What do you do when your pain doesn’t go away?

One of the great challenges in health practices is the chronic pain case. To be specific, “Acute” and “Chronic” are time descriptors “Acute” means recent onset and describes presentations which are generally started less than 4-6 weeks ago.  A “Chronic” presentation is one which has been present for more than 2-3 months.

Often patients use the terms “Acute” and “Chronic” to describe intensity or severity of pain which is technically not correct or appropriate.

When we talk about “Chronic pain” cases we are generally referring to those that have been suffering for 6 months or more. Generally speaking, these cases are complex and have often had lots of treatments without great success.

But what is Pain anyway?

What constitutes pain is a hotly debated and researched topic in the scientific literature. Pain is essentially an electrochemical phenomenon. There are no pain receptors in the body and pain is not an entity in itself. We have receptors for: heat, pressure, vibration, touch, as well as our higher senses: light (vision), auditory (hearing), and olfactory (smell). When we have a stimulus applied to one of these receptors, an electrochemical message is transferred through the nerves in the body to the spinal cord and up to the brain, which then interprets this message as either painful or innocuous.

Our interpretation is based on the threshold in our central nervous system. Think of this as a rating out of 10. If our threshold for pain is 5/10 and we receive a 7/10 stimulus, we will experience pain. Our response gives a release of neurotransmitters and hormones and a feedback mechanism to the muscles in the limb to help us avoid or manage the situation to try to reduce the pain we experience.

If a stimulus is 4/10, then we pass this off as a non-painful. The experience is different, the release of neurotransmitter and hormones and the feedback mechanism if different.  What this means is that pain is a perceptual phenomenon which occurs within our brain, in other words, pain is ALWAYS in our head.

But what happens if our threshold is reduced?

Many things will influence our threshold. Stress, anxiety and depression can dramatically reduce our threshold. Often very “focused” or “intense” people are potential candidates for chronic pain. However, sometimes we end up in a pain “loop” which alters our threshold and contributes to a “Chronic Pain” presentation. When our threshold is reduced our system is more “sensitive” and the level 4/10 stimulus which we previously passed off as irrelevant is now perceived as a painful event and we have the same pain experience that occurred in the earlier example of a 7/10 stimulus.

The problem with chronic pain is that healthcare practitioners often struggle to get good outcomes. Patients will often describe a Yo-Yo phenomenon where they have pain, so they withdraw from their usual activities somewhat, which causes deconditioning, then they get fed up with doing nothing and get back into the normal activities, which causes another pain response, which then leads them to withdrawing again. This is often a downhill slide, where less and less is accomplished with increasing frequency and/or higher intensity pain; a self-reinforcing negative struggle. These cases are often being described as hypersensitive and in some cases will be diagnosed as having “Fibromyalgia”.

So how do we address these cases?

First and foremost, a thorough examination should be conducted to ensure that serious pathology is not present. Unfortunately, many of these cases have had extensive examination and investigation (often lots of x-rays) and are not being managed well.

If the case fits the profile of having increased sensitivity, then generally speaking, developing a routine is important. It is critical to identify what are the specific factors which trigger a pain response. For example: vacuuming the house causes pain. It is important to develop a degree of specificity around this. Often if the patient vacuums the entire house they will have pain, however, if they only vacuum one room, they will not have pain. This will often help us develop intervention strategies. At the same time, we will want the patient to shift their focus away from the pain and focus on good function and activities.

If for example a patient gets pain after a 15 minute walk, we may start with a strategy of walking for 5 minutes twice per day for the first week. We progress to a 6 minute walk for the second week, 7 minutes the third week and so on. This might seem like small steps, however, if a person has had 3 years of ongoing pain, and we follow this principle, then within 6 months they will be walking 30 minutes twice per day. If this is achieved without causing pain, we teach the nervous system to desensitize and adapt, the body is increasing strength and control and their threshold will slowly be pushed up.

So does this work all the time?

