An exercise in seeing…

One thing that has always surprised me is how different a patient’s posture can be from the way patients see themselves. I ask people if the are sitting up straight and they reply yes yet they have their neck leaning forward at a 20 degree angle. I ask people to stand on one leg and tell me if they are standing up straight and again the answer is always a resounding ‘yes’. It seems that we believe what we think until we are forced to do a reality check which is something that rarely happens before coming to me.

So I thought maybe if I gave you a couple of things to try out on your own you might start to get a better idea of what reality is like for you, before you necessarily have any complaints. Ready to have a go?

First, you will need at least one if not both of the following tools. I like a mirror because it is in effect dynamic and will show you exactly what you are doing. Preferably a full length mirror because it leaves you with no where to hide and exposes any faults that might be present. Alternatively, you could use a camera (still or video) which also will tell you similar information. Unfortunately with cameras it is harder to get immediate feedback unless you have it connected to a large screen monitor or TV (which is not always convenient). (note – if you have any health problems that restrict your ability to exercise then please check with your health care provider before attempting to try out these exercises)

Ok now once you have your tool(s) it’s time for a couple simple tests.. Try standing in front of the mirror: hips straight and pelvis not rotated, feet pointing straight forward and placed under your shoulders, knees slightly flexed over the middle of your feet with the weight distributed equally. Try to set yourself up without looking in the mirror and then look up and see if everything is where you think it would be. Common faults are having one foot turned out, one arch flattened/raised, more weight on one leg, the trunk leaning off to one side, one knee pointing either towards the middle or away from mid-line.. the list goes on!! At first it might not be obvious to you what you are doing and a photo or video recording may allow you to relax and review what your posture is like after. It is good to look for natural vertical lines (or you can hang a string behind you to act as a plumb line) so you can compare where you are positioned to what I have asked for.

Happy with where you are? Okay then lets progress to the next step. If not, then see if you can work on getting your body to take on this basic posture.

Now that you think can find a balanced position it’s time to add a bit of chaos :’ ).

Stand on one leg with the knee slightly bent and see if you can once again line yourself up with everything straight as in the first test. Can you do it? No? Well, many people can’t and this time faults are even more obvious. You may find that on one side it is easy to do but on the other your knee twists in quite a bit, the foot twists out, the pelvis rotates, you lean over quite a bit to one side… again the list can be extensive!! You may need some help from a friend who can look at what you are doing and give you honest feedback to help you correct your positioning. A healthy adult should potentially be able to stand up straight without leaning/twisting for up to 2 minutes without huge difficulties. Most people won’t be able to do this but that does not mean that they are not capable. ┬áIf you can get into this posture then see if you can relax and breath comfortably and hold the position with the least amount of effort. You should not have to strain yourself when you doing these exercises.

Sometimes I will do things to see if I can identify what the potential cause of the leaning/twisting is. For example, if I think that the person has weakness in their hip muscles then I give them a weight (a couple of kilos/up to 5 pounds) to hold onto on the same side they lean to. If this makes the list go away then the weight is doing what the hip muscles are supposed to be doing and I tell them that they should be doing something to strengthen the hip to see if that makes controlling the movement easier. I also like to see if the list happens before they actually try to shift their weight which might be more a habit than something their bodies are forcing them to do.

There are more things that can be tested/evaluated but you can at least start to see ,from what I describe, the process that needs to be carried out to improve your performance of these tests.

These sort of postures are similar to what people may do in some yoga, qigong and tai chi classes. I am not pretending to be teaching these arts but what I think is that someone in the past decided to provide simple preventative posture exercises that would be useful in keeping up one’s strength and coordination. I personally feel they are a useful tool and still have a use for most of the population these days.

Dealing with an acute low back pain attack

People always ask what to do when they have acute back pain. There are many answers depending on the exact nature of your problem but one thing people forget about is that pain is a perception and not a thing.

One common way of looking at how you perceive pain is to visualize your nervous system being like a telephone exchange. When a signal comes into the spinal cord it is prioritised according to the speed it comes in at, it’s intensity and what other competing signals are arriving at in roughly the same time period. Sensations , such as temperature(hot or cold),vibration, auditory information etc, arrive on insulated nerves and move at a fairly quick pace. Pain travels on uninsulated fibres and thus tends to arrive less quickly and can be blocked out by the faster signals that arrive first. A perfect example is a toothache that you hardly notice all day as you are bombarded by other information yet it is felt as a pounding toothache once you get into bed. Once the other signals are absent your nervous system becomes focused on what is left and you perceive the remaining pain as much stronger than you might have during the day. This is one reason why so many treatments have a short term effect that reduces what you feel yet don’t really get rid of the underlying problem. If you put on a heat rub/ice pack, have a massage, use a TNS machine then you will have some relief but only as long as the effect of the treatment remains. If there is still an underlying irritation it will all come back until you have dealt with the thing that is irritating your body in the first place.

The simple answer is when you first have an attack of back pain the best thing is to find a comfortable neutral position (usually lying on your back with your legs up on a stool/couch or on your stomach with a couple of pillows underneath) and apply any form of treatment that provides an alternative sensation to help settle down how much your nervous system is focusing on your back pain. Once you have had a day or so to let things settle then you have a wide choice of treatments that might help depending on what has gone wrong. With acute attacks many things will help including manipulation, massage, exercises and possibly other treatments such as acupuncture.

In the long run, you are best to calm your back down, have some form of treatment to settle your back further and then go back and focus on the things that really matter. Most back pain occurs because of bad habits, poor posture, trauma or working too long at something your body does not tolerate well. If you learn to take care of yourself better in your day to day activities you will find you have less (or maybe no) attacks and be better prepared to get on with your life.

Best of luck with taking care of yourself!!

Ross

Be careful what you wish for….

These days we are inundated with information. One problem is trying to decide how much information you really need and what do you do with it once you have it?

Take for example imaging of work or sports injuries. We can see what the cause is and should be able to provide better treatment. Right? Well it’s not that clear cut.

A couple of recent studies come to mind. The first, a study on low back pain, found that patients who had been given MRI scans took the same amount of time to heal as people who had not been scanned. Straightforward and what you would expect. What was surprising was that the MRI group suffered more and had much higher disability scores during the healing period compared to the non-scanned group. Knowing the intricate details of their injuries seemed to disturb more than re-assure the MRI scanned patients. The second study looked at what injuries/problems a doctor could see as possibly being present from evaluating an MRI scan of a shoulder. A variety of injuries were observed in 40% of the participants including significant muscle tears. This study sounded straight forward as well except for one small problem. The subjects in the second study were all high level athletes with no symptoms or reported complaints and at 5 years follow-up no problems had been reported.

The moral? The human body is extremely adaptive and we get by in spite of various injuries that may really just become quiescent rather than totally disappear. Sometimes knowing more than really necessary can create anxiety that make someone’s suffering worse than it could be. We need to trust that our bodies will tell us when something is truly amiss. So, before you go to your doctor asking for a scan or x-ray for an injury you might want to think, is there anything to indicate that this is really serious enough to need imaging? It’s not always good to know everything..

It’s sometimes said that what you don’t know can hurt you but sometimes what you do know can hurt you too!! Be careful what you wish for, what you get/find out isn’t always good for you. ;’ )

Ross

http://ajs.sagepub.com/content/31/5/724.abstract

http://www.ncbi.nlm.nih.gov/pubmed/22415000