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Back Pain – There is Good News

relieve-back-pain

The bad news is you may have or know someone that is experiencing chronic or persistent back pain. The good news is, there is a way forward.

Yesterday, three important papers about back pain published in the Lancet (one of the world’s oldest and best known general medical journals) were referenced in the The Guardian, The Telegraph, the BBC News and the Daily Mail . So current evidence-based information, at last, making its way to the public domain.

In briefly reviewing the papers (published March 21, 2018), the key points for me are these:

Low back pain is now the leading cause of disability worldwide.

“Prevention of the onset and persistence of disability associated with low back pain requires recognition that the disability is inseparable from the social and economic context of people’s lives and is entwined with personal and cultural beliefs about back pain.”

“Most low back pain is unrelated to specific identifiable spinal abnormalities,”

Globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences.”

“Recommendations include use of a biopsychosocial framework to guide management with initial nonpharmacological treatment, including education that supports self-management and resumption of normal activities and exercise,…”

Thank goodness this is getting the attention it deserves so it can help people who need it most. And that’s a LOT OF PEOPLE.

Why now, finally? I think it’s gaining traction due to spiraling health care costs along with the opioid crisis that is so prevalent.

Over the next while I’m going to break down and comment upon some of the points and principles presented in the papers, as many form the basis of my work.  In the meantime, if you care to read the papers yourself they can be found here.

Lorimer Moseley, one of the world’s top researchers on pain continues to make the related point that people need an understanding of what pain is and what it isn’t, as he does with a touch of humor in his TEDx Talk in 2011.  Professor Moseley is most known, however, for publishing 260+ papers on pain science and his continued work as Professor of Clinical Neurosciences and Chair of Physiotherapy at the University of South Australia. And one of many leading the charge globally in what he calls a Pain Revolution.

A huge paradigm shift is required as understandably, information about what works to treat back pain and what doesn’t is confusing.  It seems counter-intuitive to ask people who are in pain to ‘just move more”. As the latest interviews I’ve listened in to with Lorimer, he states that with what we’ve learned ‘recovery is, back on the table’.  There is hope. As I mentioned earlier, there is a way forward.

I talk about this all the time with family and friends … who often have a hard time believing what I describe as it is a change from what we have believed for most of our lifetime. 

But, if we really truly want to get people out of this pain cycle (and I will say most any pain cycle) we need to help with the understanding of what the evidence shows and how to best work with it. This will also require huge shifts in our public policy, etc. as stated in the Lancet papers.

“These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.”

So come along for the ride if you or anyone you know is experiencing chronic or persistent low back pain (or any pain, really).  With 1 in 5 experiencing chronic pain of some kind, unfortunately, you won’t have to look too far.

 

 

What might be useful skills?

Funniest thing I read the other day.

Being flexible ain’t all it’s cracked up to be

Doing the splits is not exactly a useful skill.

– Painscience.com

I’ve written about this before, here. But I think it’s important to talk about again.

People associate yoga with flexibility.

I do associate the word flexibility with yoga, but it’s in how we apply flexibility to our life.

That is, we have lots of choices available to us.

People often get stuck and then their choices become smaller, and smaller, and smaller… until they feel something a little like this; boxed in.

stuck

What I’m really looking for is this:

Freedom.

Do you have freedom, to do what you want in your life?

Do you have the freedom to BE you?

Skills that may aid in this might be strength. Physical strength if you want to move around in the world. Be able to go jogging, walking, cycling. Even to simply pick up and play with your kids/grandkids.

Maybe you are an office worker or writer and need to sit a lot of the day. What skills might be useful to do that?

A skill may be the ability to voice your opinions at work?

Or the skills required to get a good night’s sleep, so you have the energy for the coming day.

A useful skill may be noticing what creates tension in your body.

Try sitting in a dentist chair for any length of time and notice how you feel?  A sore jaw, perhaps, makes sense. But what might your shoulders feel like? Or your leg muscles? Imagine doing this, unknowingly creating tension throughout the day, and what it might create? Pain, fatigue, stiff or sore muscles.

Yoga, is all about the noticing.

Which helps guide our life, …

out of the box, and toward spaciousness and freedom.

 

 

 

 

Just, … breathe

People often sit at their desk, laptop, TV, or plugged into a smartphone with their earphones in. Listening to music, podcasts, videos on YouTube, working, or whatever.

As an experiment, the next time you put your earphones on, don’t ‘listen’ to anything except your breath.

It may not be as noticeable if you’re on the bus, driving, in an airport or a similar noisy environment. But, still, I think you’ll find it to be … telling.

