight, while a BMI over 30 is classed as obese. And being overweight or obese has a significant impact on your knees by increasing the stress on them. Losing weight will significantly improve your knee pain as well as having lots of other health benefits. You can work out your BMI here.

Being overweight is a major contributor to all types of knee pain

In spite of what many very fashionable fad-diets will tell you, there is only one way to lose weight: to be in a calorie deficit. This means as long as you are eating fewer calories than you are using, you will lose weight.

Here’s an online tool to work out how many calories you can eat (otherwise known as your Basal Metabolic Rate – BMR).

If you eat exactly the same number of calories as your BMR you will stay the same weight. If you eat more calories than your BMR you will gain weight. If you eat fewer calories than your BMR you will lose weight. It’s that simple!

When knee pain is more than knee pain

You should see your GP if any of the following happen in your knees:

  • You can’t put any weight on your knee
  • If your knee locks or gives way frequently (painless clicking is normal)
  • If your knee is red, hot and swollen and you also feel unwell/hot and cold/shivery
  • If your knee has changed shape
Most knee pain can be treated with non-invasive techniques and does not require a GP or hospital visit

The Big Secret…

Welcome to 2019! Happy New Year! I hope this year is a wonderful one for you and your family.

At this time of year, it’s only natural to look back and reflect on the year that has been, as well as make plans going forward. We may even make a resolution or two.

I’ve historically never been one for resolutions, but last year I made a few and found it really helpful. It was actually amazing to see how small changes, made regularly and turned into habits, make a huge difference by the time New Year rolls around again. It even became my unofficial motto for the year: “It’s better to be consistently good than occasionally brilliant”

A large study done 2 years ago by The Kings Fund – a large, independent charity working to improve healthcare in England – found that over 80% of diseases and conditions here in the UK are either partially or entirely mediated by 3 lifestyle factors. Put another way – crack these 3 lifestyle habits, and 8 out of 10 premature diseases could simply pass you by.

And here are those 3 factors:

  1. Exercise – Adults should aim to take part in at least 150 minutes of moderate intensity physical activity each week, in bouts of 10 minutes or more. Included in this, all adults should undertake muscle strengthening activity twice a week and minimise the amount of time spend sedentary for extended periods.
  2. Diet – Adults should aim to eat a diet with the right amount of calories (this is individual to you, but generally around 2000Cal/day), with 40% of their food intake being fresh fruit and vegetables (not including potatoes), and choosing foods high in protein, fibre and EFAs (essential fatty acids) over foods high in processed sugar and salt.
  3. Exposure – Stopping smoking and reducing your alcohol intake to less than 14 units per week (this is now the same for men and women – new research showed the old limit of 21 units for men was too high)

These may sound like things we have all heard before. We’re familiar with the health campaigns of “eat your 5 a day”, “stoptober”, “dry January”, “move more”.

But just take a moment to review that statistic that I shared earlier. Get these 3 things right, and you’ve lowered your risk factors for 80% of known health conditions.

In fact, even just implementing the exercise guidelines reduces all causes of mortality by 30%.

Just think about that.

So what New Year’s Resolutions will you be making? What new healthy habits are you taking forward into 2019? Remember that a small change, done consistently, can snowball into big changes.

And don’t be put off by the amount of time it will take to achieve your health goals. The time will pass anyway – the only question you need to ask yourself is “by next New Year’s Eve, do I want to be as healthy as I am now, or healthier?”

Leave a comment and let me know your New Year’s Resolutions! Wishing you a happy and healthy 2019!

Osteoporosis

Osteoporosis is often known as the “bone thinning” disease that strikes in old age – but is this an accurate description? And is it an inevitable problem in old age or are there steps for you to take right now that will make a difference?

The first thing to say is that osteoporosis is not a painful condition, but it can become painful if you fracture a bone, which is more likely if you have osteoporosis.

What happens in osteoporosis?

We often think of our bones as big solid lumps of calcium, but actually they are arranged in a matrix of criss-crossing pillars of calcium and protein called trabeculae. These run in lots of different directions, which means that the bone is strong in lots of different directions and able to resist forces through all kinds of movement.

