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

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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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

Eight Tips To Getting Rid of Any Pain

Tobias Hall — Sun, 21 Aug 2022 20:51:12 +0000

Eight Tips To Getting Rid of Any Pain

Pain is complex – it’s a huge topic – but the good news is that some general rules form a sound basis for navigating your way out of most aches and pains in the longer term. Let’s get started.

Rule 1 – If there is no significant medical issue, assume there is a weakness.

If all your scans and blood tests have come back clear, you probably have some weakness in your area of pain. You won’t be too surprised when I tell you a significant part of the solution will likely be strength work. The only note of caution is that if the tissues are inflamed, they may not respond to strength work without a bit of treatment beforehand.

Working on pain is a bit like working on dental issues; sometimes, you need to get through the treatment side of things before you go away and work on the big picture. Pain relief methods are an essential step towards being able to strengthen your weakened painful areas without risking making them worse. But once that is done the majority of pains relate to some need for increased strength and muscle support.

Rule 2 – Be willing to think outside the box.

If you have been doing the same treatments with the same providers for a long time and aren’t seeing progress, be willing to try out new things. Doctors are great (mine saved my life once), but only a tiny part of their training relates to pain management. Physios are great, but sometimes there is more to pain relief than exercise prescription. Chiropractors are great, but not all pain comes from the joints. Osteopaths are great, but not all pains will respond to a gentle approach. Flexibility and open-mindedness are essential qualities when it comes to working with stubborn pain issues.

Rule 3 – Start with what makes the most sense to you.

The start point of ALL healthcare procedures that involve a conscious and consenting patient is the patient deciding to permit a procedure because it makes sense to them. Find a practitioner who views things in a way that makes sense to you and uses methods that make sense to you. If something doesn’t sound right to you, get a second opinion and a third if necessary. If, however, you know that you glaze over the moment anyone talks about health the way I do when they talk about IT solutions, find a friend or family member you know is more clued up than you and ask their advice. Base your decision on whether the practitioner offering help seems qualified & sincere. None of these principles necessarily mean you will have found the right practitioner. There is, however, a knowing in most people about their pain. This ‘knowing’ means that most of us can tell when we are being given an accurate assessment of what is causing our pain.

Rule 4 – Assume that there is scar tissue if it’s stubborn.

If you have chronic stubborn pain in your back, shoulder, knee, foot or hip, you may not have any scar tissue in that area. So many people do, though, that you are better off assuming that there is scar tissue and finding someone who is qualified and interested in looking into it for you. Countless people with stubborn pain have unseen tracts of scar tissue that form adhesions, irritation and pain in their bodies. If there isn’t any scar tissue, you have ruled it out; if it turns out, you did have scar tissue, releasing it is often transformative. The good news is that straightforward ways of working with scar tissue-related pain are helpful for many of us.

Rule 3 – Start with what makes the most sense to you.

Rule 4 – Assume that there is scar tissue if it’s stubborn.

Rule 5 – Keep moving within reason.

Research has shown that people who stay active have less pain, recover faster from pain episodes, handle pain better and even experience less pain internally than their inactive neighbours. The trick to benefitting from movement and exercise for pain is to follow my golden rule; A bit of pain during a workout is OK, and a bit of pain after training is OK too. If, however, you find that a particular activity is leading to worsening your pain or perhaps increasing your pain for days after the session, that’s a sign of backing off that specific activity for the time being.

Rule 6 – It’s never just old age.

No matter what age you are and what pain you may have, your pain is not ’caused’ by your age. There are always a million other people the same age as you who don’t have the same pain. Usually, they have stayed fitter than you, had fewer injuries, are less stressed, or done more rehabilitation than you. The good news is it’s never too late; I have personally seen 90-year-olds have legitimate breakthroughs in their lifelong pains. Even when you are 95 and you have a sore hip, guaranteed there will be other joints in your body that aren’t sore; those other joints are the same age. Think about it!

Rule 7 – Always be as conservative as possible.

This is common sense, but it’s surprising how often even highly qualified doctors and surgeons overlook this rule. The principle is this, always choose the least risky option with the fewest likely side effects available to you. It makes no sense to take toxic anti-inflammatories, which have many possible side effects if a massage or a chiropractor can relieve your pain. If there is even the slightest chance that rehabilitation will prevent you from needing surgery, try that first. Only consider the surgical option later down the track if you have to.

Rule 8 – Deal with your stress and trauma.

Cognitive Behavioural Therapy is now officially part of the international guidelines for managing stubborn back pain. Extensive research has shown that stress and unresolved trauma can play a significant role in persistent pains like back pain.

The analysis is detailed; if we add this dimension to our efforts to manage pain, we may find major benefits. How we choose to manage stress and resolve trauma is primarily up to us, there are many possibilities. Three possible options that have been very helpful for me are the ‘Wim Hof Method’ – floatation tanks and the ‘Hakomi method’.

Rule 7 – Always be as conservative as possible.

Rule 8 – Deal with your stress and trauma.

Final Thoughts

It has been my learning over two decades of helping people with pain that for every 1000 people who have been told their pain is untreatable (or who have said to themselves that it is untreatable), there is only a tiny handful for whom it is true. With the right mindset and tools, the overwhelming majority of pains can be managed in one way or another.

Call us at Featherston Pain Clinic on 04 385 6446 to make an appointment.

Sciatica: What to Expect?

Tobias Hall — Tue, 02 Aug 2022 21:40:40 +0000

Sciatica: What to Expect?

What is Sciatica?

Sciatica refers to radiation pain or paresthesia (pins and needles) down the pathway of the sciatic nerve from the lower back, through the hips and down the leg. Sciatica affects 10% to 40% of the population, typically around 40 years old or above. In most circumstances, sciatica only impacts one side of the body. Sciatica usually occurs due to a lumbar herniated disc (90%). Often, a particular event or injury does not cause sciatica—instead, it tends to develop over time. Sciatica is common in specific types of occupational work that are physically strenuous, such as machine operators or truck drivers—specifically, people who often bend their spine forward or sideways.

What Are The Symptoms and Causes of Sciatica?

Some hallmarks of sciatica include: radiation pain down the lower back, buttock, back of your thigh and calf. Sciatic pain can present in other areas but is rare. The severity of the pain can range from a mild ache to a sharp, burning sensation or excruciating pain. Sciatic pain can have a positional element, it can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually, only one side of your body is affected. When presenting with severe burning pain and numbness radiating down both legs, it can indicate other conditions like cauda equina syndrome.

Sciatica occurs when pressure on the sciatic nerve increases and becomes pinched. In most cases, it results from a herniated disc, usually compressing one or more spinal nerve roots (L4-S3) that form the sciatic nerve. Other common causes include: degeneration of tissues in the lumbar spine, narrowing of the spinal canal (spinal stenosis) and minor stress fractures causing one of the vertebral bodies to slip forward on another (spondylolisthesis), resulting in inflammation, lower back pain, hip pain and numbness in the affected leg.

What Are The Symptoms and Causes of Sciatica?

