Who wants to join me for a weekly Wednesday wander around Trent Park?

Wednesday walk in Trent Park

Do you ever think about going for a walk, but the thought of going alone doesn’t appeal? I’m sitting at my desk looking out at the sunlight on the tree-tops in Trent Country Park  – a beautiful gift of a park with horses, forests and lots of space in which to lose yourself – and thinking that I’ve hardly been out of the house this week. This isn’t an unusual occurrence. My osteopathic practice is at home and I’m in the first year of an MSc in Pain Management. If I’m not careful I could spend most days at home, working and studying, and not moving nearly as much as I need to.

So, when I can I go for a walk in the park. This always makes me feel so much better about life, less stir-crazy and gives my life some perspective. I actually feel I can start to breathe again. The Japanese call it Shinrin-yoku or “forest bathing”. It’s basically taking a walk in nature. In Japan the government have been advising it for decades as a way to manage stress and lower blood pressure. We are really lucky to have Trent Park at our disposal and I’m always amazed at how few people I come across there – on the odd times that I manage to leave the house.

This made me reflect on the fact that one of the simplest pieces of advice that I often give my patients suffering from back pain is to go for regular walks. In general, backs don’t respond well to us sitting down all day – that comfy sofa is doing you no favours – but what they absolutely do love is a bit of good old-fashioned ambulation. It’s not talking on your mobile phone, it’s not looking down at the ground with hands stuffed in your pockets, it’s walking, hands-free and connecting with the world around you – and in a park or wood that means nature and other people.

I’m sure you don’t really need to be told how good walking is for your muscles, including your heart, but how about the fact that taking a stroll with other people is great for conversation, for connecting, which is a great cure for loneliness.

So, in the spirit of forest bathing and my contribution to getting people locally to connect, I invite anyone to come for a walk with me in Trent Park on Wednesday mornings. I will be waiting outside 1st Call Osteopaths, 219 Bramley Road, Oakwood (On the corner of South Lodge Drive and Bramley Road) from 9.15am, and we’ll set off at 9.30 and be back here by 10.30 at the latest.

If, like me, you want to leave the house more, and if you’d prefer to walk in the company of some friendly faces, then why not join me? There’s no commitment and no obligations, just a stroll in the park with some new friends.

Bring yourself, bring someone else, bring your walking shoes.

SPECIAl OFFER for men during Men’s Health Week (June 12-18)

Gentlemen, are you bravely soldiering on with an everyday, sports or work-related muscle or joint injury?  You may not realise that this strategy could be costing you more in the long term.

Men booking during Men’s Health Week – get 15% off first and follow-up appointments.

We osteopaths notice that men tend to put up with a lot of things, like aches and pains and especially bad backs, and they tend not to do anything until their partners get so fed-up with hearing about it and book an appointment for them. The problem with this is that, firstly, aches and pains tend to get harder to treat the longer you have them and, secondly, that, as good as your body is at compensating for a problem, it can eventually reach a limit and shore up bigger problems for the future.

So, what’s stopping you from getting treatment? Maybe you think you need to be stoical and not ask for help because it will “sort itself out”.  If it’s a pain that you’ve had for a while and really aren’t sure what to do about it, maybe your body just needs an expert hand to guide it towards the right direction.

So, in recognition of Men’s Health Week we are offering any man who books an appointment this week a 15% discount on their first and follow-up appointments (worth £95).  Who knows, you might end up feeling better than you’ve done for a long time. Contact First Call Osteopaths

Behind the doors of a pain clinic.

corridor, doors, pain, clinic

My afternoon at a pain clinic.

Some of our patients attend pain management centres, but it wasn’t until last Friday that a friend of mine invited me to the Friends & Family Group Meeting at INPUT Pain Management, which is part of St.Thomas’ Hospital, opposite the Houses of Parliament.

My friend is a chronic pain sufferer coming to the end of the second week of a 4-week residential course there.  She had a hunch that I might be interested in coming along, as I am studying for an MSc in the Management of Chonic Pain and Headache Disorders. Well, she was right.

