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The Truth About Bursitis

Tobias Hall — Sun, 03 Mar 2024 22:50:44 +0000

The Impact Of Bursitis

Bursitis is a very common ‘inflammatory’ disorder of the body’s bursa. But what’s a bursa? Well, bursa are small fluid filled sacs that cushion the spaces between bones, tendons, muscles, and ligaments.

The pain and misery associated with bursitis often goes way beyond inconvenience. For many, bursitis badly impacts performance of essential tasks, exercise activity and general quality of life. Hip and shoulder bursitis can be particularly punishing, because of how much we use those joints during daily activities.

Yet, despite how common and how debilitating it is, bursitis remains widely misunderstood. And many get stuck with bursa pain simply due to a lack of real understanding.

In a significant minority of cases bursitis can be caused by an infection. So it’s very important to get it checked out by your preferred healthcare professional. With a view to antibiotics. But if you can establish that there is no infection, there is a riddle to solve. Why did my bursa become inflamed?

The Body’s Airbags

Understanding and resolving bursitis starts with acknowledging the job bursa were designed to perform.

Bursae are the body’s airbags. They are designed for protection. Protection from impacts and mechanical stresses.

In the same way a vehicle deploys airbags to save its passengers. Bursa ‘blow up’ to prevent wear and tear occurring between neighbouring structures in your body. Like airbags this is a form of ‘emergency cushioning’. When bursae blow up like this, medicine calls that condition ‘bursitis’.

Like airbags, bursa stay pretty well concealed when things are going well. But when there’s mechanical stress around joints like the hip, shoulder, knee and elbow, the bursa expands as a protective measure. Just like airbags in a car, only much much slower.

The Real Cause Of Bursitis

So if you don’t have a raging infection and you haven’t fallen down really hard, your bursa will have become ‘inflamed’ due to repetitive strain. In she shoulder this is often due to overuse and bad posture. In the hip and knee it’s commonly caused by issues like flat feet and leg length discrepancies. Old injuries that didn’t heal properly are also a common cause of bursitis in my experience.

So, for those of us who care about the ‘true cause’ of our pain, bursitis is a mechanical disorder not an inflammatory disorder.

In a sense when we throw anti-inflammatories and cortisone shots at bursitis it’s like focusing on the airbag after a car crash. If you want to understand a car crash, look at how the vehicle was being driven, the mechanics of the vehicle, and the conditions of the road. Not the airbag.

Yet of course, relief from the pain of bursitis is the first step towards being pain-free in the longer term. So anything that helps with the pain should be considered.

The Reason This Matters

By shifting our perspective to understanding conditions like bursitis (and tendonitis for the record) as biomechanical challenges, we open wonderful new avenues for treatment. We start to seek the true causes of our pain. Which is just as valid as acknowledging that sugar is what causes tooth decay.

Truly understanding our pain brings us closer to a future where we see that pain is not a disease to be cured, but a vital signal helping us identify our bodies needs. But what are the practical solutions to bursitis? .

Treatments like radial shockwave therapy and LLLT laser can bring great relief from ‘bursitis’ cases, even in the short term. They help the bursa to heal. This frees bursitis sufferers up mentally and physically to resume living a normal life, but also to ‘look under the bonnet’ of the vehicle to identify why the bursa became ‘inflamed’ in the first place. This usually reveals patterns of weakness and compensation in the body that can be resolved with gentle home based strength exercises. For bursitis around the knee and hip arch supports can also sometimes be extremely helpful.

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Understanding ‘Bursitis’. Moving Beyond the Inflammation Misnomer

Tobias Hall — Tue, 16 Jan 2024 19:27:25 +0000

Understanding ‘Bursitis’. Moving Beyond the Inflammation Misnomer

Introduction to Bursitis:

Bursitis is a very common musculoskeletal diagnosis. This ‘inflammatory’ disorder affects the bursae, small sacs filled with fluid that cushion and lubricate the spaces between bones, tendons, muscles, and skin. Yet, despite how common it is, bursitis remains widely misunderstood.

Bursitis can affect various joints in the body, including the shoulder, hip, elbow, and knee. It’s frequently associated with repetitive motions, overuse, or injury, making it a common diagnosis among individuals engaged in activities that exert continuous stress on specific joints. Leading to pain, swelling, and tenderness in the affected area.

Navigating Complexity

While bursitis is often perceived as a routine consequence of aging or inevitable athletic wear and tear, its impact on individuals’ lives should not be underestimated. The pain and functional limitations associated with bursitis can extend beyond a mere inconvenience, affecting one’s ability to perform essential tasks, engage in physical activities, or maintain quality of life. So this common ailment deserves a closer look. With a view to dispelling some of the most common misconceptions and exploring more effective avenues for diagnosis and treatment.

‘Bursitis’ and also ‘Tendonitis’ are two conditions that have been subject to significant shifts in our comprehension in recent years Traditionally labeled as inflammatory disorders, recent research has prompted a reevaluation of these terms, creating a far more nuanced understanding of the underlying mechanisms and paving the way for a paradigm shift in treatment approaches.

Rethinking Tendinopathy: Beyond Inflammation

For decades, “tendinitis” was (and still is) the standard term for any pain associated with a tendon. ‘Itis’ implying inflammation is the cause of the pain. However, as our understanding of musculoskeletal disorders has advanced, so has our awareness that not all tendon-related pain stems from inflammation. The far more accurate term “tendinopathy”has emerged to encompass a broader spectrum of conditions affecting tendons.

Research has played a pivotal role in challenging the inflammation-centric perspective. Studies have revealed that the vast majority of tendon pain cases involved degenerative change rather than inflammation. Tendons, once believed to impacted by inflammatory responses, are now recognized as structures undergoing a complex interplay of degeneration, failed healing responses, and mechanical stress. Tendonitis is out, and tendinopathy is in.

This shift in terminology from tendinitis to tendinopathy acknowledges the multifaceted nature of tendon-related conditions. It emphasizes that our approach to diagnosis and treatment should extend beyond addressing inflammation to encompass the diverse factors contributing to tendon pain. But it also points to similar truths that are emerging about bursitis.

Bursopathy Unveiled: Similar Evolution in Understanding

In parallel with tendinopathy, the term “bursitis” historically suggested inflammation within a bursa as the primary cause of pain. Yet, just as with tendons, our understanding of bursa-related conditions has evolved. The notion that all bursal pain is inflammatory in nature has been challenged by research indicating that various pathological processes, including degeneration and mechanical stress, contribute to the complexity of bursopathies.

The term “bursopathy” has gained traction, reflecting a broader understanding that encompasses conditions beyond mere inflammation. Like tendinopathies , bursopathies are now recognized as a spectrum of disorders involving structural changes, failed healing responses, and biomechanical stress in addition to inflammation.

Debunking the Inflammatory Misnomer

The mistake of labeling these conditions as primarily inflammatory stemmed from an oversimplified view of musculoskeletal disorders. In the case of tendinopathy and bursopathy, the focus on inflammation overshadowed the intricate interplay of degeneration, failed healing responses, and mechanical stress contributing to pain and dysfunction.

By broadening our understanding, we pave the way for more accurate diagnoses and targeted treatment strategies tailored to the specific characteristics of each case. When it comes to bursopathy and tendonopathy that means treating the degenerative changes we now know drive these conditions.

Enlarged Bursae: The Airbags of the Musculoskeletal System?

If you contemplate the nature of bursa and ‘bursitis’ for as long as I have a compelling analogy emerges. The resemblance of enlarged bursae to airbags in a car. Just as an airbag doesn’t cause a car crash but responds to the impact, an enlarged bursa is not the root cause of pain but a protective response to underlying issues.

Enlarged bursae could be seen as the musculoskeletal system’s way of mitigating biomechanical stress. Instead of viewing an enlarged bursa as a disorder in itself, we might interpret it as a symptom—an adaptive mechanism the body employs to protect vulnerable structures from ongoing mechanical strain.

A Paradigm Shift: Biomechanical Stress as the Underlying Truth

The deeper truth behind conditions like tendinopathy and bursopathy lies in biomechanical stress. These disorders are not merely medical in nature; they are often manifestations of how our bodies respond to repetitive strain, improper movement patterns, or other mechanical stressors.

By shifting our perspective from seeing these conditions as isolated medical issues to understanding them as biomechanical challenges, we open new avenues for treatment. Addressing the root causes—whether they involve poor biomechanics, overuse, or other mechanical stressors—becomes paramount in developing effective and lasting solutions.

Hope on the Horizon: Treating the Cause, Not Just the Symptoms

As our understanding of tendinopathy (tendonitits) and bursopathy (bursitis) evolves, there is hope on the horizon for more effective and targeted treatments. Embracing a biomechanical approach will allow healthcare professionals to tailor interventions to address the specific factors contributing to each individual’s pain.

Instead of relying on toxic anti-inflammatory ‘band aids’, treatments can encompass strategies to improve biomechanics, modify movement patterns, and enhance musculoskeletal function. This shift towards a more comprehensive and personalized approach holds promise for better outcomes and long-term relief for individuals grappling with tendon and bursa-related issues.

Conclusion: A New Era in Musculoskeletal Care

The evolution of our understanding of tendinopathy and bursopathy marks a significant milestone in musculoskeletal care. By debunking the inflammatory misnomer and embracing a biomechanical perspective, we pave the way for more accurate diagnoses and effective treatments.

Enlarged bursae, once perceived as problematic in themselves, emerge as adaptive responses to biomechanical stress. Recognizing this provides a foundation for a paradigm shift—one that acknowledges the deeper truth behind musculoskeletal pain and fosters hope for a future where these conditions are not just manageable but truly treatable.

In the journey towards better musculoskeletal health, understanding the intricate dance between our bodies and biomechanics brings us closer to a future where pain is not a mystery to be solved but a signal guiding us towards holistic and personalized care.

And perhaps the best news of all is that treatments like radial shockwave therapy and LLLT laser can bring rapid relief from ‘bursitis’ cases even in the short term. Which free’s us up mentally and physically to resume living a normal life, but also to work on the preventative measures required to stop our pain from returning.

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Respect All Of Science

Tobias Hall — Wed, 02 Aug 2023 23:08:22 +0000

Respect All Of Science

Few things in life deserve more respect and appreciation than science. Science has made our lives so much easier, warmer, drier and safer that it is hard to fathom.

Medical science has made a particularly large contribution to the quality of life we are blessed to lead now. Only 250 years ago, a child born in a Western country had less than a 20% chance of making it into their early teens. Taking out funeral insurance for your child as soon as they were born was common practice. Now only a handful of generations later, the loss of a child is more like a lightning strike than the everyday occurrence it was only a handful of ages ago. Thanks to innovations that all stem from medical science.

Closer to 500 years ago, King Henry VIII was infamously one of the worst husbands in all recorded history. But uxoricide wasn’t his only interest in life; he was also very interested in medical science.

Henry founded the Royal College of Physicians in 1518 and amalgamated ‘The Barbers Company of London and the ‘Fellowship of Surgeons’ to form the Company of Barber-Surgeons in 1540. His administration passed seven acts of parliament aimed at regulating medical practitioners that would endure for 300 years after his death. Henry presided over major improvements in public health, installing public water supplies and sewers and implementing segregation and disinfection processes during epidemics.

Henry’s interest in medicine may have arisen (as it often does) from his own substantial health struggles. In his early life, Henry was an unusually fit, healthy, strong, and robust young man, an athletic 6ft and 15 stone of muscle. Then, in his late 30s, he injured his foot badly playing tennis (most likely a bad sprain) and sometime later had an ulcer (probably caused by a mixture of stress and injury) in the same leg. Both of which resolved but foreshadowed the unimaginable physical suffering that would ultimately end his life.

In 1536 at 44 years of age, Henry suffered a catastrophic injury when he fell from his horse during a jousting match—sustaining what was almost certainly a severe brain injury and fracturing at least one leg bone. Following the injury, Henry exhibited signs of what we now know as CTE (chronic traumatic encephalopathy), which more than likely contributed very significantly to the fragmentation of his mental health. Then in the months following, he once again suffered from ulceration of the tissues in his leg, which this time was not destined to resolve.

Over time the ulcerations in Henry’s leg became giant deep pus-filled fistulae. For treatment, these frequently required red hot pokers to be inserted into them, such were the medical procedures of the day. Which, even in an age of anaesthesia, would have been a hellish cycle of pain most of us can’t imagine. The repeated cauterising of the wounds helped temporarily reduce individual ulcerations but was ultimately ineffective at halting the progression of the physical processes playing out in Henry’s leg tissues.

The day-to-day existence of a person whose legs are being eaten alive by bacteria is about as bad as it gets medically. It undoubtedly contributed to Henry’s ever-increasing proclivity for boiling people alive when they inconvenienced him later in life.

It is highly likely that Henry had DVT (deep vein thrombosis), where blood clots form in the blood vessels of the leg. Similarly, the presence of Type 2 diabetes is retrospectively a virtual certainty. The majority of DVT and diabetic ulcers are known to be bacterial ‘culture positive’, which means that even in modern times, the ulcers that form as a result of these vascular blockages often develop colonies of virulent bacteria.

