This time of year, we see an increase in people coming to see us for new episodes of back pain. These often follow a similar sort of story- carrying heavy bags of Christmas shopping, twisting awkwardly bringing the decorations down from the attic, or falling off ladders putting up festive lights.
If you’re struggling with back pain at Christmas, there are a few simple things that you can do to help yourself recover from an acute episode of back pain.
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.
Want to know a secret? There is no other activity that delivers so many benefits with little effort then sleep. Restful sleep is one of the five pillars of health and getting a good night’s sleep should be at the top of your to-do list this month. Everyone knows there’s nothing like a good night’s sleep for feeling refreshed and alert in the morning. Let’s take on 2017!
Emma’s sleep workshop is on Saturday 28th from 10-12pm at Acorn Health. Tickets must be booked in advance and are £25.00 cash on the day of the event. Please call 01243 379693 to book. We are a small group tackling the common problem so many of us have: how to get a really good night’s sleep.
Are you interested in finding out more information on hypnobirthing, and how it can help you and your partner have the best birthing experience possible?
Diana Tibble, a former midwife and experienced hypnobirthing instructor will be offering a FREE information evening every Wednesday starting on Wednesday 18th January from 8pm. These weekly information evenings will help you find out more about hypnobirthing and how it can help you learn to trust your body during birth and work with it, as well as how to free yourself of negative emotions that lead to fear causing unnecessary pain and unyielding muscles.
Hear it from one of Diana’s clients below with her video testimonial.
Please note spaces at the free hypnobirthing information evenings are limited so booking is essential. Please reserve your place by calling Acorn Health on 01243 379693 or Diana on 07595 693230.
Chronic shoulder tension. Knots in your upper back. Stiffness, headaches, neck pain. Sounds familiar? Yep- we see chronic shoulder tension a lot in clinic- but allow us to explain why simply treating the shoulder isn’t going to solve the issue.
Firstly, muscles don’t work alone.
Our body moves and functions through a combination of movements in a coordinated group of muscles, ligaments, fascia, tendons and joints. Back pain is our bread-and-butter as chiropractors, and we know from both research and experience that pain in the back doesn’t necessarily mean a problem in the back. That pain could be caused by a problem somewhere completely different- something that often causes a bit of confusion when you come to see us for pain in one area and we end up treating somewhere completely different.
Let us paint you a picture. You work in an office. You’re stuck at a desk all day, sitting on your behind, slouched and worn out by 5PM. Your shoulders are tight and sore, and you can feel the knots building up in your upper traps, giving you a thunderous headache by the end of the day. Now, you know those knots and tense muscles are going to cause problems of their own, so you had an upper back massage two days ago and they should be feeling better… but they’re not. So is the problem the upper traps and shoulders, or is it something else?
Let’s look at the latissimus dorsi.
It’s a muscle that originates from the spinous processes of T7-L5, the iliac crest around the top of the pelvis, the thoracolumbar fascia in the middle of our back, the lower border of the shoulder blade and the lower 3/4 ribs. (Yep, it’s massive!) All those fibres attach to the humerus (the long bone in the top of your arm). Why are we talking about a muscle in the lower back? Surely a muscle in the lower back controls the lower back, right? Wrong. The lat dorsi actually serves to extend, adduct, flex and internally rotate the shoulder, and lends a mere helping fibre or two to extend and laterally flex the spine. (In case you’re interested- it also helps with our lung function and breathing. Safe to say, it’s a pretty important muscle.)
So, back to you sat at your desk.
You’re slouching, your lumbar spine is curved and unsupported, so your latissimus dorsi is stretched beyond the norm and the fibres can’t fire properly. As a result, the muscle can’t complete the role it’s supposed to, the upper trapezius steps in to help and is left to do all the hard work controlling the shoulder itself (Just like that last project your boss asked you and Jane to do together and Jane left it up to you to do all the hard work- thanks Jane….) This leads to imbalance and weakness in both the lats and lower traps not to mention a very grumpy upper trapezius. You’ve tried treating the site of the pain (with that amazing back, neck and shoulder massage) and it feels better for a day or two afterwards but then it comes back.
It’s fairly obvious by now that the problem with your tight and knotty upper traps isn’t caused by your shoulders- it’s something further afield.
So we have to look elsewhere- we look at your lower back and find that your latissimus dorsi is, surprise surprise, not happy with life. Now we’ve found that we also need to look at the Posterior Oblique Sling.* The POS includes the latissimus dorsi, glut med (in the back of the hip) and the thoracolumbar fascia (in the middle of our back.) *NB When we talk about one of the “slings” in the body, we’re talking about a specific group of muscles, fascia and ligaments which all work together to stabilise and mobilise the body.
Guess what we find when we examine you?
Your lat dorsi isn’t firing properly, which is throwing off the stability in the posterior oblique sling. Your lower back is stiff and restricted, and you can’t laterally flex properly- further compounding the problem with the latissimus dorsi (remember us saying it helps with lateral flexion of the lumbar spine?) So you can see how you’re caught in a vicious circle of dysfunction creating more dysfunction, and, in your case, leading to chronically tight shoulders that just never seem to get better!
The above is just an example of a classic case we often see in clinic.
Now, there are approximately 640 muscles in the human body, all intricately involved with the others in a chain of movement, that can have a chain of consequences if something in that chain misbehaves. To state the obvious again- each person we see is an individual, and the way dysfunction comes about is different for each person, as is the way in which the body adapts to that dysfunction.
