15Nov/14

5 facts about repetitive strain injury | RSI

 

Repetitive strain injury (RSI) usually refers to pain and other symptoms felt in the hands, wrists and arms, often gradually becoming more noticeable. Unfortunately, many people continue in the same vain at work without seeking advice or changing their habits, resulting in a persisting sensitivity that can become very limiting — often in relation to typing and writing, but this can extend to any activity involving the arms and hands. RSI is also called a work related upper limb disorder (WRULD).

1. Despite the pain and other symptoms (e.g./ pins and needles, numbness), there can often be no significant tissue damage or injury. Hence, debatably it is not actually an injury or even a ‘strain’.

2. It is common for the pain and symptoms to be noted on both sides. Despite the problem beginning on one side, communication within the neuroimmune system gran underpin ‘mirroring’.

3. There can be an altered sense of the hands — feel cooler (the brain perhaps not recognising the hands as self and changing blood flow), bigger, detached. You should report any experience to your healthcare professional because these are important features that guide the type of treatment and training you need.

4. Hypermobile joints are common within the overall picture — BUT, hypermobility is not a problem per se. Just look at all the top athletes. They are hypermobile! You may be a bit clumsy and walk into furniture. Body sense should be re-trained or developed if so.

5. RSI or the like can be embedded within other painful problems such as IBS, migraine, widespread joint and muscle pain. It is not just office workers, text-maniacs and computer users that suffer, new mums are commonly affected with the host of repetitive (new) chores.,

If you think you are suffering with RSI or a similar persisting pains, come and see me to find out how to overcome the problem — RSI clinic in London, call 07518 445493.

If you are a business that is keen to prevent RSI and other persisting pains (e.g./ neck pain, back pain), come and talk to learn about strategies that you an put into place to save money and increase productivity: 07518 445493

14Nov/14

5 facts about complex regional pain syndrome | CRPS

 

Thanks to modern pain science we know a huge amount about complex regional pain syndrome (CRPS). Of course there is much more to know, and the way in which we think and take action to tackle the problem will evolve accordingly.

 

Here are 5 facts that I believe to be important:

1. The pain is not directly related to the extent of the injury or damage — the pain in CRPS can be unimaginably horrendous without any great change in the tissue health. Remember that pain is part of the way that the body protects itself, and not an indicator of tissue damage.

2. The affected limb can feel very different to the way it looks; size and temperature included.It can even feel like it does not belong, being described as detached or ‘not mine’. The loss of sense of ownership is because the brain provides this sense, but can also modulate it.

3. The symptoms can change according to your mood and the way you feel — stress can often make the pain worse. This is due to the perceived threat to the whole person triggering protection.

4. Seeing someone else move their corresponding body part can hurt. The brain starts to plan the same movement and will also protect at this stage, causing actual pain.

5. The limb changes colour because of blood flow changes. The autonomic nervous system (ANS) controls blood flow. This is the system that responds to perceived threat — ‘freeze, flight or fright’. In essence it is a system that responds to how and what we think. When we are embarrassed, we turn red (blood flow). This is because of the way in which we think about the situation:’ I have said something that I now think is silly’, ‘Is he looking at me?’ The ANS can also become sensitive, and is very involved with CRPS — colour change, altered sense of size, sweaty palms etc.

Suffering complex regional pain syndrome? Visit my specialist CRPS clinic in London to start your programme: call 07518 445493

09Nov/14

My top 5 pain myths

In my view, it is the lack of understanding that causes so many problems with pain in terms of how pain is viewed, treated and conceived as being changeable. Pain can and does change when you understand it and think about it in accordance with the modern (neuroscience-based) view and have a definite plan that is followed with big action towards a vision of where the you want to be. Having seen many individuals put this into practice, I am confident that the start point is always how we think because this is from where the action emerges. The right thinking begins with understanding your pain.

In the light of this, here are my top 5 pain myths:

1. Pain comes from a ‘structure’ in the body — e.g./ a disc, a joint, a muscle.

2. The amount of pain suffered is related to the amount of damage or the extent of the injury.

3. Pain is in your mind if there is no obvious cause in the body — i.e./ via scans, xrays etc.

4. There are pain signals from the body to the brain.

5. Pain is separate from how you feel or think.

There are many others.