Normal trabeculae in a hip bone

As we’ve discussed in previous posts, the body is highly adaptable, and is able to change its composition to deal with lots of different environments and challenges. This is true of muscles, for example, which get bigger and stronger with use. It’s also true of the nervous system, which is able to re-wire itself to learn a new skill or technique. And it’s also true of your bones, because they are able to deposit extra calcium along these trabeculae when the bones are regularly used and loaded. They are also able to do the opposite – to remove calcium from trabeculae that are not being used or loaded.

This is what we see in osteoporosis. When we look on an x-ray, the bones appear almost stripey, because the trabeculae running in one direction have thinned and become less dense, leaving a darker stripe running through the bone.

The classic stripey pattern of osteoporosis in the knee

What can I do to prevent/treat osteoporosis?

Some bone thinning in older age is normal, but when it occurs faster than it should, then this is diagnosed as osteoporosis. If you remember back to the blog post about osteoarthiritis, we saw there that certain cells called osteoblasts are responsible for building new bone. In osteoporosis, these cells are unable to do their job and there are 5 main causes for this:

  1. Inactivity – the osteoblast cells are stimulated by movement and loading, so a sedentary lifestyle will slow down the activity of these cells
  2. Drinking heavily and smoking – both alcohol and cigarette smoke are known to inhibit osteoblasts, and early research on vaping suggests it may also have a similar effect, although this is not conclusive.
  3. Having a low BMI – being underweight is a risk factor for developing osteoporosis, partly because it is indicative of a diet low in fat, calcium and Vitamin D – all of which are needed to build healthy bones. But weight is also important because it affects hormone levels (see below)
  4. Hormonal changes – osteoporosis is most common in post-menopausal women because osteoblasts slow down when there’s a drop in oestrogen, as happens in the menopause. Testosterone is also important for healthy bones in men, so changes in these hormone levels may cause osteoporosis too. Also too much of the thyroid hormones (in both men and women) can slow down osteoblasts
  5. Some medications – for example, long term use of corticosteroids

The great news is that, if osteoporosis is caught early enough, it is actually possible to reverse it completely. And even if it is caught later on and is already quite advanced, it is possible to slow its progress, stop it progressing completely or partially reverse it. From the list above we can clearly see that a healthy BMI with an active lifestyle, good diet, moderate alcohol intake and no smoking would help prevent osteoporosis.

If you have a family history of osteoporosis, or are have already been diagnosed with it I would recommend the following:

  1. Regular weight bearing exercises
  2. A strong calcium and Vitamin D supplement
  3. Quit smoking and reduce your alcohol intake
  4. Get some sunshine! (this helps with Vitamin D, but in the UK you will always need to take a supplement as well)
  5. See your GP for advice on medication (there are medications available which help with building bone back up again)

Ankylosing Spondylitis (AS)

Ankylosing spondylitis (AS) is a long-term condition in which the spine and other areas of the body become inflamed.

The symptoms of AS can vary but usually involve:

  • back pain and stiffness that improves with exercise and isn’t relieved by rest
  • pain and swelling in other parts of the body, such as the hips, knees and ribs
  • fatigue (extreme tiredness)

These symptoms tend to develop gradually, usually over several months or years, and may come and go over time.

In some people, the condition gets better with time, but for others it can get slowly worse.

It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27. Having this gene does not necessarily mean you will develop AS. It is estimated that 8 in every 100 people in the general population have the HLA-B27 gene, but most do not have AS. It is thought that having this gene may make you more vulnerable to developing AS, and the condition is triggered by one or more environmental factors – although it is not known what these are.

AS tends to first develop in teenagers and young adults. Most cases first start in people aged 20-30, with only a minority of cases first affecting adults over 45.

AS is around three times more common in men than in women.

There are around 200,000 people in the UK who have been diagnosed with the condition.

Keeping active can improve your posture and range of spinal movement, along with preventing your spine from becoming stiff and painful.

As well as keeping active, manual therapy is a key part of treating AS. A chiropractor, osteopath or physiotherapist (a healthcare professional trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme that suits you.

Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important.

