Back Pain Solutions - The latest research

As a practitioner in the field of back pain and a member of ‘Backcare’ the UK’s national back pain association I receive regular updates on current research and recommendations.  The most recent publication contained several interesting articles which I will summarise and share with you.

Orthopaedic surgeons speak out about what they see as the alarming trend in dangerous and unjustified back surgeries.

To quote George Ampat a consultant orthopaedic surgeon based at Royal Liverpool University Hospital ‘Unfortunately, there is a false belief that surgery or new technology can fix back pain.  This is far from the truth.’  He says that out of 100 patients who see a health professional for back pain 97/98% will get better without surgery through exercise and over the counter medication.

There are many products on the market for the condition known as sciatica, most of which you will see advertised for a while before they disappear – usually because they don’t work.  Sciatica is usually caused by a collapse of the spinal discs pushing the intervertebral cushion out, a bit like squeezing jam out of a doughnut.  Fortunately, with time and stability work this will usually ease within a few weeks.  One research study in the US looked at the results of surgery and showed a benefit for up to 8 years after surgery.  In the same study, those who did not have surgery also continued to improve over the same period.  Another study looked at the return to work ratio of those having surgery v those not having surgery.  The result?  26% of those having surgery returned to work v 67% of those who didn’t.  In addition, there was a 40% increase in the use of painkillers in those who had surgery.

Exercise myth busted - Don't delay, be active:
Nick Sinfield, a chartered physiotherapist says that a common effect of pain is that you become fearful of movement or believe that a certain movement will damage something.  In fact you should be moving and doing physical activities that move the spine normally.  Moving with a rigidly protected back will prevent your recovery not help it.  By not bending and moving correctly strain is placed on already sensitive soft tissues.

In my opinion if your back is sensitive, painful or stiff you should choose your exercises carefully.  Pick those which will reduce stiffness with gentle controlled movement and minimum spinal load on the spinal structure.  This type of exercise will improve the function of the spine, enabling it to cope better with everyday life. The ligaments and muscles which support your back require strengthening and rest will only weaken these leading to more back pain.

Remember the proven benefits of exercise:

Increases blood flow to all muscles which helps the healing process

Reduced muscle spasm, especially with biomechanic based anti-spasm techniques

Increase in your confidence in your body’s ability to move

Reduction in anxiety which helps with soft tissue relaxation.

Improved body awareness enabling you to listen to your body better in the future therefore reducing the likelihood of a recurrence.


Surgeons Speak out - Surgery can't fix all:
David Hanscom an orthopaedic surgeon specialising in complex spinal surgery says that although there is no connection between disc degeneration and pain there are hundreds of thousands of spinal fusion operations being performed for back pain every year based on MRI scans showing disc degeneration.
He says that in the over 60's, disc degeneration is present in 100% of people - most of whom do not suffer from chronic back pain.  This is normal.  Disc degeneration is not a disease, it is a normal part of aging, like grey hair.  Add to this the research that looks at back surgery patients after 2yrs with only a third showing improvement and you can see that it is easy to end up in what he calls the 'failed back surgery syndrome' with crippling pain for ever.

So, why do so many people see surgery as the best solution?

Well, there seems to be a number of factors having an effect.  Firstly, the health industry is increasingly commercialized with huge sums of money to be made from drug development and spinal devices. So it’s no wonder that these are promoted.

Add to this the fact that exercise in the UK is still almost entirely unregulated so usually excluded from being prescribed on the NHS.

Also, the training required to be effective as a back specialist forms something of a barrier to many exercise professionals.  As a result only a small number of us are fully aware of all the techniques and therefore the best way to help people with back pain.

Finally, people will always tend to select the solution that requires them to do the least work.  Often the choice will look like a life time of exercise against an operation and a period of recovery followed by a pain free existence.  Unfortunately this view is being called into question more and more.

My opinion?

This situation is a great shame because exercise is a cost effective, less invasive and therefore risky, solution.  However the fix for all this is not easy and probably would involve some form of regulation for those exercise professionals who would like to provide the service for the NHS.  Also doctors and surgeons need to be aware of the success rates of the exercise alternative, and also be directing patients down this course.
You can see from this why I feel so strongly that exercise options should be thoroughly tried before progressing to surgery. 

If you have any questions on this just give me a call

Pelvic Floor Dysfunction - More common than you might think

 HAVE A LOOK AT THE NEW PELVIC FLOOR WORK - IT
AFFECTS MORE PEOPLE THAN YOU MIGHT THINK

Pelvic Floor Dysfunction: What is it, why do you have it and how can you correct it?

To start with, new research in 2014 shows that 80% of women will have Pelvic Floor Dysfunction (PFD) at some point in their life and 30% will have stress incontinence.  Men are also affected by PFD, frequently as a result of prostrate problems, although this is talked about much less.

What is Pelvic Floor Dysfunction?
A dysfunctional muscle is one which will not contract nor release so it tends to be both tight and weak, and consequently, unable to function correctly.
The pelvic floor is the muscle group which forms the 'under carriage' of your trunk.  It supports your internal organs, includes the "bathroom" muscles and adds support to the sacro-iliac joint. So it is essential that it functions correctly.  If it is dysfunctional it will be tight, short and weak instead of being flexible, long and strong.

Symptoms of PFD may include:
Abdominal separation following pregnancy
Stress incontinence
Pelvic discomfort
Back and Sacro-Iliac joint pain

The contributors to PFD include:
Pregnancy
Crunches and sit ups
Poor posture
Wearing high heels
Sitting for too long 

What is the solution?
New research has identified that the pelvic floor will not work effectively in isolation, it will function up to 75% better through a specific mix of muscle group activation rather than with the traditional 'kegels' exercises (controlled lifting of the pelvic floor in isolation).
In addition, all exercises should be performed with the pelvis in a neutral position, not in the pelvic tilt position.
The specific mix of muscle group activation is to work the Glute (butt) muscles in conjunction with inner, and outer, thigh muscles.  This is the key combination for optimum pelvic floor engagement and improved support to the pelvis.

