New draft guidelines issued for consultation by the National Institute for Health and Care Excellence (NICE) advise against the use of many routine drugs for chronic primary pain. This includes paracetamol, non-steroidal anti-inflammatory drugs (i.e aspirin and ibuprofen) benzodiazepines or opioids. The guidelines state these should not be offered because there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress.
One of my Telehealth patients recently asked me “Why does my back always hurt more when I’m having a bad day at work?” A good question, and one that comes up quite regularly in fact! My simple response to this is normally something like “Because pain is an absolute blighter, and likes to kick us when we’re already down” but I thought today I’d put pen to paper (or fingers to keyboard, these days) and explain why and how our mood and pain levels are linked.
It’s world Nutrition and Hydration Week! To celebrate, we are holding a one-off event for a limited number of guests.
Dr Philippa Oakley (Doctor of Chiropractic) has a specialist interest in chronic pain management, and will be leading a workshop on Saturday 17th March from 10-11.30am at our clinic in Emsworth. The focus of the workshop will be to discuss foods that influence pain, and how you can use your diet to manage chronic pain and inflammation. You will also benefit from a group health coaching session with Rhiannon Oakley, qualified Personal Performance Health Coach who will help you plan your next steps to a healthier lifestyle. The workshop is ideal for people who are working towards their ideal weight, managing chronic pain conditions or IBS symptoms.
Throughout the week,we will be providing advice on nutrition and hydration across social media and we’re excited to partner with Emsworth Cookery School who are producing exclusive healthy homemade recipes for you to cook at home. Don’t forget to follow our Facebook Acorn Health to receive updates.
Sitting at a desk all day may mean you’re conscious of poor posture. You’ll know it can lead to headaches, muscle pain, stress and more. You may therefore be familiar with “Upper Crossed Syndrome “without even knowing it.
It’s not a serious condition but it can give rise to headaches, migraines, joint pain, muscle pain and stress. If you’re a keen gym-goer, it can also prevent you being able to reach your optimal training threshold.
What is Upper Crossed Syndrome?
It’s caused by overlapping overactive and underactive muscles throughout the neck, chest and shoulders. The chest muscles (pectorals) and muscles at the rear or side of the neck (upper trapezius, levator scapulae, suboccipitals and sternocleidomastoid) are overly tight or “facilitated”. The deep flexor muscles in the front of the neck and the rhomboids, lower trapezius and serratus anterior muscles are weak or inhibited.
A chap called Janda coined the term “Upper Crossed Syndrome”. According to his book “Assessment and Treatment of Muscle Imbalance: The Janda Approach” Upper Crossed Syndrome can lead to…..
“Dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration (Janda 1988).”
You can see how a simple matter of muscular imbalance can lead to a range of issues.
What causes it?
This is caused by a build up of small issues, such as:
Prolonged sitting at a desk then causes forward head carriage.
Poor technique when training (such as overtraining the chest and neglecting the mid-back) affects the chest and upper back.
Having a large bust contributes to rounded shoulders.
What are the signs and symptoms?
Forward head carriage- when looking at yourself side-on in a mirror, your ear should be in line with your shoulder. If it’s not, it’s what we call forward head carriage.
Increased inward curvature of the cervical spine (hyperlordosis).
Increased outward curvature of the thoracic spine (hyperkyphosis or “humpback”) . Tight muscles in the front of the chest pull you forwards, weak muscles in the upper back can’t resist the pull. Add in forward head carriage and you can end up with hyperkyphosis. In some cases, the neck can look normal because we simply overextend through the neck to hold the head up properly!
Breathing dyfsunction caused by over-activated muscles and compression of the rib cage.
Rounded shoulders and rotator cuff issues- Muscular imbalances affect the function of the shoulder joint. Due to the imbalance, rotator cuff muscles then have to work harder to stabilise the shoulder joint. This can ultimately lead to shoulder impingement and rotator cuff strain.
Winging of the scapula- the shoulder blades jut out instead of lying flat against the ribcage.
Chronic pain caused by trigger points (tender points) in the affected muscles.
Migraines and tension headaches due to tension in the surrounding muscles and dysfunction in the cervical and thoracic spine.
Pins and needles or tingling in the arms- Rounded shoulders and forward head carriage can compress the blood vessels or nerves in the space between your collarbone and first rib.
The affected muscles have a lower threshold for irritation and dysfunction. This means they very quickly become affected by faulty movement, leading to more pain and problems. As a result this puts stress on the involved joints, leading to further pain. As you can see, poor posture is contagious. Not like a bad cold shared around the office… Instead it starts in one area and then affects another, which in turn affects another.
How can we treat Upper Crossed Syndrome and Poor Posture?
Your chiropractor will work with you to restore normal function to your upper back and neck. If underlying joint function is abnormal, exercising in this state may simply cause the muscles to adapt to the underlying dysfunction. (For more on this, read our stretching blog here.) This is why joint function must be restored first and foremost. Gentle stretches and exercises can then help relieve tension and strengthen the weaker muscles.
Here’s a video on our one simple way to improve your posture at the desk.
Begin with the chin tuck exercise. This ultimately counteracts forward head carriage.
Stand upright with your back to wall.
Slightly tuck chin to chest and draw head back to wall.
The muscles in the front of the neck should be active when holding this position for 5-10 seconds.
You may feel some stretching of the scalene muscles on the side of the neck that go down to the collarbone. You may also notice the suboccipital muscles at the top of the neck and the base of the skull. This exercise begins to strengthen the muscles in the front of the neck and muscles of the upper back.