You will also be prescribed medication. Some medication is taken to slow down or halt the progression of AS, others are to help with pain or inflammatroy “flare ups”

top 5 tips for managing AS
  1. a tailored exercise programme – to relieve stiffness and discomfort and improve strength and flexibility
  2. massage – your muscles and other soft tissues are manipulated to relieve pain and improve movement
  3. hydrotherapy – exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); the buoyancy of the water helps make movement easier by supporting you, and the warmth can relax your muscles
  4. quit smoking – not only will the inflammatory chemicals in tobacco make your symptoms worse, but AS also puts you at a higher risk or heart disease, and smoking will contribute to this too
  5. improve your diet – introduce foods which will reduce inflammation, such as fresh vegetables, oily fish and spices like turmeric. You should also increase your calcium and Vitamin D intake to support the health of your bones, as AS puts you at a higher risk of osteoporosis (thinning bones)

Inflammatory Arthritis

In our last blog post, we talked about the two different types of arthritis – osteoarthritis and inflammatory arthropathies (aka rheumatic diseases). This posts will concentrate on inflammatory arthropathies, the most common of which is rheumatoid arthritis (RA)

RA is a type of autoimmune disease – the immune system mistakenly attacks the lining of the joints, thinking it is a foreign substance. This causes the joint to become red, hot, swollen and stiff. The symptoms are particularly worse if you’ve been sleeping or had a period of inactivity. You can also get “flare-ups” where the symptoms become particularly severe. It often runs in families, and is more common in women and in the over 50s. It can sometimes have effects in other areas of the body, such as the eyes, heart and lungs. It’s also common to get other symptoms like fatigue and poor appetite. No-one knows why the immune system starts to behave this way, and the only known risk factor is smoking.

In a previous blog, I talked about inflammation as the first stage of the healing process, and this is true. However, in the case of these autoimmune conditions, the inflammation is happening in the absence of injury, and so the immune system is breaking down perfectly healthy tissue. In these cases the inflammation is inappropriate and so, rather than letting it run its course (like in an injury), it is best to stop it in its tracks.

There is no cure for RA, or any of the other inflammatory arthropathies. However, the medication currently available is very effective and there are many other things you can do to help manage the symptoms.

  1. Appropriate Exercise Movement in the joint will provide relief from stiffness and swelling, and strengthening the muscles, tendons, ligaments and bony structures around the joint will also help the joint to stay stable and healthy. However, overly strenuous activity can lead to a release of substances that promote inflammation, so it’s best to avoid high impact exercise like running/aerobics or contact sports like rugby and football. For a tailored programme specific to you, talk to a chiropractor, physiotherapist or OT.
  2. Diet The things we digest become the things that make up our bodies, so eating things that promote the formation of anti-inflammatory substances can be helpful in RA. These include fresh leafy vegetables, tomatoes, fish and spices like turmeric. Similarly, avoiding things that promote inflammation can be helpful, like nut butters, meats that have been battered and/or deep fried, and alcohol.
  3. Smoking Smoking increases the risk of developing RA and it also exacerbates the symptoms
  4. Supplements The government recommends that everyone, regardless of age, should take a 10mg Vitamin D supplement every day. However, evidence has shown that Vitamin D at higher doses can help to properly regulate the immune system, and therefore help manage RA. There is also some (slightly weaker) evidence that a high dose Vitamin D supplement can reduce the risk of ever getting RA, but this is less clear.
  5. Treatment Manual Therapies such as chiropractic, and also medical acupuncture, can help with pain relief during a flare-up, and reduce the frequency and severity of a flare-up
  6. Get Support RA and the other inflammatory diseases are life-long conditions. Although good medication is available and good self-care can help enormously with symptom control, it is almost inevitable that flare-ups and relapses will occur. This is a condition you will have to learn to manage for the rest of your life. Sometimes it can help to talk to people who are going through the same thing. You can find your local branch of VersusArthritis (previously ArthritisCare) here.

What is Arthritis?

Arthritis is the general name for a joint complaint. It comes from the latin “arthr-”, meaning joint, and “-itis” meaning inflammation.

If you’d like to see a Flourish patient testimonial from someone with OA in both knees, click here (it’s the third video down).

