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.

I have arthritis, should I exercise?

Some Facts about arthritis:

• About 70% of people over the age of 65 will have some level of arthritis and 1 in 5 of the whole population.  This equates to around 10 million people in the UK.
• A number of people will have no symptoms and be oblivious to the fact that they have arthritis, but most people with it will suffer some symptoms, such as pain and stiffness, on a daily basis.
• The most common type of arthritis is Osteoarthritis, followed by Rheumatoid (especially in women) and Gout (especially in men).
• There are actually over 100 different diseases that can cause the problems characterised as arthritis.
• There is no cure for arthritis.

 
What is arthritis?
Arthritis affects the joints of the body.  At least two bones meet to form a joint, but some joints have three and wrists and ankles have more. Each joint in the body is constructed in a slightly different way.  Most of the main joints have cartilage covering the bone ends and the whole joint is enclosed in a sort of bag called the joint capsule.  This bag holds synovial fluid which effectively lubricates the joint.
Arthritis develops when the cartilage has become worn, torn, or has been removed, often due to trauma.
The synovial fluid within the joint capsule becomes thicker or ‘stickier’ as we age and as a result doesn’t coat the cartilage as well.  This results in increased wear to the cartilage and the bone ends which become roughened.  The joint can no longer slide smoothly and pain results.  This is typical in osteoarthritis of the knees, shoulders and hips.
With Rheumatoid arthritis joints become swollen as the body attacks its own tissues.  There are many other forms of arthritis, such as spondylitis which is when inflammation around the spine causes pain.

What causes arthritis?
Arthritis has a variety of causes, most of which are not fully understood.  For example:

• Trauma to a joint earlier in life frequently makes arthritis more likely.  A car accident, sporting injury, trip or fall can all cause damage to a joint, weakening it and making it susceptible to arthritis, sometimes not manifested until later life.
• Cartilage has a poor blood supply which means that when damaged by twisting or tearing is doesn’t heal very well.  As a result, it was common for cartilage to be removed following trauma, although nowadays this is less frequently performed and exercise is used to manage the situation.
• Carrying excess weight puts more strain on the joints increasing the amount of wear and tear.
• There is a clear genetic link which can increase the risk factor for Rheumatoid arthritis which can be activated by trauma.

 
Exercising with arthritis.
Arthritis causes joints to be stiff, painful and to have a reduced range of movement.  Exercise can improve these symptoms but it needs to take account of the arthritis. I work to create an environment and exercises within which the joints can be moved freely and without pain and you feel able to exercise within you own capabilities.  In addition, exercise can encourage good posture, which is essential in keeping the spine straight and reducing the risk of kyphosis – rounding of the neck shoulders as well as potentially slowing the progress of degeneration.
 
Key points to remember:

• Loosening joints, using movement which is pain free, is essential to encourage and keep the maximum mobility.  For example, in ball and socket joints, simply rotating the limb within the joint capsule can have a beneficial effect, by encouraging the synovial fluid to coat the whole joint and become less ‘sticky’.
• Specific muscle strengthening work to support the damaged joints will help reduce pain on a daily basis.  This is especially beneficial for the hips, shoulders, knees and spine.
• Do not push through the pain, look for a different way to loosen or strengthen the painful area.
• Avoid overstretching and putting joints into positions out of their normal range.  For example, knees are a hinge joint, designed to bend in a forward and backward motion with limited rotational range.  Sitting with legs crossed will stress the joint and in time can cause wear and then damage.
• Note which activities cause pain and look to find other ways of doing them.  Exercise can be designed to help you strengthen your body enabling you to do regular activities with less pain.

Finally:
Arthritis can be debilitating and has no cure, but exercise is one of the recommended treatments - don’t let arthritis be a reason to stop exercising.

 

Exercise - Benfits more than just your body!

When you think about ‘exercise’ you probably think about the benefit to your muscles and cardio vascular system, that it may hurt, you may ache afterwards but you’ll feel better for it and you’ll spend time with a group of likeminded people at your class or in the gym.  The first few statements relate to the physical benefits, but the latter are the extra benefits you may not have considered as being so important.