Some hallmarks of sciatica include: radiation pain down the lower back, buttock, back of the thigh and calf. Sciatic pain can present in other areas but is rare. The severity of the pain can range from a mild ache to a sharp, burning sensation or excruciating pain. Sciatic pain can have a positional element, it can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually, only one side of your body is affected. When presenting with severe burning pain and numbness radiating down both legs, it can indicate other conditions like cauda equina syndrome.

What Factors Contribute To Sciatica?

Some common factors that contribute to the risk of sciatica include:

Age: Age-related changes to the spinal column can result in conditions such as herniated disks and bone spurs.

Obesity: Carrying excess body weight can result in maladaptations to the spine that can apply pressure to the sciatic nerve and trigger sciatica.

Occupation: A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for extended periods might play a role in sciatica. Furthermore, individuals who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people.

Diabetes: This condition, which affects how your body uses blood sugar, increases your risk of nerve damage.

While in most situations, people recover from sciatica without any long-term effects, sciatica can result in permanent nerve damage without proper treatment. If you’re having symptoms of loss of sensation in both legs down to the bottom of the foot, loss of bowel or bladder function, numbness in the buttocks, perineum, and inner surfaces of the thighs (saddle region), seek medical attention immediately.

How To Prevent Sciatica?

While there is no full-proof method for preventing sciatica, and the condition can reoccur, adapting some lifestyle changes can significantly reduce the risk. These include:

Exercise: Ensuring you keep a well-developed abdominal core muscles and a strong lower back is critical for sciatica prevention due to playing a pivotal role in proper posture and alignment.
Ergonomics: Maintain proper posture when you sit. Choose a seat with good lower back support, armrests and a swivel base. Keep your knees and hips level. Consider placing a pillow or rolled towel on the lower back to maintain its normal curve.
Maintaining healthy movement patterns: If you stand for long periods, rest one foot on a stool or small box from time to time. When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

How To Prevent Sciatica?

While there is no full-proof method for preventing sciatica, and the condition can reoccur, adapting some lifestyle changes can significantly reduce the risk. These include:

Exercise: Ensuring you keep a well-developed abdominal core muscles and a strong lower back is critical for sciatica prevention due to playing a pivotal role in proper posture and alignment.
Ergonomics: Maintain proper posture when you sit. Choose a seat with good lower back support, armrests and a swivel base. Keep your knees and hips level. Consider placing a pillow or rolled towel on the lower back to maintain its normal curve.
Maintaining healthy movement patterns: If you stand for long periods, rest one foot on a stool or small box from time to time. When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

How is Sciatica Treated?

The goal of treating sciatica is to decrease your pain while increasing mobility. A significant portion of cases of sciatica self-resolve over time. Simple self-care treatments may be all that’s needed. These include: ice packs, over-the-counter analgesics, and gentle stretching. However, depending on the cause, treatment may be required. After a six-week trial of conservative, self-care treatments that have provided minimal relief, or your symptoms are severe and unrelenting, more aggressive treatment options may be required.

Other treatment options include:

Physical Therapy: The goal of physical therapy is to find exercise movements that decrease sciatica by reducing pressure on the nerve. An exercise program should include stretching exercises to improve muscle flexibility and aerobic exercises (such as walking, swimming, and water aerobics).

Corticosteroid Injections: Injections into the lower back may help with reducing symptoms of pain and swelling around the affected nerve roots. However, these are usually short-lasting (typically up to three months) and can have significant side effects such as cartilage damage, death of nearby bone, joint infection and nerve damage, especially with repeated injections.

Spinal Manipulation: Manipulation of the spine frees restricted movement and helps restore vertebral bodies to their proper position within the spinal column. This can help with reducing nerve irritability, muscle spasms, pain, and other symptoms commonly seen with sciatica.

Shockwave Therapy: In cases where sciatica originates from the pelvis, extracorporeal shockwave therapy (ESWT) softens the tissue around nerves and increases blood flow and reduces pressure from the soft tissue (specifically the piriformis muscle) that may be pinching onto the sciatic nerve.

If you have any questions regarding your sciatic pain, don’t hesitate to give us a call on 04 385 6446.

Three Easy Tips to Resolve Sciatic Pain

Tobias Hall — Tue, 26 Jul 2022 23:51:01 +0000

Three Easy Tips to Resolve Sciatic Pain

Sciatic pain is one of the most uncomfortable complaints we see in the therapeutic pain management game. Having back pain is one thing, but having severe nerve pain down the back of your leg (the most common symptom of Sciatic pain) is a whole other level of pain altogether. The good news is there are solutions. Whilst sciatic pain is excruciating, in almost every case, it will resolve; it will just take time. Unless you are extraordinarily unlucky, getting stuck with sciatic pain long-term is virtually unheard of. Here are three tips for understanding and resolving your sciatic pain.

1 - Get A Correct Diagnosis

Sciatica or Sciatic pain means pain down the back of the leg. There are many possible causes of pain back down the leg, which means many possible causes of Sciatic pain. Sciatic pain or Sciatica is not a diagnosis; they are a symptom. To have the best possible chance of resolving your sciatic pain, you must find out precisely what is causing your sciatic pain. Knowing the exact problem tends to lead to valuable tools and solutions.

Sciatic pain is usually caused by inflammation/damage in the spinal tissues, tumours/masses in the spinal column, muscle spasms/space-occupying lesions in the pelvis, and neurological problems. With such a broad scope of possible causes, it is vital to find out which is causing your sciatic pain.

Happily, most Sciatic Pain cases are not sinister and relate more to stubborn mechanical issues in the lower back and pelvis. The other good news is that diagnosing most cases of Sciatica is simply a matter of performing some specific tests and often does not even need an x-ray or a scan. And yet, of course, there are other instances where a sciatic pain diagnosis does require scans and blood tests etc.

2 - Keep Moving

As we mentioned before, sciatic pain is excruciating, and that doesn’t exactly make you want to run around the place, far from it. However, the research on pain and rehabilitation supports a more active approach to recovery these days. The days of bedrest, whole body casts, and neck braces are long gone, just as they should be.

A big part of why active recovery is supported these days is because inactivity leads to muscle wasting. Furthermore, active movement elevates mood, which has also been shown to reduce pain signals. Naturally, if you have a very severe case of sciatic pain, you won’t be going for a run, much less lifting weights or anything like that, and this is just as it should be. The type of ‘active’ that the research supports is not the strength and performance type; it’s keep the body moving kind of activity.

Being active while you recover from Sciatic pain means getting up and moving around as much as possible. It means avoiding bed rest, and it means knowing that, for the most part, it is more damaging to life to be still than it is to keep moving.

2 - Keep Moving

3 - Get Treatment

In just the same way that it is impossible to resolve your own toothache, it is seldom possible to resolve your own sciatic pain. It is one thing to have low-grade ITB pain and do daily foam rolling to manage it, which is valid. However, it’s another thing altogether to try and self-diagnose and treat something as serious as Sciatic pain. Self-care and self-stretching are essential parts of any recovery. However, they are not a substitute for actual hands-on treatment with professionals who have experience resolving Sciatic and back pain.