Now, this all sounds rather negative and I like to turn this on its head and look at how we can positively influence health in order to change pain. The programmes that I create with individuals for them to follow are all about creating the right conditions in the body systems, all beginning with the right thinking that often challenges existing ideas and notions about pain.

Struggling with pain? Persisting pain? Call me 07518 445493 | Specialist clinics for pain and persisting pain in London

28Oct/14

Intense pain after wrist fracture — predicting CRPS

A recent study concluded that “… excessive baseline pain in the week after wrist fracture greatly elevates the risk of developing CRPS. Clinicians can consider a rating of greater than 5/10 to the question “What is your average pain over the last 2 days?” to be a “red flag” for CRPS”.

Most of what we need to know as clinicians comes from what the patient says. I have written previously about the importance of the narrative and taking heed. It appears from this study that paying attention to the early levels of pain after a wrist fracture can indicate a risk for developing complex regional pain syndrome.

Pain is poorly understood, especially more complex and persisting pain. Raising the level of pain understanding is fundamental to its treatment and for sufferers to overcome their problems. In knowing that intense pain (more than 5/10) could be a sign that CRPS is developing, the right action can be taken early and thereby prevent the condition evolving uncontrollably.

Of course the intensity of pain is but one dimension and clinicians should observe other characteristics of protection to design a comprehensive rehabilitation programme — e.g. inflammatory signs, posturing, behaviours and language to name but a few; this in the name of tackling the problem of pain more efficiently and successfully.

CRPS clinic in London — call us now to start your comprehensive treatment and training programme 07518 445493

 

 

28Oct/14

Top 5 back pain myths

Welcome to my top 5 back pain myths. What are these you may ask?

Around pain and in particular back pain, there are many phrases and explanations used to try to educate the patient. These have been handed down through the generations and can appear to be logical. Fortunately, the science has moved on and we know better.

Here are 5 common beliefs that have been challenged:

**I have not included the myths of core stability because this has been well documented previously. Pulling in your abs does not solve the complexity of back pain, especially chronic back pain.

1. Bending is dangerous

2. Discs slip

3. Nerves are trapped

4. Pain comes from facet joints, discs etc

5. Low back pain is in isolation to everything else in your life.

Comments below:-

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1. Bending is normal. Sure it can hurt when the back is being protected, and when we have back pain the muscles are guarding and this can reduce the amount of movement. In the acute phase, most positions and movements hurt, but this is protection and it is meant to be unpleasant in order to motivate action. Moving little and often, changing position and breathing all help to keep blood and oxygen flowing.

2. Discs are not actually discs and they do not go anywhere. Yes they can be injured like any other tissue. They can bulge and affect the local environment, and they can herniate, triggering a healing response — both can hurt because protection is initiated. The fact that there are so many nerve endings around the area mean that sensitivity can arise in a vigorous manner. Again, this is a normal if highly unpleasant experience. Remember that a 1/3 of the population have such changes in their spine but without any pain. The body as a whole must rate the situation as threatening for it to hurt.

3. Nerves do not get trapped. Local swelling and inflammation can sensitise the nerves meaning that they send danger signals. There is not too much room either, so if there is swelling or a bulge, this can affect blood flow to the nerve itself and cause sensitivity to movement and local chemical changes. Again, this can happen without pain as well, so it is down to the individual’s body systems and how they respond. Understanding, gradually moving and breathing can all help ease you through this phase.

4. Pain is whole person and involves many body systems that are protecting you. There is no pain system, pain centre or pain signalling. Pain is part of a protective response when the body deems itself to be under threat. We feel pain in the body but the underlying mechanisms are upstream of the body part that hurts. To successfully overcome pain we must go upstream as well as addressing the health of the body tissues.

5. Low back pain is embedded within your lifestyle. It is not separate to how you live — e.g. lack of exercise, postures, work, stress, emotional state, previous experiences, understanding of back pain, gender, genetics, just to name a few. This maybe more complex, but this provides many avenues for overcoming pain.