By 1543 Henry was 51 years old and weighed around 30 stone. The vile stench of his leg ulcers could be detected from 3 rooms away. He was literally decomposing whilst refusing to rest whatsoever and continuing to fully function as Britain’s monarch. Then in 1547, after a decade of agonising decomposition and violent rage, Henry finally succumbed to the organisms that had been slowly consuming his tissues for all that time. The end would have shown up as a raging fever as the infection managed to take over his internal organs.

So, just a handful of generations ago, the wealthiest man on the planet died one of the most horrifying deaths imaginable. And if you suffer from the same health issues now, it is highly likely you would be fixed up within a month of antibiotics and anticoagulants, followed by some judicious longer-term dietary adjustments. None of which was available to Henry, who, despite having unlimited resources, had to watch helplessly as his body was slowly consumed by a large payload of (somewhat karmic) bacteria. He didn’t even have any pain relief to cover the countless days on which hot pokers were inserted into his leg ulcers.

Thanks to medical science, even the poorest among us now live a more privileged existence than the king of everything did only a very short time ago. The vast majority of yesterday’s fatal diseases, accidents and infections have been reduced to today’s mild inconveniences.

Today we get to complain about the negative impact antibiotics have on our guts and waiting times at emergency departments. Yesterday those were luxuries that even kings and queens could only dream of. Modern medical science is a technological marvel.

Yet, despite its success in treating diseases, medical science has many failures. And one of those is its failure to make any meaningful impression on the pandemic of chronic pain we live amidst. In that instance, it has proven to be as ineffectual as Henry VIII’s physicians were in their attempts to prevent his legs from being consumed.

When it comes to healthcare, the word ‘science‘ is commonly misappropriated and misrepresented. Increasingly the term science is used to mean ‘ isolated, tested and statistically proven by large volumes of recorded experimental data’. The type of science we use to discern the effectiveness of drugs. Which is a part of some sciences but categorically not what science is.

There are whole branches of science that are purely theoretical and not based on experimentation, like theoretical physics. The mechanisms proposed in scientific concepts that we accept wholeheartedly, like natural selection (evolution) and the big bang, are theories.

Science: ‘The systematic observation, explanation and experimental investigation of the physical world’s mechanisms’.

Science is not ‘experimental data’; it is something much broader and deeper than that. Amongst other things, science includes sound methodologies, theories and working hypotheses. All of which are valid.

The scientific process is something far broader and more nuanced than ‘data’.

Modern medicine has heavily inferred that it’s best to limit one’s pain treatment options to those that are ‘scientifically proven’ by data. Yet, in the real world, this approach rarely leads to the best possible long-term outcomes for chronic pain sufferers.

The best results in pain management come from a willingness to take the current evidence and build on it with a sound working hypothesis, like many other sciences do, and put these hypotheses into action. Both with proven tools and other tools that have yet to be properly ‘researched’; but nonetheless have a strong anecdotal track record. Then apply all of the above aggressively in an attempt to get the patient out of pain now. Not in some distant and improbable future where we have enough data to act effectually.

Sadly, pain management is a speciality plagued by a severe lack of high-quality ‘scientific data’ regarding the effectiveness of treatments. Relative to the scale of the problem, at least. This is in no small part due to the extreme difficulty of generating high-quality data for pain treatments. For study design and economic reasons, it is infinitely harder to generate high-quality data on a new osteopathic treatment than it is a new non-steroidal anti-inflammatory. And sadly, drug therapies don’t resolve pain; they simply mask it.

You would be mistaken if you assume that this lack of quality research only applies to allied health treatments like chiropractic, acupuncture and osteopathy.

Consider the following statement published in the British Medical Journal. Based on a 2021 meta-analysis of a large number of randomised control trials on the effectiveness of elective orthopaedic surgeries.

‘No strong, high-quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives.’.

The data analysed revealed that 8 out of 10 orthopaedic surgical procedures either had no evidence to support their effectiveness or had evidence that specifically pointed to a lack of effectiveness. Relative to the far safer alternatives, like acupuncture, shockwave therapy, LLLT, osteopathy and exercise prescription.

For complete clarity, the pre-eminent British Medical Journal is telling us that there is a severe lack of high-quality scientific evidence to support the use of 8/10 of the most common orthopaedic surgeries.

The funding pool behind surgical research outstrips every other pain management profession by an exponential margin. Yet, despite this vast research budget, orthopaedic surgery for pain still seriously lacks quality supporting data.

Sadly this data on surgery, or lack thereof, accurately reflects the broader state of pain management research in the 21st century.

Yet, a lack of data does not necessarily imply a lack of effectiveness.

A ‘lack of evidence’ often just means that no one has got around to generating any quality data. With pain treatments, one tends to find a few scraps of data but no rigorous study on a large enough group of patients to have gained any certainty.

More often than not, this leaves the scientifically minded patient and practitioner alike being forced to choose between no treatment and ‘unproven’ treatment. But luckily, a strong case can be made for trying out many ‘unproven’ pain treatments.

Reflecting on non-healthcare disciplines sometimes helps pain patients develop some comfort with the idea of ‘valid but unproven science‘. Which, in truth, applies to the vast majority of life’s competencies.

Over the past 20 years, Brazilian Jiu-Jitsu (BJJ) has moved from complete obscurity to becoming one of the world’s most popular martial arts. BJJ is a reiteration of Japanese Jiu-jitsu, modified into a shockingly effective system of grappling, chokes and submissions.

The primary feather in the cap of BJJ is that it was once tested in open competition against many other martial art forms and came out on top of the heap. Thus ending countless testosterone-laced debates about which is the most effective martial art. BJJ also has a proven track record for enabling smaller men to beat much larger men in martial arts contests—a major feat and one that has been performed repeatedly with the BJJ system.

For those of us who have no experience in the grappling arts, being on the ground with the wrong amateur BJJ practitioner has great potential to be a life-altering unpleasant experience.

On being instructed to avoid getting choked or having any of our joints snapped, we make a few instinctive attempts at self-preservation. Then, depending marginally on our level of physical strength, within a handful of moments (or possibly just one), we would find ourselves in serious trouble.

An instinctive movement of our neck, arm or leg that felt like the right thing to do. Leading on to a sudden realisation that something important, like an elbow, was about to snap out of its socket. Other exciting possibilities include blacking out due to a lack of blood in our brain faster than we dreamed was a physical possibility or having our ankle joint snapped. Luckily for us, though, most BJJ practitioners are very wholesome types who wouldn’t dream of fully executing the move. So the whole thing could be put down to a near-death experience for the elbow.

For those of us who have no experience in the grappling arts, being on the ground with the wrong amateur BJJ practitioner has great potential to be a life-altering unpleasant experience.

Now, if we take that same novice BJJ practitioner who went easy on us and put her against a fully-fledged black belt, her experience could easily be over faster than ours was. She would almost certainly lose 100/100 matches against her teacher. Then having conducted that experiment, if we take that black belt and put them against a BJJ world champion, once again, we would see someone being submitted very fast every single time.

You could go to any number of clubs all over the world; and find a gravely consistent disparity in ability between yourself and the novice, between the novice and the black belt, and between the black belt and the champion. Which incidentally is a lot like repeatable scientific data.

BJJ is an effective, practical and repeatable system based on sound scientific principles. If you doubt this, all you need to do is go to your local club and tell them; they will help you to understand better.

Now that you understand BJJ a bit, there is something else important to understand. ‘There is zero scientific data to support BJJ’s effectiveness. It is ‘scientifically’ completely unproven.

There are no research articles published on BJJ’s effectiveness at breaking elbows. There are no literature reviews on how consistently black belts choke out blue belts. There are no in-depth peer-reviewed technical papers on the best way to secure an arm bar. And there are no randomised blind controlled studies on the probability of getting choked unconscious by a club black belt after you tell them in front of the class that BJJ is an unscientific system.

BJJ’s effectiveness is ‘purely anecdotal’ in scientific terms. And yet, this utter lack of data has no bearing whatsoever on the stark, visceral and predictable reality of grappling with its practitioners. BJJ is a verifiable and repeatable science.

But if BJJ practitioners limited themselves to the parts of their art form that were scientifically proven by medical standards, they would all just have to sit on mats looking at each other – Paralysed by the need for statistical proof. But they don’t worry about that; they just get on with it – extremely well.

It is possible, of course, that BJJ isn’t the best all-around martial art. In fact, rolling around on the floor isn’t always the safest form of combat when it comes to self-defence in the real world. The point is that it is a verifiably effective science that has been developed without the need for ‘scientific proof’.

What if successful management of chronic pain is the same? An area where competence is possible despite the lack of quality research data. Do you choose to steer clear of it due to this lack of high-quality evidence? Or do you dive in?

Regardless of what your answer is, pain management is not a martial art. There is an unseen subtlety and complexity to effective pain management. One that is admittedly lacking relative to the art of choking one’s neighbour unconscious in white pyjamas.

Pain resolution is a nuanced well-being issue. The underlying goal of which is achieving a good state of health, given that a healthy body and mind naturally tends to be a pain-free body and mind. So in the data drought, the pain sufferer finds themselves in, it’s worth wondering whether we have any collective track record for gathering valid health and well-being knowledge; outside the medical science realm. And happily, we most certainly do.

The old Norse word for cod liver oil is ‘lysis’, which means light. Which we can safely assume was a name born out of reverence. Light has special significance to cultures that spend a large part of their yearly cycle in relative darkness.

Over 1000 years ago, the Vikings had come fully to terms with the unmatched benefits of Omega 3 fatty acids. Ten centuries before we even knew Omega 3’s existed, Norse cultures prized fish liver oil to such an extent that they referred to it as ‘the gold of the ocean’. They were not the only culture to uncover this class of ‘medicines’.

The oil of marine species’ livers has a long history of medicinal use. In ancient Greece, Hippocrates himself (the so-called “Father of Medicine”) prescribed dolphin liver oil to treat skin problems.

The Vikings most commonly extracted cod liver oil by laying birch tree branches over a kettle of water and placing fresh fish livers on them. The water was brought to a boil, and as the steam rose, the oil from the liver dripped into the water and was skimmed off. They also had methods for producing fresh raw cod liver oil.

The Vikings primarily consumed cod liver oil during winter when the days were shorter and lacked sunlight. This was both convenient and poetic, given that they referred to it as ‘less’ light. Vitamin D is a key constituent in cod liver oil and a key benefit of sunlight. They may well have been aware that the benefits of light and oil were comparable. Living in the open air in an intensely seasonal environment offers many subtle insights that would be lost on us.

Ultimately, cod liver oil was prized by the Vikings because they knew its ability to prevent sickness and disease. So they rubbed it on their bodies and routinely consumed whole fresh livers dipped in liver oil.

Cod liver oil has remained a widespread folk remedy in Northern European fishing communities over the centuries. And we can safely assume they were not consuming it because of its flavour profile.

As early as 1782, English physicians began studying cod liver oil and prescribing it for rheumatism. In 1822, cod liver oil was officially recognised by the medical profession for its curative powers. Yet no one understood why or how it worked. By the mid-18th century, it was widely observed that cod liver oil was highly effective in the treatment of rickets, rheumatism, skin wounds, chronic pain, gout and some forms of tuberculosis.

Cod liver oil is approximately 20% omega-3 fatty acids. Though similar in fatty acid composition to other fish oils, cod liver oil has higher concentrations of vitamins A and D. According to the United States Department of Agriculture, a tablespoon of cod liver oil contains 4,080 μg of retinol (vitamin A) and 34 μg (1360 IU) of vitamin D.

In the modern era, the use of Omega 3’s, a dietary supplement, is supported by a mountain of scientific data. They are one of the very few nutritional supplements whose value there is no disagreement upon. The benefits are extremely broad and well-documented across brain and mental health, cardiovascular health, eye health, liver health, respiratory health and bone health. It would be easy to make a case for Omega 3 fatty acids being the king of ‘nutraceuticals’.

So The Vikings and many others before and since managed to identify that there was medicinal magic held within fish livers. And not only that, they accurately discerned that it was the oils in the cod liver that had special significance and possibly even that it contained a key benefit that matched the benefits of sunlight. When all is said and done, they discovered what may be the world’s most important nutritional supplement 1000 years before medical science was even conceptualised.

We clearly have the ability to perform sophisticated problem-solving in the wellness arena. Without modern medical science. By means of empirical and experiential real-world problem solving, and ultimately, science.

The only conceivable argument against this type of learning being a valid part of how we select healthcare interventions is our inherent fallibility. Yet there are few more well-documented examples of a fallible system than the very one that claims, above all others, to be supported by medical science—the pharmaceutical industry.

In the past decade alone, big pharma has paid out in excess of 20 billion USD in damages and criminal fines due to the wholesale carnage caused by drugs that were deemed ‘proven’ therapies by the data-based standards of Western medical science. The real story behind these numbers is not a financial one but one of heartbreaking human suffering on a grand scale. Caused by complete failures on the part of medical science itself.

All forms of science carry some level of fallibility. From those we develop purely through real-world experience to those that are validated by substantial investment in the generation of ‘medical proof’.