Not all arthritis is the same

There are actually over 100 different types of arthritis – far too many to go into detail about here – but they fall under 2 simple categories.

Inflammatory Arthritis/Rheumatic Diseases happens when the immune system attacks something in the joint, whether that’s the cartilage, the bone, the joint lining or other parts of the joint. It is characterised by redness and swelling, which often happens in flare-ups, and will affect lots of joints around the body and other areas of the body.

Osteoarthritis happens when there is an irregular surface in the joint. This means the joint cannot glide through its movements like it used to and often becomes stiff. This is by far the most common type of arthritis, especially in those over 50, and is what most people mean when they say they have “a bit of wear and tear”. This is the type of arthritis I’ll be addressing in the rest of this article.

(If you want to read more about inflammatory arthritis, stay tuned for another article coming soon.)

What is Osteoarthritis (OA)?

It’s a joint condition characterised by stiffness, mild swelling and pain. It happens mostly commonly in the weight-bearing joints, such as knees and hips, but also joints that get a lot of use, like the hands. On examination, it’s often found that the muscles that travel across the joint have become tighter and weaker.

When we see OA on an xray, this is what is looks like:

  • The normal space between 2 bones in a joint is narrower than it should be. This is because the layer of cartilage (which you can’t see on an x-ray, so it just looks like empty space) which would allow the joint to glide freely has become thinner
  • The surface of the bone looks bumpy instead of smooth, giving the appearance that is has been worn away
  • There is less fluid in the joint than there would usually be

There isn’t a cure for osteoarthritis, since it essentially occurs in response to everyday living, but there are lots of strategies that can be used to reduce the symptoms and many of these are incredibly effective and easy to do.

Why is OA painful?

So here’s the interesting thing. OA isn’t painful at all. None of the changes associated with OA that we see on an x-ray actually cause pain in and of themselves. In fact, many people don’t even know they have OA because the don’t experience any pain or stiffness at all.

There are cases where the OA can become very severe and cause pain in other structures (for example, if the extra bone deposits started pushing on a nerve or a tendon) or if eburnation – bone rubbing directly on bone – occurs in the joint then this can also be painful. In cases like these a joint replacement is often recommended. However, when a clinician sees evidence of OA on an x-ray or another scan, it doesn’t automatically mean that it will be painful or symptomatic.

It’s not wear and tear, it’s wear and repair

When viewed on an x-ray, OA gives the appearance of a bumpy and irregular surface, and so many people assume that the bone is gradually being worn away over time. But in fact what we are seeing on the x-ray is MORE bone being deposited onto the joint surface, not less. The bumpy surface we see is actually the site of extra bone growth, which is taking place to make the bone stronger in an area where the body feels it needs building up.

In response to force or load through a particular joint, cells called osteoblasts become more active. It’s the osteoblasts’ job to deposit calcium and other minerals into the structure of the bone to increase its density and strength.

In the same way, the cartilage within the joint is capable of regrowing and, although this is a slow process, even a small amount of regrowth can reduce the symptoms of OA.

The body is adaptable

In OA, the body is simply adapting to the stresses and stimuli of everyday life, and most of the time that is beneficial. It’s also true to say that if we change those stresses and stimuli we can halt – or sometimes even reverse – the changes in the joint that we see in OA.

Here are my top tips for managing OA:

  1. Exercise – research shows that exercise prescribed by a professional (such as a physical therapist, chiropractor or physiotherapist) is more effective than medication for managing pain and stiffness in arthritis.
  2. Manage your weight – putting extra weight through your joints will accelerate the process of wear and make it harder for your immune system to keep up with the healing process
  3. Increase your intake of GAGs – glycosaminoglycans (GAGs) are the building blocks of new cartilage, and you can find them in bony oily fish like sardines and mackerel. They are also available in tablet form, in supplements like Glucosamine and Celadrin.
  4. Get a good night’s sleep and deal with unresolved stress – both stress and poor sleep will slow down your body’s healing processes, but a good night of rest for your joints will help take the load off
  5. Don’t smoke – this stunts blood flow to everywhere in the body, including your joints, which need good blood flow to repair. Smoking increases your risk of developing many different kinds of arthritis.

