Home » Chiropractic » Chiropractic for GP’s
Category Archives: Chiropractic for GP’s
Morning Stiffness..
Morning stiffness can change with age! The stiffness I refer to is of joints and muscles, the commonly accepted symptom of ageing, that doesn’t make sense from a purely chronological perspective.
Muscles and joints can become stiff for many reasons (see last post). One of those reasons is linked with the activity of the immune system. I’m sure being stiff and achy in muscles and joints during a bout of influenza is a common experience that most adults will have known at some point in their life. Here’s the science. When I become sick the autonomic nervous system up-regulates activating smooth muscles in fascia. As a consequence of the smooth muscle activity fascia restricts muscular activity preventing full range of joint movement. Stiffening fascia also produces TGF-B1, which increases T cells, a type of white blood cell, aka the soldiers of the immune system.
Immune system soldiers are mobilised during the defense to something in the (inner or outer) environment (perceived and/or real).
Your Chiropractor’s job, when you are under the weather, is to know the likely source of muscle and joint stiffness and to check your muscles and joints have returned to their most efficient normal once your ‘influenza’ or illness has passed. It is possible for your muscles and joints to stay stiff after your immune system has switched off the defense.
A Chiropractor can re-boot your muscular tone and your joint mechanics helping your muscles and joints to healthily communicate with your brain. Lessening the phenomenon where your muscles and joints learn to have a stiffer and stiffer normal over time. An accumulated progression or adaptation.
Yes there really is a muscular component to an immune response. Whilst your chiropractor can’t magically cure your illness they can help you with the muscle and joint component to what you are going through.
Psychosocial Determinants of Musculoskeletal Pain
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.
Is a Stiff Spine really Stiff?
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)
What can I do, I have back pain…?
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
Working through it…
When you are a can do-er working through discomfort can be a part of your life. Pushing the envelope to grow toward your potential is commendable and I thoroughly recommend it. When you do work through a discomfort (or a pain) you can psychologically move to a new normal; no problem. Psychologically we have no boundaries. Physically we do; the most obvious being your skin less obvious being dysafferentation.
Due to the lack of knowledge that humans have about a human body we humans can sometimes create more problems than we solve when we push through it once. When we push through it more than once we can accumulate (learn bad habits) errors. As we move with error we abnormally load our body tissues. Abnormal loading of body tissues leads to degeneration. Normally loaded tissues last a lifetime. If you are broadening your horizons your body might just thank you now for regularly taking it to Fascia First Chiropractic. Your psychology can thank you later as you enjoy your body for years longer. This is of course my opinion but here’s a little of the why:
- The fascia of the human body talks to the brain telling it where and how your body is.
- The superficial fascia is densely packed with pain fibres.
- Fascia is the reason (not muscle tissue) why you get D.O.M.S. (delayed onset muscle soreness) after exercise.
- Fascia has more free nerve endings in it than your eyes; so the potential for pain is very high.
- Under abnormal loading fascia can grow in on itself creating an ‘in-growth’ of highly pain sensitive tissue. Perhaps how something seems to ‘go’ without due provocation.
- The fascia is responsible for housing nerves. The nerve sheath is innervated by the nervi nervorum and could be the cause of ‘nerve’ pain. Fascia can also mimic muscle pain….
- Increased adrenergic signalling in the fascia leads to a vasoconstriction of blood vessels slowing up nutrient delivery to your fascia. This could worsen an immune condition, a pain syndrome or a symptom that seems to be ‘stress related’.
- Autonomic tone can change fascial stiffness; When you are stressed your autonomic tone will change as will the stiffness of your fascia (body). This stiffness needs to be balanced not just worked out.
- The fascia feeds information into your insula nucleus in your limbic brain about the pH, temperature and ion content of your connective tissue. Your limbic system can alter your ability to handle stress, socially interact well, and alter your sensitivity to fear and pain.