It is possible, and perhaps perfectly reasonable, to hire your pain management team on the same basis you hire a lawyer, martial arts coach, singing coach, piano teacher, carpenter, or even a barrister. On the basis of education, experience and a sound working hypothesis about the cause of your pain. Rather than on the basis of rigorously designed, large-scale, double-blinded, randomised control trials published in peer-reviewed journals, which seldom exist in any case.

There are times when it is safer to keep the entire scientific process locked away from the public through the entire arch of its development. Successful development of bioweapons would be an excellent example of this. And many drug therapies need to be treated with similar caution.

There are, however, also times when it is far safer to unleash the scientific process on the general public at the ‘working hypothesis’ stage. An exploding global pandemic that shortens millions of lives and ruins the quality of countless others could be an example of this – certainly when the safety profile of the relevant procedures is beyond a reasonable doubt – as it is with the likes of acupuncture, fascial release, meditation, core exercises and spinal mobilisation.

And when all is said and done, the entire topic of science is only one part of healthcare.

Healing disciplines are not science; they are based on science. In the real world, all healing disciplines are, to varying degrees, art forms based on scientific principles. Pain management is a safe and effective art form based on scientific principles.

Those of us who are suffering with chronic pain have a golden opportunity. To dive into effective pain management on the basis that it is an ‘unproven’ but valid art form underpinned by scientific principles. Like Brazilian Jiu Jitsu, or the extraction of oil from fish livers using wisdom, birch and steam.

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Shockwaves, Pain Treatment & Hormetic Stress

Tobias Hall — Tue, 11 Jul 2023 23:39:53 +0000

Shockwaves, Pain Treatment & Hormetic Stress

Using hormetic (healthy) stress to heal painful tissues is a crucial element of pain management.. Even for pains that are predominantly nervous system based (like PTSD-associated pain), there is great value in healing and strengthening painful tissues.

‘Hormetic stress‘ is a term few have heard of. Yet it’s a cornerstone of health, of our lives, and the entire natural world. Hormetic stress is also a significant key to getting out of chronic pain.

Hormetic stress is an invisible by-product of healthy life processes, and it’s everywhere. If life were a chocolate cake, Hormetic stress might be the baking powder. An invisible flavourless ingredient that nonetheless holds everything together. Without this, the entire recipe becomes an unappealing stodgy mass.

In nature, the benefits of hormetic stress show up under a wildly diverse and broad set of circumstances. Its benefits support individual cells, organs and muscles but extend to shaping entire species and even the environments they live in.

Excessive stress of almost any kind can destroy life very quickly. Zero stress tends to cause a slow death and failure to thrive. But, with the right amount of stress, life is fortified and can truly thrive. This healthy stress is hormetic stress.

If you set up a warm, damp environment in a petri dish, bacteria love it. Then, if you add a sugar solution, they can continue to survive. But there’s another ingredient that you can add that will cause them to truly thrive—a microdose of arsenic.

Bacteria left with the perfect conditions for life are consistently outperformed by bacteria with the perfect conditions for life – plus a little bit of poison. Knowledge of this fact reveals a great deal about life, health and successful pain management.

Bacteria with too much arsenic die. Bacteria with no arsenic just survive. Bacteria with a microdose of arsenic become a roaring success. The right amount of poison in their environment acts as a hormetic stressor. A manageable dose of stress forces adaptation and makes them stronger. In this way, infinite versions of hormetic stress benefit all of nature, from single-cell organisms to entire ecosystems.

Giant Sequoia trees bear the largest scars on any life form on earth- Scars left by fire. Sequoias are utterly besieged by seasonal fires in a way that is almost impossible to believe could be helpful to them in any way – Until you look closer.

Sequoia once occupied the entire Northern Hemisphere. Yet only three species have survived ‘recent’ ice ages. The Giant Sequoia is one of the three. And their home range is now limited to 77 small tree communities in a 260-mile strip of the Western Sierra Nevada mountains.

Compared to Giant Sequoia, human biology is ant-like. They are living, breathing apartment blocks with three-foot thick skin. The largest being 100 ft in circumference at the base and 26 stories tall. Body masses that exceed that of 15 blue whales (or 300 elephants) are common. Single trees can live 3-4 times longer than the most successful human cultures, over 3000 years. But these are not the big numbers.

The Giant Sequoia’s direct bloodline is around 150 million years old. That’s about as long as the entire mammalian family tree. And they may achieve a longer stay on the planet than all of the dynasties of dinosaurs combined. They are a single, seemingly immortal species that have outlived numerous biological epochs. And the secret to their success is mastery of hormetic stress.

The Sierra Mountains are prone to biblical forest fires. A bad forest fire can burn for up to 6 months at a time. And fire, being fire, has the capacity to decimate vast tracts of forest. The Castle Fire in 2020 destroyed 4 million acres of forest. Smaller tree species tend to get the worst of it. Yet when fires are bad enough, Sequoia groves can suffer catastrophic losses too. But giant sequoias are uniquely fire-tolerant.

In the same way that antelope are highly adapted to the specific goal of not being eaten. Sequoias are highly adapted to the specific goal of not being burned alive. What a lioness is to an antelope, too much fire is to a Giant Sequoia. So a substantial portion of their biology is dedicated entirely to fire resistance.

Naturally, large enough fires can wipe out sequoia groves. Like too much arsenic poured on a bacterial culture. And even the most massive trees can succumb to fire. Larger trees need to burn for months for it to happen, but once several feet of bark armour is breached, the delicate heartwood can burn, and the tree will die.

But even when the protective bark is breached by fire, sequoia usually doesn’t die. Instead, they end up with giant scars that can be up to five stories in height. These giant black V-shaped scars serve as a stark reminder of how fragile all life is. And that even the immortal sequoia, who lives through the rise and fall of empires, has its own vulnerability and impermanence. It is also the scars that create the false visual impression that fire is the Giant Sequoia’s enemy.

Seeing the damage fire inflicts on these magnificent beings; it appears certain that fire is a destructive presence in their lives. But nothing could be further from the truth. Fire deeply nourishes, supports and even births sequoia trees.

Sequoia requires vast resources to support its growth. Fire clears out smaller trees that might otherwise compete for the nutrients they desperately need to support their enormous mass.

Sequoia needs granite-hard pine cones. So their seeds are safe from pests during the 20 long years their cones take to grow. Only fire can crack open the cones and birth the sequoia’s baby seeds. Flames fulfilling the role of midwife to the trees.

Giant Sequoia is a pioneer species. Once their seeds are free, rising hot air from fires gently lifts Sequoia seeds. It carries them to their own part of the forest, where they have a chance to establish themselves at a healthy distance from their giant parent.

Despite their parent’s size, sequoia seeds are the size of an oat flake and very fragile. If the seeds do not land on bare earth, they dry out and die. So fire lovingly clears debris from the forest floor, creating the perfect bare soil conditions for the seedling to sprout.

Young sequoia grow very slowly compared to smaller tree species. So when fire pre-clears the forest of smaller trees for the seed, it also removes competition that might otherwise choke the slow-growing baby tree and compete with it for light.

When Giant Sequoia seedlings sprout from the ground, their ‘first meal’ is the fertilising ash left behind by fire. Like a first drink of mother’s milk, fed directly to it by the process of fire.

Once adults, sequoias are strengthened and supported by the presence of fire also. Fire adaptations make sequoia taller, thicker, and more resistant to pests, rock falls and droughts. These attributes enabled them to ‘outrun’ all other tree species in their environment. Thus winning the race for light, water and nutrients.

In the right amounts, fire acts as a classic hormetic stressor to the biology of Sequoia trees. By harnessing and adapting to it, they have become some of the largest, longest-lived and broadly indestructible organisms on earth. The fire that appears as such an alarmingly destructive force to the sequoia is its very lifeblood.

Sequoia requires vast resources to support its growth. Fire clears out smaller trees that might otherwise compete for the nutrients they desperately need to support their enormous mass.

It is deeply telling that such potent and successful life forms have an intense relationship with hormetic stress. It points to how essential hormetic stress is in enabling all life to thrive. It also points to how important it is that we understand hormetic stress’s role in maintaining our general health. And how vital it is to harness this wisdom when seeking to heal tissues that are stuck in the cycle of chronic pain.

Hormetic stress supports life on every conceivable scale. From micro-organisms all the way up to entire mountain ranges. And everything in between, including the human body. There are countless ways that hormetic stress benefits the human body.

Exercise is a hormetic stressor to humans. The most obvious hormetic stress mechanism in our human world is physical exercise. We all know the body needs the constant stress of movement to support healthy muscle and cardiovascular function.

Gravity is a hormetic stressor to humans. Without the stress of gravity, bone demineralises and wastes away. One year in space can leave a cosmonaut with over 20% of their bone mass wasted away to nothing. Without constant mechanical strain, bone stops regenerating itself effectively.

Heat is a hormetic stressor to humans. Sauna research has shown that when we are exposed to heat, our body’s cells generate heat shock proteins. Heat shock proteins assist with cell repair, muscle repair, inflammation control, improved immunity, cardiovascular function and elimination of free radicals.

Cold is a hormetic stressor for humans. The stress of regular cold exposure has been shown to increase dopamine levels, promote greater well-being, reduce auto-immune inflammation, boost immunity to viruses and boost metabolism.

Fasting is hormetic stress for humans. Calorie restriction imposes healthy stress on the human machine. Intermittent fasting can trigger a healthy switch from glucose metabolism to ketone metabolism, increase stress resistance, increase longevity, and decrease the incidence of diseases, including cancer and obesity.

Toxins are hormetic stressors for humans. Tannins found in tea are poisons. Yet, in controlled doses like a cup of tea, they are known to protect against cell damage, heart disease, cancer, invading microbes and toxic free radicals. In larger doses, though, tannins are very toxic to the body, like all forms of hormetic stress.

But the question is, how does this all apply in more specific terms to successful chronic pain management?

Hormetic stress can be harnessed and directed to resolve pain, to significant effect, in the overwhelming majority of cases. And the hormetic stressor most vital in healing chronic pains is not heat or cold of chemical stress; it is ‘mechanical stress’.

Mechanical stress can be used almost universally to stimulate the healing and strengthening processes required to resolve chronic pain. To some extent, this is common knowledge, as hopefully, we all understand the central role exercises play in resolving chronic pain. Yet another integral phase of hormetic healing is required (usually before exercise prescription). Where treatments that harness mechanical stress are necessary to trigger healing in painful tissues. If you have found that exercises increase your pain, this should be of some comfort.

There are many pain treatments that leverage hormetic stress to heal tissues and reduce pain. In fact, the overwhelming majority of effective pain relief tools involve the application of mechanical stress to tissues. One example, in particular, serves as an excellent window into how these treatments work.

Quite unexpectedly, it turns out that intense soundwaves can support tissue healing, the same way fire supports giant trees, by delivering a controlled dose of healthy stress that supercharges biological processes.

Extracorporeal Shockwave Therapy (ESWT) was originally developed in the late 20th Century for the treatment of kidney stones. Some brainiacs realised that intense soundwaves travelling through fluid created a shockwave. And that these shockwaves were strong enough to crack a piece of porcelain; but did not harm living tissue. Because tissue is mostly fluid and offers less resistance to the energy. These observations teased the potential for safe, non-invasive breaking up of kidney stones using shockwaves.

After many years of research and development, ESWT was cleared for use on humans with kidney stones. Which is when something very curious started happening among the test subjects -In the form of unexpected side effects.

After the successful dissipation of their kidney stones, numerous patients felt to compelled to inform the researchers that stubborn pains they had suffered for years had spontaneously resolved. At first, this was understandably dismissed as either placebo or a coincidence. But then something far harder to ignore happened.

A patient with chronic hip pain found that it spontaneously resolved shortly after the treatment of her kidney stones. Which in itself was not unusual, except that the known cause of her hip pain was osteonecrosis (bone tissue death) of her femoral head (upper thigh bone). Then, when x-rays were taken, the bone had spontaneously healed itself. The tissue had mysteriously come back to life. An unheard-of and ‘medically impossible’ event had taken place in her tissues.

Osteonecrosis of the femur happens when the head of the bone loses connection to its blood supply. This can happen as a knock-on effect of other health issues, including radiation treatment, various diseases, and trauma. And often also occurs for no apparent reason. Starved of its blood supply, the bone tissue literally rots away inside the body, causing inevitable pain and disability.

So the only reasonable explanation was that shockwave treatment had triggered the dying bone to re-establish its own blood supply. Naturally, this warranted significant further investigation.

Fast forward 40 or so years, and ESWT is a gold standard treatment for an incredibly wide range of musculoskeletal pains. Plantar fasciitis, heel spurs, tendinopathies, calcific tendinopathy, stress fractures, Achilles pain, tennis elbow, knee pain, and frozen shoulder are all firmly on the list. And many others, like back pain and neck pain, have yet to be studied in depth but, nonetheless, often respond well in real life.

