Back to Basics
Dr Jess Milsom “When back pain suddenly shows up, we are tempted to blame it on the last minor stressor that affected it, such as a soft bed in a hotel. This is like blaming your bankruptcy on the last latte you bought before your account finally went into the red.” – Todd Hargrove. When pain occurs it’s not uncommon for us to try to find a triggering event. Sometimes, this can leave us stumped as there wasn’t a clear change from our normal activities, it kind of just came on, or we must have just slept funny. Pain and our body’s physiology are not simple, most of the time it isn’t caused by just one event (unless your injury was a result of direct trauma). Research suggests that pain is complex and can occur from physical factors, lifestyle factors, and mental factors. Put simply, pain tolerance levels are closely linked to our entire well-being. Think about how complex the balance of nature is. Extinction of one species can influence the population of other species, or altered weather patterns can affect the growth of plants and animals. Like the intricate balance of nature, our pain symptoms can rely on the stability and good functioning of our body systems. This is what we refer to as the body’s homeostasis. The self-regulating process of the cells in our body to maintain stability and adapt to conditions. When there is an accumulation of small and subtle changes to these cells – a constant and steady increase in cortisol (a natural stress hormone) – it affects the functioning of other cells. When perceived with a threat, a natural stress response is triggered. Cortisol increases your blood sugar levels, which increases brain activity and increases the available substances needed for tissue repair. It also dulls non-essential functions of a fight or flight situation. These include your immune system, digestive system, and growth processes. It lowers testosterone, which is a vital growth hormone for men and women. This is optimal for short-term survival in stressful situations, however, if cortisol levels remain elevated things can start to go haywire. When we experience prolonged stress, our bodies have reduced pain tolerance and heightened pain. This is a process known as ‘sensitization’. We may struggle to maintain or grow muscle mass due to the dampening effect cortisol has on our growth hormones, and we might find ourselves getting struck down by the common cold often due to our weakened immune response. This ultimately leads to a change in the function of your whole well-being. So, the next time you notice a flare-up of symptoms, or a new unexplained injury occurs, let’s take it back to health basics. Ask yourself: • Am I fuelling my body with nutritious foods?• Am I drinking enough water? • Am I getting enough sleep? • Am I exercising on a regular basis? • Am I exercising too much and not letting myself recover properly? • How are my stress levels? • What am I doing to manage this stress? • How many inflammatory things am I putting into my body? For example, smoking, vaping, highly processed foods, and drinking excessive alcohol all increase inflammation in our bodies.• Am I spending enough time with those I truly care about and with the same values and interests as me? • Am I spreading myself too thin with superficial relationships? We’ve all heard the saying “you can’t pour from an empty cup”, well this extends to pain and injury too. If your body is already fighting to maintain homeostasis, then how can you expect it to repair damaged tissues and cells at a quick rate?
Don’t Tread on Me
Dr Braeden Melmer Can your shoe be causing you pain? OR Are your shoes the reason for all your pain? Why my shoes are causing PAIN Choosing a shoe can be difficult, especially when it comes to exercise. There are many factors that can influence the type of shoe we choose such as the shape of the foot, the brand of shoe, walking/ running style, the form of exercise. If you find yourself getting pain or discomfort when walking or exercising in the following body parts -foot, toes, heel, calf, knee, hip, or low back There is a good chance you may be wearing the wrong shoe OR the shoe needs to be modified for your feet. Although there has been a shift in shoe design in the last 5-10 years due to foot mechanics research most traditional shoes do not support natural foot mechanics. This is due to a modernized design of style which creates a narrow toe box. This inhibits natural foot mechanics in a few ways. Imagine you’re at the beach walking on the sand or in the yard walking on the grass barefoot we feel the sand and grass between our toes and as we put weight over our foot and push off our toes spread apart before we push off. With most shoes, a narrow toe box prevents this and causes or toes to compress up against each other. This can change toe off-angle which resultantly can increase shear forces through the knee and hip which over time leads to dysfunction. Continuing off the last point most formal shoes or dress shoes and women’s heels have a heel lift which causes the forefoot to drop, respectively. A raise as little as a 2-5cm increase in heel lift shortens the achilles tendon and prevents the foot from naturally flexing. At this heel elevation, shear forces increase through the forefoot and knee up to 23% increase in body weight. If we were to increase that to a 7.5 cm heel, which can be quite a common height, the forces shoot up to 76% body weight felt through the foot and knee. These are quite large increases in forces that the lower limb will not withstand for long. Long term effects that can come from such dysfunction are: Choosing a Shoe Right for You Three main shoes we typically are looking at Minimalist shoes have become a more popular choice for exercise, and I do advocate for this type of shoe, in most circumstances, and for day to day movement. However, they may not always be appropriate as I will high light. Minimalist shoes usually have a wide toe box and as the name suggests “minimal” cushion