The Pain Game

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We’re led to believe that experiencing pain is a dangerous phenomenon and should be suppressed by any number of medication currently on the market. If you’ve got a headache take a headache pill, joint ache take a pill or rub pain relieving cream into the area etc.

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But what is the pain trying to tell us?
Pain is the way the body can communicate injury, infection and dysfunction to the conscious part of the brain. Is this something you really want to ignore? Unfortunately turning down the pain doesn’t address its cause but purely the symptoms. Its like disabling the fuel warning light in your car. It doesn’t address the fact you’re nearly out of petrol.

It’s therefore fair to say that PAIN IS NOT THE PROBLEM. It’s just an alert telling us there’s more going on.

But how accurate is pain as an indicator?
Although essential for our survival pain isn’t particularly good at telling us what the problem is, in fact at times it can be quite misleading. For example we have a huge amount of pain receptors in our mouth and lips. Biting your tongue can be extremely painful for a reasonably small amount of damage done while other people experience minimal pain after rolling their ankle which can cause significant damage to the ligaments.
With spinal dysfunction pain can also be quite misleading. Our spines are an incredibly strong, flexible structure which is comprised of a number of extremely versatile tissues. It is very difficult to damage a healthy functioning spine. Pain arising from the spine is often the last part of a bigger picture of dysfunction to arrive. Postural issues, prolonged sitting, incorrect lifting, previous injury etc can grumble in the background slowly disrupting these strong tissues causing us minimal to no pain. In fact slight stiffness might be our only conscious indicator. And then one morning we bend to put our shoes on, pick something up, twist awkwardly and ouch PAIN! When asked what caused the pain we attribute the putting on of our shoes when in fact it’s been building momentum over a long period, like a car rolling down a hill with no brakes. The putting on of the shoes was the final straw.

What separates chiropractic from other health modalities is we address the underlying cause of your problem and although we are compassionate about the pain you’re experiencing we know there’s more going on. In fact getting rid of your pain can often be the easy part, correcting its cause is where we stand head and shoulders above other practitioners.

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As mentioned earlier pain is the last thing to show itself with musculoskeletal conditions and is the first to go. Unfortunately that doesn’t mean the problem has gone and unless the underlying dysfunction is addressed a relapsing cycle of painful spells is likely to occur with no real progress being reached. You’ll be treading water. That’s not how we, as Chiropractors, work.

The Pain Game is a multi billion dollar industry.  Why? Because pain will always comes back if you don’t address its cause and masking pain may lead to further injury and the cycle starts all over again.

What’s your strategy to tackle pain? But more importantly what’s your strategy to address the cause?

Early morning exercises: The hidden danger to your back.

early morning run

Its important to say at the beginning of this article that the people who get up early before work or on their day off to exercise should be commended and this article is not meant to discourage. My aim is that it highlights a couple of easy to do actions which could prevent low back and disc injuries creeping in.

To fully understand the concerns with early morning exercise we need to review the anatomy and physiology of the spinal discs in the low back. The discs primary role is to aid the spine in distributing weight and force evenly through the body. It was often thought that their main role was shock absorption but this has since been dis-proven and they are now more accurately described as force distributors.

The discs are made of two types of tissue. A toughened rope like outer structure called the Annulus fibrosis and a softer toothpaste like inner structure called the Nucleus pulposus (see picture below). Over time poor posture, prolonged sitting and repetitive movements can cause small tears in the outer tougher Annulus. With repeated tears over time the inner Nucleus will migrate to the outside of the disc. It is at this point symptoms are felt as the disc presses on surrounding sensitive tissue and nerves.

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The discs absorb its nutrients and water when we are sleeping and non weight bearing. These nutrients are vital for the health and strength of the disc. Like a sponge filling with water the discs become saturated. On waking first thing in the morning the discs are at their fattest. We are actually slightly taller first thing in the morning compared to last thing at night. This though can be an issue when wanting to do strenuous exercise. When the discs are fully saturated more pressure and stress is exerted on the Annulus during compressive loading. This means that excessive stresses and strains through the disc could cause tearing of the outer fibres and/or bulging. Exercises like running, squats, dead lifts, lunges and jumping place large compressive loads on the spine and discs and therefore could cause problems. Morning sit ups are definitely not sensible, no matter what the Rocky training montages may suggest.

So should I completely avoid doing these exercises during my morning routine?

Definitely not. It is important though you take the time to prepare your body for the demands of these exercise. Spending the first 30-40 minutes of the morning weight bearing (standing and walking) allows the discs to adapt to the pressures and loads not experienced during sleep. This will actually remove some of the water from the disc but in doing so allowing it to be more strong and stable. Discs can also be put under huge stress from sitting so people who have a long commute to work or those to tend to sit down early on should take note. I advise my clients to have their breakfast standing if possible. This will help the disc adapt to the stress of weight bearing without stressing it enough to cause an annular tear. After weight bearing for the first 30-40 minutes a thorough warm up is needed. Don’t start with a weighted bar when doing squats or dead lifts. Use body weight and dynamic movements which increase in range as the warm up set progresses ie. Cat Camel.  If running, spend the first part fast walking slowly building to your running pace over 5 minutes.

