Musculoskeletal pain is essentially pain felt in the body or thought to be coming from muscles and joints (tendons, ligaments and fascia also). Psychosocial describes factors in a persons life that affect, impact, alter or change the way a person thinks and socialises.
I joke in my practice that the cause of back and neck pains, headaches and migraines is work! Therefore curation of such pains would occur if work was given up. In reality it is the perceived control, support and satisfaction of a person within their role at work, the spending of their time as well as inconsistencies between effort and reward that have been highlighted as features of psychosocial (pain) factors in the workplace. (1)
The interaction we have with our pain and the common brain states that we reside in will also affect our experience of pain. Disproportionate pain, where pain is intense yet tissue damage is minimal, can trigger fear avoidance behaviour which is a strategy in real life to keep an experience. Replace pain with pleasure and take a moment to consider how much effort would need to be diverted to your strategy of living a life to avoid all pleasure. A strategy that would inevitably make you hyper-vigilant about pleasure experiences drawing your attention to, not away from, pleasurable experiences.
Chiropractic Care includes the advice and knowledge passed to you by your chiropractor about your symptom experience. Gaining insight into why you might have a painful body can relieve the intensity and duration of your pain. Facilitating improved muscle and joint balance through Chiropractic adjustments complements your insight derived from talking to your knowledgeable chiropractor. Chiropractic Care is an opportunity to learn a new normal whilst unlearning the unwanted, old (painful) normal.
Vargas-Prada S and Coggon D Psychological and Psychosocial Determinants of Musculoskeletal Pain and Associated Disability. Best Practice and Research: Clinical Rheumatology 2015 June; 29(3) 374-390.
Croton Oil an old psychiatric punishment for patients being held at a psychiatric hospital and is these days used for skin exfoliation. When Croton oil is topically applied it can give us an idea of the type of pain that originates at the dermis, the most superficial section of fascia in the human body. Croton Oil brings on a sharp pain experience coupled with a deep pain experience when applied to the skin. This fact enables us to imagine the pain pathways from fascia that relay the sharp and deep pain experiences. Deep pain does not necessarily mean a deep structure is in play or injured. Neither does sharp pain, often called an acute pain, mean that we have active damage and a nerve entrapment. Fascia can give rise to both deep and sharp pain experiences and thus should be a first port of call for people who have these experiences before their logical mind starts to relay to themselves that they have a nerve problem or a deep seated defect within their body.
Keeping on top of your fascial condition can be done with regular variety of movement (Tai Chi, yoga and Pilates) and with regular chiropractic care, in my humble opinion. don’t let it build up keep treatment simple and virtually painless and keep yourself well.
Tom Myers is well known to have disseminated knowledge of human anatomy whilst attempting to tie into his Rolfing practice the felt experience of having a human body. Myers has been touted as the Father of Fascia, quoted by a Canadian Masseur come science writer as being ‘over it'(1).
The architecture of the cell is remarkable for many reasons, the one of importance here is that when a cell is under tension from its environment as opposed to tension within its inner environment a change in genetic expression occurs. Yes! The nucleus of a cell alters the expression of its available genes from external tension placed upon the cell. If my body to some degree is a collection of cells that exist within the medium of my connective tissue. Then differences in connective tissue tensions have a genetic difference in how my cells within my body express the 23,000 (ish) genes I possess.
Allowing for markedly different function(s) to occur in adjacent areas of the body. Undoubtedly in my mind having an effect upon the mechanics of the area and the felt sense of the area and of the inner experience of the area; not to mention a different physiology of the area. A different genetic expression may give rise to a strength, or a vulnerability, altering ones health.
Is the falling rate of male fertility in modern society a result of immune system dysfunction? eg leukocytospermia. The dysfunction of white blood cells has been linked to MMP signalling proteins which also interact with c fibres of the nervous system (a route to give a pain signal). To summarise genetic expression, immune function and pain levels are all linked by science to connective tissue tension (aka fascia).
