Good Morning,

Another week of lockdown has gone by, and hopefully another week closer to resume some sort of normality.

Lockdown Fitness.

I just wants to share a quick bit of general fitness advice for people perhaps a little concerned with a few pounds creeping on over the lockdown period!

Below is a link to a video clip I created and posted to the Central Sports Massage Facebook page. Take a look for a simple breakdown of how to maintain fitness and weight during this period.

https://www.facebook.com/centralsportsmassage/videos/2954426021318327/

Why not give this a try and feedback to me how you found it!

…and as ever, if you have an questions or would like some further advise, please just give me a shout!

OH, AND OF COURSE…HIT LIKE ON MY FACEBOOK PAGE!!

lockdown exercise

Alex

CSMHi All!

Ongoing Service….

I just wanted to let you know that although I am not in clinic for hands on treatment, there are still plenty of services that I can offer. I am always on hand to help anyway that I can; whether online help with any pain issues your have, or training and performance assistance.

Here are a few ways that I am still able to assist during this difficult period:

Telephone / Online Service & Email consultations.

Although I cannot be in clinic, I can still offer sessions via the methods above. If you are suffering with any issues I am available for consultations, during which we can discuss the symptoms and onset of your issue, formulate a plan of action, and advise on methods that you can incorporate at home to find resolution to your issue.


Fitness/Training Plans.

Since finishing work in clinic, I have been busy creating tailor made fitness plans. It is important that although we are on lockdown, we maintain a good level of activity. For some people, this time provides a window of opportunity. For example, runners can use this time to work on areas their fitness that may usually get missed.

Running Strength Capacity Testing.

If you are a runner and would like to identify where your strengths and weaknesses are with your strength & conditioning I can provide your with a strength capacity testing protocol that you can easily carry out at home.

This is a one off fee and can act to then guide your training. A tailored training program based on your results, if desired.

Here is a example of some clips that have been put together from a training plan designed for a distance runner working on their strength and conditioning:

https://www.facebook.com/centralsportsmassage/videos/1067813646906785/
As you can see – although I may not be in clinic, I can still be of valuable service!

Please get in touch for further details!alex@centralsportsmassage
07795436130
Alex

It is with regret that our clinic is now closed for the foreseeable future, until the current coronavirus pandemic reaches a resolution.

We cannot continue to work in an environment where we could be risking our own and our clients health.

We are in the process of contacting all of our clients that had appointments scheduled and are sure that you will all understand this decision.

Being self employed, we will look to ways whereby we can still offer a service to our clients.

If you have a specific issue/injury we are happy to assist you virtually. We can put together a document with advice and rehab protocols for you to complete at home along with unlimited email support. This enables you to still proactively make moves to help yourself beat your pain. – Please direct message for details.

We hope that this period of uncertainty passes as quickly as possible and our doors will be open once again to welcome you all back!

Alex & Donna
Central Sports Massage

Well….these sure are challenging times that have descended upon us all.

There is plenty of official information out regarding what we should all be doing during this time….and plenty of unofficial people also producing information (rightly or wrongly).

I shall not be preaching on any of that!

What I thought may be useful however, is some relevant, practical information (only from my area of expertise of course) of how you can make the most of your time at home to ensure optimal health & wellness.

First, lets look at pain. 

paincorona

The chances are that you originally came across me because you were experiencing some level of pain, and you may or may not be experiencing pain or discomfort at present.

If we take a quick look at how pain works, we will soon see that over the coming weeks and months we may well find that we are experiecing more than usual. Whether aching shoulders, low back pain, sciatic symptoms – ANY pain symptoms may be amplified.

The BIOPSYCHOSOCIAL model. 

This simply breaks down the 3 factos that can influence pain:

  • Biological (Physical)
  • Psychological
  • Social

Pain is a complex, multifactorial experience. It is never as simple as ‘my shoulder hurts therefore I have damaged my shoulder’.

We can experience pain even if we have NO physical damage. It is best to think of pain as a warning signal rather than an indication of damage. What’s more, pain can be altered by purely our perception of what may be wrong.