The short answer is no. In many cases with a methodical consistent approach, great success can be achieved. Sometimes other strategies are required. For difficult cases it may be useful to see a psychologist who specialises in Pain Management to help develop coping strategies, for some clients addressing anxiety, depression and stress issues will also help.

We sometimes will refer to a Musculoskeletal physician who specialises in Prolotherapy injects, which may help to break the pain cycle and get patients back on track.

Understanding and education are really the key, it will take time to gain control over the cycle, but consistency and persistence will pay off in most cases.

If you are interested in learning more about pain and management strategies, the book, “Explain Pain”, by David Butler and Lorrimer Mosely is an excellent read.

Hydrated and Happy

During the warmer months of the year it becomes more and more important to stay properly hydrated.

Water is our body’s principal chemical component and makes up about 60 percent of our body weight. Every system in our body depends on water and during the hotter periods we may need more than usual.

We all know that we should be drinking more water in order to remain hydrated, but how much is enough? As a minimum, an active adult should be drinking at least 2 litres per day, but this may need to increase during physical activity. Sitting in the sun on a hot or humid day, even if you aren’t exercising, can also cause your body to need more fluids.

WHY IS STAYING HYDRATED SO IMPORTANT?

• Energy levels – Our brains consist of mostly water so being dehydrated can greatly affect how we function cognitively. Dehydration also causes the blood volume to drop which in turn lowers the flow of blood and oxygen to the brain. This can affect the way we think, focus and concentrate, as well as decreasing our mood, level of alertness and co-ordination.
• Toxin removal – Water helps our bodies to get rid of waste through sweat and urination so a lack of adequate hydration can lead to increased toxicity. Water is also essential to digest our food and helps prevent constipation.
• Avoid headaches – When we become dehydrated our brain tissue loses water causing the brain to shrink and pull away from the skull. This triggers pain receptors surrounding the brain which then leads to headache.
• Beautiful skin – Without enough water, our skin loses moisture and will lose its softness, freshness, and smoothness. It will start to dry out which can lead to premature ageing as well as problematic skin conditions.
• Healthy weight – Water is a natural appetite suppressant, raises our metabolism and has zero calories. Often thirst is mistaken for hunger which can lead to an increased calorie intake and weight gain.
• Reduce injury – Water helps soft tissues to be more elastic and stretch further. Dehydrated muscles are tight, crampy and at risk of injury. Proper hydration also helps keep joints lubricated to allow them to move easily through their full range of motion.

Avoid the problems dehydration can bring and keep a water bottle on you at all times. If you struggle with the taste then add a squeeze of lemon for a added liver detox or treat yourself to some sparkling water. If you’re unsure whether you are drinking enough water on a daily basis then check the colour of your urine. If it’s pale and clear it generally indicated that you are well hydrated. If you find that your urine is dark then it could be that you need to drink more water.

Remember, feeling thirsty means you are already dehydrated so don’t wait until then before you take a sip. Try to keep your water intake regular and consistent throughout the day. Severe dehydration can actually lead to heat stroke and even death, so it is not something to be taken lightly.

Tension Headaches

Written by Jakob van Vlijmen (chiropractor)

Many say that a tension headache feels like a tight band around their forehead. Other symptoms include tender shoulders and neck muscles, a sensitive scalp and a tendency to worsen as the day continues. These types of headaches can last from 30 minutes to several days.

In some people, tension headaches are caused by tight muscles in the back of the neck and scalp which can result from bad posture, sitting too long or emotional stress. In others, tightened muscles are not part of tension headaches and the cause is unknown. However, tension headaches are generally triggered by some type of environmental or internal stress.

While regular chiropractic adjustments can go a long way towards preventing tension headaches, you may find yourself coping with one every now and again even with regular care. If you still have occasional tension headaches after visiting with your chiropractic team, the following tips may help:

• Look for triggers. Headaches can be caused by certain foods, sounds or lights. They can also show up after a vigorous workout or changes to your blood sugar.

