If it is due to a traumatic incident it is best to call for medical assistance as you need to ascertain if anything is broken.
This following advice is meant as a guide and you should seek advice for your particular problem.
Assuming it is due to an unguarded movement (by that we mean the muscles didn’t support your joint) the best thing to do is get a flexible ice pack over the painful joint. This must be wrapped in a thin cloth to protect the skin from a burn. The length of time depends on the depth of the joint.
As a general rule do 10 mins for neck, upper back and limbs and 20 mins for lower back. Try to apply 3-4x a day, mainly from mid morning onwards. You will probably feel best having a hot shower in the morning to loosen the overnight stiffness.
The next important thing to do is stay mobile on a regular basis if possible. This may be difficult to do initially. However as you move you will inhibit pain, so start gently and gain flexibility slowly. Do not test your movement in the direction of pain, as it will only aggravate your condition.
You would as a general rule benefit by going into the pain free direction. Please note with sciatica due to a disc prolapse you go into the direction that reduces leg pain even it the back aches a little. Please see the section on sciatica for further information.
Take a look in a full length mirror at yourself and see if the following applies to you.
A commonly seen aberrant posture in clinic is one where your foot is turned out, the arm on the same side is held slightly flexed at the elbow and is rotated inwards so that you can see more of the back of the hand than the other side when looking face on. The same shoulder will also be held forwards. Typically this is due to weakness of the anti-gravity muscles down one side of the body and is a milder presentation than Pyramidal Weakness found in some typical stroke patients.
The anti-gravity postural muscles hold the shoulder back and rotate the arm outwards. They also lift the leg and foot from the floor. Commonly this pattern of weakness leads to rotator cuff problems, tennis elbow, hip pain, shin splints etc. If you have had any of these problems or get them repeatedly despite having had treatment then you possibly have a functional weakness of a relay area in the brain called the Ponto-Medullary-Reticular-Formation or PMRF for short.
You can have as much Physiotherapy, Chiropractic, Osteopathy or whatever other therapy you like, but if the weakness is established the problem will keep recurring. Why? Because the brain will keep pulling you into the poor posture. If you are exercising and getting stronger you will have less symptoms, but push it hard and you’ll be likely to get your injury again. This is because the area in the brain will fatigue one side faster than the other and your control will diminish. The result, yet another injury. Just think how many sports people have struggled through their careers with hard to treat injuries. The list is endless.
By specifically treating to enhance function in this area we can help to restore normal function. If we combine this with visual exercises we can help to hard wire the pathways to strengthen them. This requires repeated stimulation over a short period to get the nerves to express genes that lead to growth of new connections. It won’t happen without repetition.
So if you’ve ever had a car accident or a whiplash type injury from sports such as horse riding, skiing, boarding and obviously boxing then you may be prone to these problems. If you’ve ever had a concussion or been knocked out the chances of this are significantly increased.
Make sure you find someone who can look at these patterns to help you for the longer term and not just a quick fix.
Last week (April 2015) a study was published in the British Medical Journal that got a lot of headlines. An analysis of 13 quality trials showed that Paracetomol is no better than a placebo for treating back pain, arthritic pain and disability. What’s more, those patients regularly taking Paracetomol for back pain or arthritis were 4 times as likely to have abnormal results on liver function tests. So taking this medication for your pain will make you less healthy.
Similarly taking Non Steroidal Anti-inflammatories (NSAIDs) such as Ibuprofen and Naproxen can lead to health problems related to gastro-intestinal inflammation. Interestingly Aspirin did not cause inflammation of the small intestine (2). This inflammation leads to increased permeability of the intestine. If you consider that the intestine is the barrier between you and your food, bacteria and powerful enzymes it’s good to keep it healthy.