So lets take each of those 3 categories and briefly look at what they mean:

  • Physical
    The classic, generally understood, component. This could be overdoing something, such as heavy lifting. Once you surpass your body’s tolerance level the nervous system may become irritated and pain will be the result. Think of it as your brain telling you ‘You’d better stop!’ Biological input would also be a muscle tear or trauma i.e sports injury.
  • Psychological
    This is a HUGE factor. Often neglected as people focus on the physical elements. But as it happens, pain is strongly influenced by psychology. The way we think affects how we feel. For example, our belief systems. We may associate pain with certain activities, which leads to fear avoidance. This can have a massive effect. In practical terms, someone may feel discomfort when bending to pick something up. This could lead them to avoid bending forward altogether. The problem is, bending over is not dangerous, it is just temporarily sensitive for that person. By avoiding that movement altogether the consequences are going to grow. That movement will continue to sensitise, the movement capacity of the person will reduce, and the cycle continues. Also, stress can act to ‘turn up the volume’ on pain. Due to the hormonal response to stress on the nerves that detect ‘danger’ in the body. So any discomfort we may be experiencing is sure to be amplified when our stress levels increase.
  • Social
    Lastly, but importantly given the current climate, this relates to how social factors can influence pain. For example, a runner who’s social life revolves around running may have to cease from running after sustaining an injury. Not only are they unable to do what they love, but they are cut off from their social activity/potential friendship group, which can lead to loss of identity, increased feelings of isolation, low mood. All feeding into the pain experience.

Biopsychosocial

Hopefully that all makes sense (it is a difficult topic to simplify in such a brief manner!).

How is this all relevant? Well, in 3 simple sentences:

1. We are going to be restricted from a lot of our usual activities – gyms, sports clubs, fitness classes etc.

2. We are experiencing high stress levels due to uncertainty of work, finances, health.

3. We are isolated from our usual lifestyle, families, hobbies.

During this difficult period, every element of the biopsychosocial model has significant drivers that will all affect how we feel.

Now, I am not suggesting that we can eliminate any pain ad discomfort that we may feel. But there sure are ways that we can look after ourselves and reduce the negative consequences of our current reality.

  •  Find time to focus on things that we enjoy. Reading, watching a movie, country walks, listening to music. Ensuring we don’t overstimulate ourselves with a constant barrage of virus input!
  •  Exercise. Movement. Whatever it may be. Whatever you enjoy. Get your body moving, reap the physical benefits of increased strength and fitness, reduce pain, reduce stress and anxiety leverl, improve sleep quality. The list can keep running for this one. 

Over the next few blog posts I shall be sharing some ways that I use to keep fit and active in the confines of my home. Stay tuned!

Something that I have been exploring with my research on my masters course is the important role of the ‘hip abductors’ in reducing risk of injury. So I thought I would create a quick blog post to highlight the role they play and the importance a good function.

 

What are the hip abductors?

Primarily, we will look at the gluteus medius & gluteus minimus (to keep it simple).

 

What do they do?

Their role during the gait cycle is predominantly one of stabilisation. When the foot strikes the ground there is a strong horizontal force acting on the hip that pushes the hip outwards (laterally). The hip abductors resist this movement, acting to maintain the mediolateral balance of the hips.

If they are unable to resist these forces the result is that the hip will go into adduction (the angle of the leg moves towards the centre of the body). When this happens, the knee is forced in to a valgus position (knee will drop in, putting pressure on the inside (medial) aspect of the joint), the tibia (shin bone) will externally rotate which in turn will likely cause the foot to pronate.

All of this as a domino effect from the hip! – In fact, the two most common running injuries, patellofemoral pain syndrome & IT Band Syndrome (which both present with pain around the knee) have both been shown to be correlated to weakness in the hip abductors.

So that gives you an idea of the importance of a strong healthy hip! Below I have listed a few exercise examples that target the hip abductors – these are all evidenced based exercises that have been shown to result in the highest activation of the gluteus medius:

 

Side Lying Abduction:

side abductiom

Step 1: In side-lying, bend bottom leg for support
Step 2: Keeping the top leg straight & foot horizontal, raise the leg up, and slowly lower back down.
Step 3: Ensure hip does not hike when raising the leg.
Destefano et al. 2009 in an EMG study found that this was ‘the best exercise for Gluteus Medius’.

 

Wall Press:

wall press

Step 1: Stand next to wall, raise leg with a flexed knee.
Step 2: With hip flush against the wall push back against the wall
Step 3: Hold for 30s, repeat 3-4 times both sides.
O’Sullivan, Smith & Sainsbury, 2010 found, when compared to the Pelvic Drop & Wall Squat, that the Wall Press had the highest MVIC of 76%

 

Side Plank with Adbuction:

plank abduction

Step 1: From a side-lying position raise your body up to a plank position using the forearm and bottom foot.
Step 2: From this position raise the top leg straight up, and slowly lower back down.
Step 3: Ensure not to hike at the hip when raising the leg.
Boren et al. 2011 top exercise for activation, beating single leg squat.