• Try to avoid sitting in the same position for extended periods of time. This can lead to pressure on your spine and muscles, which may result in a tension headache. If you have a sedentary job take frequent stretch breaks to allow your muscles to relax.

• Avoid clenching your teeth. If you find that you’re frequently grinding or clenching, you may want to talk to your chiropractor or dentist.

• Given that tension headaches often go hand in hand with anxiety and stress, some sufferers find calming activities such as yoga, meditation or spending time in nature can help by reducing stress levels.

 

 

 

 

 

 

 

 

Proper work posture and why sitting is bad for your back

Written By Jakob van Vlijmen:profilepic

 You probably have seen it talked about recently, in the media or on facebook: working upright is supposed to be healthy but why ? This article will discuss the reasoning behind this claim and why getting out of that chair is so important !

Let’s start with discussing how much we actually sit in a day. We get out of bed and sit down for breakfast. Then we sit in the car to drive to work where most of us sit down for a few hours until it’s time to go home. We get in the car, drive home have dinner and sit down in front of the television to relax. Some lucky few have a job that doesn’t require them to sit the whole day and there are some that even cycle to work. However, this isn’t the Great Kingdom of the Netherlands so there aren’t many that cycle to work and its not very well catered for. Which is way Australia’s population is getting fatter by the minute. Research has shown that, on average, people sit between 7.5 to 15 hours a day! Additional research has also shown that it doesn’t matter how much we work out in the gym or on the pitch we can’t undo the damage done from sitting for extended periods of time.

 

Why sitting is bad for you back
Curves are a normal part of the spine’s structure. Looking at the spine from the      side several curves can be seen. From this angle, the spine resembles an ‘S’    shape.

Spine

 

These curves enables the spine to distribute the load evenly. Maintaining a good posture means actively maintaining that S curve in your spine.This becomes quite difficult during a long road trip or after being seated behind a desk for an extensive period of time.
We usually start out pretty good, but before you know it we’re hunched back in our chair or bend forward over that book or phone.
During any body position there will be some loading on the intervertebral discs (1) and vertebral bodies(2) of the spine. Research has show this pressure to be the least when we lie on our backs and the highest when we are seated, almost twice as much as when we’re standing !
When people sit for extended periods of time their pelvis shifts and their lower back ends up in a C shape as opposed to the S discussed earlier.
This increases the pressure even more and stretches the back muscles and ligaments which can cause further pain and discomfort.

Not just sitting in a bad posture, but also sitting for extended periods of time can be detrimental to your spinal health.
Our intervertebral discs lack their own blood supply. They have their nutrients supplied to them by movement in the spinal column.
Which means that if we remain seated for a long time we are starving our intervertebral discs !
Which leads to degenerative changes in these segments, which are irreversible. As a consequence the spine has decreased in strength  even low loading now has the potential to cause pain.

 

 

Other health issues caused by sitting 
Research has shown that besides the effect on the back, prolonged sitting can cause all sorts of other health problems.
Various research papers have shown that prolonged sitting is bad for your mental health and it increases the change of diabetes.
Furthermore, the chance of cardiovascular problems increase as cholesterol levels and blood pressure rise.
The researchers also saw an increase in different types of cancer due to sitting for extended periods of time. Namely, bowl cancer, cervical cancer and lung cancer.
The risk increase per 2 hours was 8% for bowel cancer, 10% for cervical cancer and 6% for lung cancer. What is more people who sit extensively tend to have a lower life expectancy.

 

All his research shows that we need to drastically rethink our attitude towards sitting.
Especially since, as we’ve earlier discussed, you cannot undo the damage done from sitting all day by spending an hour or two in the gym.
This is why many companies have started to invest in standing desks. These desks can be worked on in a seated as well as a standing position, this way you can stand up and continue your work standing when you want to.
If such a desk is not available to you, try and stand up when you’re on the phone or go for walks during your lunch breaks, this will help decrease the time you spend sitting down.
And if you want to help your colleagues be healthier as well, suggest having standing meetings as research has shown that this leads to more creativity greater cooperation and faster decision making.
And who wouldn’t be interested in that !? So tomorrow at work change your workstation and get up from that chair !