The background

This type of pain management centre represents the most up-to-date, evidence-based format for treating people with chronic pain of all types. It helps with not just the biological aspects of persistent pain, but also, and arguably more importantly, the psychological and social dimensions. This is known in the trade as the “biopsychosocial approach” to chronic pain management. Briefly, many good studies show that pain, which is the body’s way of alerting us to an actual or potential threat, is complex and very particular to each person.  In addition, the negative effect that persistent pain has on our relationships, our poor psychological state, together with a faulty belief that how much pain we’re in is an indication of the amount damage, can actually make our nervous system acutely alert to even the smallest threat – like a very sensitive car alarm that is set off by a falling leaf.

Current evidence shows that this approach to dealing with persistent pain is superior to the spiral of pain-killing medication, which is only effective up-to-a point, and which requires frequent trips to the G.P. and other specialists for medication reviews and further tests and investigations.  The idea is that with pain education and psychological tools, sufferers can play an active role in reducing the negative effects that pain has on their life.   This is far better than medication alone.  What it does not do is perpetuate the false hope that there is a therapy or scan or drug that will take the pain away permanently.  I imagine that accepting this crucial point is the biggest hurdle.

During the group session

There were about 10 participants on the programme, 9 of whom were women, all suffering with persistent pain.   A physiotherapist and an occupational therapist lead the group discussion, and I was struck by how seamlessly they wove their messages and learning points in to the exercises.  Even the ice-breaker was an opportunity to learn.  For this we had to pair up and tell another group member two facts about ourselves  – one true and the other a lie.  Our partner then had to uncover the lie by interrogation.  The point about this was to teach us how much harder it is to present a “false face” to the outside world, in other words, constantly telling people that you feel OK when you don’t.  It takes more energy to keep this falsely optimistic mask up than to interact with people in an authentic way.  My lie (that I was born in Uganda, of all places) went undetected – what does that say about me, I wonder?

Then the physiotherapist took us through an exercise which involved holding a finger in front of our face.  We then had to focus our attention on this finger.  She then asked us to notice what the background looked like – blurred, we all murmured. Next,  she asked us to change our focus to the other things that were in the room and asked us what the finger looked like – again, we all agreed that the finger now looked blurred. We then discussed how, if the finger represented pain, and if all we ever thought about, or “ruminated” on, was our pain, then this made this feeling stand out even more.  This would also be at the exclusion of everything else.   Making an effort to notice the world around us (also known as “being present”) could make the pain fade into the background more.  Try the exercise yourself, it really works!

Next, we were asked to play a game where each person in the group took a turn to make a particular movement.  Everyone else was then encouraged to follow this person’s movements. We were then asked to take note of how we copied the movements – whether exactly, which leg or arm we moved first, to what degree.  After most people had the chance to be copied, we then discussed the importance of being mindful about everything we do and also to judge for ourselves what our personal limits are with any activity. This introduced us to the concept of “pacing”.  So, we don’t have to do any activity at someone else’s pace or rate, it’s important to choose a way of doing things that we’re comfortable with.

Finally, the occupational therapist gave us a Post-It note and asked us to write down one thing that we wanted to achieve this year. He then asked us to write down all the barriers to achieving this goal.  We then paired up to discuss what we had written and to be encouraged by our partners to come up with some ways of overcoming these obstacles and achieving our goal.  This concept of “goal setting” is important because we learn that we don’t have to limit ourselves, and that by considering our goals and evaluating the obstacles we can then plan to achieve them – whether it’s riding a horse twice a week, walking for half an hour a day or swimming for 10 minutes at a time.

Phew! Quite a lot in a 90-minutes.

After the session

The participants had clearly built up a good rapport with one another, so much so that afterwards one of them told me that she felt so upset, that she had to leave the friends and family session, because she felt that the tight-knit group had been invaded. I quite understood, because to be able to share their experiences with other people living with persistent pain, to spend productive time on themselves and not feel like they were being a burden on their carers, family or friends, and to learn so many active and sustainable skills that they can practise over an extended period must be a very powerful and life-changing experience.

