How could meditation possibly cure my pain? That’s impossible, isn’t it?

Channel Nine news in Brisbane recently ran a story about using “mindfulness” to treat back pain. A couple of patients have since asked me about it, so I thought I’d use that story as a catalyst for this month’s piece.

What is “mindfulness”?  Mindfulness is a form of brain exercise in which you try to keep your thoughts only in the present. While doing this meditation you attempt to let go of worries, thoughts and judgments, and concentrate only on observing yourself; most people find it easiest to focus on the inward and outward flow of their breath. Once you have achieved this state of mindfulness, you can then add other mental techniques such as progressive muscle relaxation and positive thinking.

But, I hear you wondering, how could such a simple technique help overcome back pain? Surely fixing my bulging disc, relaxing my tight muscles or loosening my worn out joints have more to do with curing my pain than some silly meditation?

"Back Pain: How to get rid of it Forever"

I pondered this question myself at length many years ago when researching for my book “Back pain: How to get rid of it Forever'”.

I spoke with psychologists and doctors, and examined a lot of research, including some very interesting work done on chimpanzees. I gradually realized that psychological approaches to pain are one of many tools that you have at your disposal to help you improve your health. Just like stretching and strengthening exercises, physio treatment, good nutrition and keeping fit are all a part of the holistic treatment of conditions such as back pain, having the correct mental approach is another weapon that you can use to cure yourself. Even better, once you master the meditation techniques they are free!

As a result of my studies into the psychological aspects of back pain, I expanded the relevant chapters into a separate booklet entitled “Using your Brain to get Rid of your pain”. (Keep reading for free gifts at the end of this article!) This booklet explains how your mindset can either cause or help to cure physical ailments such as headaches, back pain and even arthritis.

It’s a very complex subject, but the summary is as follows:

Stressed mum

Modern day stress can arise from many sources

Stress from any cause – not enough money, fighting with your partner, or just being too busy with a young family etc etc – induces a reaction in your body known as the fight-or-flight response. In this state your body releases hormones and other chemicals designed to help you fight (to save your life) or to run away from danger. In ancient times this response was useful, but nowadays, when our worries are often more prolonged than being attacked by a dinosaur, the fight-or-flight response gets in the way. Ultimately it can cause pain and other physical symptoms.

How does the fight-or-flight response cause such pains and problems? First, the released hormones change your bodily systems so that blood flow and energy are diverted to your muscles in preparation for battle or escape. To facilitate this it shuts down or minimizes background systems such as repair and maintenance. This state is fine for a few minutes, but if maintained through a long stressful period then damage will eventually accumulate due to the low background rate of your body’s repair systems. This can cause many symptoms such as stomach problems, skin conditions, artery damage and even physical joint pain.

Second, the constantly heightened state of muscle activity causes them to become tight and overactive. Other muscles, especially the deep core muscles that are of little use in a fight-or-flight situation, become weak. This imbalance then causes joints and tendons to be moved incorrectly, and slightly out of alignment. When this faulty movement pattern is repeated thousands of times the joint, tendon or disc becomes worn out, inflamed and painful. Voila! Your mind has caused you pain!

muscle imbalance

Muscle imbalances cause injury!

Third, if your mind is in a heightened state of stress then it is far more susceptible to sensory input. For example, imagine you are sitting around a campfire in a completely relaxed frame of mind and you hear a twig break. You’d probably ignore it altogether. But now imagine that you’re stressed and anxious and hear that same sound – you’d probably jump and startle. Why? You’re anxious mind is in a flight-or-flight state, and is searching for any sign of danger. When in this state, all sensory input is heightened – including pain. So the same injury will feel worse when you are stressed compared to when you are relaxed.

So there are many well-established pathways by which your frame of mind can directly cause or heighten injuries and wear-and-tear. By learning mindfulness and other relaxation techniques you will have another method with which to help yourself feel better.

Old version - isn't that cover just awful?