The first step towards finding treatment is finding someone you know has the requisite experience treating Sciatica and whom you feel you can trust. This could be a practitioner you have worked with in the past, someone working with your family, or someone you find whose website resonates with how you see things.

It is a little too much to hope that any single treatment like Acupuncture or Chiropractic will resolve the Sciatic pain. Because Sciatic pain is so severe and so stubborn, the best approach will likely be flexible when treating the pain. So preferably, if you know someone who will take a flexible approach, that is most likely to get the result you want.

Conclusion

The overarching and most crucial point regarding Sciatic pain is to keep the faith as millions of people have suffered from Sciatic pain and resolved it. Knowing this can be of great comfort when dealing with a significant amount of pain.

The people who have suffered and resolved from Sciatic pain tend to be the ones who have taken the time to look after themselves and sort the proper care and advice along the way. These are sound principles for dealing with life’s complex health issues, and sciatic pain is no different.

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Three Steps for a Pain Free Future

Tobias Hall — Sun, 17 Jul 2022 23:52:14 +0000

Three Steps for a Pain Free Future

It is common knowledge that we struggle profoundly with certain aspects of healthcare, especially when it comes to prevention. If I told you that we struggle with preventing and treating mental health issues as we do with obesity, it probably wouldn’t raise many eyebrows. It is less well known that we struggle just as much with preventing and treating chronic pain as we do with obesity and mental health. Given how much our culture struggles with treating and preventing chronic pain, the number of cases we find responding exceptionally well to straightforward pain management strategies at our clinic is surprising. Most people who come to us with chronic shoulder, back, hip, and foot pain respond exceptionally well to the same fundamental approach to managing pain.

Here is a simplified overview of what that process looks like;

Step One: Get an Accurate Diagnosis

If you are looking to get out of pain, you need to know exactly where the pain is originating. You need to know precisely which of your body tissues has become inflamed or degenerated. It is not enough to know that you have mechanical lower back pain; you must determine which tissues are causing that pain.

It’s not enough to know that you have sciatica; you need to know what is putting pressure on the sciatic nerve. It’s not enough to know that you have rotator cuff issues; it’s essential to determine which rotator cuff tendon is hurting and what is putting pressure on it.

If you can go from knowing that you have sciatic pain to knowing that your sciatic pain is due to your piriformis muscle spasming and putting pressure on the sciatic nerve, you have the basis of some treatment that may bring rapid relief. If you only know that the pain is sciatic, it is tough to know precisely how to get out of it. Once you have identified which structures need treatment, followed by getting the correct treatment, it is often astonishing how quickly even the most stubborn and chronic pains can be reduced.

Step One: Get an Accurate Diagnosis

Step Two: Get Consistent Treatment

If you have had shoulder pain, hip pain or back pain for a long time, it stands to reason that that issue is not going to heal overnight, even once you have found the correct treatments. Much like going to the gym, tissue healing means putting in repetitions. You can’t get a six-pack in three gym visits, and you can’t heal chronic pain in three treatment sessions. Once you have found the right treatments, it is typical for healing to take 3-6 months for most chronic pains. Of course, some outliers heal very fast, and those who heal slower, but 3-6 months is a pretty good timeframe to reduce pain to a manageable level in those who have struggled for a long time. Amazingly, the body can sometimes hold pain, degeneration, and repetitive strain for decades and still do a great deal of healing within six months. But it seldom does that without a very significant level of effort from both the patient and the practitioners.

When patients come to us with the most stubborn pains, we often work on them twice a week for the first three months of their care and sometimes reduce that to once a week for another three months. It can feel like a lot of work at the time, but of course, it’s more than worth it if I get you out of pain. It is also not a great deal of work compared with how long these issues take to manifest. It is frustrating to go through so much inconvenience and expense to get pain-free. It can be like the combination of hassles involved with a weight loss journey and getting a bunch of dental work done simultaneously. But let’s face it, what were the chances of chronic pain being something that would go away easily given how much we still struggle with it in our modern microchipped world.

Step Two: Get Consistent Treatment

Step Three: Get Strong

A significant part of why so many of us have the stubborn pains we do is because we are so inactive. It’s not our fault. We needn’t beat ourselves up because the world we were born into requires us to sit to survive and feed ourselves. Our Ancestors needed to run around to survive, and now we need to sit to survive. The massive popularity of the physiotherapy approach to pain with exercise prescription is a nod to the fact that this is common knowledge. When you constantly sit, muscles in your body waste or atrophy. This process is accelerated in body parts that carry chronic pain and or a history of injuries. The hard part, however, is following through in the long term. Everybody wants to do their exercises while still in pain, and a tiny percentage of people still want to do the exercises once their pain is gone. Yet when the pain goes away, the real Mahi must begin for those who wish to be pain-free in the long term.

If appropriately taught to isolate the areas and muscles you need to restore; the good news is that strengthening long-term rehab can be done with as little effort as is involved with looking after your teeth. Ten minutes a day is plenty if you’re isolating the right muscles.

Conclusion

We struggle with the treatment and prevention of chronic pain, but this doesn’t necessarily imply that the solutions will ultimately be complex. The absence of electric cars on the planet calls for intricate and clever solutions. However, the prevalence of chronic pain on earth doesn’t necessarily mean we need high technology or particularly complex solutions. Many of our struggles as a species are caused by oversight rather than the absence of high technology. Although we struggle with chronic pain, resolving it is seldom rocket science. Like so many of life’s problems, simple, systematic, commonsense solutions applied steadily over time are the key to success in the long term; that’s how you manage pain!!!

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Gait Speed & Ageing: Is There a Connection?

Tobias Hall — Thu, 04 Nov 2021 02:26:39 +0000

Gait Speed & Aging: Is There a Connection?

Age is just a number. At least, that is what we would love to believe. However, as time goes on the body faces inevitable wear and tear. At the same time, this doesn’t mean you don’t have some control when it comes to aging gracefully and maintaining your independence, mobility, and function.

Recent research indicates that a reduced gait speed is associated with adverse health outcomes, including an increased risk of disease, falling, disability, and hospitalization. Overall, gait speed assesses a person’s functional mobility. Studies further show that decreased functional mobility may be associated with an increased mortality risk. So, let’s dive into this topic a little further. What is the connection between gait speed and mortality? And what can you do to gain back control and improve your life at any age?

The Impact of Gait on Mortality and Aging

A 2011 study demonstrated how predicted survival rates in older adults based on age, sex, and gait speed were just as accurate as those based on age, sex, chronic conditions, the use of mobility aids, smoking history, body mass index, hospitalization, and blood pressure. This indicates that gait speed plays a major role in longevity and health as we age.

In other words, gait speed offers an accurate assessment of overall health. It provides a window into muscular strength, balance, knee and hip joint function, and more. And when moving is tough, we likely feel more inclined to move less. In turn, this can create a downward spiral where your physical health quickly detoriates.

As you may already know, regular movement is an essential factor in maintaining good overall health, including mental and physical components. Various research even proves this to be true. This means if you’re struggling to walk or move, it’s of the utmost importance that you actively find ways to improve this and increase your strength and mobility.