There are a number of residential pain management centres in the UK, however demand is very high.  This, of course, means that the patients have to wait for up to a year for a place which, studies show, leads to poorer outcomes in the treatment of persistent pain.  It’s a shame that because of the current 1-year waiting list for INPUT at St. Thomas’, they have just had to cut the residential programme to 3 weeks, instead of the usual 4, giving less opportunity for participants to practice what they have learnt under the guidance of the skilled pain management therapists.  It will be interesting to see whether this truncated programme is as effective at helping sufferers manage their pain better.

My friend said that since being on the course she has felt completely exhausted at home at the weekends, and that she even begun to feel more pain than when she had started the course, probably because she was she was asking a lot more of herself. However, she felt hopeful that, over time and with practise, she would be able to use these new concepts and techniques to feel more in control of her symptoms and have a better quality of life, despite the pain.

These types of pain management centres have been shown, over the longer-term, to reduce over-reliance on medication and lead to fewer G.P., specialist and hospital visits.  However, in the short-term, politics and the need to balance NHS budgets means that this type of care is in shorter supply than it ought to be, given the overwhelming evidence to support it.

It would be great to hear from anyone who has had experience of this type of pain management centre.  Has it helped in the long term? Feel free to leave a comment below.

 

 

Find out why you groan when you stand or sit.

groan, move, grunt

Have you started to groan when you stand up or sit down?

Have you started to let out a grunt or groan when you stand up or sit down?  A patient came in to see me this week and was wondering why he’d started to groan every time he stood up or sat down. He was about to turn 40.

“Activity groan” is one of those things that can betray you. It creeps up on you (like grey hair) and before you know it, BOOM! You can’t take your body for granted any more and everyone thinks you’re much older than you actually are.

It’s often not the challenging things – walking up hills or running for a bus – that you start to dread. It’s finding it a bit more of an effort to do everyday things like getting up off the sofa, picking up something from the floor, or clipping toenails that gradually make us feel older than we are.

Getting older doesn’t have to mean feeling older.

You may accept that this is just part and parcel of getting older, after all it happened to your parents and their parents before them, but, have you ever thought that it could just be because you’ve spent years not moving your body enough and in the right way?

Your back is made up of many little joints, ribs, muscles and ligaments. They all need to work together like a finely tuned engine, and when they do it can make you feel younger and more flexible.  Whatever your age, you always have the capacity to move more freely and do the simple things in life without the added sound effects.

What you can do about it.

Osteopaths are very experienced and well-trained in improving the way your body moves.  We always take a 360° view of your complaint, taking into account the body and how it adapts to the various stress factors in your life.   We can then set you off in the right direction with a personalised treatment plan, good advice and a few, well-chosen exercises.

If you, or someone you know, suffers from activity groan, call us and find out how we can help.

 

In Praise of Movement

active, jump, happy

In praise of movement

Having just praised rest, I’m going to contradict myself and look at the benefits of movement. There has been a lot of interest recently about how bad inactivity is for our health – it has been described as ‘the new smoking’. Clearly, sitting all day at the computer, coming home, and then sitting for a few hours on the sofa is not good for us.

It’s actually very easy to avoid being totally inactive and it has enormous benefits, so it’s not one of those ‘oughts’ and ‘shoulds’ that we need to get too stressed about! Here are some thoughts and ideas that will get you moving:

Even those who are unfortunate enough to be confined to bed or a to wheelchair can do movements. A simple technique is to move each joint in turn, starting from your feet. Gently move the joint up and down a few times, or rotate it (e.g. ankles, shoulders and hips).

In the same way, being confined to the desk needn’t stop you moving. As well as moving each joint in turn, you can exercise your legs and hip muscles by pushing your feet down, leaning into the back of the seat, and clenching your buttocks 5 or 6 times. This exercise causes your weight to come off the seat a bit and keeps your buttocks from getting chair-shaped!

Take active breaks from your desk every 25 minutes. Get up and move around the office or home.  It will refresh your brain as well as your body.

Exercise doesn’t have to be always about getting out of breath. Light exercise can help your circulation, your coordination, your mood, the health of your joints, and has numerous other benefits.