Old version – isn’t that cover just awful?

To finish this article I have two special offers! First, to all readers of this blog I would like to offer a complimentary copy of an audio MP3 entitled Using your brain to get rid of your pain. To use this file simply follow the link to our publishing web site, download the file and transfer to your phone or MP3 player. You can use this track to help you master the skills of meditation and mindfulness.

The second gift is an offer to Bulimba and Mansfield PhysioWorks patients ONLY. I have recently released a new version of the booklet “Using your brain to get rid of your

The new edition of "Using your brain..." Available as e-book or in print form amazon.

The new edition of “Using your brain…” Available as e-book or in print form amazon.

pain.” However I still have some old copies of the first edition in stock. So if you would like a complimentary copy of the original booklet (it’s the one pictured here with that awful yellow cover) , please simply contact your nearest PhysioWorks centre and let us know.

Other readers can purchase the new edition of the booklet (as an e-book or in print) at a very low price from Amazon or your favourite online book store.

So start relaxing now and reap the benefits, not just for your mind, but for your physical pain and problems as well!

Arthritis: do I have it? What can I do about it?

What is Arthritis?

Arthritis is a group of musculoskeletal conditions in which there is wearing and inflammation of the joints causing chronic pain, swelling and stiffness.  Nearly 3.3 million Australians have a disability due to arthritis and related conditions, and more than half of these have chronic or recurrent pain. Even though many different conditions are labeled as arthritis,they each have very different causes and so require different treatments. The most common forms of arthritis are:

  • Osteoarthritis (OA). This is by far the most common type. It is caused by wear-and-tear that grinds away at the smooth lining of cartilage that covers the joint surfaces, exposing the rougher bone underneath. This process causes pain, stiffness, creaking and sometimes swelling. osteoarthritis_diag
  • Rheumatoid arthritis (RA) This is an inflammatory disease that primarily attacks the small joints in the hands and feet. It is caused by a dysfunctional immune system in which your own cells attack the joint linings.

    rhematoid arthritis

    rhematoid arthritis

  • Gout is usually found in the big toe joint. It is caused by a build up of crystals within the joint.
  • gout

    gout

  • There are many other different but rarer types of arthritis such as Ankylosing Spondylitis, Juvenile arthritis and Systemic lupus erythematosus (lupus), just to name a few!

Is my sore joint arthritis?

There are many different reasons why your joints may be sore. Not all pain in your joints is caused by arthritis. It could be from an injury or using your joints and muscles in an unusual way (for example, playing a new sport or lifting heavy boxes). Talk to your physio if you have pain and stiffness that:

• starts for no clear reason

• lasts for more than a few days

• comes on with swelling, redness and warmth of your joints.

How can I find out if I have arthritis?

Your physio will ask you about your symptoms and examine your joints. They may do some tests or x-rays, but these can be normal in the early stages of arthritis.  Your physio may also send you to a doctor for blood tests, or to a specialist for a surgical opinion, if either is warranted.

The Role of Exercise

Moderate, regular exercise has been proven to aid in the prevention of arthritis, and offers you a host of side benefits.  Exercise can reduce your joint pain and stiffness, build strong muscles around your joints and increase your flexibility and endurance.

The Role of Physiotherapy

If you have OA you could benefit from physio work to loosen your joints, and electrotherapy to ease your pain and inflammation. We can also give you muscle strengthening exercises to realign your joints—almost like giving your car tyres a wheel alignment. Localized, specific massage techniques can also break up the ’rust’ from your affected joints, greatly reducing your pain.

hip stretch

Loosening a hip joint to lessen the effects of arthritis

Physiotherapy can reduce arthritic pain and reliance on drug therapy. Unlike pharmaceuticals, physiotherapy has few side effects or contraindications. So although arthritis is a chronic disease, treatment and management techniques can control and reduce the effects of the condition, and prevent further deterioration.

Almost like a miracle cure!