 

Crab Walk:

crab walk

Step 1: Position a band around lower legs.
Adopt a quarter squat position, feet shoulder-width apart, head and chest up.
Step 2: Take a slow, lateral step. Keep toes pointed forward. Step 3: After completing the step, follow with the opposite leg. Keep the feet at least shoulder width apart to maintain band tension.
Distefano et al, 2009 found good activation of the gluteus medius

 

Pelvic Drop:

pelvic drop

 

Single Leg Squat:

single leg squat

Step 1: Stand on your left leg and lift your right leg up and straight out in front of you. Lift your arms in front for balance.
Step 2: Sit your hips backwards and bend your standing knee to lower down towards the floor.
Step 3: From the bottom position, push down through your heel to extend the knee and stand back up to a tall position.
Step 4: Switch legs and repeat
Boren et al. 2011 showed good Gluteus Medius and Gluteus Maximus contraction of 81% of MVIC for Gluteus Medius and 71% for Gluteus Maximus.

 

So this is just a quick post to highlight the role of this muscle group. It is particularly important for distance runners to ensure that they possess adequate strength to be able to tolerate the loads for the period of time that they run.

Feet

       If you are a runner and you are serious about avoiding injury, then there 3 things you need to be sure to do for sure!

– Look after your Feet

– Look after your Hips

– Manage your training load

Of course,  there are many other things that will help avoid injury but these 3 areas sure are important.

Over the next few updates I will break each of these elements down with a few pointers to get your heading in the right direction to bullet proof your body!

Starting with the Feet…

On average, the each foot strikes the ground between 80-100 times per minute when running. With each strike equal to approx. 3 times the person’s bodyweight.

The feet are responsible for absorbing that impact and transmitting the forces up through the body efficiently & effectively.

The better shape the feet are in, the better they are at dealing with these forces without a) becoming injured and b) placing more strain upon joints further along the chain (i.e. knee, hip) due to their inability to move well and absorb.

…So let’s look at what we can do to prime our feet.

Mobilise:

Running is very repetitive, with the feet pounding the pavement in the same movement pattern for a long time. Coupled with the fact the majority of recreational runners may also spend 5 days a week confined to restrictive work shoes, spending some time each week to keep the feet mobile and free will be extremely beneficial.

Here of some example of things that you can try:

Hockey Ball Roll
Soft Tissue Therapy Planter Fasciitis

After a long week of pounding the pavement, help to ease all of that built up tension in the bottom of the foot by spending a few minutes applying pressure through a hockey/tennis ball.


Fingers between Toes
Toe Stretch

Just as we like to stretch and move all other areas of our body, our feet and toes are no different. There are many small but very important muscles in the foot that can benefit greatly from a couple of minutes of separating the toes and rotating in small circular motions.


Knee to wall
Knee to Wall

This can be used as an assessment to compare range of movement of the ankle. It can also be used simply as a way of working through a full range of movement of the ankle by spending a minute or two slowly moving in and out of that end range position.


Massage / Joint Mobilisations
Mobilisation

Your feet carry you through all of those long miles, so it makes sense to treat them to regular treatment in order to keep them working optimally for you. Massage is a great way to ease off sensitivity in the area. The major joints of the feet will benefit from mobilisations to ensure free movement to allow the them to efficiently absorb the forces placed upon them.

Stretch:

An inadequate range of movement around the foot/ankle can cause a number of issues with running. If there is not enough free movement for the forces of impact to be dealt with at the ankle, then these forces will travel upwards and end up being placed upon the knee and hip. Over time this kind of faulty loading pattern can contribute to the onset of pain.

Below are some suggestions of stretches that can be used to ensure full movement of the foot & ankle: –

Gastrocnemius
Calf Stretch
Leaning against a wall, straighten the back leg and drive your heel into the ground.

Soleus
Soleus Stretch
Leaning against the wall, bring the back foot in slightly and sit back towards the heel. This will put a good stretch on the soleus.

Achilles
Achilles Stretch
Wearing running shoes, bring your front foot towards the wall and places the toes up against it. Bend the knee towards the wall, this will produce a stretch that puts emphasis on the achilles tendon.