Getting a bit out of breath and breaking into a sweat helps exercise the heart and lungs, but this doesn’t mean you have to drag yourself down to the gym. For example, why take escalators and lifts if you are otherwise healthy? Also, if you have to walk to work, walk a bit faster than you normally do, using your whole body including your shoulders and hips in the movement. What’s a good idea is to start off walking at a leisurely pace for a few minutes. Use that time to relax your whole body and let it find it’s rhythm, then put on some power!

Being inactive won’t necessarily provide the rest you feel you need. Perhaps you need a rest from the computer and the stress of work. Going out for a walk can help provide all the rest your body needs. Exercise can also improve your sleep, and that can be crucial for recovery, and for muscular aches and pains.

Ask your body what it wants. You might feel mentally exhausted and dispirited but your body might be tired of sitting down and being confined.

Do things that your body is not used to. We tend to do the same things every day and this gives the body a rather limited set of movement patterns. A great way to give the body something different to do is to dance! It really doesn’t matter how bad you are at dancing – the worse the better! No one needs see you shaking a tail-feather to the radio in the kitchen!

Finally, how can I praise both rest and movement? “Isn’t that a confusing message?!” I hear you ask. What I want to get across is that we spend far too long neither at rest nor in motion, but in a state of inactive stress. For example, sitting at the computer sweating about a spreadsheet, or sat collapsed on the sofa watching the latest antics of Donald Trump on the news, wondering if we’ll all survive his presidency! Or maybe watching someone being shot on a detective series. When you rest, really rest, both mind and body. Otherwise be active!!

In praise of rest…

In praise of rest

Watching the clouds go by…

…and our tips on how to get some.

Are you getting enough rest? When you’ve done what you need to do, can you stop everything, do nothing and feel relaxed and content?  Do you find that you still feel guilty and tense with a list of ‘to dos’, ‘shoulds’ and ‘oughts’ lurking in the back of your mind? Do you drive yourself hard until you give up, exhausted and dispirited?

We see many patients who could really do with a proper break. This is especially the case when they are suffering from some sort of painful condition and the body is just crying out for rest and recovery.  If you don’t listen to your body, it will only prolong the pain.  If this is you, here’s how to break free from the cycle of pain and guilt.

Our advice to those suffering from pain and exhaustion:

  • Recognise that you’re in pain and in need of rest. Typical signs to look out for are that your performance at work is deteriorating, despite you trying harder, you’re not sleeping well, your appetite has changed and you’re becoming snappy and irritable.
  • Approach this realisation with kindness. It may be your instinct to talk harshly to yourself when your perceive you’re failing in some way, but instead, stop a moment and cultivate a little gentleness to yourself and your body. Listen with a quiet mind to what your body is telling you. Filling your head with judgement or fearful speculation will mean you’re not able to tune in to your body’s signals. You could start by imagining how you might listen, gently and without judgement, to a distressed child. You might not like what your body is telling you at first, but stay with it and breathe into the pain or unpleasant feelings. Reconnecting with your body will ultimately allow you to gain insight into what is triggering your stress and what you need to rest from.

So, if you’re tired and in pain, break the habit of talking to yourself harshly, take your foot of the accelerator and become aware of what your body is telling you. You might learn, for instance, that you need time away from what is causing your shoulders to tense up. Maybe you need a break from the computer, and a walk around the block is what’s required. Or maybe you’re physically exhausted and just need to put your feet up for a while. That way your body’s stress hormone levels will decrease and allow you to recover and rebuild.

Slow down and start listening to your body today.

The hidden cost of binge-watching box sets.

television, back pain

Binge-watching and back pain

Have you noticed that your back’s been more stiff and achey than normal?  Well, January’s not a great month for doing much – it’s too cold and you certainly didn’t have any spare cash to spend after Christmas. So, like so many others, you may have decided it was better to save money, stay in and binge-watch Narcos or Game of Thrones. But there is a hidden cost to this sort of hibernation that you should be aware of. It’s what I call Box-Set Syndrome. You’ll know when it strikes because you find it difficult to sit still or get comfortable, or you might start to regularly wake up with stiffness in your back that takes a while to free up.

Why am I getting back pain?

