Approachable Fitness & Physical Therapy

Pain is not as simple as you might think!

Almost everyone will have felt pain at some time in their life. Here at the studio we see a lot of people suffering from pain, mainly associated with movement or a persistent ache. We can usually help to alleviate this either by reducing it or by offering techniques to manage it. What you may not realise is that there may not be a physical reason for the pain.

To get a better insight into what is going on when you hurt, we need to understand how you feel pain.

The ability to feel pain is very important to our wellbeing. It stops us doing things that are damaging to our bodies, and makes us rest to allow our bodies to recover from injury. So you really should not ignore pain, or simply "work through it".
Firstly you should make sure that there is not physical damage causing the pain.

The expected mechanism of pain starts with some physical damage which causes receptors within the nervous system to fire. This action creates minute electrical currents which are passed from nerve cell to nerve cell up to the pain perception center in the brain. It is here that these signals are actually converted into what we know as pain. All along this pathway it is possible for your body to mistakenly trigger, sometimes from a sort of nerve memory. Hence, for example, the site of an old injury can often be painful even though there is no damage or reason for that pain.

The brain itself is quite capable of "making up" pain. If you injure your ankle your brain will avoid movements that cause pain in the damaged area. This is good. However once the damage is repaired, the brain continues to avoid movements that were painful. The fear of pain can cause actual pain. The brain has to be retrained to understand that the pain is no longer there by specific repeated movement patterns.

Often in avoiding pain the body will stress another area and cause a pain there. It doesn't always make the right decisions as to the best way of helping your body.
We see this type of issue often at the studio. A client may have had a small injury to a back muscle lifting something heavy out of a car (shopping or a child are frequent culprits here). The body's defense mechanism leaps into action and activates a range of alternate muscle actions to protect the damaged area. Unfortunately this will usually cause a misalignment, or imbalance in the body, often resulting in the stressing of and possible damage to a whole set of different muscles ranging from shoulders to knees and ankles.

Clients come to us with a problem in their knee. However, when we have taken a holistic review of their gait and completed a range of movement tests we can see that the problem is not in fact in the knee at all, rather it is a bodily imbalance brought about by a completely different issue.

So, if you have pain, my advice is:
Firstly, check with your GP to rule out a structural or other cause which needs medical treatment.
Then, come to The Studio for a half hour one to one consultation so we can assess the best ongoing solution.
Alternately, or in addition, if you have access to a physio ask them for muscle testing and exercises.

Frequently the solution from me (or a physio) will be regular exercise combined with soft tissue treatment and exercises to include in your existing fitness regime or to do at home.

Don't put up with pain, call us, we may well be able to help.
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Back Pain Solutions - The latest research

As a practitioner in the field of back pain and a member of ‘Backcare’ the UK’s national back pain association I receive regular updates on current research and recommendations.  The most recent publication contained several interesting articles which I will summarise and share with you.

Orthopaedic surgeons speak out about what they see as the alarming trend in dangerous and unjustified back surgeries.

To quote George Ampat a consultant orthopaedic surgeon based at Royal Liverpool University Hospital ‘Unfortunately, there is a false belief that surgery or new technology can fix back pain.  This is far from the truth.’  He says that out of 100 patients who see a health professional for back pain 97/98% will get better without surgery through exercise and over the counter medication.

There are many products on the market for the condition known as sciatica, most of which you will see advertised for a while before they disappear – usually because they don’t work.  Sciatica is usually caused by a collapse of the spinal discs pushing the intervertebral cushion out, a bit like squeezing jam out of a doughnut.  Fortunately, with time and stability work this will usually ease within a few weeks.  One research study in the US looked at the results of surgery and showed a benefit for up to 8 years after surgery.  In the same study, those who did not have surgery also continued to improve over the same period.  Another study looked at the return to work ratio of those having surgery v those not having surgery.  The result?  26% of those having surgery returned to work v 67% of those who didn’t.  In addition, there was a 40% increase in the use of painkillers in those who had surgery.

Exercise myth busted - Don't delay, be active:
Nick Sinfield, a chartered physiotherapist says that a common effect of pain is that you become fearful of movement or believe that a certain movement will damage something.  In fact you should be moving and doing physical activities that move the spine normally.  Moving with a rigidly protected back will prevent your recovery not help it.  By not bending and moving correctly strain is placed on already sensitive soft tissues.