The Impact of Gait on Mortality and Aging

How to Maintain Your Physical Function At Any Age

Aging gracefully and maintaining walking function isn’t as complicated as you might think. Overall, it comes down to doing the basics when it comes to taking care of your physical health. This means:

1 - Participating in Regular Exercise

The human body thrives with moderate movement. Daily walks, strength training, and stretching routines are crucial pieces of a healthy routine, especially with age. In particular, walking is a fundamental part of many daily activities. As with most things, practice makes perfect. Walking further improves muscular strength and cardiovascular and respiratory function.

Additionally, strength training increases muscle mass, which begins to decline after the age of 30. Stretching a few times a week can also help maintain flexibility of your joints and muscles.

2. Eating a Healthy and Balanced Diet

The saying, “You are what you eat,” isn’t that far from the truth. Your body can only do so much with what you give it. Obtaining a variety of nutrients, vitamins, and minerals through your diet contributes to optimal functioning and cellular repair. Focus on consuming whole foods and making meals at home as opposed to eating or ordering out. This way, you know exactly what goes into the food you eat.

3. Limiting or Avoiding Smoking and Alcohol Consumption

If you’re a smoker, one of the best things you can do for your health is quit. On top of this, limiting your alcohol consumption to a few drinks a week or not drinking at all can substantially improve your physical health. After all, your liver isn’t just in charge of detoxification. It also contributes to enzyme activation, the storage of vitamins and minerals, the production of certain proteins, and more. Ensuring your liver can do its job right is a major factor in overall good physical health.

4. Prioritising Your Sleep

Sleep deprivation is associated with obesity, type 2 diabetes, impaired immunity, mood disorders, neurodegeneration, high blood pressure, and more. Sleep is essential for repair and restoration of the body and its systems. This is why it’s so important to ensure you go to bed and wake up at the same time, as well as practice proper sleep hygiene, such as sleeping in a dark, quiet, and cool room. Most adults should get about 7-9 hours of quality sleep a night. If you’re getting less than this, it’s time to make a change!

5. Get The Right Healthcare

Effectively treating any pain that is limiting your movement is an important first step towards better long term mobility. At Featherston St Pain Clinic we use cutting edge technology to identify gait weaknesses and asymmetries – this data enables us to prescribe specific exercises that target your legs stabilising muscles. We monitor and measure patient progress carefully using the same software over time. Many people who suffer with poor health outcomes due to gait degradation have high arches or flat feet, for these people we prescribe custom insoles which can have a profound impact on the preservation of mobility in the long term.

Not Sure Where to Start?

At the Featherston Street Pain Clinic, our expert team can perform a biomechanical analysis of your gait and help you make a plan to restore your health and improve your life. That way, you won’t let life pass you by. Instead, you can spend more quality time with the people you love and participate in the activities you enjoy. Book your appointment today.

Not Sure Where to Start?

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A Holistic Overiew Of Chronic Pain Management

Tobias Hall — Thu, 04 Nov 2021 02:01:44 +0000

A Holistic Overview Of Chronic Pain Management

Living with chronic pain is an ordeal, one that many of us fail to comprehend. As a society, we struggle to manage with chronic pain effectively, and part of the reason for this is that we often don’t take a sufficiently holistic and broad minded approach to its treatment.

A broad, flexible multifaceted approach is necessary to make a significant difference in most cases of chronic pain. Complex problems often require complex solutions. Outside of the treatment technologies and specific rehab that your pain treatment calls for, making necessary lifestyle adjustments can be a big help in getting n your pain under control.

Pain is a highly evolved form of physical feedback, designed by nature to tell us where we are going wrong. As we are growing up its pain that teaches us about ‘too hot. ‘too hard, ‘too fast’ etc., all the things we need to know in order to survive on this rough and ready physical plane. As adults, pain continues to try and help teach the best way forward, but the messages mostly differ in meaning. The stubborn pain that adults experience is just as instructive as the pains children go through when they are learning to play safe. Except due to the nature of the mistakes we make as adults the messages change from messages like ‘too hot’ to ‘too sedentary’, from ‘too high’ to ‘too stressed‘, ‘too weak’, ‘too much

The pains that children go through are feedback about the physical environment, they teach us about, too hard, too fast, too hot, too high, too careless.

The pains that adults go through, due to the differing nature of adult stupidity are physical feedback about lifestyle. Too sedentary, too fat, too much, not enough, too stressed, too tired, too codependent, too weak, too hunched. They are less about immediate feedback from the environment and more about the persistent mistakes we make that prevent our bodies from expressing their full potential for comfort, movement, health, and wellbeing.

The funny thing is though, the pains adults go through get wildly misinterpreted in our culture and our healthcare system. Medicine tends to treat pain signals as just another inconvenient ‘disease state’ and switch them off using pharmaceuticals, and the general public tends to attribute stubborn pains to aging or an absence of the right miraculous healthcare ‘cure’.

But once you remember and affirm that your pain is your body’s guidance/cry for help mechanism you might change how you approach your pain relief journey. Some of the best questions being along the lines of … what am I suffering from too much or too little of in my day to day life???

Sleep

The modern landscape of sleep research is pretty terrifying for those of us who often come up short of a quality 7 hours plus. Even subtle reductions in sleep duration and quality are associated with increased risk of obesity, chronic disease states, and a host of sub-optimal well-being outcomes. Science is being revealed by the science to be a ‘vital sign’ just like blood pressure and heart rate etc.

The connection between chronic pain and sleep can be both a chicken/egg and an egg/chicken type scenario. Obviously, pain can interrupt your sleep in and of itself. But also, chronic forms of stress like overworking, over-training, over-worrying can erode your sleep; and thus impact the amount of pain you live with. Pain can impact sleep and sleep can impact pain.

If you are living with chronic pain learning about good ‘sleep hygiene’ may prove to be an excellent investment in your longer term wellbeing. And fortunately, there is a vast amount of high quality online information available on this vitally important topic.

Sleep

Weight/Blood Pressure

Research suggests that people with a higher BMI are more likely to suffer chronic pain. It is unclear why this is. Some evidence suggests that chronic pain itself leads to a maladaptive relationship to high blood pressure. On the flipside losing weight is associated with better pain outcomes. Acute pain puts the body in a fight or flight response and makes us more tolerant to pain. When the pain is chronic though, higher blood pressure increases pain sensitivity (Sacco, Meschi et al. The Relationship Between Blood Pressure and Pain).

As a patient, it can be very very frustrating to be told by your doctor that you need to lose weight, after asking for help with treatment if your chronic pain. This frustration is completely justified.

Weight gain can influence your pain levels for sure. But there is a lot more to managing and healing pain than simply losing weight. On top of this, if you are in pain and it prevents you from exercising effective treatments will be needed before you can start to reduce your weight effectively.

Weight loss should be considered a valuable and important ‘component’ of long term pain management – a piece of the jigsaw.

Weight/Blood Pressure

Weight loss should be considered a valuable and important ‘component’ of long term pain management – a piece of the jigsaw.