Suffering with persisting back pain? Have other seemingly different problems such as irritable bowel syndrome (IBS), headaches, migraines, other joint pains, muscular pains, pelvic pain, jaw pain, recurring bladder infections? Contact me today to learn how you can move forward and overcome your pain: 07518 445493

26Oct/14
Mindfulness

Pelvic pain in men

Many men experience chronic pelvic pain that significantly affects their lives. When we talk of pelvic pain, we often think about women and their suffering, however, this problem is one that besets both sexes and hence we must encourage all who endure such pain to seek help. As with any persisting pain state, pelvic pain impacts upon the way we think, the way we act and the decisions we make, thereby intruding on quality of life.

There are many reasons why men can suffer pelvic pain. To identify all the causes is not the purpose of this blog, but rather to highlight the problem and provide an insight into how the body becomes stuck in a protective mode. This is the experiential dimension, the story that is told and the narrative that provides all the clues. For the pelvic pain itself is downstream, and with chronic pain we must also go upstream to look at the context within which the pain is happening.

Most people who come to see me do not have pathology or ‘damage’ that justifies the pain response that they suffer. Some have nothing of note at all as shown by scans and other tests. Understanding that you can be in pain without an injury is an important step towards changing pain — for those new to this notion, consider phantom limb pain for a moment. Often there is a start point that involves inflammation, which shifts the body into protect mode. Protect mode involves many body systems, conscious and unconscious behaviours (the latter being habits and conditioned responses). When the body is protecting itself, the area needing attention and defending will hurt, but we also move differently and think differently — if you have a painful ankle, you may think twice about ‘popping’ out to the shop for a paper.

In many cases, these protective responses die down as healing progresses. However, this does not always happen, and with statistics suggesting that 20% of the population suffer chronic pain, many continue to experience protection despite the tissues healing — pain, tension, a different sense of the body (there are many other feelings and sensations described to me, and I encourage this narrative so that I can fully appreciate the story). My thinking about this on-going protection is that the body senses all is not as well as it should be. In other words, the individual is not fully fit, the tissues (muscles, joints etc) are not entirely healthy, behaviours are not orientated towards health, and lifestyle factors in which pain is embedded have not been addressed satisfactorily. This is a huge topic to address at another time, but suffice to say, as much as pain is multi-factoral, so is recovery, which is why a programme to change pain must address the biology of pain and all the influences upon this biology (they are also biology!).

Back to the pelvis, an area full of muscles, nerves, blood vessels, ligaments and other soft tissues. From the pelvis ‘hang’ the legs, and on top sits the trunk. And let’s not forget the genitals, and both their importance and necessary sensitivity. The deep tension and pain that one feels in this region is truly visceral, radiating out into the groin and abdomen, accompanied by an awful tension and pulling in the muscles and testicles. Once the pelvis is grabbing your attention, it can be hard to distract yourself without learning how to change body tension.

In this very personal tale of pelvic pain, Tim Parks describes his own journey via the book he wrote, “Teach us to sit still”. It’s a wonderful read for so many reasons, and I frequently encourage patients to tuck in. For me though, the bottom line is that Tim has validated a problem that needs addressing in a comprehensive manner, because so often there is no serious pathology despite the significance of the suffering. Getting to grips with this is part of moving forward and should be embraced. We do not need pathology to hurt. There are other reasons, one of which includes, as Tim says, sitting on your pelvis for 20 years and being stressed — this is by far enough to cause nasty pelvic pain!

What do you do when you are stressed? Tense muscles. This has an energy cost and impacts on the way oxygen is delivered to those very muscles. Consider exercising a muscle over and over. It hurts. It is exactly the same in the pelvis that you may be parked (no pun intended Tim!) on for extended periods of time. “I don’t get stressed” you may say. First of all, I don’t believe you (sorry!), because we all stress out at times and secondly, most of the time we are unaware of what our body is doing in response to our thoughts, environment and what we are doing; that is until it is too late — ooh, my ____ hurts because I haven’t moved for ____ hours (fill in the gaps).