Shockwaves’ ability to heal bone and soft tissue means that it has potential application for treating pain almost anywhere in the body. In addition, it has become a standard treatment for erectile dysfunction. And its ability to trigger nerve regeneration has even led to it being studied for its potential use in treating spinal cord injuries, brain damage and Alzheimer’s.

Underlying all this lies a bewildering number of well-documented cell and tissue healing responses. Exactly the type seen when stem cells go to work. New blood vessel growth, new cartilage growth, protein synthesis and the release of various ‘growth factors’ are all well documented.

All of which come directly from the application of mechanical stress to the cells and the spaces between the cells. The soundwaves create intense pressure, which creates mechanical stress in the tissue, which creates a hormetic response.

So ESWT is a classic hormetic stressor. It imposes healthy stress on tissues and stimulates a wide range of healing responses, which lead to a reduction in pain. Fundamentally acting just like controlled doses of fire do on groves of sequoia trees.

ESWT is very typical of the treatments that most reliably lift people out of chronic pain. Because most of them also apply mechanical stress to the tissue and elicit a hormetic stress response.

Rehab exercises, deep tissue release, spinal manipulation, yoga, pilates, cupping, fascial release and acupuncture and trauma release exercises are other excellent examples of how home mechanical stress can be exerted in order to heal tissue.

For most pain sufferers, the secret to harnessing these hormetic stressors is to use multiple stressors in conjunction with each other. Combining ESWT with cupping, for example, dramatically improves its already excellent hit rate. In addition, it’s usually necessary to do things in the right order.

The more passive treatments (i.e. the ones you just lie down on a treatment table and receive) should be used first to heal the tissues and reduce pain. Then, when the pain has reduced, less passive treatments like strength exercises should be used. This helps avoid bad reactions to exercise by ensuring the tissues are sufficiently healthy before strengthening starts.

The best way to explore all the options is to find a clinic where they systematically mix and match treatments. Failing that, you can curate your own investigation into various hormetic stressors. By hiring a deep tissue therapist, a shockwave therapy practitioner, a chiropractor and an acupuncturist (just for example). In addition, always prescribing your own dose of hormetic stress by keeping your body moving regularly and in healthy ways (as much as you can without causing more pain).

A strategy of this nature ensures that your painful tissues receive diverse forms of mechanical hormetic stress. The benefits of which should become apparent within weeks, or at least months. Once the treatment combination is right for your body, that is.

Beyond these pain specifics, it’s also well worth considering a more holistic embrace of hormetic stress. Sauna, cold plunges, cardiovascular exercise and fasting have all been of immeasurable benefit to people on healing journeys of all kinds.

Annoyingly, both in and out of pain management, hormetic stressors tend to be uncomfortable. Shockwave therapy isn’t always fun, running up hills isn’t fun, and cold plunges are generally even less popular. So it takes willpower to repeatedly throw one’s self into these fires. But ultimately, a life hollowed out by chronic pain is infinitely worse. So once they fully understand the value of hormetic stress, most pain sufferers find the choice between the two quite an easy one to make.

It’s a mystery why the body needs agitation to be fit .. to heal pain. But it so often does.

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The ‘I’m Fixed’ Myth

Tobias Hall — Tue, 11 Jul 2023 01:55:19 +0000

The 'Im Fixed' Myth

Latency & Complexity

-‘Latency’ is when the body has a clear and present health problem but no symptoms.-

Most people stand very little chance of escaping the chronic pain cycle until they fully understand ‘latency’. Because truly healing chronic pain requires ongoing, sincere effort long after symptoms have resolved.

Many health conditions spend a significant part of their ‘life cycle’ in an invisible state of latency. Asthma is an excellent example of this. The asthmatic has asthma 365 days a year but only suffers attacks at certain times. Most pain conditions behave exactly like this to some degree. This can create a great deal of confusion. Many patients express shock and distress when symptoms that have resolved return.

The human body is a deep and mysterious phenomenon. It’s a bit like the ocean. We see what goes on at the surface, but most of what it does is unseen ‘stuff’ going on under the surface. Like the ocean’s depths, we actually still know very little about the body’s inner workings.

The 30 trillion cells reading this text all work together like instruments in an orchestra via quantum computing, which is way beyond our current understanding. Every three days, 1000 billion of these cells die off and are completely replaced.

Cells only make up about ⅔ of your body mass; the rest is fluids the cells are bathed in. Then there is the small matter of an estimated 39 trillion other life forms that live in the body at any given time. Meaning there are more bacteria, viruses and fungi in us than there are human cells

In the time it takes to eat your breakfast or send an email, literally, hundreds of trillions of cell processes occur. Yet how much of this do we actually experience? Not much. The body sends 11 million bits of information per second to the brain, and the conscious mind can only compute 50 of those bits per second. The rest is mostly reconciled to the great mystery of life.

Symptoms and Tests

Yet obviously, there are still many useful clues as to what is happening on the inside of our bodies. When we are very healthy or very sick, these are especially obvious, even to the untrained eye.

Symptoms tell us a lot, and so can investigations like blood tests and scans. Yet clearly, the awkward truth is that 99.9% of what the patient’s body does is still unseen and unmeasurable. It’s easier to investigate outer space than the inner workings of the body.

So much goes on without being seen, felt, heard or measured by us or our doctors.

If someone is on course for a heart attack two years from now, they might already have some symptoms – but it’s also possible they have no symptoms. Their first symptom might be the heart attack itself, after decades of heart disease. This is an example of latency.

There is often an incubation period between contracting a virus and the onset of the symptoms. In fact, some infections like the Herpes virus can sit in the body for decades undetected. This is another example of latency.

We observe breast screening routinely because we know that breast tissue can easily harbour cancerous cells that are not noticed by a patient. Unseen, unfelt cancerous cells in breast tissue are an example of latency.

People with IBS can go for long periods with no symptoms until they encounter some stress or eat the wrong thing. The IBS was sat in a state of latency until it was triggered.

These small examples demonstrate how latency works. And that we are mostly aware that latency is common to many, if not all, chronic health complaints. Yet many pain sufferers still completely overlook the fact that latency applies to pain too. But they shouldn’t because it applies to chronic musculoskeletal issues in a big way.

Radiologists routinely find spinal disc protrusions, arthritis, cartilage tears, enlarged bursa and tendon tears in patients that have no symptoms whatsoever. Many of these people go their whole lives with no symptoms. Others have very intermittent symptoms, like an asthmatic. This is absolutely normal and clearly demonstrates latency in the musculoskeletal system.

Outside of physical wear and tear, latency also applies to simple mechanical pain. The headache sufferer, neck pain sufferer, back pain sufferer, RSI sufferer, and Achilles pain sufferer all tend to have symptoms that come and go. Many go long periods with no pain at all, only to find it comes back at certain times or periods of their life.

Yet obviously, there are still many useful clues as to what is happening on the inside of our bodies. When we are very healthy or very sick, these are especially obvious, even to the untrained eye.

So much goes on without being seen, felt, heard or measured by us or our doctors.

People with IBS can go for long periods with no symptoms until they encounter some stress or eat the wrong thing. The IBS was sat in a state of latency until it was triggered.

Thinking You Are Fixed

Many patients think of themselves as ‘fixed’ once they find a treatment that resolves their symptoms or when they naturally arrive at a pain-free chapter- in a way that people with conditions like asthma never would.

We know full well it’s not safe for cancer patients to self-discharge after treatment just because they feel better – we let the scans determine when treatment has been successful. Asthmatics don’t throw away their inhalers after an attack. But chronic pain sufferers routinely self-discharge based on how they feel. Believing that being symptom-free for a short time indicates they are ‘fixed’.

And in fairness to them, there are times when that strategy works just fine. When we were children and had a virus, Mum kept us home until we felt better, then sent us back to school. When we cut our fingers, they do heal, and it’s pretty obvious when that process is complete. Food poisoning is generally short-lived, and when we feel better, it’s genuinely over, thankfully.

Even more relevant, simple musculoskeletal injuries are often fully healed once the pain stops – which is the crux of the issue. We tend to keep pain in the same file as injuries. Unfortunately, though, chronic pain is far more complex.

The natural history of chronic pain is the same as asthma, IBS, endometriosis, psoriasis or cardiovascular disease. It is a chronic condition that tends towards periods of latency and subsequent relapses until its causes are healed.

Chronic and recurrent pains are signs that the 30 trillion cells are going through some struggle – usually patterns of biomechanical strain, poor lifestyle choices, emotional stress, and sometimes unresolved physical or psychological trauma.

Why Symptoms Go Quiet

The body is a bit like ‘you’

If you were unhappy at work, chances are you wouldn’t complain constantly – much of the time you would probably be too busy to complain. You might only complain at specific times, like on really bad days. The body does the same. It only ‘complains’ via symptoms when things are really bad. The rest of the time, it just quietly does its best and makes do.

In rare instances, chronic pain can become constant. But mostly, the body suppresses pain. Sometimes for years. Sometimes for parts of the year. Sometimes for part of the month. Sometimes for parts of the week. Sometimes for parts of the day. But the underlying problems persist during pain-free times. This tendency is probably due to our ancient survival hardware.

Our distant hunter-gathering grandparents led a hard-knock life. If they’d felt every bit of inflammation in their bodies, they would have felt sore all the time. In order to hunt and gather consistently, it’s necessary to suppress a certain amount of pain. Or live with the discouragement of constant pain.

Food and water are far more important than aches and pains in the big outdoors. So from an ancestral perspective, it makes perfect sense that latency would be baked into the chronic pain cake. Latency saved us from spending our lives hobbling instead of hunting. Through the vast network of cell processes, we learned to suppress pain in favour of supporting survival.

The Importance Of Pain-Free Times

There is a big reason why understanding latency is so vital to truly recovering from chronic pain. The real work of resolving chronic pain happens after the symptoms go away. Just like it does with dentistry.

We don’t stop flossing and brushing just because our cavity was filled in by the dentist. We understand that teeth take lifelong care and stewardship in order to stay healthy. Why would body parts that have struggled with chronic pain be any different?

Consistent strengthening, stress management, self-care and biomechanical checkups are the ‘dental floss’ that keeps pain at bay in the long term.

The problems underpinning pain might not go away the moment symptoms stop. And they seldom spontaneously vanish in between episodes. So they do usually require longer-term attention. But once we figure out our causes, gentle but persistent effort is enough to resolve them in most cases. Symptoms or no symptoms.

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The Old Age Myth

Tobias Hall — Tue, 11 Jul 2023 00:28:54 +0000

The Old Age Myth

Over time, a toxic belief can be as harmful to the body as a toxic chemical.

One of the most toxic and inaccurate beliefs nurtured by many pain sufferers is that their pain is caused by getting older. This old age myth may stem directly from the global family doctor’s office, where it is often advertised, but it’s hard to know for sure where it started.

For some, dispelling the age myth is the most important learning on their road to recovery. Developing clarity around this myth has the capacity to profoundly impact people’s quality of life: if not immediately, at some point in their future. Many people can achieve clarity in a matter of minutes and find it serves them for years.

Words hold great power over our health and well-being. Especially the ones we repeat often. Imagine the long-term health impact of sitting a small child down every day and telling them in a serious tone, ‘All exercise is very, very bad for you’ or ‘Only stupid people eat vegetables’. Words and phrases, when repeated often enough, can have a life and death hold over us.

‘It’s just old age’ is a phrase that I have seen wreak direct havoc on the health of countless people, for decades.

‘It’s just old age’ are words that contain many subtle threads of meaning, but ultimately it boils down to ‘nothing can be done because my machinery has broken down irreversibly’.

You may have noticed that friends, neighbours, healthcare providers (and even yourself?) frequently attribute pain in the over 40’s to ageing. In contrast, after 20 years in the front lines, managing the pain of people from 90 days old to 90 years old, I have come to believe ‘It’s just old age’ is one of the most overused, inaccurate and seriously harmful phrases in the English language.

Did you know that research has shown, beyond any doubt, that people in their 50s get far more back pain and neck pain than people in their 80s?

Did you know that the majority of age-related disc bulges never cause any pain?

Did you know that only a very small percentage of arthritic joints actually cause pain?

Most of the people I talk to about pain and their ageing process are surprised by these facts.

Des was 93, and he felt it. He was the kind of older gentleman who everyone finds adorable. No doubt, he had always been a sweet-natured man. But over 93 years, life had softened him to the point of being baby-like in his ability to light up a room. I had known Des for six years and liked him a lot, but I never saw much of him.

Long before I met Des, he had started attending the clinic where I worked to get his lumbar spine checked every six months. These legacy treatments had been agreed upon by Des and my predecessor after he had serious back pain in his ten years earlier. And I continued that care with Des. This meant that Des and I had brief interactions twice a year. And in time, I became aware that they were highly repetitive in nature. Word for word, our conversation always followed the same pattern.

Me. ‘Hey Des, how are you feeling at the moment?’.

Des. ‘Oh you know, I feel old; I’ve had a good life though; I’ll be quite happy to go soon, I don’t mind’.

Me. ‘What parts of you feel like that, Des?’ (fishing for specifics)

Des. ‘Well, you know I am so stiff all the time. It’s hard to get up in the morning, and I can’t even go for a walk. Going upstairs is a struggle; I am just very, very old, you know. But you know I’ve had a good life, I’m not complaining.