Nutrition

A healthy diet is paramount to avoid chronic disease. Depending on the kind of pain, different approaches are promising. Increased omega-3 intake might help with inflammatory pain; avoiding polyamines (as found in soy and nuts) can reduce hyperalgesia; broccoli, spinach and vitamin E have a possible effect on diabetic neuropathy. Fasting shows evidence to help improve mood in pain patients who also suffer from depression but regular caffeine consumption can influence how some antidepressants are taken on by the body.

Chronic pain is associated with increased cardiovascular risk and a balanced diet helps mitigate that.

Co-Morbidity

If you suffer from other chronic conditions, such as coronary heart disease, or obstructive pulmonary disease, you are more likely to report chronic pain than the general population. One suggested mechanism is the added challenges for people with chronic pain to exercise, increasing their cardiovascular risk. Other considerations are chronic conditions turning up the volume and making pain more intense in an already challenged body, and the influence of stress and disability from other diseases. Chronic pain cannot be treated in isolation; the whole person with any other illnesses needs to be considered.

Mental Health/Stress

Along with scar tissue, emotional and psychological stress may be the most underestimated factors in all chronic pain management. The vast majority of stubborn pains are underpinned in part by patterns of stress and trauma held in the body’s tissues and the central nervous system.

To add insult to injury pain itself compounds and exacerbates stress, forming a negative feedback loop. The more pain I get the more stress I experience so the more pain I get. Many chronic pain sufferers find that the uncertainty of being in pain is more stressful than the stressors that lead in part to the pain in the first place.

Work/occupational factors

Certain kinds of exercise might be more useful for certain pain conditions. Personally tailored advice with relevant movements are more successful than general exercise.

For many people with chronic pain it is important to be able to return to their preferred activities of daily living, may it be returning to work, playing team sports, or getting out into nature for gardening, a walk, or a multi-day tramp. Many studies show improvements in mood and sleep with increased exercise, and doing what you love surrounded by friends, family, and/or nature further helps with co-morbidities and perception of chronic pain.

Exercise

Certain kinds of exercise might be more useful for certain pain conditions. Personally tailored advice with relevant movements are more successful than general exercise.

Exercise

Certain kinds of exercise might be more useful for certain pain conditions. Personally tailored advice with relevant movements are more successful than general exercise.

Pain

The most common downstream risk of suffering with pain is more pain. If you already experience pain, you are more likely to develop pain in other areas and more likely to have relapses of the pain you suffer with now. It is important to address your pain as soon as possible to avoid tissue atrophy and changes in the brain to make you more susceptible to pain.

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You Are Living In The Midst Of A Lower Body Pain Pandemic – Why?

Tobias Hall — Thu, 06 May 2021 07:39:53 +0000

You Are Living In The Midst Of A Lower Body Pain Pandemic - Why?

Normalising Pain

You have lived your entire life in the middle of a pain pandemic, that almost no one talks about. We suffer terribly with pain and disability, even (some say especially) in the world’s wealthiest countries. Large population based studies indicate that somewhere between 30-50% of people in developed countries suffer with chronic pain. The researchers behind these studies predict a steady increase in these rates of pain due to our increasingly sedentary lifestyle and an aging population.

I wasn’t alive in the 1600’s, so it’s hard for me to know for sure, but I would imagine that people just accepted the fact that rotten teeth were a completely normal part of the aging process. If everyone you know had rotten teeth by the time they were 30 it’s highly likely that in the absence of any deeper scientific insight you would simply assume that dental decay was a normal part of the aging process.

If this was the case, it most certainly reflects our current cultural attitude towards back pain, hip pain, knee pain, ankle pain and foot pain. We by and large accept them as part of the aging process. It is only natural to assume that the health issues we face en masse are a normal part of reality.

Imagine you are visiting in your time machine, chatting with your dentally challenged foreparents in the 1600’s. The conversation turns to dentistry, and they tell you their black teeth are ‘just old age’. What would you want to explain to them??

In our luxurious ‘first world’ life is good, better than it’s ever been before maybe, at least in terms of the broader conditions most conducive to a long healthy life. We don’t have to hunt large aggressive wild animals for food anymore, yet we are still sitting on top of the food chain. We live in warm dry homes. Very few of us perform gruelling manual jobs. We breath clean air for the most part. We are well fed, well healed and well vaccinated. We have ample time to move our bodies in whatever way we choose. We don’t have to fight to maintain our territory. We have comfortable furniture and nice squishy mattresses.

Desk work is far from ideal, but realistically it isn’t coal mining and it isn’t hunting. In the latter cases we are talking about careers where death and dismemberment are ever present risks.

Seemingly life is not that hard on our bodies, yet we suffer with an unfathomably widespread pandemic of lower body pain. A pandemic that we have normalised so wholeheartedly that it is quite normal for people to hold some expectation and acceptance of stubborn pain beyond the age of 40. Possibly much like the presumable acceptance of universally black teeth in people over 30 in the 1600’s.

How Much Pain? Heaps!

It is hard for anything to compete with the likes of refined sugar, smoking and alcohol in terms of impact on societal wellness. The impact these highly lethal yet culturally sanctioned products have our health makes for disturbing reading. But you might be surprised how competitive chronic pain can be. Pain is a legitimate major public health issue, especially when you take into account …

– All the pain, in and of itself.

-All the physical disabilities associated with chronic pain.

– The financial cost to society through loss the of productivity, impact on individual careers and healthcare spending created by chronic pain.

– The well documented (and completely awful) impact chronic pain has on mental health.

– The incredibly serious mental and physical impact of pain medications have on pain sufferers. Including the shocking death toll of opioid based pain medications in certain developed nations

– The well documented interaction of chronic pain and poverty.

– The common and tragic illicit drug addiction that can arise from chronic pain (this is a huge topic in the US).

– The death toll on operating tables, the failed surgeries and post surgical infections.

-The fact that chronic pain can wreak havoc on close relationships.

-The serious long term harm done to people’s cardiovascular system through forced inactivity (this is an extremely common and and largely untold epidemiological story that impacts a very significant number of people)

It is very difficult to put total numbers on the amount of heel pain, ankle pain, ankle sprains, iliotibial band pain, knee pain, hip pain, plantar fasciitis and back pain that we suffer with in our society. Such is the enormity of this situation we don’t stand much of a chance in effectively unifying the statistics. In reality though, the data on individual complaints easily speaks to the bigger grimmer picture. The data on back pain alone is indicative of a profoundly serious global healthcare issue.

We have no longer term need to dwell on pain statistics, thankfully! It is a little dull even from my perspective. The journey with our own pain is a rehab journey – that’s where the rubber hits the road. Bearing in mind that to fix something we must first accept that it is malfunctioning: let’s take a few moments to stand back for a moment and survey the cultural-wide carnage. This may help reduce your sense of suffering alone, and hopefully reinforce the idea that something is genuinely not right with ‘us’

Lower Back Pain

The World Health Organisation have officially christened lower back pain ‘a major cause of disability’ across all Industrialized nations. The WHO have also stated clearly that back pain is the leading cause of work absence throughout the developed world.

The 2010 ‘Global Burden Of Disease Study’ placed back pain among the ‘10 most impactful conditions to people’s overall wellbeing in developed countries’.