How are you breathing?

Are you breathing fluidly?

Is there equanimity on the inhale and exhale. Or is one shorter or longer than the other?

A pause in between may be good. But do you find that you’ve actually stopped breathing? As in not breathing altogether of course, but that your breathing is not fluid. Easy. Continuous. That there is a long pause, perhaps, between the two. That you fail to begin the inhale, until long after the exhale.

  • Why might that be?
  • How do your neck muscles feel, while you’re noticing ‘this’ breath?
  • How does your torso or trunk feel?
  • How does your abdomen/belly feel?
  • Do you notice or feel anything at all?
  • Do you sense anything?
  • What might this noticing, this awareness tell you?

In the meantime, try this.

Inhale, and exhale, along with the shape below.  Expansion, contraction.

breath

I’m curious to hear of your experience.

I can say for sure, I noticed a few things about my own breathing patterns.

When there is quiet, what do I hear?

(Though we’re in the midst of a cold winter, I find I can ‘listen’ more clearly to my breath when swimming or floating in water, similar to listening with earphones in as above. Or if I submerge myself in bathwater. So choose what’s best for you, whatever might be your season.)

Please feel free to comment, in the space below.

 

What can you do today?

Most of the time I’m not sure where I’m at with my practice.

(I tend to substitute ‘my practice’ at any given time with ‘my life’, to get to the bigger picture).

  • Am I doing enough?
  • What should I be working on?
  • Is there enough time in the day?
  • What comes first?
  • What’s most important?

I used to get, oh, so bogged down in the details. I would be stuck because there were so many areas I needed to work on, I didn’t know where to start.

What I’ve learned over the past 3-4 years in looking at the research, the evidence about movement, manual therapy, yoga, etc. it’s become clear to me it’s not so much what I choose to do

… but that I choose to DO something.

Today I will go for a skate. Hopefully, I will remember to do a few useful stretches / movements before I begin. I know that doing these will be of benefit to me. Particularly in the cold weather and, well, because I’m getting older.

Canal

When I feel the muscles in my back, shoulders, and face tighten from the cold I will try to remember to release some of the tension there. Soften.

I will try to remember that LESS is MORE.

I’ve only been skating once this year, so it probably doesn’t make sense for me to skate the WHOLE canal.

Listen to the whispers that tell me when I’m feeling fatigued.

It is enough.

Sit back down. Unlace my skates. Grab some hot chocolate and call it a day, … well done.

What will you do, today?

 

 

It’s your life

Consider the ways you need to use and move your body every day.

It's your life

Depending on your life, how much you move throughout the day may be fairly limited or alternatively, you might go through a whole range of movements.

Do you work in an office? Sitting, walking, reaching, writing might be some of the things you do in a day. I suspect sitting, is a primary one. Do you work as a plumber? Your movement needs are different than the office worker. As are what a doctor, teacher, hairstylist, service worker, etc. will be, who are often on their feet much of the day.

What you need to ‘train for’ is different than what anyone else needs to ‘train for’.

What a person needs who sits at a desk all day, is different than what a parent with toddlers needs, versus what a teacher might need.

train for your life

We sometimes get into trouble when we’re doing exercises, that don’t always or altogether correlate so well to what’s actually required in our life. If you’re exercising for basic fitness and enjoyment, that’s fantastic. That in itself is an achievement. But perhaps you might consider adding more to the mix if you’re someone who also experiences pain, fatigue, etc.

This is important:

  • If you’re hitting the gym every day, building strength and stamina but suffer from low back pain because you’re also sitting in a chair for 8 hours a day, perhaps you need to train differently or add something to your training routine.
  • If you are the most amazing yogi but suffer from hip strain or other pain symptoms because during the rest of the day you’re standing on your feet, perhaps you need to look at what you’re training for.
  • If you’re out on the golf course getting your exercise and fresh air daily, but cannot ‘do, or manage’ the rest of your life, perhaps you need to do something else as well.

What happens all too often is the hour of exercise we get at the gym, yoga studio or out on the golf course doesn’t quite support all the rest of what we need to do in our day.

  • If you need to sit, train as best you can so your body can adapt for this.
  • If you need to stand, train what’s required in order to stand a lot.
  • If you are the golfer, train for whatever it is you need to do, besides golf.

But how can you do this and where to find the time?

It’s not always easy, but you can learn to build it into your day. It doesn’t always have to take another hour going to the gym, paying for a babysitter, driving through the snow. There are simple tools, you can use. Anywhere, really. That don’t take up a lot of time.