Me. ‘Well, let’s take a look and see if we loosen things up a little bit for you, Des; let me help you onto the table’.

Des. (very slowly clambering onto the table) ‘It’s okay, I’m just getting old’.

The treatments themselves were also highly generic. Some gentle dry needling and mobilisation. Which Des always felt helped loosen him up slightly. Enough to make it feel mildly beneficial was my impression.

Des was living with a lot of stiffness and pain, mostly in his lower back region. He felt extremely stiff, stooped and uncomfortable all day, every day. And naturally, he attributed it to the ageing process. The treatments took the edge off this feeling.

In the unspoken background to these conversations, I sensed Des was suffering a great deal. Despite being superficially philosophical, his eyes told a different and far more emotional story.

A percentage of older men who’ve led a full life appear to soften as they age. And thus, find their emotions far more raw and visible than they were in their youth. They cry more easily than most younger men. Des was one of those gentlemen, and it made him incredibly easy to read. In these talks, his eyes watered visibly, and it was painfully apparent from his demeanour that he felt a great deal of anguish about his loss of mobility.

Older people who battle just to get up and dress themselves in the morning suffer. Dementia notwithstanding, they all remember vividly what it was like to leap up without a second thought. Just because they have different numbers attached to their birthdays, it doesn’t mean they like being crippled any more than the rest of us would. Des was suffering.

There was another unspoken narrative in the background of these predictable chats with Des. The physical things I was seeing and feeling as a clinician. And they were causing me to become highly sceptical of the ‘I’m just old’ narrative, unbeknown to Des.

From the way he moved, I could see there were certain legitimate age-related changes that accounted for parts of what Des was feeling; he was 93, after all. Yet there was also something very suspicious going on. Something easy to miss—unless you treat biomechanical pain for a living.

If you treat enough chronic pain patients, you eventually attune to how different types of patients move. Gout sufferers, hip pain sufferers, frozen shoulder sufferers, disc pain sufferers, back pain sufferers, knee pain sufferers etc. They all tend to move in their own specific and predictable ways, especially when they rise from chairs and then climb onto treatment tables, as luck would have it.

This was the suspicious thing about Des’s ‘I’m just old’ diagnosis. He didn’t move from chair to table like a struggling 90-year-old. Des moved like someone who had back pain. And for as long as I had known him, he always had done.

Another ill-fitting jigsaw piece was Des’s left sacroiliac joint. Motion palpation of the dear old boy indicated this joint was perpetually locked and very inflamed. It gradually became impossible not to suspect chronic mechanical pain, as opposed to old age pain.

Despite my suspicions, I never wanted to rock the boat. I admired Des’s commitment to maintenance care and didn’t speak up about my suspicions for a long time. It’s often harder than you might think to have those conversations. Des really truly believed his immobility was old age, and so did his family doctor of 50 years. Pushing back on these narratives can create discord. But eventually, I spoke up. The opportunity presented itself after Des’s pain and stiffness went through a flare-up.

Long story short. I could tell Des thought my ‘back pain, not old age’ theory was at least 90% youthful overconfidence, but he trusted me. So he gave me the green light to treat him the way I’d been wanting to, instead of the legacy treatments we had always done. This involved manipulating his sacroiliac joints far more firmly than most people would imagine being appropriate for a 93 yrs old—deep tissue release for his lumbar fascia, then rinse and repeat twice weekly for two months.

After the first sacroiliac adjustment, Des stood up straighter than he had in over a decade. He was completely astonished. From week 3 of the new plan, Des’s entire demeanour changed, and he never mentioned feeling old and ready to die again. He resumed his daily short walks after a 5-year hiatus. Found getting up in the morning comfortable. He dressed himself easily. And his general energy and mood were completely transformed.

Once things had settled, Des decided he would resume his maintenance care at a fortnightly interval rather than the original six-month intervals. This kept him mobile for his remaining years.

Des’s experience played out exactly as it does when you unlock chronically inflamed sacroiliac joints in 50-year-olds. Admittedly he remained frail. But Des didn’t perceive any suffering in his normal age-related limitations. It was the chronic back pain that caused him to suffer. And once that was gone, Des had a new lease on life at 93.

Des’s actual diagnosis was ‘sacroiliac joint pain syndrome’ or, if you like ‘, simple mechanical lower back pain’.

The original misdiagnosis was severe ‘It’s just old age-itis’. That small cluster of seemingly reasonable but deeply malignant and deeply inaccurate words, ‘it’s just old age’, had been ruining a precious and meaningful part of Des’s life.

Some 80-year-olds play golf three times a week, go to the gym twice a week, and manage multiple cruises a year. Other 80-year-olds can barely dress themselves because of crippling disability that hollows out their quality of life. The slowing down of humans is not a straightforward and linear process; it’s a complex topic.

If I could convince you that even arthritic pain isn’t ‘just old age,’ it might be easier to believe your pain isn’t ‘just old age’.

*This is a conversation about ‘wear & tear’ arthritis. As opposed to the likes of rheumatoid arthritis is an autoimmune condition.

At a glance, arthritis certainly appears to be a very simple case of ‘just old ageness’. Old people’s joints just wear out and get sore. But in truth, this is an oversimplification that borders on the utterly absurd.

Even the most basic facts of arthritic pain reveal an infinitely more complex situation.

Over 90% of joint surgeries for arthritic pain are performed on patients who don’t require the same procedure in their other knee, hip, ankle etc. So neighbouring joints that are the same age have not worn out.

Over 90% of joint surgeries are in the lower limbs. Not the joints in the upper half of the body. This is because arthritis almost never develops symmetrically or evenly throughout the body.

The majority of arthritic joints never hurt and go completely undiagnosed.

Wear and tear arthritis frequently shows up in people who are far younger, usually in highly specific and isolated parts of their bodies.

If I could convince you that even arthritic pain isn’t ‘just old age,’ it might be easier to believe your pain isn’t ‘just old age’.

*This is a conversation about ‘wear & tear’ arthritis. As opposed to the likes of rheumatoid arthritis is an autoimmune condition.

Even the most basic facts of arthritic pain reveal an infinitely more complex situation.

Over 90% of joint surgeries are in the lower limbs. Not the joints in the upper half of the body. This is because arthritis almost never develops symmetrically or evenly throughout the body.

The majority of arthritic joints never hurt and go completely undiagnosed.

Wear and tear arthritis frequently shows up in people who are far younger, usually in highly specific and isolated parts of their bodies.

These cursory facts alone reveal ‘arthritis is just old age’ to be little more than a contemporary superstition. Just like ‘pain is just old age’.

To make this more tangible, let’s take a closer look at a very typical pair of 75-year-old knees.

Gary is tough, way harder than your average customer and for good reason. His childhood was very impoverished by modern Western standards. Then his early adult life was difficult too.

Gary’s unique selling point is that he once raised three children alone with essentially no money. His wife died suddenly, leaving him unable to reconcile the logistics of paid work with the full-time care of 3 small children. He had no extended family or childcare to lean on. And was too proud to receive government support.

He survived by growing his own food and hunting constantly to feed his family, subsidised only by a very small amount of paid employment. Very few people alive today have lived as a borderline hunter-gatherer, so it makes him a rare and interesting case history. His is an impressive story of love, grief, hard work and ultra-resilience. And what makes Gary even more extra-appealing to me personally is that despite the hardships, he has no rough edges to his character. He’s like a teddy bear made of thick indestructible canvas.

If there was a flaw in Gary, it would be that he is far too willing to put up with pain and hardship. He goes through all sorts of difficulties without asking for help. And it’s not hard to guess why.

Self-sufficiency is clearly a virtue, but excessive self-sufficiency can become dangerous, especially when it comes to health-related matters that need treatment. It’s a well-documented source of problems in male patients.

Gary’s right knee had hurt for decades, so much that it had genuinely tested Gary’s toughness to its limits. All said and done, it had severely reduced his ability to live the life he wanted. He’d been on a fraction of ‘the walks’ (hunts) and had a fraction of the decent sleep that he deserved to have had; over many years. And his day-to-day life was blighted with chronic disability. All because of his knee. His right knee had progressively worsened over 30 years and eventually reached its 75th birthday. So no surprise it had extensive arthritis as well as pain.

Meanwhile, Gary’s left knee had never hurt a day in its life. ‘My left knee is perfect’, he would often say. Although if you squint hard enough at the left knee x-ray, it has a tiny bit of painless arthritis.

Asymmetric problems like Gary’s are very typical for older patients with knee and hip pain/arthritis. A closer look at this fact reveals the absurdity of casually dismissing knees like Gary’s and the suffering they cause as ‘just old age’.

Both Gary’s knees have done the exact same mileage – both had the same job – both played all the same sports – both raised the same children – both had been on all the same hunts – both worn all the same boots – both lived and worked on the same surfaces – both been on all the same runs – both slept in all the same beds – both had the exact same nutritional support – both have the exact same genetics – and above all else.. both knees are the same age.

Yet Gary’s two knees had in some way led to such different lives. Going back 30 years, his right knee already had intermittent niggles that stopped him from road running. Then 15 years previously, the right knee even made walking on gentle hills and sleeping afterwards a challenge. By the time Gary was 65, he felt 85 half the time, just because of the right knee. His left knee had never hurt even once.

This is routinely how life impacts pairs of identical neighbouring joints in the same person. So looking with open eyes, how can we keep a straight face and say the right knee has pain and arthritis because of old age?

If arthritis was ‘just old age’, it would develop symmetrically in pairs of joints that had done the same work. Which it almost never does. The same is true for all musculoskeletal pains.

In the real world, pain and osteoarthritis are not simple; they are complex. They relate to the intermingling of genetics + lifestyle + psychosocial stress + biomechanics + injuries + mileage. And these complex truths definitely applied to Gary’s case.

The arch of Gary’s right foot collapsed when he walked millions of times a year. He also had very weak muscles in his right leg from an early age. This situation developed after a very bad sprain to his right ankle, sustained on a hunting trip when he was 28.

After the injury, the disastrous decision was made to put him in plaster for five weeks and then in a moon boot for six months. When he finally escaped the damn boot, it took him another year to be able to walk properly. There was never any actual rehab. Compounding this, Gary has also led a very physically and emotionally stressful existence. Also, tellingly, both Gary’s parents had arthritic joints.

It may not have rolled effortlessly off the tongue like ‘it’s just old age’. But the above paragraph is the authentic explanation for why Gary’s right knee had mysteriously disintegrated. And after addressing these factors, Gary was able to enjoy more hunts in his late 70s than he had in his early 60s.

So even arthritis in 75-year-olds is not simply ageing. Let alone lower back pain in 45-year-olds. For many, this knowledge opens the door to a far happier, healthier, more connected and more comfortable life.

Next time you are at a large international airport walking (hopefully) to your gate, pay close attention to your fellow passengers. When it’s time to walk the half mile to your gate, you get a chance to see how age does not determine pain and immobility.

There are those 70-plus’s who walk the half mile quite normally, keeping up with the younger passengers. There are those who walk okay but much slower than the herd. There are those 70-plus’s who walk with some degree of assistance, like a stick; most of these need to take breaks too. Then finally, there are those 70-plus’s who are in such a poor state that they require the nice man driving ‘the golf cart of shame’ in order to get to their next gate. Yet all these elder folks are in the same age group.

Obviously, our bodies naturally stiffen up as we get older. The average age of those riding the golf cart is far higher than those who walk to their gate; that’s pretty obvious. Wear and tear is a real part of life, after all. This is not in doubt. The thing is, though, ‘correlation’ and ‘causation’ often look like the same thing. But they are not the same thing.

Wear and tear happens over time, but it’s not the time itself that inflicts it.

I challenge you to name one chronic physical problem that doesn’t tend to show up more in older people.

Older smokers cough more and get cancer more; are their coughs and tumours ‘just old age?

Older couch potatoes are more obese and have higher BP, is their physical deterioration ‘JUST old age’?

Older type 2 diabetics suffer from terrible skin sores and neuropathy as they get older; is that ‘just old age‘? Or is it the long-term ravages of a disease?

Older sugar addicts have worse teeth than young sugar addicts, are their black teeth ‘just old age’?

Tissues that are exposed to long-term stress suffer more and more with the passage of time. But it’s the stress and not the time itself that’s the primary problem.

‘JUST old age’ means that time and mileage are the only factors that led me to where I am at. This is literally never the case with pain or with arthritis.

People can get pain at every stage of life. Some knees wear out by their 70th birthday; some don’t. Some humans wake up on their 80th birthday and throw themselves at 18 holes of golf; other 80 yr olds can barely get to the toilet unassisted. Some people have a hip joint replaced at 45. Some people have terrible back pain in their teens and then none later in life. Pain and mobility are complex issues. If we can learn to respect these facts, it opens us up to a world of pain solutions that are otherwise ruled out.

The person who has flat feet and a strong tendency towards ankle sprains in their teens and 20s. Then later develops chronic knee pain in their 40’s & 50’S; will tend to suffer a lot when they are older.