In my opinion if your back is sensitive, painful or stiff you should choose your exercises carefully.  Pick those which will reduce stiffness with gentle controlled movement and minimum spinal load on the spinal structure.  This type of exercise will improve the function of the spine, enabling it to cope better with everyday life. The ligaments and muscles which support your back require strengthening and rest will only weaken these leading to more back pain.

Remember the proven benefits of exercise:

Increases blood flow to all muscles which helps the healing process

Reduced muscle spasm, especially with biomechanic based anti-spasm techniques

Increase in your confidence in your body’s ability to move

Reduction in anxiety which helps with soft tissue relaxation.

Improved body awareness enabling you to listen to your body better in the future therefore reducing the likelihood of a recurrence.


Surgeons Speak out - Surgery can't fix all:
David Hanscom an orthopaedic surgeon specialising in complex spinal surgery says that although there is no connection between disc degeneration and pain there are hundreds of thousands of spinal fusion operations being performed for back pain every year based on MRI scans showing disc degeneration.
He says that in the over 60's, disc degeneration is present in 100% of people - most of whom do not suffer from chronic back pain.  This is normal.  Disc degeneration is not a disease, it is a normal part of aging, like grey hair.  Add to this the research that looks at back surgery patients after 2yrs with only a third showing improvement and you can see that it is easy to end up in what he calls the 'failed back surgery syndrome' with crippling pain for ever.

So, why do so many people see surgery as the best solution?

Well, there seems to be a number of factors having an effect.  Firstly, the health industry is increasingly commercialized with huge sums of money to be made from drug development and spinal devices. So it’s no wonder that these are promoted.

Add to this the fact that exercise in the UK is still almost entirely unregulated so usually excluded from being prescribed on the NHS.

Also, the training required to be effective as a back specialist forms something of a barrier to many exercise professionals.  As a result only a small number of us are fully aware of all the techniques and therefore the best way to help people with back pain.

Finally, people will always tend to select the solution that requires them to do the least work.  Often the choice will look like a life time of exercise against an operation and a period of recovery followed by a pain free existence.  Unfortunately this view is being called into question more and more.

My opinion?

This situation is a great shame because exercise is a cost effective, less invasive and therefore risky, solution.  However the fix for all this is not easy and probably would involve some form of regulation for those exercise professionals who would like to provide the service for the NHS.  Also doctors and surgeons need to be aware of the success rates of the exercise alternative, and also be directing patients down this course.
You can see from this why I feel so strongly that exercise options should be thoroughly tried before progressing to surgery. 

If you have any questions on this just give me a call
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Risk v Benefit - Keeping your exercise programme safe


Risk v Benefit Keeping your exercise programme safe

 

There is much in the popular press about the benefits of exercise for both physical and mental health.  Many people are encouraged to take up exercise by their doctor or physiotherapist.  On the other hand, there are many articles about the risk of injury from exercise.  For example one study showed that over 60% of runners will pick up an injury in any one year, and another stated that 35% of women exercising on a regular basis will have a musculoskeletal injury.  

 

As a fitness professional and physical therapist I use a variety of techniques to ensure that my clients gain the benefit and do not suffer any injury:

 

I encourage clients to work at their own level, not keeping up or competing with each other.

I keep a close eye on the posture of each client as they exercise.  If there is a postural fault when a client walks in, they will probably keep that faulty position as they exercise.  This will be a habit that I am keen to discourage and correct with exercise.

When I spot a common postural imbalance within a group I will add exercises to help them correct it.  This could be drawing back rounded shoulders, lengthening the neck or stretching tight hamstrings to encourage better pelvic alignment.

At the beginning of each session I check how everyone is feeling and how long standing injuries are progressing.  I will include the best exercises to help each persons condition.  This could be reducing range of movement to encourage stabilization of a lax joint, work to strengthen a weak joint or stretches to help muscles tightened up by other sports such as running or cycling.