In industrialised societies the lifetime frequency of back pain is estimated at 60-70%.

Studies in the United Kingdom have revealed back pain as being the leading cause of disability in young adults and attributes 100 million lost work days per year in the UK alone.

A survey carried out in Sweden during the 1980’s identified back pain as the cause in 21 of their 28 million total lost work days in Sweden per year.

The US estimate for the financial cost of back pain to society through people missing work alone – is between 100-200 billion dollars per year. *Even allowing for a few mental health days and hangovers being blamed on

back pain, these numbers should have the power to shock.

Hip Pain & Knee Pain

Hip & Knee Pain

In the UK research indicates the percentage of 65+ year olds reporting hip pain is 19.2%. While the percentage of 65+ year olds reporting knee pain is 32.6%. The percentage suffering both hip or knee pain was 40.7%.

General health status scores of elderly people are similar to those of people aged under 65 yr in those who aren’t living with chronic pain.. This shows a correlation between pain and wellness in older adults.

A study carried out in the US indicated that a total of 14.3% of participants aged 60+ reported significant hip pain on ‘most days’ in the 6 weeks leading up to the survey.

Knee pain is estimated to affect approximately 25% of all adults, at levels that limit function, mobility and quality of life

From 1991 to 2006, the numbers of total knee replacement in the United Kingdom more than tripled.

In the US, the rate of knee replacements among individuals over 65 years increased about eight-fold from 1979 to 2002.

Ankle Pain & Ankle Sprains

Sprained ankles have been estimated to constitute up to 30% of injuries seen in sports medicine clinics and are the most common musculoskeletal injury by far.

25,000 Americans a day sprain their ankle, and more than 1 million visit emergency rooms each year because of ankle injuries.

Lateral ankle sprain accounts for up to 20% of all sports-related injuries. Indoor and court sports have been shown to carry the highest risk of ankle sprains.

UK study estimates 302,000 new ankle sprains and 42,000 new severe ankle sprain patients bad enough to attend emergency departments in the UK every year.

A US Army study found that ankle sprains are the most common foot and ankle injury in active-duty Army personnel with a rate of 103 sprains per 1000 persons per year.

Approximately 40 percent of those who suffer an ankle sprain are estimated to experience chronic ankle pain, even after being treated for their initial injury.

Studies indicate that ankle sprains are not simply a matter of bad luck, certain people suffer re-occurring sprains and many others live their whole life without ant ankle sprains.

Heel Pain & Plantar Fasciitis

Approximately one million doctors visits per year in US are due to plantar fasciitis.

Some literature on plantar fasciitis shows the prevalence rates among a population of runners to be as high as 22%.

Heel pain has long been recognized as highly prevalent in the senior population, which impacts approximately one third seniors older than 65 years.

There is data that indicates the type of functional issues seen in the feet of plantar fasciitis and heel pain sufferers is associated with poor balance and increased risk of falls.

Heel pain is the most common in active people over the age of 40.

Osteoarthritis

According to the CDC in the US today there are estimated 54 million people with osteoarthritis.

Osteoarthritis is the most common cause of disability in adults globally .

The lifetime risk is of developing symptomatic knee osteoarthritis in Western Society is 45%.The lifetime risk is of developing hip osteoarthritis with noticeable symptoms is 25%.

There are 14 million individuals in the U.S. who have symptomatic knee osteoarthritis at any given time. Nearly 2 million of these are people under the age of 45.

The overall rate of osteoarthritis in military service members is 26 percent higher than the general population, at age 20 to 24 it is twice as high as the general population aged 40 and older.

A study in 2012 demonstrated that osteoarthritis was the highest cause of work loss and affected more than 20 million individuals in the U.S. The estimated cost to the economy is more than $100 billion annually.

What I hope that you can sense here is that for there to be this much pain afflicting people who essentially every advantage in life there is surely something up?????

Opiate Prescription

For a better acknowledgement of how severely we struggle with pain: there is some value in being at aware of the opioid crisis that has plagued the US over the past 20 years. Prescription opioids are a justifiable tool for about 0.0001% of pain sufferers. The class of poor unfortunate souls who have suffered the likes of extensive burns or nerve damage. Significant trauma and significant disease, are sound justifications for the use of this class of drugs.

At the height of the American opioid epidemic in 2012; the number of annual prescriptions peaked at 255 million. OxyContin is to heroin what treacle is to table sugar; the distinctions are more micro-molecular than they are meaningful. So realistically this was a case of 255 million ‘heroin’ doses being dispensed to chronic pain sufferers by American doctors in 2012. A huge number of these patients would have been back pain, hip pain, knee pain, foot pain sufferers and the like.

Statistics published in the American Journal of Public Health: estimate that there were between 17,000 and 32,000 deaths from prescription opioids during 2016. Each of whom was someone’s mum, dad or at least someone’s child, lest we forget what stats represent.

On top of the thousands of deaths you can safely assume that for each death there are perhaps 5-10 or even 20 other patients living an utterly miserable addicted existence.

The American CDC estimates the total economic burden of prescription opioid misuse in the US is $78.5 billion a year.

Realistically, all the stats are glorified guesses, no one really knows how bad it all is. Death certificates for the 42’000 total opioid overdoses in 2016 do not make a distinction between deaths caused by illegal opioids like heroin, and deaths caused by prescription opioids.

These opioid deaths are not like the inevitable toll we associate with extreme medicine, like emergency open heart procedures where it was touch and go for the patient pre-admission. These are deaths caused by pain relief medications!!!!

If chiropractors dismembered 30,000 Americans during 2016, that would be shocking would it not? It should be even more shocking that a single class of prescription pain medications (with very few sane applications) does. For some reason we tend to leave these kind of stats under the rug, while others not so much. If chiropractors killed 300 Americans a year you would hear ALL about it… lest they should kill 30 thousand.

The human story behind the medically endorsed and executed opioid death toll includes the ‘surface symptom’ that is chronic pain. It also includes the profound physical unwellness, emotional trauma, physical trauma, cycles of abuse, poverty, stress, poor diet, a lack of proper rehabilitation and a severe lack of education.

The type of patients who become opioid statistics are nearly always either the hardest of the hard, or the fragilest of fragile… or both. As a collective they cost society more than all the other pain sufferers put together. They require more help and support than all the other pain sufferers put together… literally! The reality is that an inconveniently massive amount of love, care, rehabilitation, support and education is needed for many of these patients to stand any chance of a normal pain free life.

To respond to all this, not with acknowledgement, not with support, not with rehabilitation, but instead ‘systemically sponsored’ drug dependency and societal ‘addict stigmatisation’ is heart breaking stuff. And the fact this happens in our supposedly modern world speaks deeply to our struggle with chronic pain.

The Rest

For the sake of brevity I have carefully left out all the IT Band issues, bursitis, piriformis syndromes, achilles pain, calf pain, groin strains, hamstring issues, sciatic pain, disc injuries, shin splints, stress fractures, bunions, ingrowing toe nails, Morton’s neuroma and others. But rest assured they add up in a big way.

I know this is a bit dry, but at least now you are fully aware of the vast and very human mess you are a part of when you live with pain.