The person who is vigorously healthy but suffers a dramatic motor vehicle accident followed by a sloppy rehab process in their 50s has a far higher probability of chronic pain when they are older.

The person who lives with long-term neck pain throughout their whole life and never seeks treatment will tend to suffer more when they are older.

People who go through substantial emotional adversity in their childhoods tend to have far more chronic pain throughout their lives. Then when they are older, their arthritic joints hurt far more than people who haven’t held stress and trauma in their body’s for a lifetime.People with untreated trauma and PTSD suffer from a lot of pain and disability later in life.

People who don’t exercise and carry extra weight for long periods tend to suffer with pain and mobility when they are older.

These are the type of poor souls who rely on sticks and golf carts in their latter life chapters. And when they are younger, for that matter.

The milder patterns of pain we live within the first half of life often herald the onset of premature disability later in life. There is nothing random, mysterious or inevitable about any of it.

Many much younger patients show early signs of arthritis on x rays. Some studies have even shown that up to 15% of school leavers have the tiny but demonstrable beginnings of spinal arthritis. Arthritic changes often start slowly, very early in life.

Our beliefs hold great power over what happens to our bodies. Even a physical challenge as simple as the removal of a splinter becomes impossible if we say that it is. Simply because we seldom put any real effort or energy into tasks we believe are impossible. The chances of us truly applying ourselves to treatment and rehabilitation for a body part we believe is fundamentally ‘worn out’ are slim to none. This is the power beliefs have to determine our health.

Yes, older people suffer more joint pain in their lower limbs, but conversely, they get far less back pain and headaches. So we must be careful not to conflate all pain into a single ‘old age basket’.

The ‘Just old age myth’ is ensnared into the fabric of how we approach pain as a global culture. It isn’t just a superstition held by those without the advantage of a medical degree. Elders with pain are systemically under-served.

A 2011 study published in The European Journal Of Pain found that the median duration of a doctor consultation for elderly patients requesting help with pain is 2.3 minutes. It’s fair to surmise that this is most likely a clear non-verbal cue that these doctors subscribe to the old age myth. For comparison, at a clinic like mine, it is 45-60 minutes, and that is just the first step.

Over the course of my career, I’ve met literally thousands of older patients who had been told in no uncertain terms that their pain was untreatable when in actual fact, it was eminently treatable. This systemic neglect is driven in no small part by that malignant little phrase that just rolls off the tongue so effortlessly ‘It’s just old age’.

My advice is to reject our culture’s catastrophically oversimplified ‘just old age’ narrative. Instead, open your mind and your body to the far more complex and fruitful truth about pain. If you can do that, you’ll naturally open up to the countless solutions for pain that actually work at every stage of life.

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Injury Myths

Tobias Hall — Wed, 05 Jul 2023 01:15:04 +0000

Injury Myths

– A true injury is what occurs when physical forces conspire to damage a previously 100% healthy tissue. –

The nature of a classic injury doesn’t require much explanation. Life has an all too obvious capacity to break bones, rupture tendons, tear muscle, dislocate joint tissues and rip ligaments. Less serious ‘true injuries’ cause the microscopic equivalents of these major injuries. Microtears to muscle fibre and ligament tissues and the like.

Healthy, strong tissues are highly resilient to damage; if they weren’t, there would be no such thing as contact sports. So true injuries are, without exception, memorable physical events. If you experience a ‘sudden pain’ in your spine picking up a box of tissues, it is worth questioning how healthy your spine is; and whether it really qualifies as a true injury at all.

The most obvious feature of true injuries when they occur is how much they hurt. The purpose of this pain is protective. It is nature’s way of protecting you from the unthinkable horrors of running on a broken ankle bone or ACL tear. When you are injured, the body fires pain signals and releases a cascade of essential inflammatory chemistry. Under normal circumstances, you feel all that as temporary pain and swelling. This pain of injury is absolutely vital for the preservation of life.

Yet, if an injury site hurts for too long or resolves temporarily, then comes back later, it stands to reason that there is something more complex going on. A persistent or recurrent pain after an injury is something that you should pay great care and attention to in the long term. The body is a very sophisticated system. One that seldom (if ever) generates persistent symptoms without a good reason to do so.

The progression in how we manage significant injuries in the past 100 years is a match for the improvements we have made in telecommunications and transport in the same time period.

At the beginning of World War I, as many as 90% of leg fractures were fatal. Most ultimately bled out after being thrown carelessly onto stretchers with no splints or casts. These days, however, almost no one dies of a broken leg, even in war zones. We have truly wondrous high-tech surgical means to preserve life and limbs after major injuries. Yet the longer-term rehabilitation of injury (which is supported by a mountain of scientific literature) still frequently remains an afterthought in today’s frontline healthcare setting.

There is still a dark side to the way we tend to manage injuries in the 21st Century.

Louise was an apparently healthy 32-year-old American lady with lots of curly hair and the look of a world traveller. On first impressions, she seemed pretty normal, if a little stressed.

Once you get talking to Louise, you gradually realise she isn’t living a normal life at all. You also notice after a few minutes that she isn’t able to sit in one position very long, and she constantly moves her body weight in the chair. The other thing you fail to notice right away is that she has some very dark blackish stripes across her face that she partially covers with makeup. These stripes are very distracting once you have noticed them because they are not the colour of any scar or birthmark you have ever seen. They are really, really black, like rubber.

When she was 23, Louise was driving home late one night in the small car her parents had purchased for her 21st birthday. For reasons she can’t explain, at an intersection, she accidentally ran a red light. As she crossed the intersection, her tiny little car was directly hit side-on at 90 mph by a very large commercial vehicle.

The impact was so significant that it crushed her little car like an empty beer can. And in a bizarre, miraculous, incredible, one-in-a-million turn of fate, she seemingly wasn’t injured. She had no broken bones. She had no joint dislocations. She had no damage to her internal organs and no internal bleeding. And there was no brain damage or damage to her spine and central nervous system. She didn’t even have any concussion symptoms.

The only visible injury that Louise presented with at the hospital was two deep indented black marks which extended from her cheekbone across her eye into her forehead. These were caused when the frame of the car window drove itself into her face on impact. When I met her ten years later, she still had two long black stripes so deeply impregnated with rubber that they looked like strange black facial tattoos.

The night she was in the hospital, all her tests were done within less than 2 hours. Then the ED doctors report back to her on the miracle they had discovered. None of her scans or x-rays showed any major trauma whatsoever. The ED doctors confirmed that based on similar crashes, they would have expected her to have sustained multiple life-ending injuries. Yet she didn’t even so much as get a broken wrist for her troubles. All she had was the two black facial lesions.

All in all, after the most extreme car crash imaginable. Louise was congratulated and sent home with a few days worth of codeine and told she wouldn’t even need any follow-up physiotherapy. She was in the hospital for less than 3 hours.

It all seems like a pretty happy story until you hear the rest of it.

Louise went home the night of the crash with a pounding headache. Then when she woke up the next morning, every muscle in her body felt like it had been torn apart. She also felt such an intense pain throughout her spine that she felt like it was literally on fire. The day after the crash, she also had a violently intense migraine that lasted about 3 hours.

Fast forward six months, and Louise was still in just as much pain as she had been the day after the crash. Her whole body ached and throbbed constantly. She also still had debilitating spinal pain and crippling daily headaches. She was unable to work, exercise or socialise. Her family doctor had diligently ordered a second set of scans several weeks after the crash, all of which also came back clear. He had prescribed her some strong painkillers and told her to wait it out in the hope that her body slowly recovered, which it was showing no sign of doing.

A year or so after the injury, she got desperate and took matters into her own hands. She started seeing a chiropractor and a soft tissue therapist. Two years of weekly soft tissue sessions gradually got her muscle pain to a level where she found it manageable. While frequent gentle chiropractic sessions got her migraines down from 7 days a week to 3-4 days a week. Nothing touched the spinal pain, however.

Fast forward ten years, and Louise is sitting in my office on the other side of the world in New Zealand. Shifting around in her chair to take pressure off her back and telling me about the level of chronic pain she lives with.

When she met with me ten years on, Louise literally couldn’t remember a single waking moment without pain since the crash. She had never got rid of the headaches, and the spinal pain had simply never gone away, even for a moment. She estimated that her day-to-day quality of life was about a 4/10 due to the pain. She had long since given up on the career she had planned because she could only work about 20 hours per week, choosing to go on a long-term working holiday instead. She had not played sports or exercised with any intensity since the day of the crash. Her pain had not reduced in any appreciable way in the previous seven years.

It took two more years of intense weekly treatment and spinal rehabilitation to finally get Louise’s pain under control. At this point, she was able to resume a fairly normal life, aside from the ongoing work she requires to prevent the periodic relapses she is still prone to.

All of Louise’s scans and x-rays were clear. Yet the reason for her headaches and spinal pain was clear as day if you know what you are looking for. Her functional spine tests and motion palpation tests (performed by me ten years later) revealed that she had sprained virtually every joint in her spine. These joints remained locked and inflamed a decade later, having never been mobilised. The fascia (connective tissue) around her spine had lost all its elasticity due to widespread scar-like adhesions. And ten years on, the muscles surrounding her spine were so tight it was as if the crash had occurred the previous day.

In other words, Louise’s entire spine had sustained an incredibly severe whiplash injury. And subsequently, they did not even make a partial recovery. Instead, it had transitioned into a chronic unhealed state which included the addition of extensive chronic inflammation and scar tissue. Perhaps none of which is that surprising given the nature and severity of her accident.

Louise’s story contains many grim lessons about how badly our culture can still fail people with pain and injuries.

The obvious healthcare fumble presented by Louise was the complete lack of a diagnosis. It is still common practice to assume that the only injuries worthy of note are those that are identifiable with the limited medical scans and imaging we have. This is a corruption of the ‘disease model’ of healthcare which makes great use of ‘ lab tests’ to identify organic diseases in the body. And also works well for identifying fractures and the like.

The ‘if it isn’t visible on the scan, it didn’t happen’ approach overlooks the elephantine fact that only a micro-fraction of our mechanical pain and injuries can actually be seen using medical scans and tests. The inflammation, joint stiffness and even scar tissue of a severe whiplash cannot be seen on MRI scans, x-rays, CAT Scans or ultrasounds. But that doesn’t mean they don’t exist.

Louis’s case also highlights the fact that we have yet to become a rehab culture in the sense that we are already a surgical and pharmacological culture. The notion that a human body could go through an impact of that magnitude and not need any follow-up physical therapy is outlandish. Admittedly Louise’s case is a particularly extreme example of ‘rehab oversight’. Yet it is a fair reflection of a widespread problem. We still routinely perform major surgeries and discharge major injuries (and pains) without meaningful rehab.

Another grim observation posed by Louis’s terrible suffering is the fact that many injuries simply don’t heal unless they receive substantial encouragement. Many of them seemingly need a great deal of stimulation before the body is able to express its potential for healing.

It is not known why so many of our injuries don’t ‘just heal’ fully.

It’s worth noting that our bodies have a great capacity for strength and fitness, yet without the proper stimulation, they turn to jelly. The same is true of healing. Our bodies don’t need to move much these days, compared with the outdoor life they are evolved for. This ‘sedentary factor’ may at least partially explain why so many injuries fail to heal on their own terms. It would also explain why all injury rehabilitation involves ‘supplementary movement’. To replace the natural movement we are starved of, perhaps?

There is one further thing that is fair to say about Louis’s catastrophic spinal whiplash. It was definitely a true injury – Unlike many of the ‘sudden pains triggered by movement‘ that we call injuries, but are, in fact, something far more complex and insidious.

There is a massive amount more to the topic we call injuries than meets the eye. The life cycle of a true injury is relatively simple. Yet, many of the musculoskeletal injuries we sustain unfold in a manner that is far more complex and concerning, often having far-reaching consequences for our health in the form of slow recovery, relapses, reinjury, chronic pain and chronic disability.

Complex Injuries

“When back pain suddenly shows up, we are tempted to blame it on the last minor stressor that affected it, such as a soft bed in a hotel. This is like blaming your bankruptcy on the last latte you bought before your account finally went into the red.”

– Todd Hargrove

Complex injuries look and feel like true injuries. They are triggered by movement and involve a sudden onset of pain. In reality, however, they are caused by a buildup of repetitive strain that weakens the ‘injured’ tissue long before any symptoms appear.

Miles was 6ft 4 inches tall and routinely squatted 130 kg for reps at the gym. He was one of those men who were born destined to be big. He had heavily supplemented his genetic fate with a lot of weight-lifting over many years. Then one day, he had occasion to pick up a small dog kennel.

Despite the kennel weighing in at a mere 30kg, the lift completely detached Miles’s right bicep tendon at its insertion point on his elbow. When this happens, the visual impact is remarkable. The whole bicep muscle bunches into a tennis ball-like appearance at the top of the arm. And it hurts every bit as much as you would imagine. Surgery was needed to reattach the bicep tendon at the elbow.

Even to the casual observer, Miles’s bicep tear was clearly something more complex than an injury. When a man that strong tears a tendon during such an insignificant lift, it’s pretty clear that something was not right with that tendon. And then there was the fact that Miles had always been one to over-train his well-developed biceps.