So, what can we do. What do we need to do. Here are a few things that I believe are fundamental to changing what your body is doing:

  • Understand your pain and condition — that’s your clinician’s job, to help you.
  • Create awareness of how your body is responding rather than being on autopilot and then fire-fighting when it gets too much.
  • Think about what the body needs — oxygen to the tissues, especially nerves that become very grumpy when the supply drops (numb bum from being sat too long) — and make sure you do enough to nourish the muscles: move and breathe!
  • Go upstream of the pelvic pain, and look long and hard at your lifestyle and environments — e.g. How are you doing things? Where are you doing things? What habits can you release and change?

Chronic pain is a huge and costly global problem. The main reason why this is true is because of misunderstandings and the low expectations of successfully overcoming the condition (patients and clinicians) because the focus is upon treating ‘structures’ deemed to cause pain. Pain is not a structure, hence why this approach fails. The science of pain has moved forward hugely over the past 10 years and continues to deliver a new understanding. This new understanding challenges existing thinking, and it needs to. Pioneers of pain are hard at work and are finding ways to reduce suffering, and we can. It starts with a change of thinking based on new knowledge. Your knowledge that is translated into effective action.

If you are suffering pelvic pain, get in touch and start your programme to overcome your pain — call us now 07518 445493 — Specialist clinic in London and Surrey for chronic pain & persisting pain

 

22Oct/14
IMG_1693.JPG

Girls, stress and pain

I have seen a number of teenage girls over the past year who are affected by chronic pain. They are often referred because of recurring headaches or migraines but we discover that there is widespread sensitive at play. How does this happen? Why does it happen?

Headaches and migraines can be functional pains. When these pains are part of a picture of sensitivity, often accompanied by anxiety, there are often other problems such as irritable bowel syndrome, pelvic pain and jaw pain. Whilst these problems all appear to be different, they have a common biology. Typically I work with women aged between 30 and 55 who suffer these aches and pains, but increasingly this is an issue of the younger female. Having said that, when I explore the story of an adult, we often find reasons for sensitivity that begin in childhood. This priming sets the scene for later events.

As adults we face many challenges. We have body systems that are trigged by these challenges, especially if we think they are threatening to us. In particular the autonomic nervous system (ANS) is quite brilliant at preparing us to fight or run away, which is very useful…..if you are facing a wild animal. On a day to day basis, it is in fact useful for the ANS to kick in and create some feelings in the body that alert us to danger — the caveat being, nothing is dangerous until it is interpreted as so, and hence we need a construct of ‘danger’ and of the thing that is perceived to be dangerous. For example, a baby may not have the construct of a lion and hence sees this big, cuddly, moving….thingy…like my teddy (may not have a construct for any of these either!), and essentially detects no threat. As the baby detects no threat, he or she behaves in a way that may not threaten the lion and hence the lion may feel safe. Both feeling safe, they become friends. Perhaps — these things have happened apparently. Please do not try this at home, but hopefully you get the idea. Back to day to day….

In the modern world we often feel anxious. This is the body warning us that something is threatening. In many cases that I see, there is a strong reaction to banal events and non-threatening cues. Or if the cue is worthy of attention, the response is well out of proportion — e.g. utter panic and defensive thinking-behaviours. To what do we respond most frequently? Definitely not lions. Muggers? Gunmen? Earthquakes? Tidal waves? These are all inherently dangerous situations, that we simply do not often face. Sadly some people do have such encounters but the majority of us do not. The answer is our own thinking. The thoughts that are evoked — seemingly appearing form nowhere at times — are not the actual problem but instead the interpretation of the thought (metacognotion; our thinking about our thinking). The meaning that we give to a thought, often automatically, will determine the body response as our thoughts are embodied. And just to complicate things further in relation to thinking, there’s a world of difference between the experiencing-self and the memory-self. The former refers to what is happening right now, the latter to what we remember, or think we remember. In terms of pain, if our memory of a painful event concludes with a high level of pain, this will flavour the memory-self and we will report as such. The story, which is a snapshot within our lives, and how it turns out has a huge impact upon the subsequent memory of what happened.