Plantar Fascia
Plantar Fascia Stretch
Without shoes on, place your toes up against the wall and bend your knee into the wall. Stretching in this manor will hit the achilles but also targets the plantar fascia of the sole of the foot.

Toe Separators
Toe Separators

We keep our feet locked up and restricted in shoes for very long periods of time. This can have a compressive effect on our feet – if you compare an average adults foot to that of a baby, you will see the difference between the foot as nature created, and the foot that has spent 30 years in narrow shoes! Try wearing toe separators in the evening to stretch the intrinsic muscles of the foot and regain your natural foot position.

Strengthen:

This is the biggie! Running places great load through the feet. The most effective way to manage this is to ensure that the relevant tissues are strong enough to tolerate these loads. There is an old myth that strength training for running should be light weight and high repetitions. This is in fact not true. Muscle endurance for running is built by running itself. The supplementary strength training must be designed to increase total strength capacity. The more we can lift, the better. Of course, it must be progressive, and we should build up the load gradually in order to not overload our body and cause injury.

Below are some introductory exercises for the feet/ankle. All of which can be loaded more either by performing whilst holding weights, or using heavier bands.

Calf Raises Straight/Bent Knee

Calf Rasies                      Calf Raises
These exercises through the calf, ankle and foot. The Straight leg variation will target the gastrocnemius, while the bent leg version targets the soleus. Progression of this exercise would see you perform single leg raises / load the exercise by holding weights whilst performing.

Resistance Band Eversion/Inversion/Dorsiflexion

Ankle band strength              Dorsiflexion
You can really start to strengthen and stabilise the foot and ankle by incorporating resistance band exercises that load through the ranges of movement that the ankle produces. This is a great way to increase your body’s tolerance of the demands of running.

Tip Toe Walks / Heel Walks

Toe Walks        Heel Walks
Great exercises to build up endurance in the lower leg/foot. They are good drills to use to build up movement patterns/strength for good running technique.

Pogo jumps

Pogos
Pogo jumps are a great way of starting to utilise plyometric drills in your training. These jumps will help develop the elastic strength in the achilles that is so important to run well. Focus is on pulling the toes tight towards the knee when jumping and actively planting on the landing.

Lateral Hops

Lateral Hops
This exercise is another way to utilise plyometric training. It also develops the stability of the ankle and it’s ability to deal with the forces acting on it when running. Two areas are created alongside each other and the drill is to hop from one side to the other repeatedly. Focus is on ensuring that the landing is strong and controlled.

 

This is by no means a complete nor exhaustive guide, just a few ideas of ways you can look to optimise the health of your feet. If you can incorporate even just a couple of drills from each section you will be positively impacting on the capacity of your feet to tolerate the demands of your running training.

Please feel free to get in touch to discuss any methods of improving your running performance further!

I have a 12 week running performance package that utilises strength training to improve your running – email me if you would like details.

Experiment & Enjoy.

Check out this fantastic compilation of information that is presented by Ben at Cor-Kinetic!
https://www.cor-kinetic.com/

A great bit of free information to help people who have/are experiencing back pain to learn and gain a little better understanding.

*IMPORTANT – This document does not replace professional medical advice and is only intended for information purposes.*

illustration-of-spine-on-man-with-back-pain

BACK PAIN INFORMATION

• Back pain is normal. Up to 20% of people are likely to get some each year and a whopping 80% of us will get some back pain in our lifetime, in fact it would abnormal not to get back pain.

• Back pain can last up to 6 weeks – this maybe longer than you anticipated. So if it has been going on for a bit there is no need to unduly worry. Lots of pains only last a number of days but it is still normal for it to last longer.

• Although we all know someone who has had long term persisting back pain that has caused lots of problems it is actually somewhere between 10% and 25% of people with back pain that lasts longer than normal. So you have good odds it won’t last longer than 6 weeks.

• Back pain is no different to any other pain in our bodies such as shoulder, ankle or knee pain although people do tend to worry more about it.

• Pain itself is normal and nothing to be scared of. It is a protective mechanism that has evolved help us out. You would not want to live without it!

• Pain is not a good at reflecting the physical state of our back or any body part. We can have lots of pain without  significant damage. Think about getting a paper cut or a bee sting. They can hurt like hell but don’t really damage us.