Okay, So Why Does A Global Culture That Has Been To The Moon Struggle So Much With Something As Basic As Musculoskeletal Pain? Is Pain Management Harder Than Rocket Science?

So to my mind there are really only 2 worthwhile questions to ask next once we have become enlightened as to how severe our pain epidemic is.

Very important question no. 1 – Is there an actual reason or reasons for all this pain, or is it just an inevitable part of being human?

Answer – Yes there are some really obvious reasons if you know what to look for! And no, on the scale that it exists now it most definitely isn’t an inevitable part of being human.

Very important question no. 2 – If it isn’t just an inevitability is there actually anything we can do about all this pain

Answer – Yes there is a great deal that can be done to heal, halt and reverse the pandemic of lower body pain we suffer with. We can heal this, both as individuals and as a society. We are going to move past this the same way we moved past smallpox, polio, endemic dental disease and a host of other crappy chapters in our collective medical history.

Pain management isn’t rocket science, you can trust me when I say that many of the most effective solutions are almost shockingly simplistic. As one small example of this – I personally know several hundred people who would be very happy to tell you that I helped them to resolve their severely debilitating heel pain using a porcelain soup spoon. And while many chronic pain sufferers do have complex webs of physical weakness, physical scar tissue and even emotional trauma that hold their back pain and knee pain together – in most of those cases it is really just about layering simple solutions on top of simple solutions. It really isn’t rocket science I promise you.

For most patients being stuck with chronic hip, ankle or knee pain is a bit like having a nasty splinter in your finger; but also being part of a tribe in which almost no one understands how to get splinters out. That splinter could cause you a lot of problems – but not for the want of a complex brain surgery-like procedure – just for the want of some pretty simple wisdom. If you know how to get a splinter out splinters aren’t a big problem. If you don’t know how to get splinters out, over time they can cause carnage.

If you peel back the real reasons we struggle so much with pain they are complex, cultural, quasi-scientific and somewhat philosophical. If you want to understand that better have a read of this LINK TO ORTHOPEDIC BLOG.

But we aren’t here to unpack how we got here dear reader. We are here to unpack what is actually causing all this chronic lower body (back – hip – knee – ankle – foot). And we are also here to unpack what we are actually going to do about managing all this pain.

So Hit Me With It Then – What Causes All This Lower Body Pain?

I am going to make this really really simple for you, and that’s going to be easy because on the level that we need to understand it here it is simple. The following principles are more than likely all you will ever need to know in terms of what causes your lower body pain. Bearing in mind – if we know roughly what is causing our pain we can make far more educated choices around which type of solutions we roll out. Because in the end all this talk is only for the purpose of bringing us closer to effective tools so that we can get ourselves free.

The following causes of our lower body pain pandemic are inevitably not the whole story. But they are enough to guide 99% of us to get rid of 99% of our pain if we are willing to make them , and it could be the basis of a our holistic roadmap for full rehabilitation.

Cause 1 – Hard Flat Surfaces

Our ancestors lived in the big outdoors with their feet in the mud. A million generations of your direct ancestors didn’t walk on hard flat ground like concrete and tarmac, they walked on variably soft undulating ground. Natural surfaces hug the sole of the foot as you walk on them which means that the arch receives support – and the entire foot benefits from shock absorption.

It would be very hard to overstate the impact (literally) our sudden shift from soft undulating ground to hard flat ground. After millions of generations spent evolving on and adapting to soft surfaces, 5 human lifetimes ago we invented cobble stones and flag stones and rest is hard homogenous history.

Imagine in your minds eye jumping down from a high seawall onto soft sand, and choosing to land heels first with straight legs. Most of us can clearly imagine doing this for fun, not only on sand but on a range of other natural surfaces. Now visualise the same experiment, jumping down from a high seawall – but this time landing on concrete, again with heels first and straight legs. It shouldn’t take much imagination to get a sense of how dangerous this could be. The difference between the impact of hard industrailiased ground on the tissues in our lower body and the impact natural surfaces have on the lower body is vast. This visualisation gives you a window into the increased stress that our joints an soft tissues are subjected to over the course of an entire lifetime.

With no arch support and no shock absorption our tissues are subjected to massively increased rates of microtrauma and general wear and tear. In addition to this the lack of muscle activity and balance control required to get from a-b on completely flat surfaces engenders muscle wasting in the muscles of the core and lower limb. If you go for a long walk in the forest away from any tracks you will get a chance to marinate in this truth. It is actually pretty hard work getting around in the big outdoors. But it certainly isn’t hard work strolling along the conveniently flat and homogenised surface in an urban street. The lack of challenge presented by industrially fabricated surfaces causes insidious patterns of muscle wasting in our body’s and a gradual loss of effective balance (aka proprioception). Needless to say, muscle wasting is an excellent ingredient that one might include when cooking up a recipe for chronic pains like back pain, hip pain, knee pain and ankle pain.

The combination of microtrauma induced through lack of support and shock absorption, and muscle wasting induced by the lack of work involved in moving around the planets surface make for a potent mix of pain inducing cellular changes in our body’s. As is the case with any form of stress we do of course have greatly varied levels of susceptibility to the creeping ravages of hard ground. Those of us with high arches, flat feet and wide hip angles are all examples of those who tend to suffer more than their fair share of the pain inflicted upon us by this incredibly convenient but ‘biomechanically toxic’ aspect of our modern world.

Cause 2 – Sedentary Lifestyle

Unlike the hard surfaces, the impact of excessive and prolonged periods of activity is a far more well known causative agent in pandemic of pain we are amongst. Admittedly we are far more aware of the impact that prolonged sitting has on the neck and shoulders, than we are of the impact sitting can have on the lower body. This is probably simple because we are far more attuned to the more obvious changes that happen to peoples spinal posture over time. But excessive sitting has just as much impact on alignment in the lower body as it does the upper body, just in a less visible way.

The obvious impact sitting has is that it leads to gradual loss of muscle mass. In the shoulders and spine this means loss of the upper back and core muscles. In the lower body this means a loss of tone in the stabilisers of the hip and thigh. All of which happens far more quietly and insidiously deep in behind the hip, and under the desk.

In addition to the loss of muscle mass in the lower body, excessive sitting creates loss of joint mobility and a loss of elasticity in the soft tissues of the lower body. Shortened hamstrings and shortened hip flexors are the most well known of these chronic adaptations that contribute greatly to the pool of chronic pain and disability in our world.

The legacy of all the sitting we do often bears its bitter tasting fruits during times of increased activity as opposed to during the sitting itself. What this means is that when we injure our hamstring in the masters soccer match it isn’t a true injury, but a chronically shortened hamstring that has failed to rise to the occasion. Due to 26 thousand hours of ‘chair time’ in the preceding year. When we ask our chronically shortened tissues to move, often they can’t, especially as we get older. But it isn’t age that is the cause, it is what we spend our years doing that determines what pain we have. The longer we smoke the more we cough, the longer we keep sitting the more we ache. Neither are age related they are both just bad habits.

