Pain, although a necessary part of living our lives, is a nuisance when we are trying to return to things we enjoy or trying new activities. But is all pain bad during exercise? I came across a great article by Smith et al., which breaks down the impact exercise may have on pain (Article here). To summarize, here are the main points:
It Can Help Reduce Fear of Pain
Chronic pain may lead to fear of exercising or doing activities because it hurts. This may lead to a cyclical pattern where people become fearful of movement/activities. When you have this fear it may lead to more avoidance of activities. It becomes what seems like a never ending cycle. Exercise can be the way to break this cycle.
Allowing yourself to experience some controlled pain during exercise can serve to reduce the threat of pain and increase self-efficacy. Confidence in one’s ability to achieve a task in a certain situation can shift the expectation on how they will respond to the activity. These are all important aspects when uncertainty and fear are so high.
It Can Actually Reduce Pain
There are 2 proposed theories of how exercise can reduce pain.
Enhances Immune System Function
As our understanding of chronic pain increases, we see just how many body systems are involved. The immune system is thought to be a key player in chronic pain. Exercise has been shown to have a positive effect on our bodies ability to fight off bacteria and viruses through a cascade of mechanisms. Exercising with pain can reduce the amount of signals being sent to areas that increase inflammation in our body and improve our immune systems response to different stimuli.
In summary, the area of research around the role exercise plays in chronic pain management is continuing to grow. In general, exercise is promoted because of the numerous proven health benefits. You can always start by moving a little more, challenging yourself a little more and setting attainable goals. When it comes to managing chronic pain and exercising, setting reasonable expectations/goals and appropriate safety measures can lead to success in returning to activities you enjoy.
Smith BE et al. Br J Sports Med July 2019 Vol 53 No 14
What is Fibromyalgia?
Fibromyalgia is a systemic issue characterized by widespread pain, fatigue, fogginess, and tenderness in tendons and muscles.
How do I Treat Fibromyalgia?
The best way to treat fibromyalgia is through lifestyle changes that include diet, mobility and resistance training, sleep, pacing and energy management, and returning to things you enjoy. These changes have been proven to be difficult for people for many reasons, therefore it is best to have a multi-disciplinary team that works with you to help make these changes.
Why Does Fibromyalgia Hurt?
There are processes in the body associated with Fibromyalgia that researchers are still trying to figure out. One process is called central sensitization. This is a fancy term for when our nervous system freaks out easily. With this process there are changes to how our nervous systems react to stimulus that generally are not perceived as dangerous. This can range from touch, heat, cold, scents, etc..In some cases, simply poking an area lightly can cause pain, a process called allodynia. Despite this increase in pain being experienced, it is essential to know that damage to the tissues is not occurring.
How Can Physiotherapy Help Fibromyalgia?
At One to One Wellness we focus on health empowerment, meaning we take the time to better understand what is important to you and strive to give you the tools to improve your quality of life. An assessment of your current mobility, strength, and nervous system sensitivity provides us with an idea of what additional movements, activities, resistance training or manual techniques may be beneficial to help you achieve your goals.
It is essential that time be taken to better understand Fibromyalgia and how it is affecting your life. Sessions should include education on helping you understand the symptoms of Fibromyalgia and how they relate to your experience. These education sessions are important as they can help reduce fear of the symptoms and increase confidence in your ability to return to things that you enjoy.
Want to Learn More About Fibromyalgia?
Book a Free 30 minute screening with one of our Physiotherapists to determine what would be an appropriate course of action in helping you manage Fibromyalgia.
What can we do about pain?
– sometimes tissues repair but associated protective patterns may not, and that may be creating the persisting pain. Have you developed protective, but harmful, movement patterns? Are there areas of tension, tightness, weakness, compensation, that are not allowing your body to function normally as it once did?
– some tissues don’t repair as well as we would want, so have you learned how to stabilize, support, mobilize, or strengthen the area to make it as healthy as possible?
Sciatica is the general term for symptoms-mostly numbness/tingling/burning- that occur in the low back and down the back of our leg. We mostly hear it being associated with terrifying diagnoses and terms such as bulging disc, degenerative disc disease, piriformis syndrome and the list goes on. I will touch more on this below.