You can do this exercise lying down in bed, pushing back into a pillow. Once you get the hang of it, you can then do it standing upright. You’ll soon be able to do this whilst sitting in the car or at your desk at work. Repeating the exercise throughout the day will also help improve your posture over time.
Chiropractic care can help to restore normal joint movement and alleviate muscle stress. As part of your treatment programme, you’ll be given further specific exercises to help address muscle tension and restore joint function.
To book your appointment with our chiropractor, simply use the link below.
We (as a society) throw huge amounts of money at back pain. There’s new gadgets, research, more effective drugs, better surgeries and dozens more practitioners out there all touting to be the next big thing in curing back pain, yet back pain remains as prevalent as it ever was. In fact, it seems to be getting worse.
So why is it that back pain is still such an issue?
Everyone is different. Gosh, wasn’t that a groundbreaking statement. Yes, well, forgive me for stating the obvious but, it’s true. If we treated your back pain the same way we treat everyone else’s, we’re not going to get very far, as unfortunately everyone’s backs behave differently (and misbehave differently!) That’s why all of these treatment that work for everyone else don’t necessarily work for you- because your back is different to theirs and you need to find the approach that works for you! P.S. This is why whenever someone asks me if I get bored “cracking backs all day” I can answer with a resounding NO! a) Because I don’t “crack backs” and b) because I have to not only work out what’s going on and diagnose it correctly but also work out how best to treat it based on what’s happening and what you want! It’s not quite as simple as handing over a pill and sending you out the door. Blimey, how boring would that be!
We’re treating it far too literally.
This is the big one! So many treatments out there focus on treating the area of pain as though that’s the cause of the pain. Pain in the lower back, treat the lower back. Monkey see, monkey do. Do you follow? Well, there’s two problems there. Firstly, if it was that simple to treat back pain, it wouldn’t be such a massive problem. Secondly, if we isolate our treatment and just focus on the spine, we are ignoring everything the spine connects to (and you don’t need a genius to tell you that the spine connects to everything!) As such, treating just one thing in the giant jigsaw that is your back pain is going to end up in tears and a lot of wasted time (and money). Of course we need to treat the site of pain (duh, that’s where it hurts!) but pain in itself only tells us there’s a problem, not where the problem is or what it is. Treating the site of the pain is lazy- we need to look at everything inside your body that impacts on the area of pain and could, as a result, be affecting it. Then, we need to look at everything outside your body (like your job, hobbies, environment) and see if that’s having an impact too!
As a really simple demonstration of this, do me a favour- Google “Cervicogenic headache.” Done it? What does it say? That it’s pain referred to the head from structures (i.e. soft tissues and joints) in the neck. So as you see, you could take a paracetamol or sit with an icepack on your forehead but as this isn’t the source of the pain, it’s not going to do much good in the long term. A good clinician needs to look further afield to find out what’s actually causing that pain.
Have a look at the image below- see how forward head carriage can cause dysfunction in your back and thoracic extensors?! What a waste of time it would be just treating the back and not addressing the forward head carriage (i.e. the issue that’s actually causing the pain!)
So if back pain is really so tricky to treat, what can we really do about it? Here’s two super simple tips.
1) Get in touch with mother nature. No, we don’t mean making skirts out of hemp and running naked through the wilderness (although feel free, if that’s your thing). We mean take your shoes and socks off and feel the ground.
The nerves in your lower back run all the way down to your feet for a reason! Your feet provide feedback to your brain that not only tells your brain where you are in space, but they also provide invaluable feedback to help stabilise your body. Stick some bulky trainers on to stop your feet from being able to feel the ground and those feedback signals sent to your brain get confused, which leads to instability. When the brain feels unsafe, or unstable, it’s going to make things hurt and reduce the amount of movement in the area.
(While we’re on the subject, where most people go wrong is that at this point, right when they have less movement, they strain against it to push the body beyond that threshold. As soon as you go beyond where your body is happy to go, the body has a habit of going into shutdown- it tenses up and produces pain to stop you from doing it again!)
Simply put- the more skin in touch with the ground, the more sensory input your brain gets, which it in turn feeds forward to your spine, giving you more stability and in turn reducing pain.
You’d think, given it’s something you’ve been doing your whole life, that you’d know how to breathe by now. But I bet you don’t! Do yourself a favour- for the next 24 hours, try and pay attention to how you’re breathing when you’re moving. My bet is that you hold your breath when you’re performing dynamic movements. Why? Read on, dear friends and all shall be made clear.
Breathing is closely related to spinal stability. If you think of your body as a barrel, the diaphragm is the top, and the pelvic floor the bottom. The diaphragm regulates our intra-abdominal pressure and contributes massively to our spinal stability. So when our spine is unstable and weak, we hold our breath to perform movements. This is an ill-informed attempt by our brain to increase our intra-adnominal pressure and maintain spinal stability because it’s worried that if we don’t, we’ll become unstable and get injured. Pull that belly button in towards your spine and breathe OUT as you perform dynamic movements- this will engage the good ol’ core musculature and take the pressure of your diaphragm and stop relying on the diaphragm alone to provide spinal stability. 24 hours, focusing on your breathing, that’s all I ask. Being mindful and aware is key to changing your habits.
In a nutshell, part of your treatment programme is going to involve teaching you how to breathe!
So there you have it!
Now you understand why back pain can be such a nuisance to treat. Fortunately, you’ve got those two simple steps to reducing your back pain. Doesn’t that sound like a great catchphrase?! Honestly though, if I could give one (okay, two) pieces of advice to every person I see in clinic, it would be those. Create some healthy habits to help your spine and I guarantee you’ll see an improvement.