Acupuncture has also been shown to be beneficial for reducing pain associated with OA, and for helping with the tension and weakness that develops in the surrounding muscles. Here at Flourish we treat many patients with OA and get great results! To see a patient testimonial, click here.

Stress and the Ageing Process (Part 2)

Last time we learned that our DNA is protected by structures called telomeres, and that stress can cause these telomeres to shorten. This causes the cells to reduce their activity to a bare minimum to keep the cells alive. Injuries don’t heal as quickly, cells don’t replenish as quickly, our immune system reduces in activity and we are more vulnerable to disease. Our ageing process has been accelerated due to stress.

I also told you about another exciting piece of research where Professor Blackburn sent Group A – The Stress Group away for a week-long relaxation retreat and looked at their DNA again afterwards. And, would you believe it – their DNA was longer again! How did that happen?

The length of the telomeres is held in a careful balance by two opposing processes. On one hand, each time a cell divides the telomeres get shorter. On the other hand, an enzyme called telomerase adds extra bits on to the end of the DNA to restore some of the telomere. In a normal cell under normal conditions, the balance will be tipped slightly towards cell divisions, so that each time a cell divides the telomere will get shorter and the enzyme will add on almost all of what was lost, but not quite all. Overall, this makes the telomere only a little shorter.

However, when a person gets stressed their stress hormones (adrenaline and cortisol) completely knock out the activity of the enzyme telomerase. This means that each time a cell divides, there’s no enzyme there to add on what was lost and so the telomeres get shorter and shorter much more quickly.

This explains what happened in Professor Blackburn’s research, for which she won the Nobel Prize. People who were under long-term stress, and had no telomerase working in their cells, were sent on a relaxation week. During that week, their telomerase levels rose so much that, for a short time, the balance was slightly tipped towards their telomeres getting longer.

So what are the implications for us?

We know that stress affects health in a wide range of ways, even down to the DNA in our cells. Of course, not all stressful situations can be completely avoided but Dr Albert Ellis, who developed Cognitive Behavioural Therapy (CBT) once said “man is not disturbed by events, but of the view he takes of them”.

More and more research is showing the positive benefits of reducing stress in day to day life, and developing a mindful, positive attitude. In fact, one study has showed that belonging to a faith-based community (features of which are a strong support network and a positive frame of mind during stressful situations) can increase your life expectancy by 4-14years!

Here are some practical tips to help:

  • Cliched as it may sound, it helps to talk. If you have a close friend or relative who would be able to listen and support you, arrange to meet up and talk it through.
  • Counselling may also help, if you need someone to listen and give professional advice
  • Many online or app versions of CBT (Cognitive Behavioural Therapy) are now available
  • Research has shown that belonging to a faith-based community can increase your lifespan by between 4-14years and can also increase quality of life. It’s thought that this is due to the combination of a strong support network and regular prayer or meditation.
  • Learning a relaxation technique such as mindfulness or anchoring can be helpful in the midst of a stressful situation, to keep you calm.
  • If you feel you may have anxiety or depression, then having a chat with your GP about medication may be helpful. Having said that, research has recently shown that regular aerobic exercise is more effective for combating mild depression and anxiety than any prescription medication, and has many other health benefits too.

Stress and the Ageing Process (Part 1)

Have you ever wondered how people like Tony Blair or David Cameron, enter the office of Prime Minister looking so fresh faced and optimistic, only to leave a few years later looking old, tired and haggard?

I was fortunate enough to meet Nobel Prize Winner Elizabeth Blackburn and discuss her research with her. Professor Blackburn studies a very specific part of our DNA – an area called the telomere. Her most recent research has focussed on the effect of stress on this part of our DNA.

But firstly, what is a telomere exactly?

Our DNA isn’t just in one big clump in our cells. It’s arranged into 23 pairs of individual strands called chromosomes, and on the end of these chromosomes is the telomere. It acts as a little cap on the tail ends of our DNA to protect it from damage and stop it accidentally unwinding or fraying at the edges.