The best exercises are:
Squats with correct alignment to strengthen yet lengthen the pelvic floor
Shoulder bridge with a small ball between your knees
Curtsey or split squats
Clam type exercise using fast and slow twitch pelvic floor activation
Check with an exercise professional to ensure that your technique is correct as this is essential to gain any PF benefit.  The big benefit of this new approach is that by working this specific group of muscles, correctly, the pelvic floor will activate automatically.

Exercises to avoid
Any exercise with a pelvic tilt as this shortens the pelvic floor muscle, encouraging dysfunction.
Crunches or sit ups, which increase the downward pressure on the pelvic floor.
High impact exercise.
Pilates exercises such as 'the 100'

Would you like to know more?
Just contact Anne by phone or email to discuss your needs. The correct exercises and techniques are taught in 'I Move Freely' Pilates Classes at The Studio

Risk v Benefit - Keeping your exercise programme safe

Risk v Benefit – Keeping your exercise programme safe

 

There is much in the popular press about the benefits of exercise for both physical and mental health.  Many people are encouraged to take up exercise by their doctor or physiotherapist.  On the other hand, there are many articles about the risk of injury from exercise.  For example one study showed that over 60% of runners will pick up an injury in any one year, and another stated that 35% of women exercising on a regular basis will have a musculoskeletal injury.  

 

As a fitness professional and physical therapist I use a variety of techniques to ensure that my clients gain the benefit and do not suffer any injury:

 

I encourage clients to work at their own level, not keeping up or competing with each other.

I keep a close eye on the posture of each client as they exercise.  If there is a postural fault when a client walks in, they will probably keep that faulty position as they exercise.  This will be a habit that I am keen to discourage and correct with exercise.

When I spot a common postural imbalance within a group I will add exercises to help them correct it.  This could be drawing back rounded shoulders, lengthening the neck or stretching tight hamstrings to encourage better pelvic alignment.

At the beginning of each session I check how everyone is feeling and how long standing injuries are progressing.  I will include the best exercises to help each person’s condition.  This could be reducing range of movement to encourage stabilization of a lax joint, work to strengthen a weak joint or stretches to help muscles tightened up by other sports such as running or cycling.

 

Using these methods I aim to help everyone to exercise and gain a benefit whilst not risking an injury.  Remember that your feedback is essential to ensuring a safe effective exercise programme so don’t keep quiet about any pain or discomfort as there is usually a way to manage it, and it is often a good indicator to the types of exercise you need.

Yoga:- Religion? Life Style? Extreme Exercise, Relaxing Exercise? Just what is Yoga?

Yoga:- Religion? Life Style? Extreme Exercise, Relaxing Exercise?  Just what is Yoga?

In fact it can be any of these things, and more besides.  For an understanding of Yoga it is necessary to look at the history and development of this ancient art.

 

Before we start I must point out that I am not a Hindu, neither do I teach nor practice any of the “true” forms of Yoga. I am not an expert in this field, but am offering a simplified insight into the many meanings of the statement “I do Yoga.” and what might be involved in a “Yoga session”.

 

In the beginning.

We can start with the Vedas.  These are the four collections forming the earliest body of Indian scripture, which codified the ideas and practices of Vedic religion and laid down the basis of classical Hinduism. They were probably composed between 1500 and 700 BC, and contain hymns, philosophy, and guidance on ritual.

 

It is the Vedas that are the common link between Hinduism and Yoga and which form their very foundations. Yoga is in fact one of the 6 main branches of Hindu philosophy.

The word Yoga means Union – some say union with God, others union with self. This union can be perceived through a variety of methods including, but not limited to, control of the mind and senses, meditation and caring for the body through asanas, pranayam, cleansings, and detachment from worldly objects. Yoga directs us towards a righteous path of living; it is the remover of our identification with our physical body; and the aid to achieving moksha (liberation) in this lifetime.

 

So Yoga is religious and part of Hinduism?

Yes, but not necessarily!  Even from quite early in the development of Yoga and Hinduism it seems to me that Yoga could and did stand separately from Hinduism, as well as being an intrinsic part of it.  Yoga was originally a way of life but over time, it seems, a variety of elements from the whole have been extracted, each with specific benefits, and each called Yoga.  Confusing isn’t it.

 

And now?

There are many forms of Yoga, some are named (e.g.  Hatha, Vinyasa, Kundalini, Ashtanga, Bikram, Iyengar, Anusara, Restorative, Jivamukti, to name but a few) whilst others are just Yoga.  Each focuses on a set of targets or beliefs drawn from the Yogic teachings.

 

What does this mean for me?

When you attend a Yoga class you might find you spend your time relaxing and meditating.  Or, you could find yourself attempting to achieve extreme positions.  The class might be constructed to be accessible for any age or ability, or the session could expect a high level of fitness, stamina, strength and flexibility.

There is no doubt that there can be huge benefits to be gained by the practice of Yoga … however it is also clear that Yoga can also be physically detrimental.

When you consider the history of yoga you can see that it was not invented as a remedy for back pain or other injury. If this is your aim you need to seek form of exercise with a more physiological remedial basis.

 

How can I know what I am letting myself in for?

I would strongly advise that you contact the person running the sessions and ask them specifically what the aims of the class are, what their qualifications are, and make sure that their answers match up to your own targets and expectations.  In any case be extremely wary of any class that expects you to “push past the pain”.  Pain is the body’s protection mechanism and you should only be working through pain in closely controlled circumstances with specific goals.