- An immune response can also stiffen your fascia through a marker known as TGF-B1. Think of how you might stiffen up and get achy when you have a bad bout of the flu. Yes it needs balancing out afterward. An autoimmune condition is when you are stuck in a constant immune response and an allergy is an immune response to a given irritant.
Fascia First Chiropractic is more than a quick click. Fascia is behind the rate at which you are currently stiffening (ageing) over time.
Source: Tozzi P. (2015) Journal of Bodywork and Movement Therapies 19 310-326.
Stroll under the Skin A you tube video where you can see and learn more about fascia.
How might Back Pain run in families..?
Two recent studies seem to have conjoined in my mind; one is from Zurich University Chiropractic department showing brain activity relative to lumbar spine pressure such as might happen in low back pain syndromes. The other is about training mice to ‘fear’ a smell across their generations controlling for nurture. Answering the long debate of nature versus nurture. Researchers showed that without nurture the cue for a fear response can still be passed on.
The first study carried out in Zurich; showed that back pain is linked to a part (nucleus) of the brain involved in social pain. What if we as humans could pass on in our genes information that affects the life experience of the next generation? You may find yourself as an individual with a back symptom from ‘nowhere’ due to an ancestral social cue. In generations passed going out of favour with the group could have had deadly consequences.
The second study was published in Nature Neuroscience (2014; 17, 89-96) demonstrating a transference of a fear response genetically; without nurture. The mice were shown to pass on a (protective) smell memory to their children and their grandchildren (F2).
If we as a species can have an ancestral cue for a social stress causing back pain passed on from family member to family member and social stress is not considered in your care plan. You could be forgiven for thinking that you have to ‘live’ with pain. Identifying potential cues from your environment ‘stressors’ to your behaviours, thoughts and/or feelings can be methodologically worked through. Whilst you figure out the cues to your stresses consider having body work to help you with accumulation. Accumulation in my opinion can make your condition worse.
I think when human body tissues are abnormally loaded the tissues do not undergo a training effect and instead are strained. Having a genetic fear response in social conditions where I reflexively squeeze my back muscles from an unidentified cue, providing pressure on my vertebrae, would be an abnormal load; like a repetitive strain scenario on the low back tissues of the body. Choose fascia first chiropractic it is more than a ‘quick click’.
Tight Hamstrings
The classic example of somebody having a restriction in their flexibility and they feel it at the back of the legs is thought to mean tight hamstrings. Yet in a fascial model of the body the TFL muscle is actually under about twice the strain that the hamstring muscles are under during a straight leg raise. The most obvious place to consider changing would be the side of the leg in tight hamstrings and not the back of the leg where it is felt! The fascial connections of the thigh are complex and numerous; for example in clinical practice I have ‘worked’ on the adductor muscle of the lesser affected leg and gained 20-25 degrees of extra flexibility in a straight leg raise of the more affected leg.
Having the view that my problem is where I feel it is a difficult concept for most to let go of. Sometimes where you feel it does not need to be changed. Where you don’t feel it does! Having an in depth knowledge of anatomy and understanding human movement and how tissues interact within the human body is essential to truly get to the root of a musculoskeletal problem.
Training such as in a Chiropractic degree (undergraduate Masters) is ideal to start to see the root causes of a problem within the human body. When the human body is not able to change in a certain place, the body compensates and thus moves the symptom, yet the root cause is still the same; there is just a longer more complex chain of events that exist once a compensation occurs. Addressing the fascia before any adjustments is my strategy in clinical treatment. This way I am able to work through the layers of compensation until I find the root cause. Step one for you with tight hamstrings is to come to terms that the root cause is most likely (if you’ve had the problem for more than 5 days) somewhere else (in my opinion) than the back of your leg. Psychologically speaking if you keep on putting your problem to the back of your legs you will in fact keep a problem at the back of your legs! When seeking help from a Chiropractor it can be useful to look up the conditions that have evidence behind them.