If larger molecules cross the gut wall they can stimulate your immune system to attack them. Unfortunately, this reaction can then continue on similar molecules within you. Therefore increased gut permeability (caused by expression of a protein called Zonulin) contributes to the development of auto-immune diseases such as coeliac disease and diabetes type 1. (3) It has also been recently hypothesised that joint inflammation in relatively benign osteo-arthritis is also a product of this process. If that is the case then taking Nsaids could actually contribute to the cause of the problem you are taking it for.
The research paper from the BMJ recommended exercise and manipulation to help stay pain free. Manipulation stimulates the nerves that regulate muscle tone and also inhibits pain. Most people will have pain from either over doing things or not doing enough. So if you are not active start by taking walks and then think about swimming, cycling and general workouts. Build up slowly over time and you will soon start feeling better. If you are a weekend warrior make sure you do regular consistent exercise to build up your conditioning or you will get injured. If you do have pain don’t take painkillers and NSAIDS. Use Ice, get help from an expert who understands biomechanics, athletic training, neurology, anatomy, diagnosis in other words us!! Don’t pop a pill, it will make you less healthy in the long run. If something’s wrong find out what and why and do something constructive about it. Your liver, kidneys and gut will thank you for it.
So, when you consider all of the above it is crazy to take paracetomol and anti-inflammatories as part of your training. Pain is there to warn you. If you listen to it properly it can be your best friend as it will keep you healthy and aware of issues before they become established. If you ignore your warning systems you are heading for trouble.
Yes!! Studies have shown the efficacy of taking a concentrated turmeric formulation (4). Turmeric contains Curcumins which have been shown to reduce inflammatory cascades in the early phases of inflammation. It is not heat stable so cooking will nullify it’s effects. So a curry on the way home is not good practice. It won’t act instantly like a drug but is a useful supplement to help with a number of problems caused by inflammation if taken daily. We stock it as part of our holistic approach to improving musculo-skeletal health.
For more information on any of the above topics contact us on 01202 733355 or email us.
(1) Machado GC, Maher CG, Ferreira PH et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials.The BMJ 2015;350:h1225. doi:10.1136/bmj.h1225.
When you get low back pain it can be excruciating, it can also be quite frightening for the uninitiated. Most of the time the damage caused is actually slight and the body’s reaction is disproportionate to the damage present. The reason for this is due to the high sensitivity to pain, of the structures of the back. These are the facet joints and the capsule and ligaments that hold the vertebrae together.
When theses structures are stressed beyond their normal range due to poorly functioning muscles, excessive force or lax ligaments they send pain signals that cause a reflex contraction of muscle to splint and protect the joint from further damage. For further information click here.
When we don’t have back pain we tend to get lazy and take route one to pick things up etc. When you have back pain you don’t because the body won’t let you. This is the type of movement pattern that you should be striving for when you don’t have back pain.
Very simply it is using your body’s muscles to form a corset around the lumbar spine, or neck for that matter that gives stability and control to help protect the spine from any excessive motion. This co-contraction of the trunk flexors and extensors (stomach and back muscles) stabilises the spine and gives it support. This photo shows bracing of lower back and abdominal muscles to provide stability when sitting.
Correct bracing of lower back and abdominal muscles
The easiest thing to do is tense your back muscles so that you hollow your back, then tense the abdominal (stomach) muscles as if you were avoiding someone poking you in the stomach. Then to bend, you have to flex from the hips and not the low back. If you have good Hamstring length you’ll only be able to get about 40 degrees of flexion, which means you’ll struggle to reach your knees!
Great, not very practical really is it? So you have to bend the knees if you want to get lower, but unless you were in the circus you still will struggle to reach the floor if you keep the back locked out. Especially if your hips are a little stiff. If you want to reach the floor you’ll probably have to flex the lower spine, but by this time your lower back will be supported a little by the thighs. To minimise stress further keep one leg flexed and kneel on the other, ie for tying up laces.
By the way can you spot what he is doing wrong? He is letting his head move forwards too far, he should be bracing his deep neck flexors as well. Click here to find out how to do this.