NHS Choices has this to say about exercise and mental wellbeing:

“It has long been known that regular exercise is good for our physical health. It can reduce the risk of cancer, heart disease and strokes. In recent years, studies have shown that regular physical activity also has benefits for our mental health. Exercise can help people with depression and prevent them becoming depressed in the first place. Dr Alan Cohen, a GP with a special interest in mental health, says that when people get depressed or anxious, they often feel they're not in control of their lives. "Exercise gives them back control of their bodies and this is often the first step to feeling in control of other events," he says.”
see : http://www.nhs.uk/conditions/stress-anxiety-depression/pages/exercise-for-depression.aspx for the full detail.

So, if you are feeling down, generally tired, depressed or lonely, why not try a regular exercise class?

If you’re not used to exercising particularly in a class, you may think of a number of reasons why exercise is not for you.  Often, these reasons are based on misunderstanding or misinformation.  I have listed a few common feelings here along with an explanation of what actually seems to happen.

I have never been sporty, so I don’t do physical activity.
In fact many of our class members are not sporty in the slightest, and they still find the classes are easy to do.

I always feel tired so class will simply exhaust me further.
Many exercises or movement in classes can be made easier or harder by the way you do them.  Simply do as much or as little as you feel you can.

Exercise has to hurt to be beneficial, I don’t want that.
The more recent thinking by exercise professionals is that “no pain, no gain” is not, in fact, true.  In reality we have seen plenty of people who have improved their fitness and personal wellbeing, through exercise, and have not felt any pain in the process.

When I get there everyone will know everyone else, consequently I will be left out and feel awkward.
Whilst some classes can be a bit insular, in our experience most class are actually very inclusive.  New people are joining all the time and are very soon embraced by the class camaraderie.  As an alternative why not take a friend with you?

I have tried yoga/pilates/circuits/whatever and I found it painful/just didn’t like it.
Actually, pretty well every class is different in one way or another.  The content is usually created by the person giving the class so there are as many different forms of pilates, yoga, circuits, boot camps, meditation, etc. as there are teachers.  It is worth trying a number of different classes until you find the ones that suit you.  Almost always there is at least one out there.

I have never done any exercise, there are so many different classes I don’t know where to start.
In this case, go for pilates or yoga.  Look for a class where the instructor tailors content to fit peoples’ ability. Talk to the instructor, or other class members to find out about other classes in your area that may suit you.  Then just go along and give it a go.  It is normally easy to have a trial at any class and move on until you find one you like. But it is always worth taking to the instructor about any aspect that you didn’t like because it may be that it could be change to suit you.

The fact of the matter is that almost everyone can benefit from joining a class.

If you continue to be inactive you are more likely to suffer from low mood, depression, tension, stress, anxiety and worry.

By taking more exercise you will feel better about yourself, be less depressed, less anxious, have improved sleep and better concentration, not only this, but you will improve your physically capabilities.  All great reasons to be more active, particularly the older you get.

Looking at the technical side of why we benefit mentally from being more active there is a combination of reasons, some of which are not fully understood.  The simplest factor is that exercise stimulates the release of mood enhancing chemicals, dopamine and serotonin. On top of that the social aspect of common goals and camaraderie have a positive effect, as does the realisation of achievement.  Also your support network can be extended, we have found that classes are very good at support and often bring together common experiences and solutions to life’s difficulties.

The key to gaining a benefit is in finding an exercise programme which suits you.

It needs to be enjoyable and an escape from the pressure of ever day life.

It may not be hard work and you should feel able to rest during the class when you feel that you’ve done enough.

There may be a strong social element with interaction with others in the group.  The companionship you feel from your fellow class mates can be as important as the actual exercise.

Choose a form of exercise that you can keep up on a regular basis.

Thai Boxing - Personal Training with a difference

Make a difference to yourself today.

Are you in the Warwick area and looking for a different way to get and stay in shape?

Personal training will not only help you achieve your goals but is also a great alternative to a regular gym work out and run on the treadmill!

Singkhao Muay Thai Instructor Macauley Coyle is a competitive Muay Thai Fighter and athlete.

The training he will provide is varied and is planned to suit your individual needs and goals, whether you want to work on technique, become healthier, lose weight, improve your fitness or just learn something new.

So whatever you are aiming for, Macauley can help you reach your goals and achieve them faster than you would on your own.

Personal training sessions vary from person to person, areas that you may cover in a session include padwork, technical work, cardio and plyometrics. All equipment is provided and all you need to bring is lose fitting clothing, suitable for working out in. Nutritional advice is also available on request.