 

 

 

“What has a newspaper cartoon got to do with my back pain?”

A recent B.C. cartoon published in our local newspaper reminded me of the evolution of the human spine. Remarkably, the cartoonist goes a long way to explaining why about 3/4 of people end up with back pain at some stage of their lives.

cartoon

This cartoon remarkably goes a long way to explaining the prevalence of back pain. Read on to find out why.

The following extract is from my book “Back Pain: How to get rid of it Forever“. It takes a light-hearted look at the science behind this cartoon. Enjoy!

The Evolution of the Spine – from Elasmobranches to Human Beings

Mother Nature designed our spinal column over a very long period. Helped by her design team of natural selection and evolution, she gradually fashioned the extremely complex systems that form the human spine.

The process began about half a billion years ago, when an otherwise inconspicuous ocean-dwelling animal called an Elasmobranch developed a spine. The Elasmobranch’s spine was a flimsy affair, whose chief function was to provide protection for the bundle of nerve fibres that ran down the creature’s back. Despite this inauspicious beginning, the vertebral column had arrived.

Over the next lazy 100 million years or so, other sea life such as primitive fish slowly evolved spines. These spines were also very simple, and made from soft cartilage rather than bone. They gradually assumed another job besides protecting the nerves: to provide an attachment for the fish’s muscles. This extra control allowed them to swim, and thus survive, more efficiently.

Then, about 400 million years ago, the fish did something that had a huge effect on our spinal development: they migrated to land. With this audacious move came a new problem for the spine. Gravity.

Helped along by the very small changes that are evident from one generation to the next, these early amphibians gradually developed newer, different models of the spine. The quality control manager, natural selection, tested each new design. Those animals with more efficient spines had a better survival rate, meaning that their descendants, the reptiles, inherited better backs.

By the time mammals arrived about 250 million years ago, the vertebral column had developed many desirable characteristics:

• The individual building blocks of the spine were now constructed from dense bone rather than cartilage. This change allowed them to bear more weight.

• The vertebrae – the back bones – developed joint structures that allowed extra movement.

• Shock-absorbing mechanisms evolved that helped to protect the bones from fracturing in the rough-and-tumble of prehistoric Earth.

• Strange lumps and bumps of bone developed on the vertebrae. These protuberances provided leverage for muscle attachments, allowing more precise movement control.

For a time, everything was happy in Mother Nature’s spinal design department. She had an efficient, working model that allowed good movement, offered a firm attachment point for both muscles and ribs, while offering vital protection to essential nerve structures.

Then about fifteen million years ago, probably just on a boring Tuesday or Wednesday afternoon, all that contentment dramatically changed. Something happened that would alter the requirements of the spine, and therefore its structure, forever.

An apelike creature began to walk on two legs.

Why did the ape do this? Well, nobody knows for sure. However, scientists and anthropologists suspect that the motivation was so that the creature could use its front legs – its arms – for tasks such as using crude tools, or brandishing weapons for self defence. Two-legged stance also liberated the front legs for the useful purpose of carrying objects like food, or beer cans.

ape cartoon

Mother Nature and her design team now had a new function required of the spine: to support the trunk in the upright position. Suddenly, the architecture of the lower back needed a drastic overhaul.

Undoubtedly, the first versions were poor. Any decent spinal health practitioner would have made a fortune had they been around during these early reformative millennia. However, as the centuries ticked by, evolution again provided gradual improvements. The pelvis and hips gradually changed their alignment so that the legs were roughly in line the trunk, rather than jutting out at right angles like a quadruped’s limbs. The abdominal muscles also changed their function so that they supported the spine in an upright position, rather than simply being a sling for the stomach and intestines.

As we developed, tree climbing became an occasional diversion rather than a semi-permanent home. Our tails, which were no longer necessary, steadily disappeared … which I, for one, think is a bit of a shame. Imagine how much fun you could have at a party with a fully functioning tail.