Simplified, the sciatic nerve is a big nerve that starts in our lower back, goes down through the back of the leg then splits into 2 nerves that go into our foot. It is responsible for the movement and feeling in the back of our lower leg and foot. Again, simplified.
It is important to note that the issues mentioned above (e.g, disc bulge, degenerative disc) occur in the majority of the population and people have no sciatic symptoms or pain! So we can not say for certain that these imaging findings are causing your pain. What we do know, is that nerves require a lot of oxygen to function optimally (20% of our total oxygen intake goes toward our nervous system). So no matter how the symptoms are occurring, movement is key.
Movement = Bloodflow
Bloodflow = Oxygen
Oxygen = Happy Nerves
So where do you start if you are experiencing sciatica type symptoms?
Some tests that we perform are to determine how sensitive the sciatic nerve is to movements that restrict it of oxygen. If these are positive, then we typically give exercises that mobilize the sciatic nerve to get it more oxygen and get it used to moving again. This can look very different depending on how sensitive things are. However, if you look at our nervous system, you will realize that there are numerous ways to work into mobilizing the sciatic nerve- there is always a starting point. It is also very important to understand that just because you feel something abnormal along the sciatic nerve pathway, this doesn’t mean there is damage to the nerve or you. Hurt does not equal harm.
It is recommended to get a full detailed assessment of your experience. How sciatica is impacting you and the things you enjoy that you might be missing out on, what you are currently able to do, movements that you can do and movements that are challenging. Coming up with an appropriate progressional plan of movements/exercises that relate to your goals is a good starting point to help you return to the things that make you happy.
If you have any questions or are experiencing any sciatic symptoms please do not hesitate to reach out to our team.
-Tyler Dillman – Physiotherapist at One to One Wellness
November. A month where men become a little warmer and (typically) a little uglier due to a bit more fuzz on that upper lip. One of the main objectives of November is to bring awareness to prostate cancer, the leading cancer diagnosis in men (1). Due to campaigns such as Movember, we are seeing more and more support for the use of exercise in cancer care.
According to the Ontario Cancer Care Guidelines for Exercise and the Clinical Oncology Society of Australia, exercise should be an integral part of every cancer patients treatment plan from diagnosis to post-treatment (2,3). With respect to prostate cancer and the effects of the treatments associated with it, exercise has been shown to improve and/or manage(4):
Exercise goes beyond side effect management and into improving survival rates for prostate cancer survivors. When looking at recurring prostate cancer resulting in death, men who participated in vigorous exercise > 3 hrs/week lowered their risk by 61% compared to those who participated in < 1hr/week However, if you are not at the capacity to exercise at a vigorous level, please do not be alarmed, as those who participated in a moderate exercise for <1hr/week lowered their all cause mortality risk by 46% (5).
Through all that scientific medical jargon, the main takeaway is ANY amount of exercise is beneficial for you and should be started as soon as possible.
One of the more concerning stats I have seen is that 82% of survivors of prostate cancer report their supportive care needs are not met (6), but they are also less likely to bring these concerns up to healthcare professionals, especially if it involves sexual dysfunction (6). Therefore, I encourage you to share with your healthcare team if you are experiencing any symptoms listed below (or any others) (4,8):
Sexual dysfunction; Including but not limited to: Erectile dysfunction, orgasm changes, penile shortening (95% of men)
Bowel/Bladder dysfunction (50% of men)
Loss of libido
It is indisputable that a supervised exercise program is one of the best medicines you can provide yourself. It improves physical, social, emotional, and mental wellbeing, all of which can be impacted by a cancer diagnosis and the side effects of treatments. It can be challenging and difficult to initiate this process, so if you don’t know where to start or if you are experiencing any symptoms above, please reach out and ask for help.
With regards to the brain: “All it has at its disposal is your past experience, the past experience it has wired into itself” A great quote from Lisa Feldman Barrett on how the brain works to make decisions throughout our day to day life (Interview here!)
But what does this mean for people where pain persists past normal healing time and is becoming chronic? How do your past experiences shape your current pain experience?
What Happened Before?