The reason for this is that you’ve spent so much time sitting on a squishy sofa that the discs and joints in your spine have become very compressed and the muscles in your back have started to become weaker through lack of use. This can lead to more severe problems like disc bulges and nerve damage which could give you more persistent back pain and sciatica. Sitting down for long periods without a break is a major reason for back pain and it’s often why people make an appointment to see an osteopath.  You might be surprised to learn that back pain is the third most common reason people visit their GP.

1 simple tip to help yourself

You may be lucky and not get back pain now,  but too much sitting down may be a big contributing factor in you getting a bad back at some time in the future. It’s important not to underestimate the importance of keeping moving regularly. At its most basic, going for regular walks, making sure to swing your arms as you go, is probably the kindest thing you can do for your back as it gets the small joints and muscles of the spine moving.  So, if you’ve noticed a little bit of stiffness creeping in to your back in the morning, it may simply be a question of saying no to the question, “…one more episode?”.

NEWS! Excited to be launching new app for our patients.

As part of our commitment to continually improving services for our loyal osteopathic patients, we are excited to be soon introducing the new PROM app. at 1st Call Osteopaths.

This innovative and simple-to-use app will allow patients to give instant feedback to the osteopathic profession as a whole on their experience and how their symptoms are progressing at various points along their treatment. The data gathered will then be used to inform future services, how we market the profession and, we hope, make our patients feel even more involved in their care.

This means that if you’re new to the practice or if you come to us with a new symptom, we will ask you if you would be willing to let us have your valuable feedback.

Participation is entirely voluntary and any information will be treated confidentially.

7-Step guide to happy raking.

Every year thousands of patients will make an emergency visit to their osteopath after having spent the day clearing leaves from the garden and guttering.

Usually, they will have been relatively inactive over the summer and wake up on a Saturday morning with a strong impulse to spend the whole day raking, sweeping, bagging and climbing ladders. Or as us manual therapists call it, repetitive twisting, bending, stooping, extending, lifting, climbing, reaching, balancing and carrying.   All these movements will put your back under enormous strain at the best of times.

raking leaves backpain

Here’s our 7-step osteopath’s guide to preparing for this seasonal task and reducing the risk of spending the weeks afterwards in pain.

  1. WARM UP We know that muscles are cold, discs are more vulnerable to strain right after getting out of bed. So, start the day with some gentle movements and stretches to help reduce disc pressure before undertaking heavy work. Suggestions: a 10 minute walk, 10 star jumps. Going through the motions of what you’ll be doing first in your garden can be really useful. Dress warmly to start with, you can always peel off layers as you warm up. A similar routine after your exertions can help minimise muscle soreness.
  2. SIZE DOES MATTER. Use a rake that’s suitable for your height and strength. Rakes come in different shapes and sizes, so make sure you get one that’s comfortable and easy to use for your particular body type.
  3. PROTECT YOUR HANDS. A pair of sturdy gardening gloves will help prevent blisters and cuts and is easier on the joints of your fingers.
  4. LOOK AROUND Take a moment to plan what and how you are going to do things. Leaves can easily conceal rocks, branches, tree stumps, or uneven ground. Stay alert and familiarize yourself with your surroundings before you begin.
  5. YOU CAN’T HURRY LEAVES. Sweeping and raking require enormous co-ordination from practically all the muscles and joints in the body. Research into motion patterns suggests that muscular and joint strains are less likely to happen if your mind and your body are focussed on the same task.
  6. SWITCH IT UP! Most people will naturally keep their body in the same position, based on which is their dominant hand or foot. Maintaining this position over an extended period of time will cause “repetitive strain” to one side of the body (back, neck, shoulder, etc.). Changing your arm and foot position often will easily prevent stress and strain throughout the entire body.  Always use your legs and core to shift your weight and move. This will avoid excessive use of your back.
  7. PREVENT SLIP AND SLIDE. If it’s wet leaves you’re dealing with, wear shoes with slip-resistant soles. Not only will the right shoes reduce your risk of falling, but they also minimize injury to your feet.

That’s it! Keep safe and enjoy the autumn colours.

 

Why does my back hurt?

Did you know that around 85% of all cases of back pain have no known cause?

