The victim and the criminal

Often patients ask why they have a problem in a certain place when there has been no obvious injury or reason for a complaint that has snuck into their lives.  There might not be any obvious incident and they can't think of anything they have done to cause their discomfort.

One way of looking at how the body behaves is to think that it will take care of you as long as it can. But that is as long as your wants match what is natural.  You have reflexes that try to keep your head vertical. Your nervous system is programmed to be sure that certain basic requirements happen.

In the case of a sore knee there are many factors that might be at fault.  If you have a problem your body will shift the pressure to another area to keep that part from becoming symptomatic and interfering with its tasks. This will continue to happen so as the next area becomes overloaded the pressure will shift again.  When there is no where left for the pressure to go the weakest part will become irritated.  If you get a stiff hip you may change the way you walk. This may affect your back or your ankle. As those areas start to stiffen up to try to avoid becoming irritated the knee will take more pressure.  Eventually you will find you knee complaining.  Too often treatment can be applied to the sore knee alone which is which is the victim in this conspiracy.  You have to  look hard to see the stiffness (which does not hurt, only limit you) or weakness(which you will compensate for) and the real criminal area that has made your knee hurt you. 

Whatever type of treatment you engage in the important thing in the long run is to be sure that the cause and not just the effects are dealt with.  Treating the pain alone will give relief temporarily but the underlying problems will eventually come back to haunt you.

Hope this has provoked some thoughts. Sorry I took so long to get something new on here. I will try harder next time. 

Best wishes and hope you are having a great summer!!


Canadian Back Institute

Although I obviously would like to see patients in my office I think that any organisation that promotes patient self education should be supported.

One excellent group is Dr Hamilton Hall’s Canadian back institute (

Dr Hall has always written excellent books that are plain speaking and informative.  Likewise his website offers information including an online self assessment package to help you to understand what might be going wrong and how to deal with what you find the source of your complaints to be.

Years ago, before I was a physio myself, I got tired of having problems and finding that the information I needed wasn’t available. Treatments were not always helpful ( I tried chiropractic, massage etc) and too often a passive approach left me soon back in pain again and wondering what to do.

Its worth giving Dr Halls site a view and seeing if what he tells you helps you to understand things a bit better. I know in my case it was very beneficial.

Best wishes and good health!



Its funny how the way you see the events you have been involved in determines how much you suffer.  The way you feel about what has happened can directly determine what you will feel.

Since moving to the UKin the late 1990's I have been hit in my car 5 times including once rolled the car at 60 miles an hour.  I have been fortunate and been able to walk away relatively unscathed although I did suffer for different periods of time depending on the severity of the crash.  More recently I took up playing rugby again after more than 25 years off just to see if I could do it.  Again depending on the severity of the game and the level of contact involved I found myself sufferring.

Interestingly the pain was not that different in nature or severity between the two events.. car crashes and rugby. Each time I might have 12-48 hours grace and then I ached!!!!! Sometimes I would wake up in the middle of the night and need to find a way to control what I was feeling.  Sometimes I walked quite gingerly for the next while and had to pace my return to any actitivity.  Within 7-10 days (usually 2-5) I was back to being able to do much of what I did before albeit I had to tough it out at first.  There were sometimes more severe reactions but in general things were manageable.  I think that this is not something unique to myself.  Some lads from one side I was with were hit in their car on the way back from a game and reported the accident at practice but in comparison to the game earlier the discomfort had ended up being minimal from the crash.

Having a history of being involved in contact sports I was not as affected as much as I might have been partly from physical conditioning and partly from mental attitude. I am sure a big factor was also probably luck. This has also been seen with other people around me.  I do know that there is evidence that getting and staying active once you are recovering from an injury goes a long way to keeping down the insurance bills for treatment and helps to prevent reoccurrences in the long term.

If you look on things as a knock that is part of what happens in the 'game' of life then perhaps you may find it a bit easier to get on with things and get back to living life how you want to.