Are the rising levels of immune dysfunction (demonstrated by an over reliance upon antibiotics), the rise in autoimmunity disease rates and the rise in medically unexplained symptoms all a function of a change in the tensions placed upon our body tissues, because we just do not move as much as we did?
Fascia is one view of the body and in itself is not representative of the entire conglomerate of the human body and tells us nothing of the human (interoceptive) experience of having a body. A professional body worker (dancer yogi Qi Gong instructor included) would be well advised to have an adaptable view of the human body and not become any one tissue centric about their approach. After all as a teacher, instructor, therapist, chiropractor, osteopath or physiotherapist the outcome of a patient is not a function of how right you are!
Keep going science you have a long way from which to ‘catch up’!
(1) Ingraham P Does Fascia Matter? A Science Review of Fascia
Chiropractic Care includes the interventions and advice given to you by your Chiropractor in your treatment session. I don’t really know why but some people save up a long list of things for their Chiropractor to ‘fix’ during a session. Perhaps it is value for money or not feeling as though you need much help until there are a lot of things to get fixed. You’ll have to decide for yourself…
When something for whatever reason goes wrong in your body, your body in another area will compensate or try to help and this process of help will continue until you die unless the original problem is ‘fixed’. Leaving it a longer time frame just means more compensations and more compensations make it harder to find the start of the chain of compensations (the real problem).
Getting the best from your Chiropractor would involve the 3 day rule (if you are not fixing your symptom within 72 hours then you are incorporating it into a new normal and not fixing it. This is why most niggles clear up in a few days. getting an appointment on day 4-10 is optimal.
To get value for your money have a check up / treatment 1-4 times a year and get an appointment for a new symptom between day 4 and 10 of when it first started as long as it lasts more than 3 days. If it went away in less than 72 hours there is no need to see your Chiropractor.
Muscle and joints are a relatively common cause of chest pain¹. Costochondritis a condition that is characterised by point tenderness over the rib and sternum join that reproduces the pain complained of combined with the same side arm movement reproducing that pain too, usually the point is at the 2nd to 5th ribs and sternum join². Not to be confused with Tietzes Syndrome which includes swelling and more likely in older persons and does not get aggravated by same side arm movement. Medical training tells one that costochondritis is a self limiting problem that will go away on its own with advice to take pain killers and do nothing, even if you are pregnant.
The arm movement and a recreation of pain can be indicative of nerve involvement that is unable to slide due to unco-ordination of intercostal musculature. Notably Obliques and Transversus Muscles, but Latissimus and Serratus Anterior can also play a part in faulty rib movement patterns. Yes underlying myofascial imbalance can give rise to costochondritis and can be brought on by the development of the bump in pregnancy. accentuating previously asymptomatic myofascial imbalance.
Treatment of costochondritis has been successful with manual therapy³. The over riding concern of continuing on with muscular imbalance is that our brain will adopt your myofascial imbalance as normal. If you don’t use it you lose it; you lose the body component you do not use from the map of the body in the brain. This map is competitive and neuroplastic meaning it is adaptable and does not have any ideal or starting reference. There is no factory reset or blueprint of ideal / perfect movement of your intercostal, latissimus or serratus muscles. Your normal is what it is.
Having a myofascial imbalance that leads on to chostochondritis during pregnancy can have knock on effects during delivery. Intercostal muscle function has been shown to be predictive of delivery experience and likely complications from the expulsion phase of birth (4).
In my opinion the best interests of any women who is pregnant with costochondritis would be to resolve the issue with manual care as soon as possible. Don’t worry your bump need not get in the way.