DIAGNOSIS 

Diagnosis can often be challenging with back pain although I know that people often want an answer. We don’t always need a definitive answer to help you. Here is what we do know:
• The vast majority of back pain is not serious, in fact around 99%. The 1% is mostly fractures, can include cancer, but these a pretty rare occurrences.
• Around 10% can be pinned down to a specific tissue diagnosis such as a disc or a nerve.
• These statistics mean that it is unlikely to be a ‘slipped disc’ or a nerve problem and people often throw these terms around as causes without really knowing this for sure. This can often be unhelpful.
• Therapists have some tests to tell if the problem is in that 10%. These include clinical tests for the nerves and nerve roots as well as muscle strength, sensation and reflex tests.
• It is very difficult to make a diagnosis from a MRI alone. Lots of MRI findings also exist in people without pain, hence the need for a clinical exam to accompany a scan.
• MRI’s are not able to show us pain.
• We often can’t pin it down to a specific tissue or pathology around 9 out of 10 times. There are lots of different tissues in a small space and if it is irritated or inflamed then it may affect more than one of the tissues.
• Inflammation is a good thing. It means the body is working well and doing its repair jobs.
• From a medical perspective this type of back pain is often termed ‘non-specific’ and we should see this as a positive diagnosis as it means nothing serious is wrong. It could still hurt a whole lot though.
• The term ‘non-specific’ means the tissue, not non-specific to you or has no origin. YOUR PAIN IS ALWAYS REAL AND SPECIFIC.
• Non-specific pain often responds well to moving and although we cannot give an exact label does not mean we cannot give some ideas to help or an a basic explanation about why you might have back pain.

OTHER FACTORS

• Lots of different factors (many which you may have not considered) can affect your back pain.

• This can mean that you feel your back pain has a life of its own but it maybe that you have not been informed about or considered all of the potential contributing factors.

• These other factors can include abnormal sleep, lots of life stressors including work and family, feeling that the pain will never go and negative beliefs about your back and performing daily activities.

• Its probably not your spinal posture, your pelvic tilt, a teeny weeny muscle not firing or something needing to be put back into place causing your back pain. How do we know? We have studied this stuff to death.

• If you have been told this before it could mean your therapist is not up to date with the latest research in this area. You may have been given lots of opinions previously and it can often be confusing for you and hence the need to be aware of the scientific data in this area.

TREATMENT

• There are NO magic treatments for back pain that work for everybody unfortunately.
• It might not be one singular problem but a few different things happening together. A minor pain might be exacerbated by other things that are making you a bit more sensitive.
• Your therapist should be able to give you some basic advice or point you in the direction of others who can if it needs more specialist help.
• Lots of different treatments can help in the short term, such as a few hours or days, but don’t simply put your recovery in someone else’s hands. This has been shown to often be worse in the long term.
• You may have to avoid aggravating activities in the short term but make sure you go back to doing them. Nothing should be off limits in the long term. Don’t let anyone tell you otherwise.
• People who feel they need to protect their backs can also have worse outcomes.
• Learning more about what helps you and what makes you worse is important to help you manage your back pain. Your therapists should help you do this.
• Movement and exercise might help.
• Unfortunately here are no magic exercises for back pain. Find what you enjoy and just do it. This could be Pilates, strength training, sport with friends or simply going for a walk in the park.
• Don’t feel you have to really push yourself to get stronger or fitter but it is good once in awhile to exert yourself. This gets your body used to doing it.
• Moving and exercising can help us build confidence in our bodies and this might be key to recovery rather than fixing a physical problem.

PERSISTING BACK PAIN

• The common term for persisting pain is chronic pain, The term chronic does not mean ‘worse’ it is actually just a general term for pain that has gone on for longer than 3 months.
• How we respond to back pain might play a role in how long it lasts. If you change what you do in terms of activity such as avoiding things or think very negatively about your pain and your recovery.
• We could see persisting back pain as our protective systems, in this case pain, doing its job too well.
• Although pain is normal and a good thing, we could see it a lot like red wine. A little bit is great, but sometimes we can have too much of a good thing and it leaves us with a hangover.
• Persisting pain is currently seen as problem of the protective system itself rather than simply reflective of the state of your body.
• The more we work the mechanisms that contribute to pain the stronger they can get. It’s a bit like working your bicep in the gym. Just like your muscles the protective system can adapt and get better at protecting you.
• Unfortunately this means that the things that did not used to cause you pain now can do and may explain why you can be very sensitive to things that used to be normal.
• All of this does not mean you can’t get better but it is not as simple as finding an ‘off’ switch.