Often when someone gets an injury, particularly when it is in the back, there can be spasm/tightness/cramp sensations. 

It may not be obvious but what is felt may have nothing to do with the actual injury as much as what the body is doing to try to protect itself.  You would not think that you could injure such a big area with the small movements or seemingly innocent tasks that started things off and you would most likely be correct!!  This is a protective mechanism that works much the way a cast does..things that can't move have a chance to settle down and heal.

Unfortunately the body does tend to overdo many things and the discomfort is far more that most of us want to put up with.  I have fortunately (unfortunately!!) felt this sort of thing when I have been involved in tackles playing rugby. A hit that didn't seem to do much might have irritated things to the point that I could not move my neck for a week or more.  Today I don't have to suffer quite as much as I know that with a couple days rest and the use of cold packs/heat packs/liniment/massage/acupuncture/electrical stimulation I can get the spasm to ease and try to assess what is the underlying problem. Sometimes it is just shock/reaction to pain and the problem goes away quite quickly. Other times it has been more serious and I have had to deal with the problem over a longer period of time. In either situation I have been in control, sufferred less anxiety about how my body has behaved and been able to get back to my games in optimum time.  Hey at 51 I made it through 19 rugby games this season without having to miss any play for most of the season.

Cheers from the UK!!


Pain as an indicator #1

Sometimes people have something hurt and there is good reason to avoid the pain because of recent injury from trauma.  Other times the pain is there for no apparent reason and people are not sure that it isn't just an old injury stirred up so they back away and avoid hurting things further. There are also instances where you find applying a load to a pain is relieving and starts things feeling better.

A simple way to try to get an idea of how to manage an ongoing constant pain is to load the area and see how it responds.

If you had a sprained finger and you pulled your finger backwards it would possibly aggravate and increase the area of pain or the intensity of what you are feeling.  Another response might be that although it hurts to stretch the finger there might be no change in the underlying are or intensity of symptoms.  Lastly you might find, surprisingly, that the area of pain receedes or the intensity reduces once you stop loading the area. This might be where you have pressure on a disc or cartilage and once you apply load there is less pressure in the incorrect direction and things start to settle.

So simply put, if you get a big reaction that lasts for a long time after you test a movement it is best to leave that movement alone for the short term.  If there is discomfort that is not worsened by loading then you might cautiously explore this direction of movment in your exercises as long as you are getting a reasonable response e.g. any aggravation dies down really quickly.  If the movements actually start to make you feel better (in the sense of less pain or a reduction of the area of pain) once you stop loading then could be a good strategy to apply load routinely every couple of hours and then assess how much better you had become (or not) after a day or two.

Pain is an experience and will be modified by your expectations.. Sometimes having a strategy for testing what you feel, and a sense that what you find is reasonable, makes the experience far less frightening and perhaps alot more manageable.

See if this is of any help.

Cheers, Ross 

Back Pain

Everyone seems to suffer from back pain at some time in their lives. As a chartered physiotherapist I see alot of people who can be helped with little intervention. Sometimes it is as simple as learning a bit about how what you feel relates to the type of problem you might be suffering with. 

Just to start out I would like to get people thinking about pain and see what their thoughts are.  It can be daunting to be in pain and not sure what to do. 

The first concept that is often missed is that hurt does not equal harm. If you pull your finger back you feel discomfort even though nothing has been damaged. Martial arts like aikido and jiu jitsu use this type of pain to control people who are attacking them without necessarily damaging them.  If you have been in a cast for 6 weeks and you start to move then there will be pain as the tissues have tightened, become sensitive or because they have become stuck dowon on adjacent tissues.  Often a simple stretching program will help to loosen things. In this type of situation then you need to move towards the pain to loosen things up and get your body moving again.

I am sure many of us have felt this in the past. Often  this type of pain may resolve within 7-10 days of stretching things out.

This is my first blog so patience please if I don't make things as clear as I would like them to be. I am happy to hear any constructive comments that will help people to understand what I am trying to get across.

Cheers from the UK.