support allows for the foot to act naturally while walking and the toes to splay as they should. These shoes also have minimal to zero heel raise which takes the pressure off the knee and changes gait from a heel strike to a mid to forefoot strike. This type of strike allows that calf to absorb more forces but because of this an increase in stress on the shin, achilles, and calf can occur increasing the chances of overuse injury during long periods of running or walking. In the case of running, we may want to consider a shoe with a typical or maximal cushioned support depending on the individual’s foot shape and ground strike particularly if you are a heel striker. A maximal shoe has quite large midfoot support with a slight slope towards the toe. And although this shoe may seem like a good option for running the evidence is mixed and minimal. The idea is they reduce forces through the foot and achilles but still seem to aggravate what they are helping along with the knee. My advice would be to start on a typical/neutral running shoe first before jumping to a maximal. Some other factors we must consider are as follows, which becomes tricky: Regardless of the shoe, we should always still seek out one that has a wide enough toe box for our feet. It is important to have your foot mechanics assessed along with gait and running style as this will help decide which shoe is best for you with the type of exercise being done. At the end of the day, every foot is different so different styles that are good for one may not be so for another. Therefore, it is important to always ask a professional with a biomechanical background that can help choose the right shoe for you! References: J.J. Hannigan and C.D. Pollard. Differences in running biomechanics between a maximal, traditional, and minimal running shoe. Journal of Science and Medicine in Sport 23(2020) 15-19 E. James.2014. Born to Walk: Myofascial Efficiency and the Body in Movement.
Pain Gate Theory: Use in Chiropractic Care
Dr Jess Milsom Pain is a complex and subjective experience that can greatly impact our daily lives. Whether the pain is acute or chronic, if we understand the mechanisms of pain, it helps us to effectively manage pain. One prominent theory is the Pain Gate Theory or Gate Control Theory of Pain. This theory proposes that pain perception is not solely determined by the intensity of a noxious stimulus (this is something that’s caused you pain, i.e., you’ve scraped your knee on a rock, or you’ve burnt your hand), but is changed by aspects of the nervous system which control the ‘gating’ of pain signals being sent to the spinal cord and up into the brain. To understand the pain gate theory, let’s imagine a “gate” in the spinal cord that controls the transmission of pain signals to the brain. This gate may open or close and will determine if these pain signals can travel up to our brain to reach our conscious awareness. Let’s look at the mechanisms: Activation of nociceptors When any type of tissue damage or injury occurs, nerve endings that are responsible for feeling pain are activated, these are called nociceptors. These nociceptors play an important role as they help us to reflexively remove ourselves from a dangerous situation that may cause us damage, for example, if you put your hand over a flame, you instinctively will pull it away. Transmission of pain signals The activated nociceptors send signals through nerve fibres to a section of the spinal cord, where they are transmitted to the brain for processing. This is a sort of filing system that allocates them to the ‘pain’ section of information to be sent up to the brain via the spinal cord. The gate mechanism Once these signals reach this section of the spinal cord, the gate mechanism has its moment. The gate consists of inhibitory and excitatory neurons which regulate the flow of pain signals, this means they can either inhibit (or dampen), the pain signals, or they can excite (or amplify), the pain signals. When the gate is closed, then the inhibitory signals dampen pain transmission and reduce our perception of pain. Conversely, when the gate is open, the excitatory signals can travel up to our brain through the gate and we are made much more aware of the intensity of the pain. Influence of modulating factors The opening or closing of the gate is influenced by various factors, including psychological, emotional, and cognitive factors. One easy example is the use of mechanoreceptors. These are also nerve endings, but they’re responsible for the perception of touch and pressure which isn’t painful. These fibres can travel to our spinal cord much quicker than our pain signals are and can compete to take the space which essentially closes the gate, dampening the pain. That’s why it normally feels better if we rub or put pressure on an area that we’ve just injured. Other techniques may be used to calm our conscious awareness of pain, these can include distraction techniques, relaxation exercises or positive emotions, all of which will help to close the gate. Conversely, stress, anxiety, or negative emotions can open the gate, increasing pain sensitivity. How is this used in the clinic? Many of the techniques used in our clinic stimulate the skin and activate non-painful sensory fibres, our mechanoreceptors. As mentioned above, stimulating these nerve fibres will help close the gate and reduce pain perception. Additionally, our practitioners take the time to listen to you and your pain story, creating a space where you can relax and reframe your perception of pain, to that which is less catastrophic, and more of an optimistic approach. We understand how debilitating pain can be when it interferes with your life and can reassure you that pain does not last forever. The pain gate theory offers valuable insight into the complex nature of pain perception. When we understand how the gate mechanism operates and the factors that influence it, we can develop comprehensive pain management strategies.