The brain is a phenomenal structure that drives everything we do. It receives an outstanding amount of information from your entire body in a fraction of a second, analyzes it at a ridiculous speed, tells us what action to do or not to do, and then briefly stores everything that just happened for possible future use. Beyond the fact that this happens without us even knowing, the fascinating thing is that if it keeps receiving the same information over and over, it becomes so fast and so great at analyzing the sequence, it typically has pinpoint accuracy in predicting what to do next. This is great when we are taking our next step while walking, or go to fall and are able to catch ourselves, but not so much when we are talking about pain sensitivity. So if you have been experiencing pain for a significant period of time, a major component can be that your brain is predicting things to be painful based on what’s happened previously (The Predictive Brain article here!).
The prediction of danger is a genius protective mechanism during the initial stages of healing when things need to be protected, but not so much when things are healed and life needs to return to normal. So once the danger is no longer present (i.e.,muscle/ligament is healed, cast is off etc…), thank your brain for trying to protect you, but start letting it know that it’s no longer necessary. The major question is how do you go about that? Here are a few tips: 1) Know that movement is safe and needed for healing. 2 )Pain is not a direct measure of tissue damage. 3) Keep moving within your limits. Somatic exercises can be a great place to start (Youtube One to One Wellness). Finding your limits can be difficult so seeking professional help is strongly encouraged. 4) Start loading. Our brain needs to understand that this area is capable of going under stress, and that it is safe to do so. Star with low intensity and go slowly to build up tolerance and confidence. 5)Have recovery time and sleep. Your brain and body need time to adapt to these increases in demand and it can only do so if you are getting adequate breaks and a good night’s sleep. 6) Take a look at what you are eating. There is truth to the old saying “you are what you eat”.
The changes will not happen overnight but when you provide new, SAFE experiences to help re-wire the predictive nature from danger to safety, we can change for the better.
Lisa Feldman Barrett is a neuroscientist, psychologist and author who researches how the brain constructs emotion.
We all know the urban legend that bad luck or death comes in threes. But have you heard the axiom that death comes by threes? Three weeks without food, three days without water, and three minutes without air. While this satisfies my theatrical brain, and the rule of three in drama and story telling, it might not actually be precisely accurate.
True, the body can survive, on average, 3 weeks without food (Ghandi lasted exactly 21 days on his famous hunger strike). But, we can survive a little longer than 3 days without water. Perhaps even up to a week.
As for how long we can survive without oxygen, to be honest, there isn’t an exact number, but there is a pretty basic timeline of what happens to your body and brain without oxygen:
Given that the brain governs our entire body, it goes without saying that keeping it oxygenated is integral to our overall health and wellness. There is a ton of research devoted to oxygen’s role in exercise and post-exercise, everything from VO2max, to anaerobic threshold, to EPOC. High performance athletes benefit a great deal from understanding and enhancing their body’s ability to deliver oxygen throughout their body. But what about the rest of us? Athlete or not, we would all be wise to better understand oxygen’s role in wound healing and recovery.
The body’s ability to thrive, or heal from illness or trauma, is greatly influenced by factors such as nutritional state, immune function, blood flow and volume, hormonal mediators, sleep, etc… but some research suggests that oxygen may, in fact, be a critical rate limiting factor in early stages of repair.
Injury poses two conflicting complications, as the tissue has an increased need for oxygen and metabolic energy, but injury disrupts the normal capillary network, which is responsible for oxygen delivery to the tissue. So, it stands to reason that if you are further depriving your body of oxygen, your body may never meet the demands required for adequate repair and recovery. Let’s look, with very simplified explanations, at some of oxygen’s main roles in wound healing:
There are several metabolic and chemical variables we can manipulate to improve ones oxygen intake, transport, and delivery through the system. There are exercises we can do to improve our respiratory activity, our lung capacity, and even the oxygen transport. In fact, any exercise that challenges your body’s need for oxygen can, over time, improve your body’s uptake and delivery of oxygen. And there are even various oxygen supplementation products on the market. But one free and incredibly easy thing to do is to BREATHE better. I’ve written about this in a previous blog (Just Breathe), and we’ve posted a video on Alternate Nostril Breathing (https://youtu.be/-P6cnNZpdGU), which is a very easy breathing exercise that will help increase the amount of oxygen you are taking in and improve your exhalation, helping you to release carbon dioxide.