As chiropractors, our job is to work out what’s going on and why (and then work with you to get it better) and this often involves looking at areas that might be quite far afield from where the actual pain is felt- but as you can see, there’s a reason for that.
So where to begin? How can you improve your posture and reduce pain and problems? We’d suggest starting with some simple exercises, and downloading your copy of “Understanding Pain” which will help you get to grips with chronic pain, what’s going on in your body and how you can take back control!
Alternatively, and perhaps best- is to seek professional help and get a diagnosis and treatment plan put in place. You can get started by booking your appointment today.
Living and working in Emsworth and Langstone, you’ll know that sailing is an inherent part of our community here (so much so, we’ve included some photos taken by Philippa of our lovely harbour!) As such, it’s not uncommon for us to be treating professional or recreational sailors in clinic, and whether you compete professionally or just enjoy a turn about the Solent, sailing poses as much a risk of injury as with any sport.Sailors often compete in extremely difficult conditions, battling high winds and rough seas, and as such the risk of injury during sailing is 8.6 per 1000 hours sailing when training, and 2.2/1000 otherwise. In a study on the 2003 America’s Cup, researchers found that the upper limb was the most commonly injured body segment (40%), followed by the spine and neck (30%), and the most common injuries were joint/ligament sprains (27%) and tendinopathies (20%). (1)
Who is at risk of injury?
Mastmen are at greatest risk of acute injuries, helmsmen most commonly injury the upper-limb through steering, whilst grinders and bowmen are at the greatest risk of injury from repetitive strains. High repetition activities such as hiking, pumping, grinding and sterring are major causes of overuse injury, even in the most experienced of sailors. Windsurfers are also frequently admitted to hospital suffering from chronic lower back injuries as a result of “pumping” the sail.
It’s not just the professionals who are at risk of injury, as novice and recreational sailors commonly encounter acute injuries such as contusions or abrasions after colliding with the boom or other equipment whilst performing manoeuvres. (1) Not only that, but there are other perils to consider: tripping over ropes, winches and cleats; being swept overboard or falling down open hatches!
How and why do sailing injuries occur?
[clickToTweet tweet=”What are the main contributors to #sailing #injuries? Find out here! #Chiropractic” quote=”The main contributors to sailing injuries are: Heavy weather (23%), tacking (17%), jibing (13%), sail change (12%) and alcohol (7%)”]
Injuries may result from a lack of general fitness, overuse, overtraining, or macrotraumatic accidents.
Lack of warming up, stretching, and cooling down may also increase the risk of injury.
Muscles are placed at high risk when performing explosive, powerful moves, such as those frequently required when sailing.
Shoulder and arm injuries are common through constant handling of the mainsheet, and the sudden, strong movements in hiking may lead to back and knee problems. (Remember Sir Ben Ainslie’s back injury? This was caused by repetitive, high strain hiking out!)
Inadequate leg strength and poor hiking technique are thought to predispose the knee to injury.
Boats can be difficult to navigate around and result in crew members having to adopt awkward positions, often resulting in rotating, hyperextending, locking, or twisting of joints.
Postural problems are common in the majority of the population, and these inherent issues can lend themselves to musculoskeletal problems.
Poor fitness training may exacerbate common muscular imbalances associated with changing forces on opposing muscle groups while sailing.
If ignored, it is easy for these issues to progress into a chronic problem, the possible severity of which could impact on your participation and enjoyment in the sport.
So what can be done about it? Five simple steps to avoiding sailing injuries!
A robust exercise regime is crucial, which should focus on all aspects of physical fitness in order to ensure that your body can cope with the demands of sailing.
– Cardiovascular training
– Strength training (Competitive sailors should undergo regular health screening with specific strengthening of high-risk muscle groups, synergists and stabilizers. )
– Flexibility training
– Core stability training
– For more advice on bespoke rehabilitation plans, please email us at email@example.com or visit our Langstone clinic.
Research has shown that aerobic training and fitness is directly related to an improved reaction speed to wind shifts, as well as enhanced endurance, decision making, and concentration, particularly in the later stages of races. Mental and physical recovery is faster for those who are physically fit. Suggested types of aerobic exercise that are most appropriate for sailors are rowing, cycling, swimming, stair climbing, or running.(3)/li>
Regular checkups can help ensure joint movement and function is maintained, as well as provide an opportunity for assessment of joint strength and function. Not only will this help reduce the risk of developing injuries, but it can also speed up recovery should you become injured.
Technical skill and expertise is important– if your technique needs improvement, seek out advice and informed coaching to help minimise the risk of developing an injury as a result of poor technique.
Taking frequent breaks and changing positions during long periods of sailing. This will help prevent postural stresses and strains from occurring and is a healthy spinal habit we all should follow.
Whilst we have focused on musculoskeletal injuries, there are a number of other safety measures to take into consideration. Above all, always wear a life jacket when sailing. In the UK, there were 35 sailing or water-sport related deaths at sea in 2014 alone. Safety at sea should always be taken seriously.
1. Neville, V., Folland, J.P. (2009) The epidemiology and aetiology of injuries in sailing. Sports Medicine. 39(2) 129-145.
2. Nathanson, Mello, Baird “Sailing Injuries and Illness – Results of an Internet-based survey” Wild Env Med 2010
3. Allen, J.B., De Jong, M.R. (2006) Sailing and sports medicine: A literature review. British Journal of Sports Medicine. 40(7) 587-593.