- Smythe H and Fam. A (1985) Musculoskeletal Chest Wall Pain. Canadian Medical Association Journal 133(5) 379-89
- Proulx A and Zyrd T (2009) Costochondritis: Diagnosis and Treatment American Family Physician 80 (6) 617- 620
- Rabey I (2008) Costochondritis: Are the Symptoms and Signs Likely Due to Neurogenic inflammation. Two Cases that Respond to Manual Therapy Directed Toward Posterior Spinal Structures. Manual Therapy 13(1) 82
- Demaria, F., Porcher, R., Ismael, S. S., Amarenco, G., Fritel, X., Madelenat, P. and Benifla, J.-L. (2004), Using intercostal muscle EMG to quantify maternal expulsive efforts during vaginal delivery: A pilot study. Neurourol. Urodyn., 23: 675–678
A recent Scientific Report published by Nature looked into perceived stiffness of the spine and actual stiffness of the spine and found that when people feel as though their back is stiff it is a lack of sensory motor integration and not directly due to stiffness in the back. The prediction system of the brain uses multi sensory information to predict the movement parameters of our body. When multiple sensory inputs are not integrating then the parameters can be confining felt as a stiffness in the back. The ability to co-ordinate the sensory information of the body in the brain can result in a stiffness perception that is independent of actual stiffness.
The integration of multiple sensory signals, is what can be confused or muddled that result in back stiffness problems. When integration occurs it means that Sensation A and Sensation B are needed simultaneously to understand the body in the brain map of the body. When Sensation A occurs out of sync with Sensation B then the back can feel stiff but not actually be stiffer.
I like this paper because it may help people to step out beyond the ageing model of back problems, the lingering injury / degeneration models and the useless ‘out of place’ and ‘symmetrical’ models.
When the sensory motor experience of our body goes out of kilter we can become better at feeling changes in force generated by muscles having the knock on effect of heightening protection mechanisms because we are not expecting that much effort to move in a comparatively small way.
Regular (Annual or biannual) checks of your back by a Chiropractor is important whether you are in a sense of stiffness, or not. A Chiropractor can help to re-integrate the sensory motor experience of your body.
Nature Scientific Report 7: 9681 (August 2017)
Symptoms associated with abdominal pressure dysregulation can include back pain, hip pain flank pain (kidney region), bloating, heartburn, vomiting and diarrhoea. The abdominal musculature should fire in response to lower limb movement. Notably the transverse abdominus muscle, but also the obliques, rectus abdominus and lower multifidus (back muscles) are active, ready for lower limb movement (The core). When the transverse muscle doesn’t work with the multifidi muscles then the quadratus lumborum (QL) tries to take over. The QL (a back muscle) is a notoriously overactive muscle in the experience of acute and chronic back and hip pain. The QL can also be found commonly involved in chronic recurrent lower back and or hip pain. Essentially the QL tells us that our core is not functioning well, in particular the automatic readiness of the transverse, obliques, and multifidus muscles to our normal lower limb movement is dysfunctional.
The QL is the help or aka compensation. Treatment to reduce the tightness of the QL is in fact taking away ‘the help’ the body is providing for itself and thus unhelpful in the long run. However such a strategy may be symptomatically relieving in the short term.
‘Abdominal Pressure Dysregulation’ Symptoms were published in the New York State Journal of Medicine 54:1324-1330, 1954
The best things to do for a bad back pain episode has challenged people and medical doctors for generations. In the 1980’s bed rest and even a hospital stay was the best option in the USA. In England traction was thought to be the answer to a tight contracted back, that was to gradually stretch it out. Some people had two weeks of traction as the best medical care. Today in England the main medical approach is to provide anti inflammatories and mild over the counter pain killers, with a physiotherapy referral (within a few months). The physiotherapy approach to back pain is to provide reassurance at first. Typically an episode is bad for 3-5 days and can be felt to some degree for 4-6 weeks. People’s episodes are normally over by the time a hands on approach from the NHS is provided. The way the first back pain episode is cared for can have a knock on effect to future pain episodes. If you don’t get fixed at first it just keeps on coming back until you either get fixed or get used to having back pain episodes. 1-3% of back pains will have a sinister aspect eg a red flag such as a collapse fracture
It has been known for 15 years that anti inflammatories are enzyme inhibitors that alter the natural balance between cyclooxygenase (COX) and lipooxygenase (LOX) enzymes. Altering any natural balance creates a drive to re-balance leading to more COX enzyme increasing inflammation after 2 hours. Yes there is a decrease in inflammation in the first 30-60 minutes, then a rebound increase in inflammation begins to develop surpassing previous inflammation levels at about 2 hours after taking the NSAID (Ibuprofen). The marketing of anti inflammatories is highly suggestive having a strong impact on a lot of people.