 
Using these methods I aim to help everyone to exercise and gain a benefit whilst not risking an injury.  Remember that your feedback is essential to ensuring a safe effective exercise programme so don’t keep quiet about any pain or discomfort as there is usually a way to manage it, and it is often a good indicator to the types of exercise you need.
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I have arthritis, should I exercise?

Some Facts about arthritis:
  • About 70% of people over the age of 65 will have some level of arthritis and 1 in 5 of the whole population.  This equates to around 10 million people in the UK.
  • A number of people will have no symptoms and be oblivious to the fact that they have arthritis, but most people with it will suffer some symptoms, such as pain and stiffness, on a daily basis.
  • The most common type of arthritis is Osteoarthritis, followed by Rheumatoid (especially in women) and Gout (especially in men).
  • There are actually over 100 different diseases that can cause the problems characterised as arthritis.
  • There is no cure for arthritis.
 
What is arthritis?
Arthritis affects the joints of the body.  At least two bones meet to form a joint, but some joints have three and wrists and ankles have more. Each joint in the body is constructed in a slightly different way.  Most of the main joints have cartilage covering the bone ends and the whole joint is enclosed in a sort of bag called the joint capsule.  This bag holds synovial fluid which effectively lubricates the joint.
Arthritis develops when the cartilage has become worn, torn, or has been removed, often due to trauma.
The synovial fluid within the joint capsule becomes thicker or ‘stickier’ as we age and as a result doesn’t coat the cartilage as well.  This results in increased wear to the cartilage and the bone ends which become roughened.  The joint can no longer slide smoothly and pain results.  This is typical in osteoarthritis of the knees, shoulders and hips.
With Rheumatoid arthritis joints become swollen as the body attacks its own tissues.  There are many other forms of arthritis, such as spondylitis which is when inflammation around the spine causes pain.

What causes arthritis?
Arthritis has a variety of causes, most of which are not fully understood.  For example:
  • Trauma to a joint earlier in life frequently makes arthritis more likely.  A car accident, sporting injury, trip or fall can all cause damage to a joint, weakening it and making it susceptible to arthritis, sometimes not manifested until later life.
  • Cartilage has a poor blood supply which means that when damaged by twisting or tearing is doesn’t heal very well.  As a result, it was common for cartilage to be removed following trauma, although nowadays this is less frequently performed and exercise is used to manage the situation.
  • Carrying excess weight puts more strain on the joints increasing the amount of wear and tear.
  • There is a clear genetic link which can increase the risk factor for Rheumatoid arthritis which can be activated by trauma.
 
Exercising with arthritis.
Arthritis causes joints to be stiff, painful and to have a reduced range of movement.  Exercise can improve these symptoms but it needs to take account of the arthritis. I work to create an environment and exercises within which the joints can be moved freely and without pain and you feel able to exercise within you own capabilities.  In addition, exercise can encourage good posture, which is essential in keeping the spine straight and reducing the risk of kyphosis – rounding of the neck shoulders as well as potentially slowing the progress of degeneration.
 
Key points to remember:
  • Loosening joints, using movement which is pain free, is essential to encourage and keep the maximum mobility.  For example, in ball and socket joints, simply rotating the limb within the joint capsule can have a beneficial effect, by encouraging the synovial fluid to coat the whole joint and become less ‘sticky’.
  • Specific muscle strengthening work to support the damaged joints will help reduce pain on a daily basis.  This is especially beneficial for the hips, shoulders, knees and spine.
  • Do not push through the pain, look for a different way to loosen or strengthen the painful area.
  • Avoid overstretching and putting joints into positions out of their normal range.  For example, knees are a hinge joint, designed to bend in a forward and backward motion with limited rotational range.  Sitting with legs crossed will stress the joint and in time can cause wear and then damage.
  • Note which activities cause pain and look to find other ways of doing them.  Exercise can be designed to help you strengthen your body enabling you to do regular activities with less pain.

Finally:
Arthritis can be debilitating and has no cure, but exercise is one of the recommended treatments - don’t let arthritis be a reason to stop exercising.

 
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Exercise - Benfits more than just your body!


When you think about ‘exercise’ you probably think about the benefit to your muscles and cardio vascular system, that it may hurt, you may ache afterwards but you’ll feel better for it and you’ll spend time with a group of likeminded people at your class or in the gym.  The first few statements relate to the physical benefits, but the latter are the extra benefits you may not have considered as being so important.