 

Yoga Tools – Open Your Mind

I’m going to challenge you to change things up this week. Whatever you think you should be doing, (in a movement, in your posture) whatever you’ve been told to do… do the opposite.

15327336_10157994488295226_6548450058877273096_n

As an example, while you’re sitting during the day:

  •  If you have a tendency to hold yourself rigid, perhaps with your shoulders pulled back, chest puffed out front, sitting up nice and tall, as some would say ‘good posture’, allow yourself something different. Perhaps slump a little, let the upper back round a little, feel as if you can soften the area between your collar bones, let your belly be soft and full when you breathe. RelaxI’m not saying this is what you need or you should sit this way all day. But try it for a few minutes and notice what you feel.
  • If you tend to be someone who is generally in a slumped position when sitting, try the opposite. Feel your sitting bones on the bottom of your chair, perhaps even pushing them into your chair slightly. Think about sitting tall, imagining your head feeling light above your shoulders, it lifting towards the ceiling. Collarbones wide, shoulder blades down your back.  Notice what you feel.

Though this is only one example. You might try this way of being, or doing, in a multitude of ways.

In yoga, do you always exhale when forward bending and inhale on the reverse? Try changing it up and see what you feel. What do you notice?

Experiment with doing the opposite of what you think is right for you, what you’ve been told is right for you and see how it goes. If you like, comment below so we can take the conversation further.

 

Yoga Tools – Awareness

imagesThe bumper sticker on our last Yoga Tool was to recognize that just as we take a drink when we are thirsty, eat when we are hungry, we need rest when we are weary. All of which requires first, awareness of a particular sensation in our body.

There are signs and signals speaking to us all the time, but are we really listening?

Are you like me in that you eat regularly on a schedule or do you listen to the signal telling you when you’re hungry? Do you sleep only at certain times of the day or are you paying attention to the signs that you need to rest? These are two indicators built into the survival mechanism of our body. Similarly, if you enter a room with a smell so strong it seems toxic you know to immediately step out again. If you are suddenly ill bringing up something you ate, again a signal. Your brain’s number one job is to keep you safe and protected.

Pain is no different. It is a signal from your brain, a call to action.

Below is a quick and easy Tool to begin learning to sense information your body or your brain, is providing. I often use it in the beginning of a yoga class, to bring some awareness to what we’re about to do.

one-to-fiveLie with your back on the floor. Bend your knees and place your feet hips-width apart. Let your knees gently fall towards each other, resting easy and comfortable.

Now, begin:

To sense what you feel in terms of your body’s contact with the floor. What parts of your body are in contact with the floor? Is the surface of the floor hard, soft? Are you comfortable? Do you feel the support of the ground below? Lean in. Feel grounded. Feel supported.

To feel your breath moving through your body. Where do you first notice your breath? In your chest, your lungs? Your nostrils? In your belly perhaps? Does the air feel smooth flowing in, and out? Does it feel forced, soft, cool, warm? Can you sense movement, in tune with your breath, elsewhere in your body?

To notice the tone of your muscles. Are your muscles at rest, tense, or sore? Where in particular do you notice any tension? Where might you find softness? Can you soften the areas around your eyes? Let your jaw, feel relaxed. Your tongue loose and soft in your mouth. Can you contract a muscle somewhere and then for contrast, let it go?

To pay attention to your heartbeat. Can you sense it? Can you feel it? Where do you feel it?

Going even deeper, can you feel or sense the blood flowing through your body? 

If you can’t feel a particular sensation, just notice that. Without judgement. Just let it be.

Body / Breath / Musculature / Heartbeat / Bloodflow

5 steps inside…

Take some time each day to first, pay attention. Build awareness.

Practice this once per day over the next week.

*Note: If you’re typically a doer, go-getter, Type-A, cannot sit still type of person, consider doing this AFTER a workout, brisk walk, end of your day, when you’re more likely to be at ease with the sense of quiet and stillness this exercise asks of you.

Yoga Tools – Rest Easy

Life is not easy. For any of us.  There is more than enough to do, day in and day out. Stressors at work, at home or elsewhere.

So cut yourself some slack. Give yourself permission to rest. 

restStart with just 5 minutes.  Do this at least once a day. Do it twice if you like. But do it consistently.

You might want to set a particular time for this. Perhaps at mid-day, or early evening. It’s not often you need to rest first thing in the day and this 5 minutes isn’t meant for sleeping, so not too close to bedtime either.