Many of the events we call injuries are just like Miles’s bicep. Although admittedly, it often isn’t as obvious that the tissue must have been compromised.

A prospective study of 583 habitual runners (carried out all the way back in 1989) examined factors that predicted the likelihood of running injuries. The researchers identified three factors that accurately predict which runners are most likely to get injured: Running over 64 km per week – previous injury – inexperience. Data like this reflects a universal truth, most ‘injuries’ are not random. An unknown but very high percentage of injuries are caused by factors that lead to repetitive tissue strain and tissue weakening long before the ‘injury event’.

It is common knowledge in rehab circles that there is seldom anything random about ACL sprains, ankle sprains and ‘back injuries’. They all have well-known and predictable precipitating factors. They also don’t spread themselves evenly throughout the active population like random events do, instead tending to happen to certain individuals. This knowledge sits in contrast to the more common cultural belief that injuries are all driven by a combination of luck and the sheer forces at play in the ‘injury moment’.

Many of the sudden pains we name as injuries are not true injuries. They are, in fact, ‘complex injuries’ or even just sudden pains that occur in body parts that already have big problems.

A complex injury is when physical forces cause sudden pain or rupture in tissue that had been previously undermined. Usually by repetitive strain, weakness and/or by a previous ‘true injury’. These forces are often far less extreme than the forces that cause true injuries

The confusing thing about complex injuries is that they often look and feel exactly like true injuries. One minute you don’t have a care in the world; the next, you are in agonising pain, watching your knee swell up. So, to grasp complex injuries, it is necessary to check in with what you most likely already know about the principle of latency—remembering that in life, things aren’t always as they seem.

‘Latency’ is when you are feeling great moments before you die of a massive heart attack. Latency is when you have asthma and IBS, but today you feel great and have no symptoms whatsoever. Latency is the years you spend smoking prior to the cough and emphysema. And latency is also what you are experiencing the moment before you ‘put your back out’ doing some minor DIY task.

The body absolutely does not report all tissue malfunctions at all times; in fact, not even close. If it did, our hunter-gatherer ancestors would have had so many pains and physical symptoms they wouldn’t have been able to hunt, gather and collect water consistently enough to survive.

Your body is deeply invested in the suppression of symptoms associated with everything and anything deemed less biologically important than your immediate survival activities. It has evolved this policy of suppression over millions of years. And if it hadn’t, we wouldn’t be here, let alone be the evolutionary success story we are.

Meanwhile, we have a suspiciously broad spectrum of happenings that we think of as injuries. In fact, we have a strong tendency to identify all sudden pains as injuries.

Let’s split up the type of events we refer to as injuries into five groups so you can reflect on them.

It’s important to be clear these levels are not ‘levels of injury’ – these levels reflect how extreme or un-extreme the circumstances of the supposed ‘injury’ were.

Level 5 - Major Events

These are the self-explanatory car wrecks and grizzly attacks we rightly refer to as injuries. Most of these involve full-scale rips, tears, joint dislocations or fractures, often within multiple body parts. We can safely call these true injuries. They all involve immense physical forces that would badly injure 100/100 people who experience them.

Level 5 - Major Events

Level 4 -Serious Events

These are the likes of significant sports injuries. The ‘big falls’ that tend to lead to a bone breaking, a ligament tear, or some dislocation or other. All of these lead to an extended period of recovery. The overwhelming majority of these events are serious enough to damage the vast majority of bodies.

Level 4 -Serious Events

Level 3 - Significant Events

These are the somewhat milder and more random sports injuries. The change of direction while running at a speed that leads to an unexpected but significant sprain or a cruciate ligament tear. A heavy lift at the gym that leads to a ‘back injury’. Some of these lead to extended periods of recovery, and others don’t. These are events that seldom cause problems for healthy people. The % of deadlifts reps that lead to pain is very low.

Level 3 - Significant Events

Level 2 - Minor Events

These are often ‘somewhat random’ type movements that rarely lead to ‘injury’ but do for some. Picking up a heavy-ish box leads to 2 weeks of back pain. The minor stumbles that lead to sprains. A percentage of these still lead to a lot of pain over an extended period. The incidence of these types of movements causing pain or injury relative to how humans undertake them is infinitesimally small.

Level 2 - Minor Events

Level 1 - Non Events

The twinges and tweaks that happen during inconceivably minor events but still lead to sudden pain. The sneezes that lead to back or rib pain, minor twisting movements that lead to sudden pain. These can, nonetheless, still leave people incapacitated. Again, what percentage of human sneezes lead to significant episodes of back pain? Is ‘micro-fraction’ a word?

Level 1 - Non Events

As you can see, we have had to weave ourselves a very large basket to fit all these supposed ‘injuries’ into. When you see this many differing scenarios getting thrown into one conceptual basket, it pays to be suspicious. Health and life are rarely so simple.

Let’s re-insert a definition of ‘true injury’ that, hopefully, you can agree to.

‘A true injury is a physically traumatic event – where a normal healthy tissue is suddenly overwhelmed – leaving the tissue physically damaged or compromised by the event’.

There’s no question this description applies to many real-life events. The healthiest and strongest bodies have their limits. Virtually all Level 4 & 5 events easily qualify for this injury classification.

Here’s the thing, though, the further down the levels we go, the harder it becomes to make a plausible case that we really showed up to the incident with a truly ‘normal & healthy tissue’.

Here are some practical questions to mull over; answer each of them for yourself based on your own life experience.

If you end up with a ‘knee injury’ just because you marginally increased the amount of gardening or jogging you did for a week… do you genuinely believe that was a strong, healthy knee?

You trip on a curb after two glasses of wine, your ankle is badly sprained, and you still have ankle pain six months later. Do you truly believe that was likely to have been a healthy ankle? Bearing in mind the fact that millions of people have had near identical experiences and recovered quickly/instantly.

Your brother-in-law ends up lying flat on his back for 10 days (unable to even get to the toilet unassisted) after trying to hitch a boat trailer. Do you believe it’s likely he has a healthy, strong back?

Some of us can play season after season of test rugby without a significant shoulder injury. Others can’t get through 6 months of low-key gym exercises without multiple ‘shoulder injuries’. Do you believe the difference is likely to be luck?

Countless millions of people go a whole lifetime without a sprained ankle; others suffer multiple sprains per year for their entire adult lifespan. Knowing this, do you suspect that the people with persistent ‘injuries’ may really be suffering from some form of weakness?

It takes a lot to damage healthy tissue. Healthy tissues can play professional sports, trip, fall, lift and do endless physical work without pain or ‘injury’. Healthy tissues are highly resistant to sudden pains and injuries.

Many sudden pains that look like injuries are ‘tip of the iceberg’ moments – with deep underlying biomechanical issues being their true root cause. Many of these problems have been sitting latently in the body for months or years at a time. It is a well-documented fact, for example, that the natural angle of the knee and the strength of the deep gluteal muscles can predict the likelihood of ACL tears in young athletes. In other words, knees that don’t bear weight efficiently are known to be far more prone to major ligament tears.

Once a tissue is weakened by persistent strain over an extended period of time (e.g. standing on concrete every day with flat feet, running on the tarmac with bad form for long periods, or even just sitting behind a desk for 20 years), it may become undermined. Then almost any small event can trigger pain.

The difference between a trigger and a cause can be a very big difference indeed. Imagine if you believed that tennis truly caused heart attacks, as opposed to being a trigger for heart attacks.

Without understanding the true mechanics of heart disease, you could easily assume tennis was what caused your cardiac arrest. Without understanding heart disease, it seems perfectly logical ‘I played tennis, then I had chest pain; therefore, tennis damaged my heart’.

Understanding that tennis is a trigger for heart attacks, as opposed to a cause of heart attacks, is very important knowledge. Without this knowledge, you wouldn’t respond to the heart attack by giving up smoking, stress and soft drinks – you’d just give up tennis and think your work was done.

For many pain sufferers, the realisation that they suffer from chronic weakness and tissue strain rather than recurrent injuries: is a majorly transformative step towards better health. It opens the door to finding the real causes of pain.

Once you understand the true nature of a physical disorder, it becomes far easier to differentiate causation from coincidence. Just because the heart stopped during tennis, it doesn’t mean the tennis did it.

If you understand that many ‘injuries’ are, in reality, just pain triggers, it frees you up to shift your investigation onto more plausible suspects.

Meanwhile, the damage of complex injury pain is often mistaken for true injuries by patients, doctors and insurance providers alike. If you have had an ‘injury’ or ‘injuries’ in your past, it is entirely possible that the cause was wear and tear to the tissue that finally gave way. Many of us have had this happen and been misdiagnosed with a true injury.

Culturally, we believe very strongly that sudden pains are caused by injury. Patients with new pain often say, ‘I can’t think what I have done?’. This means, ‘I have a new pain, so I must have injured myself, but I can’t remember doing anything significant’. When in reality, if we injure a healthy tissue, it is always a memorable Level 4 or Level 5 event.

Overlooking the vital nuances that separate true injuries from complex injuries being brushed over is a big issue. It’s problematic because the misappropriation largely robs us of the ability to work on prevention and full rehabilitation. Identifying the patterns that led to the injury is the key to preventing further pain and further tissue damage.

True injuries and complex injuries both contribute significantly to the pandemic we live in the midst of.

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Cupping Therapy For Low Back Pain: What To Expect?

Tobias Hall — Sun, 25 Sep 2022 22:49:34 +0000

Cupping Therapy For Low Back Pain: What To Expect?

Cupping therapy involves placing cups on the skin to create suction. This suction increases blood circulation to the area where the cups are placed. This may relieve muscle tension, improving overall blood flow and promoting cell repair. It may also help form new connective tissues and create new blood vessels in the tissue. Cupping therapy is an ancient, holistic method for treating various illnesses, diseases, and conditions, including hip pain, shoulder pain and low back pain. While the exact origin of cupping therapy remains controversial, its use has been documented in Egyptian and Chinese medical practices dating back as early as 1,550 B.C. While cupping therapy has fallen in and out of favour throughout the centuries, it’s currently making a resurgence thanks to prominent athletes and health-conscious celebrities sporting the distinctive red circular cupping marks (not bruises!).

While there are multiple techniques and methods involved in cupping therapy, here at Featherston Street Pain Clinic, we specifically focus on ‘dry’ cupping created using negative pressure suction. Our practitioners use an apparatus to create a gentle suction that draws your skin upward into the cup. (Your skin is not broken at any time in the process.)

What Does Cupping Therapy Feel Like?

As suction is directly applied to the skin, there’s an initial tightness sensation as the skin is drawn into the cup; the feeling passes quickly as your practitioner moves on to place the next cup. As the practitioner repeats the suction process, they will check to ensure the cups aren’t too intense.

While traditionally, heat was used to create a vacuum, we use a suctioning apparatus that draws the air out of the cup. As time passes, your body will begin to acclimate to the feeling of the cups. The amount of cups required is dependent on the area of complaint. When being introduced to cupping therapy for low back pain, fewer cups with less pressure will be used. The cups will be placed for 5-20 minutes; afterwards, the practitioner will release the pressure in the cup, which often gives a calming, relaxing effect. Depending on the type and severity of your low back pain, a singular cup may be used with the practitioner gliding it across your skin, commonly known as ‘running cupping’. Running cupping has been shown to locally and systemically remove toxins by stimulating the immune response by dispersing uric acid, a natural waste product from the digestion of certain foods.

What Are The Benefits of Cupping Therapy?

Your lymphatic system is responsible for clearing cellular waste and toxins from your body. While the cups are on your skin, they loosen and lift connective tissues, which increases blood and lymph flow to your skin and muscles. The targeted blood flow brings oxygen-rich blood and lymph to the affected area. Some of the benefits of Cupping Therapy include:

– Relieving symptoms of Chronic Fatigue Syndrome (CFS)

– Treating Herpes Zoster

– Lowering blood pressure

– Treating non-specific back pain

– Treating neck pain

– Reduction in fibromyalgia symptoms

– Alleviating the pain and other symptoms of Carpal Tunnel Syndrome

– Treating migraine symptoms

What Are The Benefits of Cupping Therapy?

– Relieving symptoms of Chronic Fatigue Syndrome (CFS)

– Treating Herpes Zoster

– Lowering blood pressure

– Treating non-specific back pain

– Treating neck pain

– Reduction in fibromyalgia symptoms

– Alleviating the pain and other symptoms of Carpal Tunnel Syndrome

– Treating migraine symptoms

Are Those Cupping Marks Bruises?

It’s important to understand that the red circular marks left behind by the cups are NOT bruises. They very rarely hurt. Bruises are caused by impact trauma that breaks capillaries in the impacted area. However, in cupping there is no compression or impact trauma. Furthermore, a bruise results from compression/pushing on the skin, while cupping works inversely by lifting/pulling the soft tissue and skin. The red marks result from the blood being drawn into that area. The darker the mark, the more stagnant fluids (toxins, blood and lymph) were dredged up during treatment. The marks last anywhere from a few hours to several days. The more you receive cupping for the same issue, the lighter the marks will be.