Recommendations are now recognising that for acute low back pain the best approach is to rest for the first day, then allow yourself to move around as normally as possible, light duties and slow. Consider Chiropractic Care to help (not only this episode but also future episodes – having chiropractic care for your first episode can actually prevent the next episode form occurring).
According to advise from Harvard University medical Doctors, Chiropractic Care is a very good idea. See for yourself at http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962
Thought has been described as neural activity in the human brain. All brain activity is not thought, just certain (brain) neuron interaction is considered individual thought. If thought is the interaction of nerves in the human brain, then when we change thinking patterns, we are also changing the way neurons interact in our central nervous system.
A particular type of thought; metaphorical thought is particularly influential over the interaction of brain neurons. When a person exclaims that their back has gone – where did it go? Normally the person’s back is exactly where it previously was, so what has changed? The metaphor of a back ‘going’ describes the human experience of having a body as seen by a human brain. An experience that relies upon the spinal communication from the body to our brain and confirmation from brain to body. The back can diminish or disappear from the map of the body in the brain. That aside… If I think my back is there then it is not, I will change the interaction of the neurons in my brain, about my back, giving the impression that my back has ‘gone’.
When I alter my metaphorical thought/ ideas/ perspectives I will change the chemicals at my nerve synapses. Chemicals are molecules and molecules are physical entities. Thus sustaining a change of chemistry in a physiological system will end up with a physical change first, in the type of molecules found at nerve synapses.
A change in molecular uptake in the brain will result in different neurons downstream becoming active. What fires together wires together. Thus we begin neuroplasticity; the changing of our brain’s ‘neural net’. A physical rewiring of the human brain over time.
In the human body it takes 4 months for people to learn new muscular co-ordination and unlearn their old pattern of muscular firing / activity. Physical change in musculature has been shown to occur in just 6 weeks from thought alone – no exercise or movement required! A change in muscle mass then must lead onto a change in muscular co-ordination, (Firing) as we continue along the same thought path.
If you enjoy the idea of facilitating a desired change in your body start with your thoughts about your body e.g. What does my body mean about me? Do I have a good body? Am I in a position of freedom in my life circumstances? Is my view of my body in anyway compatible with my relationship with food?…
A new Cochrane review of the best exercises for people with chronic back pain has been published this year (Jan 2016). The review is a meta analysis showing that there is no one best exercise for back pain yet it is important to exercise to help yourself. The type of exercise may well come down to your preference or possibly your practitioners experience or preferences.
How long do you continue until you throw in the towel; how long is long enough to know if your current type of exercise is helping? According to the new Cochrane review exercise programmes can last up to 12 weeks.
When I think about forming a habit I see that it takes humans between 29 and 230 days to form a psychological habit. When I see that body tissues can take 3 months to co-ordinate with each other in a new movement pattern I think 12 weeks seems that is only stage one of an exercise programme. When we first kinesthetically understand a movement in our body we are looking at a 12-16 week time frame. 12 weeks cannot include strength (posture), endurance, speed or co-ordination.
The internal arts of exercise such as Tai Chi, which has been shown to help chronic back pain is said to take 1000 hours of practise to become a beginner and 10000 hours to become adept. The internal arts help you to develop an representation of your body in your imagination. We actually have several body maps in our brain e.g in the basal ganglia (brain stem), the cortex, thalamus and cerebellum. This means that our internal perspective of our body can be altered by stimuli that does not originate from the body. This perhaps is why yogis have many different representations of their body; physical body, emotional body, spiritual body etc…
An exercise programme needs to make sense, be worthwhile affordable and accessible. Starting out with fascia first chiropractic to help your body get there quicker and to educate and reassure you that pain is not something to automatically fear; you could be embarking upon a realistic plan of rehabilitation. Walking the fine line of adaptation and neuroplasticity.