Recently, only a mere two or three million years ago, we human beings emerged from the developing gene pool. We now walked upright most of the time. In response, the spine made one further adaptation: it developed some inward and outward curves. Besides providing some extra leverage for the postural muscles, the curves had a springlike effect that helped the spine to absorb shock.

Finally, after a 500 million-year journey that started with a mutant fish, the spine arrived at the current model.

Despite the miracle of design, I award Mother Nature only nine out of ten for her efforts in spinal architecture. Why the deducted mark?

The lower back is probably the weakest mechanical link in the entire human body. It is responsible for more musculoskeletal pain than any other area. Compared with other masterpieces like the brain and the hand, the lower back looks decidedly amateurish. Paradoxically, the probable reason for this weakness also lies in the mechanism of evolution.

In our earliest caveman days, health problems of all kinds beset the average human being. Even a simple cut or abrasion was often fatal, while the most common form of death was infection from tooth decay!

Because of these appalling health problems, most human beings died at a very young age, usually less than thirty. Of course, most reproduction and parenting had to be completed by the early twenties to squeeze into this limited lifespan.

Because of the early parenting age, the natural selection process had no chance to attack the residual problems in the lower part of the spine. Most people had already produced their offspring and/or were dead before they had even begun to develop a bad back, which, as we will see later, usually occurs first in early middle age.

So we passed this weak genetic link from one generation to the next, while it patiently waited to make its presence felt when the human lifespan elongated. Now, as the average length of life approaches eighty years, we are, as a race, suffering with far more back pain than our early ancestors could have imagined.

“Back Pain: How to get rid of it forever” is available from the PhysioWorks web site, direct from our Brisbane practices at Bulimba and Mansfield, and online from www.amazon.com or www.smashwords.com . It will soon be available as an e-book online, so please watch this blog for more information.

Groundbreaking research: Can antibiotics cure back pain?

There has been a lot of talk in the news lately about antibiotics curing back pain. The theory is that patients with a certain type of back pain (known as modic type 1) have most of their pain caused by bacteria. The news articles below summarise this exciting news.

back pain picture

Back Pain: Is a cure at hand?

http://news.sky.com/story/1088460/antibiotics-can-cure-back-pain-study-finds

http://www.theaustralian.com.au/news/world/antibiotics-could-end-curse-of-lower-back-pain-say-researchers/story-fnb64oi6-1226637440700

It does not surprise me that bacteria have been found to be causing problems in the human spine. These little germs cause an amazing number of disabilities in humans, popping up in places that you wouldn’t normally expect. Bacteria, especially the anaerobic kind, cause everything from acne to gum disease to stomach ulcers.

Although this radical research has yet to be re-tested, it would not surprise me if much of it was true.

Does this disocvery mean that your back pain can now be cured with a simple course of antibiotics? Unfortunately, no. Here’s a few problems with that wish.

1. The results of this study apply only to people with Modic Type 1 changes in their spine. This means that the vertebrae have miscroscopic internal fractures, and that the bone marrow inside the vertebrae has been replaced by inflammatory fluid, just like that found in a skin blister.

2. These patients have a typical presentation of long standing pain that rarely ceases, even at night. It is made worse by exercise. They have a history of a previous disc herniation, which may have allowed the infection to enter the spine initially.

3. The study only collected samples for analysis from surgical patients, raising the question that the bacteria may have been introduced during the surgery.

4. If this treatment is to work, it will be difficult for the antibiotics to adequately penetrate into the middle of the discs, which have no circulation. Therefore, any course of drug treatment is going to have to be very prolonged, possibly causing side effects and increasing antibiotic resistance.

The simple message is that you cannot expect to simply take a tablet and be cured. Many other studies have shown great improvements in back pain using a variety of other treatments, ranging from tummy exercises to surgery. You cannot suddenly discard these options in the hope of a miracle cure.

However, if you have chronic, unremitting back pain that is worse with exercise and aches at rest, and your MRI shows modic type 1 changes in the bone, then it may be worthwhile you considering antibiotic treatment as part of your rehabilitation.