CLINICIANS ADVICE

This is some advice from some fantastic and experienced therapists from around the world who have kindly contributed to this document.

• Sheren Gaulbert – Stay connected with people who matter in your life/engage in activities you value.

• Karen Litzy – Don’t consider yourself broken or damaged goods.

• Ash James – Its often better to be at work than at home. You will move more, rest less and get back to normal stuff sooner.

• Kjartan Vibe Fersum – Important to have a shared plan (with your therapist) to move forward with.

• Tom Goom – It’s good to experiment with movement, relax into it and see what helps pain and stiffness. Movement is medicine, and like medicine it has a dosage, experimentation is needed to find the right dose for you.

• Claire Higgins – Your back is designed to be strong. It can so easily be visualised by patients to be a stack of blocks which could be “crushed” or “topple” at any moment. Education on how our backs are super strong and to trust in them is important.

• Claire Higgins – Focus on the things which turn your pain down, restoring balance e.g. exercise, meeting friends for coffee, being in the great outdoors.

Read this great, and informative post by Jamie Johnston at The Massage Therapist Development Centre. They are many more great articles to be found at his website : https://themtdc.com

Degenerative Disc Disease Correlation To Pain Doesn’t Matter As Much As You Think

He came in with a look that resembled someone in grief.

I asked if he was okay and his response was a bit surprising.

“I was just told I have a disease which is causing my back pain, as a result, the pain may never go away.”

As I inquired more he told me the diagnosis was degenerative disc disease, which was causing his spine to shrink and as a result, it was causing the low back pain he was experiencing and would now have to seek treatment on a weekly basis just to deal with it.

This once active person (in his 50’s) was now disheveled because of this MRI diagnosis he had been given by another practitioner, he felt hopeless.

Why MRI Is Just One Tool That Should Be Used

Stories like this happen all too often with our patients.

They experience some sort of low back pain, (which usually they have never experienced before) and their doctor or other healthcare practitioner orders an x-ray or MRI and the results seem catastrophic. They are diagnosed with a “disease” or “syndrome” of some sort but aren’t given any really good information surrounding their condition.

While there is a possibility that disc degeneration (DDD) could be a contributing factor to their pain, it’s not as simple as just looking at some medical imaging to get a proper diagnosis.

There are several contributing factors including environmental factors, genetics, and associations with heavy physical work, lifting, truck-driving, obesity and smoking (smoking has been found as a risk factor for pain and DDD) found to be the major risk factors. However, these do not point to a clear pattern between degeneration and clinical symptoms.

Something that doesn’t get mentioned as often, is how this is also simply a part of normal aging. One systematic review points out some interesting facts to show just how much this happens. When looking at 3110 images of asymptomatic people the review showed:

  • Prevalence of disc degeneration in people at 20 years old was 37% which increased to 96% in 80-year-olds.
  • Disc bulges occurred in 30% of people at 20 years old and 84% in those at 80 years of age.
  • Disc protrusions were 29% of 20-years-old and 43% of 80-years-old.

And all of these individuals weren’t experiencing any pain!!

Another study showed changes in the disc at multiple levels were more common in the elderly (in this case above 60 years) as well as other degenerative changes around the facet joints, ligamentum flavum, and disc bulges.

Even though degeneration has been seen in the younger population as well, there is little correlation between radiological findings and pain. Quite often people whose imaging shows major issues have no pain and those who present with minor signs experience severe pain.

Unfortunately, many of these people are referred for surgery (usually a spinal fusion) which eliminates motion and can lead to degeneration of adjacent parts of the spine. Another part of the problem here is this only addresses a symptom, not the cause and the surgical outcomes are not great. It is also important to note that 70-80% of people who have surgical indications for back pain or disc herniation recover whether they have surgery or not.

These surgical referrals usually happen because imaging has been used as a diagnosis, rather than just a tool used in the process. This isn’t to say imaging shouldn’t be used, but it should not be the only thing used. Overall we see the association between MRI findings and DDD are unreliable, so the importance remains on our clinical reasoning and of course, patient history as well as looking for any neurological deficits.

The Role Of Depression

Now that we understand DDD risk factors, it’s age-related changes, and correlation with pain there is another factor we need to look at.

Depression.