The adult within an environment that becomes threatening, the workplace for example, can become very responsive to different cues that once were innocuous. Now they pose a potential danger and each time that happens and we respond with protective thinking and behaviours, the relationship becomes stronger — conditioning. There is no reason any this cannot be the same for younger people who are consistently within an environment and context that begins to pose a threat; a demanding school environment with high expectations plus the child’s own expectations and perfectionist traits. Place this context within a changing period of life and minimal time for rest and there is the risk of burn out or development of problems that involve many body systems. We cannot, no matter what age we are, continue to work at a level that is all about survival.

I focus on girls and women because females outnumber the males coming to the clinic. Many are perfectionist, many are hypermobile, many are anxious, many are in pain and many are suffering. This is a situation that needs addressing worldwide, and starts with understanding what is happening, why it is happens and how it happens. Over the past 10 years this understanding has evolved enormously, providing tangible ways forward. This does not mean that we need to change perfectionism, but rather recognise it and use it wisely; this does not mean that anxiety is abnormal, but rather recognise it as a normal emotion that motivates learning and action; this does not mean that feeling pain is a problem to fear, but rather know it can change when we take the right action; and it does not mean that we will not suffer, but rather accept that part of living involves suffering that we can overcome and move on.

We have created an incredible, fast moving world. The body does not work at such a pace. It needs time to refresh and renew so that we can think with clarity and perform to a high level, achieve and be successful. We are humans. We are a whole-person with no division between body and mind; instead one thinking, feeling, sensing, creating, moving and living entity responding to the experience of the now and to memory of what we think happened. Gaining control over this with understanding and awareness provides a route forward to wellbeing, no matter where the start point.

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If you are suffering with persisting pains — body pain, joint pain, irritable bowel syndrome (IBS), headache, migraine, pelvic pain, jaw pain + feeling anxious, unwell, tired — call now and start moving forward 07518 445493 | Clinics in Harley Street, Chelsea and New Malden

20Oct/14

Chelsea FC – ‘long, long’ injury list

Part of the role of being a manager is to juggle the team according to injuries. The list of injured players in The Premiership at the moment is significant. Jose Mourhino described his list as ‘long, long’, hence the Chelsea manager is being forced to consider his options for the forthcoming games. With the ever-growing costs involved in football, questions about players’ availability are now a routine focus for interviews.

Diego Costa is struggling with a persisting hamstring injury. Leg injuries and pain are the scourge of footballer’s careers, but with a change in thinking, many of the on-going problems can be eradicated.

Certainly players work hard on their conditioning to make sure that their bodies are prepared for the rigour and vigour of the modern game. Time away from running and kicking allows for the body to adapt — muscles and the systems that control the muscles. Active rest is vital and should include a techniques that create calm in the body via the mind. We know only too well the potent influence of the mind upon the body and vice versa. Allowing a negative thought about pain or injury to take hold will affect movement and performance. But, there are effective ways of dealing with this and should be routine for both players and managers.

There is a difference between hamstring pain and a hamstring injury. The latter involves damaged tissue whereas the former does not. Everyone needs to understand this and know how to discriminate — by everyone, I mean players, medical staff and managers. With everyone knowing the facts about pain and injury, communication is open and free, meaning that any stress created by worry and concern is eliminated. One thing that is not good for pain is stress. Why? Because the body will be in protect mode, and this is not compatible with recovery.

Understanding pain and injury is the start point. From here, recovery can be planned and implemented, working with all the body systems involved with injury and pain — and that includes body awareness, sensorimotor function, immune function, autonomic function; all involved with protection. Protection is vital in the initial stage of an actual injury, but as healing takes hold, the biology of protection may need a helping hand to switch off.