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Although swimming doesn’t put as much compression through the spine as the other exercises described I would still follow the advice just to be safe.

In conclusion early morning training is a great way to start the day and can give you an energy boost which is felt for the rest of the day but rolling out of bed chucking on the trainers and hitting the gym hard is not the way to do it. Give yourself time to adapt. Walk and move then spend time warming up with dynamic body weight exercises. It might meaning having to get up a little bit earlier but it could mean the difference between staying fit and healthy and having a disc injury resulting in time off work and exercise.

Tight Hip Flexors: A catalyst for dysfunction

As a Chiropractor I see clients present every week with a similar pattern of musculoskeletal dysfunction. Often masked by differing presenting symptoms the same underlying bio-mechanical cause can be identified more often than not.

The spine, hips, knees, pelvis and sacrum are all strongly influenced by one of the biggest groups of muscles in the body. This group consists of the Psoas, Iliacus, Rectus Femoris and Sartorius muscles and is commonly termed the Hip Flexor complex. Responsible for bringing the knee towards the torso, these groups of muscles are very important in walking, running, squatting, lunging, balance and spinal stability. Often thought of as a secondary cause of dysfunction the hip flexor complex plays a more prominent role than it’s often given credit.

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The problem starts when the hip flexor becomes chronically tight. This doesn’t happen overnight thankfully but after prolonged hip flexion repeated daily. Most commonly this is from sitting. A large percentage of the population spend a significant part of their day sitting, whether it be in the car, at work or relaxing at home. Sleeping in the foetal position also promotes prolonged hip flexion

Over the past decade the detrimental effects of sitting have been a hot topic of research. In 2013 Dr. Camelia Davtyan, clinical professor of medicine and director of women’s health at the UCLA Comprehensive Health Program dubbed ‘sitting as the new smoking’ because of its effects on our overall health.

Focusing on its effects on the spine sitting causes the hip to be flexed, normally at 90 degrees, causing the hip flexors to become slack and bunched. Like brining two ends of a tightened rope closer together. Spending large amounts of time with the muscle in this position will cause it to adopt a chronically short and bunched (tight) position. The rope becomes shorter. This becomes a problem when we need to use the hip flexor through the hips full range of motion.

The Iliopsaos muscle, one of the big players in the hip flexor complex, attaches from the lesser trochanter of the hip to every segment of the lumbar spine. A hip flexor which is shortened will become taught during standing placing stress on the spine. Walking and running will increases this stress further. The long-term effects of tight hip flexors are an anterior pelvic tilt, which is when the pelvis tilts forward due to the pulling from the tight muscles. Alteration of the pelvic biomechanics due to this tilting has a number of knock on effects:

  • The hamstrings become chronically pulled placing them at tension even at rest (increased risk of hamstring strains).
  • The Lumbar Lordosis (low back curve) is increased placing stress on the lumbar facet joints altering the load distribution of the lumbar spine.
  • Reciprocal inhibition of the Glutes. The tightening of the hip flexors reduces the activation of the muscles primarily responsible for hip extension (glutes). This causes them to become weak. It also alters the firing patterns of the posterior muscles of the hip. The hamstrings often become the dominant hip extensor instead of the glutes. I will discuss this hamstring dominance in more detail in my next article.

This is often when people present to their chiropractor with back pain, flank pain and/ or hip pain. Sometimes it can present as recurring hamstring strains, more commonly seen in soccer players.

 ant pelvic tilt                                   

So its clear to see how the chronic shortening of the hip flexor can lead to a cascade of musculoskeletal issues which if treated in isolation may bring about temporary relief but do not address the underlying cause of the problem.

So how to we over come this?

Whether symptomatic or not people who spend a lot of time sitting should be doing the following regularly to prevent long term issues creeping in.

Stand and move often: Break the monotony of sitting and its damaging effects. If possible use a standing desk. If not then set a reminder on your phone or computer to get up and move every 20 minutes. This has been shown to help reduce the effects of prolonged sitting on the muscles, ligaments and spinal discs and well as giving the hip flexors a chance to lengthen.

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Stretching or yoga regularly. Unfortunately stretching for 10 minutes once a week is not best. Spending small amounts of time every day stretching the hip flexors will have a greater influence in restoring a good functional length. After all we do the things that cause them to tighten every day without fail.

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 Gluteal activation and strengthening. Keeping the Glutes activated and strong is very important for the stability of the pelvis and low back. Glute bridges, Quadruped Hip Extension, Single legged Glute Bridges and Clam shells are all great at activating and strengthening the Glutes

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                                                                      Glute Bridge

quadruped leg ext  Quadruped Single Leg Extension

single legged glute bridge Single Legged Glute Bridge

Core stability. The core is a general term given to a large group of muscles that work together to bring stability to the spine and pelvis. Core stability exercises re-establish the correct firing pattern of these muscles that is often altered with the biomechanical effects of tight hip flexors. The dead bug is a great exercise which can be stripped down or built up to meet the conditioning level of your patients.

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 Dead Bug

See your Chiropractor: As I mentioned at the beginning of this article the hip flexors are involved a lot of the time but not all the time. All of the above tips are great but if you have to sit everyday for long periods of time there is no substitute to seeing your chiropractor regularly for an adjustment.