For more on Back Pain, please see http://www.physioworks.com.au/Injuries-Conditions/Regions/lower_back_pain_injury or if you interested in reading my book on the subject, “Back pain: How to get rid of it Forever” then go to http://www.physioworks.com.au/store-1/books/back-pain-how-to-get-rid-of-it-forever (Note: soon to be released electronically. Watch this blog for more information!)

Back injury to Australia’s cricket captain Micheal Clarke

Today’s Australian newspaper ran an article on Michael Clarke’s lower disc injury. In the article, they discuss the opinion of  a physiotherapist on Clarke’s treatment. I feel that he raises some good points, particularly the one about over-reliance on CT scans and x-rays to diagnose the pain. (One study showed that 2499 out of every 2500 back x-rays are a waste of time.) He also mentions that much pain is caused by precipitated by poor muscle control – another well-accepted principle of treatment by most physios.  The full text of the article is below.

cricketby:Adam Shand

AT the end of a disastrous tour of India, Australia’s skipper Michael Clarke literally carries the burden of the nation’s expectations on his dodgy back.

While this weekend’s fourth Test in Delhi is the first match Clarke has missed through injury, the timing is ominous with back-to-back Ashes series looming.

Clarke’s “degenerative” back condition, a “bulging disc” first diagnosed when he was 17, has become an ever-present concern for the 31-year-old.

Leading Melbourne physiotherapist Geoff Fisher believes Cricket Australia must re-examine its protocols about managing injuries if Australia’s most valuable asset is to pay his way.

Fisher questions whether the team doctor should be in charge of diagnosing and overseeing treatment regimes for conditions like Clarke’s. “In sporting teams, doctors have become the front line of diagnosis for such pain but they are hopelessly out of their depth in dealing with musculoskeletal problems,” says Fisher.

“If the Australian team’s frontline response is medical then it will almost certainly fail.”

Fisher claims there is an over-reliance by sports doctors on CT scans and X-rays to diagnose pain. Scans often reveal abnormalities in the structure of a joint or limb, like Clarke’s bulging disc, he says.

“The doctor will say, ‘we see there is change in the structure of the joint. There’s evidence of wear and tear or abnormality. We can’t explain why it’s happening but we know it is happening because of the pain’.”

Studies have shown that up to 40 per cent of people have abnormalities in their spines that don’t automatically cause pain. Clarke’s pain, often described as his back “locking up”, may have nothing to do with discs or vertebrae. It may in fact be a protective response from the muscles of his back, not an injury at all.

It’s a problem that blights the lives of millions of people who spend too much time chair-bound or sitting in motor vehicles with knees elevated higher than hips. This places excessive strain on the postural muscles that keep the spine stable. Spinal muscles will attempt to control movement by an increase in tightness and tone.

“By reducing the range of movement, threats to the spine, are reduced. These responses are hard-wired and self-increasing, built into the neurology of the brain and spinal anatomy.”

The giveaway clue is that Clarke often suffers tightness in his hamstrings, Fisher says.

If Clarke’s problem is related to his spinal muscles, it is a treatable condition, using safe non-invasive manual therapies, says Fisher.

Working with triathletes, Fisher uses a variation of an Australian-devised therapy known as “continuous mobilisation” which might provide an alternative for Clarke.

Fisher’s method of manual therapy is designed to “turn off” the protective behaviour in the spine and the referred pain is often immediately relieved.

Fisher says that 95 per cent of his patients with chronic pain in their head, legs, knees, arms, feet or hands, are in fact suffering from “referred pain”. If, like Clarke, they haven’t suffered a trauma or arthritis, the source of the problem is invariably found in the lower back or neck where muscles have engaged in a protective response to guard the spine.

To learn more about back pain, please visit http://www.physioworks.com.au/store-1/books/back-pain-how-to-get-rid-of-it-forever