Struggling to get back to football? Have a player who is struggling? Get in touch and we can work together to return him or her to play — 07518 445493

 

 

18Oct/14

More Premiership injury woe

Headlines today in The Guardian sport section report that Daniel Sturridge is suffering from a further strain, this time in his calf. I do not know if this is the same leg as the thigh strain from which he has recently recovered, but if so, I would not be surprised. In addition, we learn that Raheem Stirling told Roy Hodgson that his legs were sore. Anyone who plays sports will know that feeling.

A second injury or pain on the same side — why?

When we injure a muscle or ligament, inflammatory chemicals are released locally. Danger-sensing nerves (nociceptors) are activated by these chemicals when their threshold of firing is lowered. Danger signals are sent to the spinal cord, where modulation takes place with signals being sent down from the brain — these are in response to thoughts, emotions, context, perceived danger etc. The danger signals are then sent up to the brain via a second neuron, where an analysis of what is happening takes place. On concluding that there is danger, pain emerges from the body in the place where it is thought the problem lies. The body uses cortical (brain) maps to allocate the pain in the body. Put simply, the biology of pain does not reside in the injured tissues but instead involves the protective functioning of many body systems working together.

Once protection kicks in, pain draws our attention to the area, our movement changes as does our thinking amongst other things. This does not involve only the injured body region, but widespread responses of body systems that protect us from actual and potential threat. The original injury goes through a healing process — we have incredibly potent healing abilities — yet the sensitivity and protection can persist. If, for example, the thigh is strained, it is all the ‘wiring’ that involves the leg that will be on alert. Without full resolution, and this includes confidence in the body, the systems are primed and hence during this period it is easier to ‘pick up’ another injury. Sometimes there is an actual injury and damage, but often there is nothing discernible yet it hurts in the same way. Differentiating an actual injury from the sensation of an injury is important. Players and coaches understanding these mechanisms (of pain) is vital in my view, so that these problems can be tackled efficiently. It would be straight-forward to deliver a mandatory, FA backed education package — contact me for details of an education programme.

In summary, why do pains appear on the same side? Because the initial sensitivity has not fully resolved in the case when no actual injury can be found. If there is a strain or sprain detected, there is a good chance that motor control, body sense and awareness and or confidence are not complete. Of course, there is always the possibility of just plain old bad luck, however I would suggest that it is more likely that the body remains in a degree of protection mode.

Aching legs and recovery

Briefly, the body needs time to recover from the demands of exercise. This can be all out rest for a short period but also active rest that would be a lower intensity of movement and activity; a skills based session for example. There are ways of enhancing recovery that include focused movements and body awareness exercises as well as the practice of mindfulness. We have a great ability to adapt, and in fact our body systems are continually changing and adapting to our lifestyles. This is one of the reasons for chronic health problems in a society that is ‘wired’ and ‘immediate’. Put simply, our bodies are not designed in this way.

Educating players about pain, injury, recovery and health empowers them to make good decisions. With coaches and managers also understanding these principles, it creates a positive culture with clear communication about injury and pain. A player should always feel that he can talk openly about how he is feeling, physically and mentally — although I would argue that these are one and the same because we are whole person: genes, character, personality, experience, knowledge, beliefs, mind, body etc., with no single feature standing above the others.

Contact me for information about pain seminars and training at your club — 07518 445493

 

12Oct/14

Recovering well from surgery

Recent research suggests that we are getting closer to being able to predict how well individuals will recover from surgery (Science Translational Medicine, doi.org/v2p). This will be an important step forward, especially if outcomes can be determined by a blood test that predicts recovery times by identifying the immune signature. The results will need to be repeated, but this is an exciting development.

I see many people who underwent surgery and struggled to recover due to pain or the lesser known sickness response. I believe that with careful observation, listening to the patient’s story and a detailed assessment before the operation, we can identify those who are likely to have problems with pain. It is in part the history that provides clues about sensitivity and also how the person is approaching the surgery. Whilst anxiety and concern are natural, if worry takes hold, anxiety affects the immune system and other body systems, potentially diverting their workings towards protection rather than healing. There are effective ways of preventing this from happening with a proactive programme that starts before surgery and then optimises the recovery after surgery.

Call us now to find out about pre-operative assessments & the post-operative proactive recovery programme – 07518 445493