At the beginning of its life, telomeres are quite long and sturdy. However, scientists have found that every time a cell divides the telomere gets a bit shorter and weaker, and so less able to protect our DNA. As we get older and older our telomeres get shorter and shorter, which makes our DNA more vulnerable to damage. And if our DNA is damaged, our bodies don’t function as well as they should.

When our telomeres get short, our cells notice this and know that they only have a limited number of divisions left before they run out of telomeres. To deal with this, they reduce their activity and only do the bare minimum to keep the cell alive as long as possible. For example, a cell on your scalp might notice its telomeres are getting short and reduce its activity to the bare minimum to keep the cell alive – it might keep producing hair, but that hair might be thinner, weaker and have less pigment in it, making it dull or grey.

This, in a nutshell, is the ageing process. When our telomeres are short and our cells have reduced their activity: injuries don’t heal as quickly, hair and skin cells don’t replenish as well as they used to, our immune systems slow down and our internal organs are more vulnerable to disease.

So, how does stress affect our DNA?

Professor Blackburn’s research shows the dramatic effect of long-term stress on the state of our DNA. She took a group of people who had been caring for a sick spouse or parent for at least 3 years. We’ll call them Group A – The Stress Group. She then created another group of people who were the same in every other respect (age, gender, social background and education) but were not under long-term stress. This is Group B – The Relaxed Group. She then looked at the telomeres of these groups, and the results were striking.

Group A had significantly shorter telomeres than Group B. And remember, the people in each group had matching ages, so this was purely down to the influence of stress and not age. When she looked closer at Group A, she also noticed that the longer the person had been caring for their sick relative, the shorter their telomeres were. So not only does stress affect the length of your telomeres, but the longer you are under stress the shorter they get. In terms of the ageing process, it means your cells get older quicker!

This is part of the answer to the question I posed earlier: why do people in stressful situations tend to look older than they are? One reason is that their cells have shifted down a gear, and aren’t repairing and healing like they used to. The ageing process has been accelerated through stress.

However, it’s not all bad news. Luckily for us Professor Blackburn didn’t leave it there. She sent Group A – The Stress Group, away for a week-long relaxation retreat and looked at their DNA again afterwards. And, would you believe it – their DNA was longer again!

How did that happen?

Come back next week to find out!

 

Summary:

Stress has lots of wide reaching implications for our health, even down to our individual cells. When we’re stressed our DNA is less protected, cells are less active and this causes the ageing process to speed up.

Your Brain’s Potential

I spent a wonderful evening in London yesterday (fancy schmancy for a Northern gal like me!). I was attending the Royal Society of Public Health Award Dinner, and it was a fantastic night. It was so wonderful to see all the great work that different charities and organisations do to improve the health of the nation.

However, there was one enormous highlight for me: the children from Breathe Arts Magic Programme were performing magic tricks for us at our table. These children all suffer with a condition called hemiplegia – paralysis or weakness on one side of their body – which can severely impact their ability to perform everyday tasks. The Magic Programme essentially took their physical therapy programmes and integrated them into magic tricks, which the children then learned, practised and performed. After only 2 weeks, the children were much stronger and more able to carry out their daily activities. (You can learn more about the programme here)

This got me thinking about the amazing ability the nervous system has to rewire and adapt to even the most challenging of situations. When I was training to be a chiropractor, we learned about the amazing potential of mirror therapy in treating paralysis in stroke victims, and how it helped so many live a normal life after serious brain injury. (You can see a TEDtalk on it here)

Your whole body is actually incredibly adaptable, and is constantly changing to best serve you in the situation you’re in. This is why the more exercise you do, the stronger your muscles get, and the more you practice the piano, the better you get. But while this adaptation can be incredibly positive you can also adapt in a negative way.

You see, your body adapts to your lifestyle. So if you live a sedentary life, your body will seek to be more efficient by not maintaining unused muscle (and this includes your heart muscle). If you are constantly stressed, your body also adapts to this as we saw in the previous article What happens when I’m stressed? (see here) and this can impact things like your fertility and your resistance to disease. And in your nervous system, if you are negative and pessimistic, your body will take steps to make sure that you don’t take risks – even ones that could be fantastic opportunities.