Nine Tips for Better Sleep
Dr Jess Milsom I’m sure most of know the feeling of having a bad night’s sleep and how it impacts the rest of the day. Sleep is a crucial aspect of overall health and well-being. It is the most effective brain enhancer, stress reliever, immune booster, and hormone balancer. Despite its importance, many people struggle to get enough quality sleep. To understand your sleep properly, I’m going to briefly explain what a “sleep cycle” is. Our bodies cycle through two different sleep phases, rapid eye movement (REM) and non-rapid eye movement sleep (NREM). NREM is further divided into 3 stages: wake, light sleep, and deep sleep. A healthy sleep will normally consist of 4 – 6 cycles. The first stage is light sleep, which involves slow muscle and eye movements, and you’ll be easier to wake up. You’ll then transition into a deep sleep in which eye movement will completely stop, muscle movement will slow further, and your blood pressure will drop. This is also when your breathing and heart rate will drop to their lowest point. During this stage, it will be harder to wake you and you may feel disorientated and agitated if woken during this phase. From there you’ll enter your REM phase. Your brain activity will be high, your eyes will move rapidly, and your dreams will be more vivid. Your muscles will become nearly immobile. The next phase may or may not be a wake phase. These can be very quick, and you may not even remember them. Generally, you’d want this phase to be as short as possible, however, if you do wake in the night (and it’s long enough for you to remember), don’t stress! It’s very normal. So now you know what your sleep cycle should look like, read on for some tips to improve the length and the quality of your sleep. Get outside and look at natural light within the first hour of waking. Do the same thing in the afternoon just before the sun sets. Try not to wear sunglasses, and don’t look directly at the sun! This is going to help to wake up your circadian clock which is essentially your body’s built-in alarm clock. Maintain a consistent sleep schedule. Try to go to bed and wake up at the same time every day, even on weekends. A good rule of thumb to find out your optimal time to go to sleep is to note the time of day you get an afternoon dip in energy. If this is consistent across most days, you can assume your optimal sleep time is roughly six hours after that dip. Don’t snooze the alarm! Going back to sleep put’s you back into the sleep cycle, snoozing the alarm and waking up later may mean you wake during a deep sleep phase and you may wake feeling irritated and tired. Avoid caffeine too close to bedtime. Limiting consumption of caffeine within 8 – 10 hours of bedtime will help ensure your body is moving into a parasympathetic nervous system, that focuses on you resting and digesting. If you struggle with anxiety around sleep, try relaxation techniques before bed. These can include deep breathing, meditation, and yoga. There are lots of free resources and some awesome ones that require a subscription. My favourites include the “Sam Harris Waking Up” app, the “Calm” app, and Yoga Nidra which you can find easily on Spotify or YouTube. Limit screen time and bright lights before bed. This can include bright ceiling lights, opt for as little light as possible after the sun sets (but obviously enough for you to be able to see where you’re going!). While blue blockers are a great option, just viewing bright artificial light too close to bedtime can shake up your circadian rhythm and lead to sleep disturbances. Avoid alcohol. Alcohol can really mess up your sleep. This is because your body is too busy trying to process the toxins in alcohol to be able to repair tissues, and you won’t be able to achieve the deep sleep stage of your sleep cycle. In fact, most of the hangover feeling you get after a big night is due to poor sleep patterns and dehydration! Create a sleep-conducive environment. Make sure your sleeping environment is dark, quiet, cool, and comfortable. Your body requires a drop in temperature by 1-3 degrees to sleep, and stay asleep. Getting too hot is one of the main reasons people wake up through the night. Try magnesium optimised for sleep close to bedtime. If you’re taking it before bedtime, I’d recommend a Magnesium Threonate or Magnesium Bisglycinate. If you don’t like magnesium there are also sleep teas that contain valerian root, chamomile, lavender, or lemon balm. All these options can help to settle into the parasympathetic nervous system, thus promoting a deep restorative sleep cycle. Sleep is a vital aspect of overall health and well-being. Sleep lays the foundation for our mental and physical health and performance in all aspects of life. We’re all human and no one’s sleep will be perfect all the time…the odd night out here and there is bound to happen (having a healthy social life is important as well!). Life, not to mention young kids, will sometimes wreck your sleep no matter how hard you tried, but don’t obsess over those nights too much. However, if bad sleep habits creep up often our life and health will start to suffer. Master your sleep and reap the rewards.