Osteo Arhtritis Vs Reumatoid Arhtritis

Written by Jakob van Vlijmen

What’s in a name ?
Arthritis is often referred to as a single disease. In fact, it is an umbrella term for more than 100 medical conditions that affect the musculoskeletal system, specifically joints where two or more bones meet. Today we will discuss Rheumatoid arthritis and Osteo Arthritis as they are the most common and there is some confusion about their causes and possible treatment methods.

Causes of Rheumatoid arthritis  and Osteoarhritits
Between the bones and joints of our body sits our cartilage, This cartilage prevents the bones from rubbing against each other and helps joints move with ease. Some wear and tear of this cartilage is a natural process and happens to all of us when we age, this is called Osteoarthritis (OA). Reumatoid Arthritis(RA) however is an auto immune disease in which the body attacks its own cartiliage causing it to break down. The cause of Rheumatoid arthritis is not clear, it is believed however, to involve a combination of genetis and environmental factors such as smoking obesity and heavy drinking.

Symptoms of RA and OA.
OA most often affects the knees, hips,lower back, big toe of the feet and the small joints in the hand at the very end of the fingers. While RA most often affects the small joints in the hand closest to the body, the feet and the cervical spine, however some bigger joints like the shoulder and knee can be involved. Patients complain of stiff and painfull joints,the pain is usually worse on waking or after having been stationary for a time. and decreases after movement. It takes a lot longer for the morning pain in RA to subside than it does with OA which usually subsides within the hour. Surrounding muscles can cramp up due to joint disfucntion which can further excercebate the symptoms and cause difficulties in adjacent areas. For example OA in the lower back can give pain in the buttock area and OA in the hip can cause pain in the groin.

Treatment possibilities
In most cases of RA a rheumatologist may prescribe a number of different medications depending on your symptoms and the severity of your condition. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce pain and inflammation. The disease-modifying anti-rheumatic drugs (DMARDs) are a special group of medications used to decrease the abnormal function of the immune system that drives rheumatoid arthritis.Biological DMARDs are the newest class of arthritis medication and work to stop the disease progressing by targeting specific molecules in the immune system. Often you may be on a combination of medications. Chiropractic care cannot stop the immune system from attacking the joint so it has a limited role to play in the care of RA. Chiropractic care can help however with symptomatic relief of pain that has a mechanical origin due to compensatory movement patterns caused by the RA. In simple terms if your left hand hurts due to RA using the right one more can cause a strain on it. Chiropractic care can help manage or prevent this.

In some cases of OA a joint replacement might be the best strategy however, depending on the degrees of discomfort and the patients lifestyle it might be managed with conservative care. In spinal OA conservative management is the only option as spine replacement is not (yet) possible. In this area chiropractic care can be of great service. How well a joint functions is influenced by many diffirent factors; the quaity of the ariticulating bones, the surrounding ligament and the muscles that move the joint. So there are quite a few factors that chiropractic care can influence and this makes a world of differences for some and for others less so. Talk to us today to find out if chiropractic care can help you.

Dizziness and Vertigo

Written by: Jakob van Vlijmen

Dizziness: What are the causes and when can chiropractic help?

There are very few complaints as difficult as dizziness. Even though most types of dizziness do not have a sinister cause, they can lead to certain risks. As you can all imagine, being in a car or on the top of a flight of stairs are dangerous places to become dizzy. The following article will discuss the different causes of dizziness, the different ways it can present and when a visit to the chiropractor can be helpful.

Light headed or vertigo?