In so much as we can improve our oxygen levels, we can also severely hinder it. While there are some conditions that might prevent a person from maximizing their oxygen potential, the single most damaging choice you can make for your overall health is… you guessed it: smoking. Chronic inhalation of tobacco smoke causes irritation, inflammation, and scarring of the lungs tissue. With compromised lung tissue, you can’t get maximal oxygen intake or carbon dioxide output. Further, smoking increases blood levels of carbon monoxide. Yup! The stuff from car exhaust is also found in cigarette smoke. Carbon monoxide has the ability to attach itself to hemoglobin where oxygen otherwise would attach. This further decreases the oxygen delivered to the muscles (and the rest of the body, including the brain). The body tries to compensate for the lack of oxygen by creating more red blood cells. This sounds like a good idea, but more is not always better. In this case, the extra red blood cells can thicken the blood and actually further slow down circulation. It’s a veritable vicious cycle!
Bottom line, if you improve your body’s oxygen levels, you’ll improve its healing potential!
By Andrea McCulloch, RMT
You may be familiar with the song which describes how the “toe bone is connected to the foot bone, the foot bone is connected to the ankle bone, the ankle bone is connected to the shin bone”. A beautifully simple and clear lesson in skeletal anatomy, but there is so much more going on!
We are born into gravity and for the rest of our lives we are in a constant relationship with it. It is sometimes a battle, and gravity very often wins! But our bodies are very specifically designed to engage in this relationship – we have bones that are shaped and placed to bear weight and/or transmit the forces associated with gravity. In theory, if we used our bodies as they are designed, we shouldn’t have a problem with gravity. And I’m not just talking about losing your balance and falling down, I’m talking about the slow deterioration of joints, the “falling” of the arch of your foot, the downward sloping of the shoulders. Of course, there is the natural ageing process, but most of us spend a lifetime developing postures and movement patterns that will potentially speed up that process. How do these dysfunctional patterns develop? Through compensations. These are the acquired patterns that we adopt to keep us moving upright through gravity when we’ve been injured – and it’s not always a traumatic injury. Sometimes the injury is the slow onset of dysfunction related to how we spend our lives – sitting 8hrs a day, for example!
How does this relate to the song? Well, as I said, there’s much more to it than one bone connected to the next – the position and function of one joint can affect joints all the way along the chain. Let’s consider a common area of injury which may result in compensations down the line. “The hip bone is connected to the back bone” – in proper anatomical terms this is the iliac bone connecting to the sacrum. Perhaps you’ve experienced some low back or hip/buttock pain and been told it is your “SI joint (sacroiliac joint)”? This is the joint between the “hip bone” and the “back bone”, and as such it is very important in translating forces between your lower body and your upper body. The sacrum is a wedge shaped bone at the base of your spine and is specifically designed to translate forces (not weight bear) from above, across the wide base at the top of the bone through to the hips. If, through trauma (a fall on the ice), or habitual positioning (seated with legs crossed), your sacrum is knocked (trauma) or pulled (muscles from habit) out of position, it will no longer transmit those gravitational forces evenly through the pelvis. Now, with a sacrum in a dysfunctional position, there is more weight being born on one side. Sacral dysfunction often does illicit local discomfort, and may prompt you to seek treatment.
But in some cases, it isn’t treated and a compensatory gait has already developed, altering the positioning of the hip, the knee, the ankle, and the bones of the foot, allowing them to bear that extra little bit of weight that is coming down the line, keeping you upright in gravity. And thank goodness those joints did compensate, otherwise a lifetime of sitting with your legs crossed would mean you would fall over every time you tried to stand up! But it also means that now these joints are doing more than their share, and here we have the accelerated ageing mentioned earlier. (And don’t even get me started on how altered movement of the sacrum can affect the contents of your pelvis (bladder, uterus, prostate, colon), and even the spine and head!)
And to be clear, it can work in both directions – maybe that old ankle injury has altered weight bearing at the foot, and years later your knee and hip are giving out. So don’t be surprised if after a thorough assessment your manual therapist tells you that even though your pain is always in your left hip, the problem is originating at your right ankle!