Headaches
Dr Jess Milsom If you often suffer from headaches, chiropractic care can be beneficial in reducing the severity of your pain. Understanding which type of headache you experience and what tissues are involved can improve your and your chiropractor’s headache management. Headaches can be primary, meaning that the pain originates from tissue within or surrounding the head or from a secondary cause such as dehydration, infection, substance withdrawal (e.g. caffeine headache), or from a dysfunction of the neck, sinuses, or facial structures (teeth, eyes, ears). This blog will discuss the three most common types of headaches, their symptoms, and the best treatment methods. Tension-type headaches A tension-type headache is the most common headache disorder. These headaches can occur commonly and may last anywhere from minutes to days. The pain is often a pressing or tightening feeling across the back of your head, temples and forehead, like a tight hat, squeezing your head. The intensity of this pain can be mild to moderate but should not be made worse by day-to-day activities. Sufferers of this type of headache may be sensitive to light or sound but not both. There is also no associated nausea with this type of headache. Psychological stress or a lack of sleep is a common cause. Treatment for these headaches commonly involves chiropractic care, simple analgesics and non-steroidal anti-inflammatories (NSAIDs), such as paracetamol and ibuprofen. Chiropractic care – massage, relaxation techniques, neck mobilisations, neck manipulations, and prescribed exercises and stretches – reduces pain intensity and improves the quality of life. Migraines Migraines are the second most common type of headache and are more common in women. The current theory is that migraines are neurovascular pain syndrome. The pain occurs through changes in the processing of signals through the brain, which may lead to painful inflammation of the cranial blood vessels and dura mater (tough, outer cover which protects the spinal cord and brain). They are triggered by skipping meals, taking blood pressure medication, poor sleep, stress or allergenic foods and perfumes. Migraines are chronic and episodic, meaning they come and go over time, beginning in puberty / young adulthood and lasting until at least the 50s. These headaches can be preceded by an ‘aura’, a momentary change to vision such as blurring, spots of darkness or zig-zag flashing lights. Migraine sufferers also commonly suffer nausea, vomiting, sensitivity to lights and sounds, and brain fog-type symptoms. The headache affects one side but not the other and will be pulsating in quality. The pain of this headache can be moderate–severe and can be aggravated by physical activity. The headache attacks can last between 4 – 72 hours. Treatment for these headaches often involves prescribed medications, caffeine, and over-the-counter analgesics. Most migraine sufferers will feel the most relief when lying in a dark and quiet room. Research regarding the effects of manual therapy on migraine headaches is somewhat limited. Chiropractic care – manipulations, massage and dry needling – has been shown to be most effective combined with relaxation techniques and therapeutic exercises. Neck manipulations may be helpful for the short-term treatment of migraines, however, do not help in the long term. Regular exercise, stress management/relaxation techniques and lifestyle modification are all suggested for the management of migraines by reducing the frequency and intensity. Cervicogenic headaches These headaches are often caused and made worse by neck movements or sustained head positioning (e.g. sitting at a desk all day). These types of headaches may also be associated with a history of trauma to the neck region, such as a whip-lash injury that occurred years or months ago. The pain is often referred from the neck and perceived in the head and face, commonly the forehead, around the eyes, around the temples or near the ears. The pain in the neck will often be on the same side as the headache pain. Pain is often easily reproduced by applying pressure through the upper neck, upper trapezius and levator scapulae muscles and by moving the neck through its range of motion. This headache will not have changes to vision or hearing and can be moderate–severe in pain quality. They may last anywhere from 1 hour – weeks. These headaches can be relieved by chiropractic care which involves neck and upper back manipulations or mobilisations, as well as a therapeutic exercise regime. If you do not fit into one of the above headaches, it may be beneficial to keep a headache diary. Take note of the location of pain, severity, additional symptoms and any noticeable triggers. Booking in to discuss your symptoms with us can also help to determine appropriate exercises and lifestyle modifications which can help you to manage your pain better. References 1. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders.2nd edition. Cephalalgia 2004;24:suppl 1.2. Crystal SC, Robbins MS. Epidemiology of tension-type headache. Curr Pain Headache Rep. 2010;14:4493. Chaibi A, Russell M. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. The Journal of Headache and Pain. 2014;15(1):67. doi:10.1186/1129-2377-15-67.4. Becker WJ. Cervicogenic Headache: Evidence that the neck is a pain generator. Headache. 2010;4 699-7055. age P. Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy. 2011 Sep;6(3):254.6. Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. The journal of headache and pain. 2011 Apr 1;12(2):127-33.7. Biondi DM. Physical treatments for headache: a structured review. Headache: The Journal of Head and Face Pain. 2005 Jun;45(6):738-46.8. Diener HC, et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol 2006; 5: 310-316.