In a three year study looking at veterans who were asymptomatic with low back pain, they were given repeated MRI’s over this three-year span. The researchers made a point of not telling the participants the results of what they saw as they didn’t want the patients to alter their symptoms by becoming sensitized to trivial issues or amplifying their symptoms.

Imaging findings varied, some discs were less severe, or even normal, and some became worse. The study concluded that central stenosis, nerve root contact, and disc extrusion were the most important imaging findings that may be risk factors for future back pain, however, protrusions were not a risk factor.

But, the strongest predictor for low back pain was depression. 

Of those who self-identified (and were being medically treated for it) as having depression, their pain scores were greater at EVERY follow-up, whereas the progression of disc changes was only occasionally associated with new pain. Some of the participants also pointed out their activities were limited because of their depression.

As we know (when reviewing the clinical guidelines of low back pain) bed rest used to be one of the main recommendations for those dealing with acute low back pain, but now exercise and movement is the far better recommendation. When we look at discs exercise does not affect them adversely and they respond well to long term loading strategies. 

So, think about that patient who comes in and is catastrophizing about the diagnosis they have just received. We know part of what we have to do is provide reassurance, in fact, this is a MAJOR part of what we have to do. Looking at all the information we have just discussed, letting them know that disc degeneration is a part of normal aging, there is little correlation between their diagnosis and pain (unless there are neurological symptoms) and quite often the issue resolves itself without surgery. Could we actually reverse their catastrophizing? Could we also assist this by encouraging them to exercise, even by getting them moving on your table to show that movement is safe? We know that exercise has great results in helping with depression and now we know it also helps with disc health, so aren’t these the things we should pay more attention to rather than focusing on MRI results? I’d say yes…and the research agrees. 

 

Read this blog and many more great posts at his website!

Degenerative Disc Disease Correlation To Pain Doesn’t Matter As Much As You Think

Leigh Wood set to defend his Commonwealth Title at Nottingham Motorpoint Arena.
leigh wood

Big boxing cards are back in Nottingham, as Commonwealth Featherweight Champion, Leigh Wood, is back in action defending his title at the Motorpoint Arena on 10.05.19.

Part of an action packed Matchroom Boxing bill featuring WBA International Featherweight Champion Jordan Gill, Central Sports Massage sponsored athlete Leigh Wood is sure to draw his home town fans in to pack the arena. A great match up against Ryan Doyle is set to create a great night of boxing!

Get on board and show your support to Nottingham’s rising talent. Tickets will be on sale soon, ranging from £40 – 120. They can be purchased from BluePrint Nottingham.

 

Here is the latest newsletter from Jamie Johnson at the Massage Therapy Development Centre with a selection of great articles from the last week!

Some extremely interesting, progressive pieces to help keep you up to date with current understanding and practice.

Follow the links below to be directed to the full articles….

Articles Of The Week January 20, 2019

 

Coming out of college, everything seemed so straightforward! You’ve got a toolbox of techniques and you may even look to specialize in one of them, all the while helping as many patients as you can. Well, things aren’t so straightforward, and the times they are a changing. With it usually taking 17 years for new research to be applied in practice, we need to stay on top of the new and evolving research, along with a strong alliance with those patients.

“Manual Therapists: Have You Lost That Loving Feeling?” – Paul E. Mintken, Jason Rodeghero & Joshua A. Cleland

Patient centred care means different things to different people. Because it has different meanings for different people, there may also be ethical dilemmas surrounding the topic as well. This article delves into some of these topics, while also having you reflect on what this topic means to you.

“‘Patient-Centred’ – What Does It Mean And How Achievable Is It?” – Andreas Laupacis & Jennifer Gibson

Using unstable surfaces for strength training and rehab has been a popular practice for quite some time. However, does it really work? Well, it depends on the patients goals, your scope of practice, and just plain sticking to the basic principles of exercise program design.

“Is Unstable Surface Training A Waste Of Time?” – Nick Ng

He has been at the forefront of pain research over the past number of years and Peter O’Sullivan is always worth listening to. No different with this article, where it shows how he and his team are using ‘Cognitive Functional Therapy’ to treat back pain.

“The ‘Mythbusters’ Of Back Pain Believe They Can Treat It – With Words” – Liam Mannix

We published a post earlier this week about when NOT to treat a patients thoracic pain, but when you can, this is a good post. Dean goes through a few different drills and exercises to help increase thoracic rotation, most of which you can do right in your treatment room.

“Cleaning Up Thoracic Rotation” – Dean Somerset