Cause 3 – Physical Injuries & Scar Tissue

Injuries are probably the most over-estimated and over-rated cause of pain in our cultural pain paradigm. And scar tissue may be the most under-rated and under-estimated cause of pain in our world. This can seem like somewhat of a contradiction in terms unless you understand that scar tissue can often come about as the result of repetitive strain and persistent lifestyle factors like poor posture.

A true injury is when we are are 100% healthy one minute and then broken the next. Many of the back injuries, ankle injuries and knee injuries we experience are however a little more complex than that. It is often our weaknesses that come to the surface during relatively minor incidents, which masquerade as true injuries. This being said there are obviously many other occasions when we sustain true injuries.

Regardless of whether they come from weakness or genuine bad luck, many of our injuries leave us with lasting challenges. This is obviously true of the majors like back pain and whiplash injuries after major car crashes, but it is in many ways just as true of the common garden variety ankle sprains.

Physical injuries cause chronic pain through the legacy of scar tissue and muscle wasting. Ineffective rehabilitation is injury management that doesn’t deal effectively with the scar tissue and muscle wasting left by classic ankle sprains. And FYI effective injury rehab is the exception not the rule in our society. These principles where chronic pain is the long term result of an injury applies to neck pain, shoulder pain, back pain, hip pain, knee pain, ankle pain and foot pain.

By virtue of the sheer quantity of weight bearing the lower body does it frequently cops the worst of what scar tissue and muscle wasting have to offer. In addition, we depend so heavily on the tissues of the lower body for movement they by and large have greater scope for manifesting chronic disability.

Cause 4 – Lack Of Education

Consider for a moment how well you look after your teeth. Five minutes in the morning and 5 minutes in the evening, erry damn day!! Regular check ups, semi-regular visits to a hygienist. If hey you have pain in a tooth you seek help immediately. And at least if you are one of the few slackers who don’t stick with the dental program, you most likely know that you should.

In contrast consider how the average person looks after their spine.. It’s fair to say that since the rise of yoga (borrowed from another culture) there a few westerners who take some time out to care for their spine. But mostly we don’t have anything like the same kind of routine ‘spinal hygiene’ built int9 our lifestyle. We don’t generally don’t work on the mobility and strength of our spine tissues in religious way. And those of us who do aren’t anything like as regular with that process as we are with our teeth.

The reason we care for our teeth so well is that we are carefully educated and indoctrinated from an early age. By the time we are 7 year old we have an excellent grasp of what it is that impacts the wellbeing of our teeth, and we know exactly what we need to do about it.

If you go onto a busy street in any city in the developed world 100 people what you should do about your tooth lain you will get near enough 100 really consistent responses. In fact 100 out of 100 will even know how you could have prevented it from hurting in the first place. On The other hand, if you head onto the same street and ask 100 people what you should do about your back pain you will scarcely the same answer twice, and take my world for the fact that very few of them will be high quality responses. We have absolutely no consensus and very little understanding of what really causes problems like back pain, hip pain and knee pain. And even fewer of us know what the real processes are for resolving these complaints once they become chronic. This is due to a lack of education… systematically and even amongst healthcare professionals.

Cause 5 – Stress & Emotional Trauma

The research has shown conclusively that there is is a profound connection between psychosocial stress, trauma and chronic pain. Broadly speaking there are 2 primary ways in which chronic emotional disturbances create and influence chronic pains like back pain and hip pain. The first is habituation of muscle tension and stress related postures which cause the type of physical changes we associate with chronic pain. The second is chronic activation of pain pathways deep in the central nervous system.

Much of our ancestry is made up of animals that were prey times for much bigger toothier critters. And all prey animals are equipped with a freeze reflex that compliments the fight or fight system.

There is a big advantage to having a freeze reflex. if you get grabbed by a big cat and you freeze instantly there is a reasonable chance it will assume you are already dead and not go in for the full neck bite. Being frozen up, only partially chomped and seemingly dead gives you a small but real evolutionary advantage. If the predator is distracted by another predator or goes off to fetch its Cubs for dinner you have a chance to escape.

Being on the inside of the freeze reflex is not a fun place to be, just ask anyone who has been there. In the moment when you feel like you need to be your strongest your body completely shuts off all motor control. As far as the nervous system goes, the freeze responds is like driving a car at 100km per hour and suddenly applying the handbrake without coming off the gas. It can be terrifying to feel weak and defenseless in a moment where we naturally want to feel strong.

Animals are far better than us at literally ‘shaking off’ traumatic events. The tremble and shake to release the freeze response and then run like the clappers. Humans have developed a tendency to react very badly to freezing moments. Having large frontal lobes as we do means in moments like that we make snap judgements like ‘I am totally powerless to defend myself’. These impressions carry with them the tendency to ball up the freeze response moments rather than express it effectively.

‘Unprocessed freezing up’ is how we carry trauma in our bodies. And the double shitty news is that it doesn’t only happen with the big stuff. Even small events can create this kind of reaction in our bodies, and it’s basically how we convert lots of small stressful moments into a build up of anxiety, fear, stress and the other emotions that we use to cover them up like anger.

Carrying these layers of unprocessed trauma in our nervous system is how many of us ultimately covert our stress and trauma into chronic pain. Chronic muscle tension and irritable nerve pathways are unsurprising knock-on effects of trauma responses stuck in the body over the longer term.

In Conclusion

So now you know (assuming you are willing to take my word for all this) that our lower body pain pandemic is not the big achy mystery it might have been – given how much there is out there.

The point of this article was firstly to acknowledge what a pain pickle we are in as a society, and perhaps reassure you that you aren’t alone if you are struggling with chronic pain. And secondly to demystify all this pain, as a start point on the journey towards full rehabilitation and recovery. Because good news I have to share is each and every one the lower body pain causes I have touched on here comes with a wide range of reciprocal and effective solutions.

The scar tissue that causes so much of our knee pain and ankle pain can be broken down. The muscle wasting causing our back pain can be resorted with the right exercises. The impact of hard surfaces can be mitigated with exercises and custom orthotics to provide support and shock absorption to our joints. We can learn about how to take better care of our muscles, joints and soft tissues. And our trauma can be healed and released, often with surprisingly simple tools and exercises.

And when we put all this together for ourselves in a way that works for us – we will have taken a small but hugely meaningful bite out of the largely silent pain pandemic we are living in the midst of.

Multi Media Versions of this Blog Post below:

Make sure you don’t miss parts 2, 3, 4 and 5 of this information series – go check them out on the links below now:

Part 2 of Pain Pandemic

Part 3 of Pain Pandemic

Part 4 of Pain Pandemic

Part 5 of Pain Pandemic

Prefer listening to the Podcast? Click here to tune into Episode 1:

Episode 2:

Episode 3:

Episode 4:

Episode 5 :

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You Are Living In The Midst Of A Lower Body Pain Pandemic – Why?

You Are Living In The Midst Of A Lower Body Pain Pandemic - Why?

Normalising Pain

How Much Pain? Heaps!

Lower Back Pain

Hip Pain & Knee Pain

Ankle Pain & Ankle Sprains

Heel Pain & Plantar Fasciitis

Osteoarthritis

Opiate Prescription

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