If you need to pick something up off the floor you can balance on one leg, lean forward from the hip and let your other leg counter balance you. Always a good idea to do this where you have a lot of space, or you could damage someone or something. Use a support for your free hand if there is one, like a golfer using his club to rest on when getting a ball out of the hole, but as I couldn’t find a photo of that here’s a close example of what I mean.
You’ve Should Have The Flexibility Now It’s Time To Go For Strength And Stamina. Only complete this part if you can comfortably get your arms flat to the wall and keep them there as you lower them on the Wall Angel. Make sure you read this first if this is the first you’ve heard of Wall Angel.
What? Equipment? I hear you say. Never fear this is where the wonderful world of exercise bands come in to play. These are relatively inexpensive but highly versatile rubber bands, the beauty of these is that they improve your control of joint movement while under resistance. As the rubber is constantly working against you you have to work harder to control the bounce back so to speak. They come in a variety of resistances that are colour coded.
The other great thing about them is that they fold away and you won’t stubb your toes on them like a set of dumbells just hidden out of sight beneath the bed!
Take a two metre length of band and fold it over, start with a resistance that is comfortable. Remember no pain no gain is frankly a stupid way to train, so if you are struggling after just a few reps, get an easier band.
It’s great to be able to do a huge lift, but after one go you’re bust, what practical use is that in every day life?
Take the band as shown below between the hands and make sure you have some tension, then lower the arms and the band will stretch. Hold for a few secs, SLOWLY raise the arms back up, pause for a few seconds and repeat until you feel that you are starting to lose good form or begining to tire between the shoulders. Remember if you are getting pain, reduce the resistance, if it continues to give pain STOP, go back to unloaded exercise, i.e. no band.
Start position (arms are actually not bent enough!)
Ladies, a little advice…don’t do this before going out, it can do strange things to the hair on the back of your head and you may end up looking like this.
Aim to do the exercise once or twice a day with a rest break of 2 days in the week. If you require more assistance you can contact me through the clinic website.
This exercise is called the Wall Angel, you start by standing about 6 inches from a clear wall, sit onto the wall so your lower back is comfortable. Then tense the deep neck flexors as you did with the Bruger’s postural relief. Now raise your arms up with the elbows at shoulder height and bent at 90 degrees.
Start position for Wall Angel Exercise
Here’s the side view:
Note the chin is tucked in
You should aim to get the elbows back to the wall and the hands flat to the wall WITHOUT letting your body arch like this:
This is wrong, back is arched too much
Now if you have a tight upper back and shoulders you won’t be able to get flat without the back arching. So you need to gently tense the stomach muscles to make your spine rigid, then just take the elbows back until you feel a stretch. Refer to do’s and don’ts of stretching for more tips before doing this. Remember this should not cause pain. If it does, go back to the previous exercise Bruger’s Relief Position.
Now you should be comfortable, back stiff and relatively flat to the wall, your arms will be somewhere between being on the wall or a long way forward. Now you need to lower the arms to your sides keeping the elbows bent at 90 degrees. As you do so you will feel a stretch on the front of the chest and tension between the shoulder blades on the Rhomboid muscles.
Note the elbows stay bent at right angles
If you have tight shoulders you will feel the hands lift away from the wall. This is fine, the trick now is to keep the spine still, so make sure you maintain tension in the abdominal muscles. As long as you feel some stretch on the front of the chest that is fine.
Note back is still flat against the wall
This shows the wrong way to do it:
Back over-extended, less specific for shoulder
OK, now you should be getting an idea that this is all about control, you really need to focus on the only movement occuring at the shoulder. Got that? Good.
Now you simply bring the elbows back up level with the shoulders, pause for a second or two and repeat about 15-20 times. Always remember quality is more important than quantity and if it hurts you stop straight away.
Within a few weeks you’ll feel alot more freedom in the shoulders.
All the best for now
Steve Oldale BSc, DC Chiropractor Back In Form Chiropractic Clinic 65-67 Commercial Rd Poole BH14 0JB