Dizziness is used to indicate a sense of instability, movement insecurity or light headedness. The term vertigo indicates a sense of spinning or whirling when the patient isn’t actually moving. Light headedness is usually caused by low blood pressure, especially when it comes on after getting up too quickly. Low blood sugar however can also be a cause. If you experience these kinds of dizziness on a regular basis it might be a good idea for you to discuss this with your GP.
The 3 systems involved in processing movement information.To be able to explain the different causes of dizziness we will have to discuss some of the mechanisms responsible for our sense of balance, the ability to register movement and our sense of positioning. These are the 3 different systems we need to discuss.

1. The Eyes. Among other things we use horizontal and vertical lines within our surroundings to determine our position and register movement.

2. The Organs of Balance. Situated deep within the ear. These organs are specialised in registering movement, acceleration and the position of the head.

3. Proprioception. This is information concerning the position of joints, the length of muscles and the force exerted by muscles.

By gathering and analysing the information from these systems numerous of times per second our brains can determine if anything or anyone is moving, what needs to be done to achieve movement and if we are in a balanced position. Perfect collaboration between the 3 systems is required. It is important to realise that these 3 systems have to work together in sync to prevent problems occurring. For example, when you turn your head to the left, the balance organs in your left ear is moving backward relatively speaking and the one in the right ear is moving forward. At the same time the position of several neck vertebra change, certain muscles are active in order for you to perform the movement and the eyes are registering the change in your surroundings. As long as all the information that your brains receives aligns with each other things will go smoothly, but if there is a discrepancy in the signals the brain receives it can lead to dizziness.

 

Different types of dizziness.

With the use of this background information a lot of common causes of dizziness can be explained:

Labyrinthitis (inflammation of the balance organ) With Labyrinthitis one or both of the balance organs becomes inflamed, most often this is caused by a virus infection. The afflicted organ is sending abnormal or incorrect information to the brain that doesn’t correspond with the other balance organ and other systems. This causes severe acute dizziness often accompanied with nausea and vomiting, sometimes the patient also experiences deafness or tinnitus. The symptoms can be so severe that the patient becomes bed ridden as every movement aggravates the symptoms. No real effective treatment exists but luckily most symptoms subside after a few days, although full recovery can take several weeks.
Meniere’s disease is an affliction of the inner ear, in which both the hearing organ and the balancing organ are affected. Meniere’s disease causes dizziness, tinnitus and deafness. These symptoms can come in waves and can persist for any length of time from a few hours to days. In some cases the deafness can be permanent. Meniere is usually treated with medications, but the success the medication has various greatly case to case.

Benign Paroxysmal Positional vertigo (BPPV).The balancing organ registers the position and movement of the head with the use of 5 fluid filled canals. Movement of the head causes these fluids to move which is registered by little hairs within the canals. BPPV occurs when tiny particles break loose and fall into the canals stimulating the nerves that detect head rotation. The brain receives the message that the head is spinning when this isn’t the case. BPPV usually comes on after a fast head movement and disappears after 15 to 30 seconds. BPPV usually comes on at a later stage in life after an ear infection or bump to the head. Your chiropractor will be able to determine if the dizziness that you are experiencing is indeed BPPV by taking a full history of your complaint and performing several tests. If you indeed have BPPV it can usually be treated successfully within 2 to 3 treatments. During these treatments your chiropractor will be moving the head in a very specific manner in an attempt to relocate the particles that have broken off. Of all forms of vertigo BPPV is probably the most easily treated.

Cervicogenic dizziness is dizziness cause by problems in the joints or muscles in the neck. As explained earlier the brain also uses the information from muscles and joints (proprioception). Injuries or movement difficulties to the neck can cause dizziness for that reason. A good example is dizziness as a consequence to a whiplash caused by a car accident. This kind of dizziness is often seen in a chiropractic office and usually responds very well to treatment. Sinister Causes? Besides the relatively benign causes mentioned above dizziness can also be caused by more serious afflictions luckily this is rarely the case, however if your dizziness is continuous and present for long periods at a time, uninfluenced by movement and accompanied by other symptoms. Such as headache, vomiting, problems with your eye sight it would be best to visit your GP.