NHS Choices has this to say about exercise and mental wellbeing:

“It has long been known that regular exercise is good for our physical health. It can reduce the risk of cancer, heart disease and strokes. In recent years, studies have shown that regular physical activity also has benefits for our mental health. Exercise can help people with depression and prevent them becoming depressed in the first place. Dr Alan Cohen, a GP with a special interest in mental health, says that when people get depressed or anxious, they often feel they're not in control of their lives. "Exercise gives them back control of their bodies and this is often the first step to feeling in control of other events," he says.”
see : http://www.nhs.uk/conditions/stress-anxiety-depression/pages/exercise-for-depression.aspx for the full detail.

So, if you are feeling down, generally tired, depressed or lonely, why not try a regular exercise class?

If you’re not used to exercising particularly in a class, you may think of a number of reasons why exercise is not for you.  Often, these reasons are based on misunderstanding or misinformation.  I have listed a few common feelings here along with an explanation of what actually seems to happen.

I have never been sporty, so I don’t do physical activity.
In fact many of our class members are not sporty in the slightest, and they still find the classes are easy to do.

I always feel tired so class will simply exhaust me further.
Many exercises or movement in classes can be made easier or harder by the way you do them.  Simply do as much or as little as you feel you can.

Exercise has to hurt to be beneficial, I don’t want that.
The more recent thinking by exercise professionals is that “no pain, no gain” is not, in fact, true.  In reality we have seen plenty of people who have improved their fitness and personal wellbeing, through exercise, and have not felt any pain in the process.

When I get there everyone will know everyone else, consequently I will be left out and feel awkward.
Whilst some classes can be a bit insular, in our experience most class are actually very inclusive.  New people are joining all the time and are very soon embraced by the class camaraderie.  As an alternative why not take a friend with you?

I have tried yoga/pilates/circuits/whatever and I found it painful/just didn’t like it.
Actually, pretty well every class is different in one way or another.  The content is usually created by the person giving the class so there are as many different forms of pilates, yoga, circuits, boot camps, meditation, etc. as there are teachers.  It is worth trying a number of different classes until you find the ones that suit you.  Almost always there is at least one out there.

I have never done any exercise, there are so many different classes I don’t know where to start.
In this case, go for pilates or yoga.  Look for a class where the instructor tailors content to fit peoples’ ability. Talk to the instructor, or other class members to find out about other classes in your area that may suit you.  Then just go along and give it a go.  It is normally easy to have a trial at any class and move on until you find one you like. But it is always worth taking to the instructor about any aspect that you didn’t like because it may be that it could be change to suit you.

The fact of the matter is that almost everyone can benefit from joining a class.

If you continue to be inactive you are more likely to suffer from low mood, depression, tension, stress, anxiety and worry.

By taking more exercise you will feel better about yourself, be less depressed, less anxious, have improved sleep and better concentration, not only this, but you will improve your physically capabilities.  All great reasons to be more active, particularly the older you get.

Looking at the technical side of why we benefit mentally from being more active there is a combination of reasons, some of which are not fully understood.  The simplest factor is that exercise stimulates the release of mood enhancing chemicals, dopamine and serotonin. On top of that the social aspect of common goals and camaraderie have a positive effect, as does the realisation of achievement.  Also your support network can be extended, we have found that classes are very good at support and often bring together common experiences and solutions to life’s difficulties.

The key to gaining a benefit is in finding an exercise programme which suits you.

It needs to be enjoyable and an escape from the pressure of ever day life.

It may not be hard work and you should feel able to rest during the class when you feel that you’ve done enough.

There may be a strong social element with interaction with others in the group.  The companionship you feel from your fellow class mates can be as important as the actual exercise.

Choose a form of exercise that you can keep up on a regular basis.
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How important is balance to your overall health and well being?


Many clients I see have very poor balance skills when they first attend The Studio.  This usually improves hugely within a few weeks.  I am frequently asked why it is that our balance is so bad, and, why it is important to improve it.