  1. Either lie down or sit in a comfortable position (*see below for IMG_9231.JPGspecifics). It’s preferable to lay on the floor but if you’re unable to do so, a bed or sofa is fine.
  2. Set a timer for 5 minutes.
  3. Close your eyes or soften your gaze.
  4. Begin to breathe in and out through your nose (close your mouth).
  5. Be here for 5 minutes, just breathing naturally. Don’t try to change anything about your breath.
    • Notice where you feel your breath. It might be most noticeable in your nostrils, maybe in your chest or perhaps your abdomen.
    • Notice how your breath is moving. If there’s any particular quality to it such as smooth, interrupted, easy, strained.
    • Then just breathe. And just notice.
    • If your mind wanders, as it’s likely to do, just bring your attention back to your breath. Feel where it’s moving through your body, where you notice it. Try not to judge the wandering of your mind as anything either good or bad.
    • And just breathe. And just notice.
  6. When the timer goes off, slowly open your eyes. Roll over and stand up.

Notice what you feel. Mentally or physically make a note of what you experienced or noticed.

Keep practising for a week.

Check in with me next Tuesday and we’ll expand on this practise.

If… you can’t find 5 minutes in your day? You might want to look at that.

If you have any questions or comments, post them below.

* Positioning if seated

  • Sit forward on a chair so your back is not touching the back upright portion of the chair.
  • See if you can feel your ‘sitting’ bones (ischial tuberosities) and let your weight be supported there.
  • Have your feet planted on the floor, hip-width apart.
  • Hands comfortably on your lap.

* Positioning if lying down

  • Lie on the ground, perhaps on a carpet or mat if available. If you have back pain, you may want to use a rolled up towel, yoga mat, etc. to slip under your bent knees for support.
  • Hands can be by your side or placed on your belly.
  • Notice the parts of your body supported by the hard surface of the floor (heels, hips, shoulder area, head).

Change the brain, the nervous system, the body

neuroplasticity-and-technology-4-728The changing of our brain …

One of the most important changes in the last 14 years or so is the field of neuroplasticity.

Scientists once thought that the brain stopped developing after the first few years of life.  Since then, we’ve come to understand this isn’t true of the brain. Research shows our brain is capable of learning, adapting and changing throughout our life.

The changing of our body …

Our white blood cells die after 3-4 days, red blood cells after about 120 days, the dermis of our skin renews every 2-4 weeks. Research shows that changes in the relative level of physical stress cause a predictable adaptive response in all biological tissue.  In other words, changes take place and what’s exciting to me is how we can take measures to influence what happens in our body.

stretchingI’ve also learned it seems we may have been ‘wrong about stretching‘ insofar as we’re not really stretching or lengthening muscles. At least not as much as we once believed. Rather, we’re changing our response to a stimulus via the nervous system.

“your ability to stretch at any range is determined by your nervous system’s tolerance to that range.” – Jules Mitchell

The changing of our nervous system …

Our brain is naturally going to respond in a protective manner to anything it perceives as dangerous.  If we are trying to re-train flexibility or just movement in the body and do so with strong, forceful pressure or stimulus … the brain/body will react by saying … stop! No! Don’t go there. It will send a (pain) signal to safeguard our movement.

stretchHowever, if we move in small incremental ways within a safe and pain-free range of motion, the nervous system will react by saying … this feels okay. Safe. I’m happy to explore this.

This is a somewhat simplified way to explain all that’s going on, but it’s a starting point we can work from. We can even begin by just imagining movement and still create changes in the brain and our nervous system. So we can, really, start anywhere.

By learning to pay attention, moving in a way that allows your nervous system to adapt and create new patterns while it feels safe, you will make progress. 

Change. Big Change. Lasting Change.

It turns out – we are adaptable!

We are adaptable

Tissue can change. Your brain can change.

brain

This provides HOPE to anyone living with pain, chronic pain, limitation to mobility or perhaps psychological pain (or unease) from the stress, anxiety, depression, insomnia that often accompany physical pain. All of which are common problems affecting a large proportion of our 21st Century population.

Pain science

The experience of pain doesn’t necessarily correlate with the state of our tissue.

You may see some awful looking images on an x-ray and yet not experience pain. You may experience pain, though not even have the limb that pains you (phantom limb pain).

Which doesn’t mean it’s all in your head but that pain is indeed, very complex

Neuroplasticity

Contrary to our understanding up to about the year 2002, our brain can change

This is revolutionary in terms of we can keep learning, and also how we can change behavior and adapt.  Most important, how your pain can change.

What does this have to do with how well you can or cannot move? The fact that you have persistent pain or not? Why it flares up?

Explore this (somewhat new) information and learn simple things you can use throughout your day that are most likely to help, according to the latest research.