Contortionist_Ravi_standing

Specialists call these “non-specific” or “mechanical”. “Mechanical” because pain is typically aggravated or relieved by a particular movement or position, such as bending forward or standing still. Non-specific back pain can range from mild aching and stiffness to severe and disabling pain.

At one time, specialists believed that back pain was due to injury or “wear and tear”, visible on X-rays or scans. Now we know that signs of disc injury or wear and tear are very common and have only a very weak relationship to pain.

The mysterious nature of idiopathic back pain is a real problem. Sufferers often go to their GP, who often feels under pressure to provide some sort of explanation. Unfortunately this is sometimes “it’s your age” or “wear and tear” when in fact it’s neither of those. Often people with back pain are referred for an X-ray or MRI scan if it’s not getting better. If the report comes back saying the back is normal, you could be left with the impression that either your back has some sinister undiagnosed disease, or you are complaining for no good reason. If you get to read the report, you might be lead to believe that normal wear and tear indicates your back is damaged and weakened. Not a happy situation.

Most cases of back pain can’t be diagnosed by MRI, X-rays or even blood tests. However, these can be useful to rule out more specific conditions. So what does cause back pain in most cases? How can you get a painful and disabling condition without disease or injury?

Well, there is a third alternative to disease and injury: dysfunction. That is, the tissues are basically healthy but the organism is in some way uncoordinated, and that puts strain on tissue, leading to symptoms: pain and stiffness.

But how can the back become “uncoordinated”, and how does that lead to pain and stiffness? The thought that the back (or the body in general) could let you down like that is rather unsettling! You have to remember that the body, like everything else in the physical world, must obey the laws of mechanics. When designing a mechanical device, an engineer is faced with certain trade-offs and needs to find the right balance. In the case of the human body and the spine, evolution/God (take your pick) has also had to ‘decide’ between stability and adaptability.

redundant chain

‘Redundant’ chain-like structures such as the spine have many ways of to carry out the same task.

This leads us to how “redundancy” is used in the design of mechanisms. Redundancy means having more than one way to do the same thing. Consider the design of spacecraft. Unlike cars, they have many layers of redundancy built in because you can’t just call out the AA if it breaks down. So, for example, the NASA Curiosity rover has six wheels instead of four, each with its own engine.

Similarly, the human spine has a ridiculous number of joints in it – 74, not including the joints between the spine and the ribs. No-one ever needs that many joints, not even for the most extreme contortionist’s party trick! Think how many joints you actually need for bending forward – you only really need one hinge joint. No engineer in their right mind would design a crane, for example, with 20 hinge joints. It would be grossly unstable unless you had a very sophisticated control mechanism, sharing out the load just right.

On the other hand, the problem of building a crane with just one hinge joint is that if that joint seizes up the crane will not work at all. But if you have two, you can use the control mechanism to change the motion pattern, which will allow the crane to carry on working. Here lies the benefit of having a spine with so many joints. There are many people walking around with worn-out intervertebral discs who have no back pain or stiffness. Their spines have adapted happily to this change.

Unfortunately, the spine doesn’t always adapt in such a way that it can carry on regardless. The fact that it can move in an infinite number of ways also means that it has the freedom to move in ways that put excessive load on certain parts of the system. It can also fail to coordinate properly so that the muscles are working against each other, leading to painful spasm. Muscle is often the immediate source of the pain in these cases because it has the ability to cut off its own blood supply. When a muscle contracts, the pressure inside the muscle rises and it doesn’t take much for that increased pressure to counteract the weak pressure pushing the blood through the muscle. If a muscle stays contracted for too long, the lack of oxygen will lead to pain and stiffness.

These cases of back pain are like an engine out of tune. If you were to take an engine that is out of tune and X-ray it, or even take it to pieces, you wouldn’t find anything wrong with it. But if you were to run it, you would hear that the engine was not coordinating properly, causing strain and back-firing.

Osteopaths aim to restore normal function to sort out the back problem. We make extensive use of palpation (locating and assessing painful areas by touch) and observation to detect things like muscle tightness, shortening, uneven distribution of spinal joint motion, imbalance of muscle activity and so on. Through advice on movement and posture, exercises, manual treatment of tight tissues and joints we aim to get the engine back in tune.