Now that you see how your body is a functional unit (not a bunch of pieces operating independently), what advice do I have? Treat it that way! Move! In every possible direction – let your muscles do all of the things they were designed for (how often do you use the full range of your shoulder?) When you move, move the whole thing! When you seek treatment for a specific pain, don’t forget to mention that you repeatedly sprained your ankle when you were younger. Don’t leave out that you have frequent headaches, or digestive issues. Your manual therapist may ask you a lot of questions that don’t seem to be related to your complaint, now you know why!
Maybe the song should be “the foot bone is connected to… everything”!
Bones and joints: bone broth provides the raw materials for building and reparation of lean tissues. There is even some evidence to support regular consumption reducing joint pain.
Many thanks to those who came to our seminar series “Understanding and Overcoming Persistent Pain” at the Halifax Library. It was great to help people gain more knowledge about treating and, more importantly, preventing pain. Based on our experience, we know there is a gap in people’s understanding of pain. We wanted to let people know that (1) that they are not alone, (2) that help is available and (3) that it’s possible to regain control over that aspect of life.
Our passion stems from helping people who are suffering with persistent pain live more fulfilled lives. Education, movement, and exercise are key to achieving this. We are firm believers that knowledge is power and it is the first step in gaining freedom from persistent pain.
We were very pleased with the turnout for the last series of workshops and recognize that people want help managing their pain or a loved one’s pain. Here are some upcoming opportunities to learn more:
April 27th at One to One Wellness:
“Health Empowerment: 4 Steps for Shifting From Pain to Performance”
June Seminar Series at the Halifax Library: “Strengthen Your Health”
We will explore different wellness principles and how putting all the pieces together helps to not only overcome pain, but to optimize performance as well. Please come along and bring a friend. If you have any questions in the meantime, feel free to ask!
My inspiration for this blog article comes from a recent visit I had this weekend at my sister in-law’s house. They are dealing with an issue that many North American families have to deal with….kids that spend way too much time using electronic devices. She was upset because on a sunny day, her son spent 6 straight hours playing X-box. In addition to that, he spent time on the computer on MSN, Youtube, Facebook, and numerous other websites. Don’t forget television as well. This trend is growing at a ridiculous rate, and as a physiotherapist I get to see the physical effects.
RSI, or Repetitive Strain Injury, is a collective term for syndromes characterized by discomfort, impairment and loss of muscle strength and function. RSI often affects the neck, the back and particularly the arms and hands. It is found primarily in adults who perform repeated movements such as those involved in typing or playing musical instruments. It is commonly named according to the part of the body affected, e.g. tennis elbow, carpal tunnel syndrome, golfer’s elbow. We are starting to see RSI turn up in younger and younger patients which is rather alarming.
In addition to computers and gaming devices, there has been a substantial increase in the amount of time teenagers spend on their cellular phones sending text messages, thereby potentially affecting the prevalence of RSI in this group (2). The increased frequency of texting is leading to a condition popularly termed “Blackberry Thumb”, or “teen texting tendonitis”. This occurs because these devices rely almost solely on the use of your thumbs (not all of your fingers) for typing. Any device that relies on the thumbs for typing can cause this type of injury because the thumbs simply weren’t designed for such use (1,3). Repetitive mechanical loading of the thumb, combined with inactivity, and prolonged slouched postures resulting in increased neural tension results in increased risk of developing RSI.
Symptoms of “Blackberry thumb” include pain and numbness in the thumbs and joints of the hand (1). But there are also other bodily symptoms:
It is estimated that teenagers sending and receiving an average of 80 text messages each day may be vulnerable to repetitive stress injuries of the thumb (4). If you think this is a high number and unlikely, consider these statistics:
If you think my sister in-law’s son is a minority, then guess again. Here is another interesting statistic: Americans between ages 8 and 18 spend an average of 7.5 hours a day using an electronic device, be it a computer, cellular phone, or television (4). If this sounds like your child, or one you know, then consider these tips to avoid developing these repetitive strain conditions:
Restricting time spent on electronic devices, and increasing physical activity will significantly reduce the risk of developing RSI conditions. If your child develops symptoms of RSI, please see an appropriate health practitioner to help deal with the issue. If left unchecked, these symptoms can progress and become quite severe and debilitating. If this issue is familiar to you, the staff at One To One Wellness would like to help you.