Firstly, why is our balance poor?
Balance is a motor skill which we acquire in childhood.  It requires the use of large muscles groups and although this skill remains with us throughout our lives it deteriorates with age.  At any stage of your life it is possible to improve your balance skills with training.
The ageing process causes muscle weakness which will affect the body's ability to recover from a trip on an uneven surface.  With age often comes inner ear misbalance causing dizziness or blood pressure issues which can cause light-headedness.  Also failing eyesight means you may mis-judge uneven surfaces, or distances from objects.  All of these situations can easily lead to falls.

How big a problem is this?
It is estimated that 30% of the over 65's fall every year, and more than half of the over 75's living in nursing homes or care facilities are unable to live independently because of falling.
Women suffer from bone thinning (osteoporosis) and this increases the risk of hip fractures if they suffer a fall.  Almost 50% of hip fractures are seen in people who had no mobility problems prior to their fall, however only 50% recovered to their previous level of mobility (NICE 2012)

How does this affect you?
  1. Every time you walk you put all of your weight on your front foot as you lift the back foot up to swing it through.  If you step on an uneven surface, ice or simply misjudge the height of a kerb you will need to be able to balance on one leg for that little bit longer than usual to avoid falling. This is particularly true when walking down steps.
  2. When you reach up to a high shelf you probably balance on one leg to gain extra height.
  3. When you get out on the car you will place one foot down and put your weight through that leg as you push up to standing.  The added twist provides more challenge to the balance and it is easy to strain your back if your muscle structure doesn't support you too.

Things to remember
  • Balance can be improved with practise both in a controlled environment such as with an exercise therapist and at home.
  • Improved core strength gives better balance.
  • A fall can signal the end of independent living, changing your life completely.
  • Improve your balance and you'll improve your overall health and wellbeing.

Take action
If you are not currently attending The Studio, call me to arrange an appointment where I can assess your balance and help you to improve it.
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Thinking about taking up Yoga?


THINKING ABOUT STARTING YOGA?

Before you do you should understand the potential benefits and dangers (yes dangers) of practising Yoga.

Yoga has been criticised for being potentially dangerous by causing injuries and aggravating existing conditions such as arthritis.  Some authors of critical articles have themselves been injured in a Yoga class, others get their information 2nd hand by talking to participants in Yoga classes. Research can be difficult to verify as there have been no specific clinical trials so information is usually taken from surveys.

An extensive survey of yoga practitioners in Australia showed that about 20% had suffered some physical injury while practicing yoga. In the previous 12 months 4.6% of the respondents had suffered an injury producing prolonged pain or requiring medical treatment. Headstands, hand stands, shoulder stands, lotus and half lotus (seated cross-legged position), forward and backward bends, produced the greatest number of injuries. Respondents commonly took the blame for the injury on themselves, citing reasons such as ‘pushing it too far’ and not warming up, along with being too competitive. Read the source document here

The same article also asked the participants for the effect that Yoga had had on a range of over 500 specific medical conditions from which they suffered.  The results were positive:

• Much better 53.3%
• Better 29.3%
• Little better 12.5%
• No change 4.5%
• Little worse 0.3%
• Worse 0.0%
• Much worse 0.4%

In my opinion there are many health benefits for both mind and body to be gained from taking up yoga.  The relaxation element is good for sufferers of depression as well as in rehabilitation from cancer and the management of heart disease.  The flow through a succession of poses can help with stress management and improved posture

Injuries seem to come from beginners pushing themselves beyond their ability and instructors with little training, or experience, who cannot evaluate each participant’s ability and offer alternative positions.  Looking at the list of positions which incurred most injuries, head and shoulder stands should only be performed under close supervision by those working at an intermediate level.  Lotus and half lotus positions place the knees in positions which will aggravate any existing damage to ligaments or cartilage whether originating from an injury or wear and tear. Forward and backward bends put load on the spine which can aggravate any degenerative conditions and potentially cause back pain rather than ease it.

Ensure that you choose an instructor who has experience and a class which works at your level.  Watch out for exercises which may not be suitable for you (see injury section above) and listen to your body.

As an exercise professional I am keen to see everyone partake in some sort of exercise, it’s a question of finding what suits you and for many Yoga will be ideal.  Give it a try, but carefully.
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