What To Do After Receiving Cupping Therapy?

– Stay hydrated. Your lymphatic system requires extra fluids to flush toxin buildup.

– Avoid Alcohol

– It’s your body processing and expelling toxins released during your cupping session. You may feel fatigued or have flu-like symptoms the next day. Take care and practice good self-care.

The benefits of cupping therapy are maximised with multiple therapy sessions. If you have any questions regarding cupping for low back pain, don’t hesitate to call Featherston Street Pain Clinic on 04 385 6446.

How Fascia Causes Back Pain

Tobias Hall — Mon, 19 Sep 2022 21:44:39 +0000

How Fascia Causes Back Pain

We tend to attribute it to sore muscles or stiff joints when we experience low back pain, neck pain, or shoulder pain. However, many chronic back pain symptoms are caused by a thin casing of connective tissue surrounding and holding every organ, blood vessel, bone, nerve fibre and muscle in place: the fascia. While receiving little attention in the modern western world, fascia plays a critical role in every movement you make.

Like ligaments and tendons, fascia is primarily composed of elastin and collagen, making it flexible and stretchy when the body moves. Interestingly, fascia also contains pain receptors and mechanoreceptors, which detect stretching or changes in pressure within the body. For this reason, some scientists consider the body’s fascia to be one giant sensory organ! Healthy fascia has a smooth and slippery texture and can shift its consistency between a gel-like state and a more fluid one when needed. However, when unhealthy, fascia can become sticky, clumpy, tight, and flaky when unhealthy. It forms restrictions, adhesions and distortions, causing various problems, including chronic back pain.

What is Fascia?

Have you eaten chicken breast or lamb shoulder recently? Notice that clear-like film that covers it? That’s fascia. At the same time, it looks like one sheet of tissue, but in reality, it’s made of multiple layers of liquid called hyaluron, intertwining all the muscle fibres. This provides the internal structure of the body, rather than it being just the skeleton that holds the body up, the facia and connecting soft tissue that keeps the skeleton upright also. The fascial tissue has so many nerve endings it’s almost as sensitive as skin. The fascial tissue is designed to stretch as you move. However, when the fascia is stressed, it tightens up. If the fascia dries up and tightens around the muscle fibre, it can impact mobility and cause painful knots to develop.

How to Maintain Healthy Fascia?

Maintaining healthy fascia has many benefits. You’ll move more quickly, have a better range of motion and experience less pain. Things you can do to prevent fascia problems include:

Developing new movement patterns – Ensuring you have a consistent and varied exercise routine keeps the fascia healthy. It produces new elastin/collagen fibres that help with reducing chronic back pain. Furthermore, if you have a sedentary job, be active throughout the day. Taking routine breaks each hour to move around helps the fascia remain supple.

Stretch regularly – Stretching often is critical for good health. Evidence shows frequent stretching is associated with reduced inflammation, improved joint movement through their full range of motion, increased muscle oxygenation, reduced risk of injury, and improved back pain symptoms.

Postural Improvement – Prolonged poor posture, such as slumping over a desk or a phone or walking awkwardly to compensate for an injury, can cause the fascia to tighten and cause back pain. Try to maintain good posture while sitting or standing.

How to Maintain Healthy Fascia?

Maintaining healthy fascia has many benefits. You’ll move more quickly, have a better range of motion and experience less pain. Things you can do to prevent fascia problems include:

What Causes Fascia-Related Back Pain and Stiffness?

When the fascia is healthy, it’s smooth, flexible, supple, and glides through all the interconnecting muscle fibres. However, when the fascia becomes gummy, tight, and wrinkled up, it forms myofascial adhesions. Causes of fascial back pain include:

Sedentary Lifestyle: A sedentary lifestyle involves very little or no physical exercise, wherein most of the day is spent sitting, lying down and expending very little energy.

Repetitive Strain: Movement patterns that overwork one part of the body excessively and neglect others.

Trauma: Such as surgery or injury leaving fascial injuries and scar tissue behind.

How To Treat Fascial Pain?

Shockwave Therapy – Extracorporeal Shockwave Therapy is a gold standard treatment for fascial back pain. Shockwave therapy was initially researched and developed for the treatment of kidney stones. Decades of further research have established it is an excellent treatment for a wide range of fascial and musculoskeletal pains. At Featherston Street Pain Clinic, we are the only clinic on the Lower North Island using both Focused and Radial Shockwave for the treatment of fascial back pain.

Acupuncture – Inserting acupuncture needles into trigger points can cause tense tissue fibres to relax. Acupuncture needles can also reduce pain signals when you have back pain.

Rehabilitation – A practical, personalised rehabilitation program targeted at treating the area of your fascial pain can significantly alleviate symptoms. On top of therapeutic treatment, having a personalised rehabilitation plan in between visits can target your areas of pain.

Myofascial Release – Targeted myofascial release sessions with an experienced practitioner who can find and apply pressure to release fascial knots.

How To Treat Fascial Pain?

Acupuncture – Inserting acupuncture needles into trigger points can cause tense tissue fibres to relax. Acupuncture needles can also reduce pain signals when you have back pain.

Myofascial Release – Targeted myofascial release sessions with an experienced practitioner who can find and apply pressure to release fascial knots.

Final Thoughts

Treating fascial back pain often requires multiple treatments over weeks or even months. Most people experience tense muscles from time to time. But it’s essential to get help for chronic or severe back pain, which may be a sign of a serious health condition. If your pain remains chronic despite your best efforts or interferes with sleep or daily activities, give Featherston Pain Clinic a call on 04 385 6446.

3 Reasons Pain Is So Hard To Treat

Tobias Hall — Sat, 27 Aug 2022 23:04:40 +0000

3 Reasons Pain Is So Hard To Treat

Even the most casual glance at research into the amount of pain we suffer confirms the truth. We struggle as much now with pain in our backs, joints, spines, and feet as we did with dental decay in the 1600s. But why on earth, in an age of electric vehicles and space travel, do we struggle with old-fashioned pain. The answer to that is a long story, but here we will look at three of the key reasons we struggle so much to manage pain in our modern world.

Number One: Pain is Invisible

It is pretty obvious and easy to diagnose a black eye, even without a medical degree. The same is true if you have eczema, a common cold, a bloody nose, and many other outwardly visible health issues. Pain, on the other hand, is entirely invisible. Not only is pain invisible to the person who is suffering from the pain, but the pain is also invisible to other people and is even often invisible to the eyes and ears of modern medicine. There is no scan or blood test to diagnose you with a migraine. An x-ray or an MRI scan will rarely show you the cause of back pain. If you have heel pain, there is no modern scan that is sensitive enough to show the subtle buildup of scar tissue in your foot, and there was undoubtedly no blood test to confirm the diagnosis. We have a long history of struggling with invisible causes of disease and unwellness.

Up until the last 200 years, millions upon millions of deaths each year at the hands of bacteria and viruses that we didn’t even know existed. Long after figuring out how to defend ourselves from wild animals, we struggled with microbes primarily because we couldn’t see them and didn’t know they existed. This situation is not too dissimilar from where we find ourselves with pain in the 21st century; we cannot see it; therefore, we struggle to manage it. Even the experts struggle to find much agreement over its true causes.

Number Two: Pain is Lifestyle-Related

If you struggle to lose weight, it is pretty common knowledge that it’s at least partly due to your lifestyle. The amount of exercise we get and the types of foods we eat are significant determinants of whether we struggle with weight management. However, when treating pain, we tend to assume that this issue sits in a different pile than weight loss. If, for example, you have a disc injury that needs keyhole surgery or you have torn a ligament in your ankle, you need a doctor. So we can say that some pains are more injury based than lifestyle based.

If you have a great deal of pain that you are struggling with, it likely relates to the levels of stress you live with, the amount of sleep you get, the food you eat, the amount and type of exercise that you take, and a host of other lifestyle factors. However, the most stubborn and chronic pains like back pain, neck pain, headaches, and frozen shoulder tend to be heavily influenced by lifestyle factors. If this is the case, then it may be that you might need to make some changes to fix your pain (Please understand that pointing out that lifestyle plays a part in chronic pain doesn’t imply that it is the whole story. Appropriate treatment, appropriate rehabilitation, genetics, and all injuries can all play a role too).

Number Two: Pain is Lifestyle-Related

However, when treating pain, we tend to assume that this issue sits in a different pile than weight loss. If, for example, you have a disc injury that needs keyhole surgery or you have torn a ligament in your ankle, you need a doctor. So we can say that some pains are more injury based than lifestyle based.If you have a great deal of pain that you are struggling with, it likely relates to the levels of stress you live with, the amount of sleep you get, the food you eat, the amount and type of exercise that you take, and a host of other lifestyle factors. However, the most stubborn and chronic pains like back pain, neck pain, headaches, and frozen shoulder tend to be heavily influenced by lifestyle factors. If this is the case, then it may be that you might need to make some changes to fix your pain (Please understand that pointing out that lifestyle plays a part in chronic pain doesn’t imply that it is the whole story. Appropriate treatment, appropriate rehabilitation, genetics, and all injuries can all play a role too).

Number Three: Pain is Misunderstood

There is no way that we will be able to unpack all how we tend to misunderstand pain in our society in this small blog. So we shouldn’t even try. In our culture, we treat pain as if it’s a disease. We diagnose pain using old-fashioned medical terminology initially developed to diagnose illness. We prescribe painkillers; we work on getting rid of the pain; we use surgery to try and ‘cut the pain out’.

Meanwhile, the most profound truth about pain is that it is a feature, not a bug. Your fire alarm is not a bug. The red lights on your dashboard to tell you you are running out of oil are not a bug. Pain is the body’s warning system, yet we treat it as if it is a disease that must be removed using ‘pain killers’. We have given in to what may be the most profound misunderstanding we could have about pain, and it is just one of many. Emotionally, it’s understandable that we want to get rid of our pain. However, when we allow that feeling of pain to infuse into our healthcare system, we try to resolve the cause instead of fixing the underlying problem. Without understanding pain correctly, we stand very little chance of managing it effectively. So, misunderstanding pain the way we do is one of the key reasons we struggle to treat it effectively.

Number Three: Pain is Misunderstood

Final Thoughts

The good news is that while pain may be invisible to scans and bloodwork, some people understand it well enough that they can identify the physical causes of your pain and treatment successfully. The other good news is that while pain depends heavily on lifestyle, you don’t necessarily need to reinvent yourself to remove your pain altogether. Often even small changes can bring significant results when combined with the proper treatment. Furthermore, whilst we struggle with understanding pain as a culture, there is already a considerable amount of research that has primarily impacted the truth about pain and is manageable for those who know.

So ultimately, this isn’t a bad news channel. We struggle with pain, yet there is so much hope for pain sufferers because we are getting better and better at managing it even though the uptake of good pain management is systemically a little slow going. If you have any questions regarding chronic pain, don’t hesitate to give Featherston Street Pain Clinic a call on 04 385 6446

Hip Pain Archives - Central Wellington - Severn Pain and Injury Care

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The Impact Of Bursitis

The Body’s Airbags

The Real Cause Of Bursitis

The Reason This Matters

Understanding ‘Bursitis’. Moving Beyond the Inflammation Misnomer

Understanding ‘Bursitis’. Moving Beyond the Inflammation Misnomer

Introduction to Bursitis:

Navigating Complexity

Rethinking Tendinopathy: Beyond Inflammation

Bursopathy Unveiled: Similar Evolution in Understanding

Debunking the Inflammatory Misnomer

Enlarged Bursae: The Airbags of the Musculoskeletal System?

A Paradigm Shift: Biomechanical Stress as the Underlying Truth

Hope on the Horizon: Treating the Cause, Not Just the Symptoms

Conclusion: A New Era in Musculoskeletal Care

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Respect All Of Science

Respect All Of Science

Science: ‘The systematic observation, explanation and experimental investigation of the physical world’s mechanisms’.

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Shockwaves, Pain Treatment & Hormetic Stress

Shockwaves, Pain Treatment & Hormetic Stress

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The ‘I’m Fixed’ Myth

The 'Im Fixed' Myth

Latency & Complexity

-‘Latency’ is when the body has a clear and present health problem but no symptoms.-

Symptoms and Tests

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Thinking You Are Fixed

Why Symptoms Go Quiet

The Importance Of Pain-Free Times

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The Old Age Myth

The Old Age Myth

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Injury Myths

Injury Myths

– A true injury is what occurs when physical forces conspire to damage a previously 100% healthy tissue. –

Complex Injuries

“When back pain suddenly shows up, we are tempted to blame it on the last minor stressor that affected it, such as a soft bed in a hotel. This is like blaming your bankruptcy on the last latte you bought before your account finally went into the red.”

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Level 4 -Serious Events

Level 3 - Significant Events

Level 3 - Significant Events

Level 2 - Minor Events

Level 2 - Minor Events

Level 1 - Non Events

Level 1 - Non Events

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Cupping Therapy For Low Back Pain: What To Expect?

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How Fascia Causes Back Pain

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3 Reasons Pain Is So Hard To Treat

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