For people that are in pain, say low back pain, for a long time, adaptations will also occur. This is sometimes known as Fear Avoidance Behaviour (FAB) They may become afraid to move their back for fear of re-injury. They may stop doing a sport or activity that they previously loved. This may impact their overall fitness and, also, their social life. It may even become a downward spiral of pain, weakness, social isolation and depression.

But the fantastic news is that, just as your body adapted “downwards”, it can adapt “upwards” again, as long as you put it in the right environment. Regular movement, gentle exercise, good diet and positive thinking can literally change the way your brain and body work. This reduces pain, improves your general health and ultimately “adds years to your life and life to your years”

What Does Good Healing Look Like?

Ouch!

If you’re a bit squeamish you might want to skip this paragraph, because earlier this week I managed to slice into my thumb with a chopping knife while I was preparing dinner. The cut is reasonably deep and it bled quite a lot, but happily it is now healing nicely, even though it looks like a bit of a Franken-finger.

But it got me thinking about the healing process and how amazing it is. Specifically, it reminded me of a big debate that happened in the Sports Science arena several years ago on the best way to treat acute sporting injuries. Until then, the standard treatment had been known by the acronym RICE: Rest, Ice, Compression, Elevation. All of these actions were specifically targeted at reducing inflammation.

What is Inflammation?

Most of us would be able to spot inflammation if we saw it – it’s typically red, swollen, hot, sore and (if it occurs in a moving body part) stiff. It’s the current state of my left thumb. But what is actually going on behind the scenes to create this inflammation?

Firstly, your body responds to some sort of stimulus, such as a bacterial infection or an injury, by releasing chemicals called inflammatory mediators. These chemical control how much inflammation you get and how long it lasts. It directs the different stages of healing which are:

  1. In the blood, chemicals are released to make the blood stickier ( this is called the clotting cascade) to make a protective mesh over areas of injury, literally patching things back together. This stops any further blood loss and protects against infection.
  2. Blood vessels widen and become “leaky” – this allows more blood to flow to the area, and from that extra blood lots of plasma will leak out. This plasma contains different immune cells. These are arriving to start breaking down all the tissue that has already died or become irretrievably damaged. These guys are on clear-up duty.
  3. Chemicals are released called bradykinins which increase the sensitivity of nerves in the area. This increases the sensation of pain, and is designed to force you not to overload the tissues that are still healing.
  4. From all the nutrients that have been brought to the area by the plasma, new structures are built to replace the old damaged structures.  Protein strands are initially laid down in big clumps to repair muscles, tendons and ligaments and then gradually remodelled to perfect the tissue. This will include building new blood vessels and nerves to supply the area.

The important thing about the healing process is that it must occur in this order. You can’t have new structures being made in step 4 only to be broken down by the immune cells in step 2. Equally, you can’t have blood vessels becoming leakier in step 2 before any blood loss has been stopped in step 1.

RICE vs MEAT

So looking back at the RICE method I mentioned earlier, it’s clear that each of these steps was designed to reduce the initial inflammation so that swelling and pain would not occur. But given that each step is crucial to the one afterwards, reducing inflammation in its early stages would actually hamper the following stages of healing.

So instead of RICE, try MEAT:

  • Movement stimulates blood flow to the area, providing a constant source of immune cells for healing and nutrients for rebuilding and repairing
  • Exercise (tailored programs that gradually load the tissue that was damaged) has a big effect on the remodelling that we mentioned in stage 4. It means that instead of the new tissue be reformed as one big clump, the protein strands will be thicker, more elastic and aligned parallel to each other to make the tissue stronger.
  • Analgesics (pain relief) should be things like paracetemol, rather than anti-inflammatories like ibuprofen or naproxen. You could even use more natural methods of pain relief like pineapple and papaya extract (bromelain and papain), which enhance the “clear out stage” of healing without affecting the overall healing process. Medical Acupuncture may also be helpful here.
  • Treatment such as manual therapies (like that provided by chiropractors, physiotherapists or osteopaths) will help to improve blood flow and reduce stiffness in pain in the injured area

So next time you injure yourself and you see inflammation, don’t panic and reach for the ice, remember instead that your body is doing the amazing process of healing itself.