Articles — Precision Movement

back pain

5 things for back pain before you see your doctor

I see a number of people who have had no success with the long term relief of back pain by going to see their doctor.  There is a lot that can be done with injury and back pain before you seek medical treatment.  Even when you go to your doctor they recommend you exercise to relieve back pain.  What they don't specify is what exercise is best for you.   One thing is for sure, pain medication will only mask your symptoms and can make you think you are ok again until the medication wares off.  Medications also put your liver and digestive system under stress.  So what can you do to ease your back pain before going to see your doctor?

1.  Notice your pattern of pain

The more information you can gather about your patterns of pain the more likely you will notice what triggers your back pain and what exacerbates it.  Do you wake up with pain?  Does it occur later in the day?  How bad is it?  Does it decrease?  By how much?  You might find that by noticing the patterns of your pain you are able to make changes to help ease the discomfort.  

2.  Move 

Movement may seem like an unlikely remedy for a back ache but it is surprisingly effective.  The key to movement for relief of pain is doing it gently.  Walking can often provide a sense of relief (however if it makes it worse and sitting relieves it then take a rest periodically).  I recommend my clients do gentle back specific mobilizations upon waking daily to ease the back into the day.  You can download your copy of the Precision Movement Daily Mobilizations

here

.  

3.  Activate your core

If you know how to do this then focus on it by activating consciously throughout the day.  For more information see my article "Does having a strong core relieve low back pain?".  If you do not know how to do this then seek out a specialist who can teach you how.  Ultimately, if your back is aching it is telling you something is not right.  From a mechanical perspective it means certain areas of your body are taking more stress and other parts are not doing their job.  You'll need help with restoring this balance so seek out a corrective exercise specialist to help you with this.

4.  Stop, look, listen

Notice what might be causing or contributing to your back pain.  It might be the heavy boxes you moved yesterday or the position you are sitting in at work.  It may even be the exercise you are doing that makes your back pain worse.  Think broadly, it might not be a mechanical cause, pain can come from digestive issues such as food intolerance or constipation and in my clinical experience pain always gets worse when you are stressed.  Look at everything.  As obvious as it seems stop doing what you think may be causing/exacerbating the pain and see if your back calms down.  

5.  Think and take control of your thoughts

I know this sounds a little ominous but stay with me for a moment.  Sometimes people who have structural damage do not experience any pain.  It is a conundrum that puzzles medical practitioners even today.  What this really means is pain does not come solely from structural or mechanical issues or everyone who has structural damage would be in pain.  What tends to happen with pain is that we let it take control and rule our lives.  I have a wonderful client who went on a silent meditation retreat last year.  While he was sitting through a 6 hour meditation session his knee began to hurt.  His meditation teacher advised that he think on the pain and try to deconstruct it.  After some time he managed to break it down into a feeling of pressure and heat.  He changed his relationship with pain and it took his pain away.  Your brain is as adaptable as your body and it will learn what pain does for you and establish a trigger that sets it off without your conscious permission.   When you let pain take over and control you no amount of exercise and treatment will help you get better in the long term. 

How to talk to your GP about your back pain

When you hurt the priority is to make it go away, quickly.  The problem with back pain is it takes a bit of time to settle and usually takes a combined of manual therapy, corrective exercise and optimisation of a few lifestyle factors.  If you are keen to sort out why you’re hurting but are skeptical about how your doctor can help read on for my 5 top tips for speaking to your GP about getting your back pain sorted.  

A GP checks and more often than not rules out urgent, serious and sinister issues and is then the gateway to further treatment options.  Personally, I’ve found that having a plan about what I would like to discuss with my GP before my appointment helps me to get the questions I have answered and also directs the conversation towards what is next in the process.

A whole approach

Back pain often needs a comprehensive approach which may include pain relief, physiotherapy, medical review and possible further investigations. Go in with a mindset of taking a whole approach to getting better.  A whole approach means taking on board all systems of your health and using more than one method to manage your back pain. 

pain medications

You and your GP may agree that you may benefit from taking pain relief. Ask your GP how the pain medication works - I always find if I know how something works I find it works better. Make sure you know the any possible side affects and talk to your doctor about dosage and how long you should take it for. If you are not keen on taking pain medication ask you doctor about alternative forms of pain relief such as acupuncture, heat or massage. Be sure to ask about whether you would benefit from a review with a sports doctor, consultant or physiotherapist.

Be specific

Notice patterns of pain, when the pain occurs, when it gets worse and what makes it get worse.  What makes it get better? Does it ease throughout the day?  All this information helps your GP to make a decision about how best to help you.  

What is the plan

Ask your GP what the plan is and what the next steps are. If you already know how you would like to manage your back pain discuss this with the GP. If a referral is indicated ask who you will be referred to and why.

Imaging

GPs will likely refer to a physiotherapist, sports doctor or consultant for the management of back pain. It is common to start with a course of physiotherapy but sometimes a GP may refer you straight to a consultant or sports doctor. It is at this stage imaging (ultrasound, x-ray, MRi, spect scans) are discussed and potentially ordered. Talk to your GP about whether you need a scan and if not now when it may be an option.  

Please note that a scan can be useful adding more information about your anatomy with respect to your presentation, but it is a snapshot of you when you are still. The body is infinitely more complex.  A scan, if indicated is added to the information about your presentation - it doesn’t supersede it.

What does it mean if you wake up with low back pain?

Low back pain is the 2nd largest reason why people take sick days from work.  80% of the UK population will at one time in their lives experience back pain.   One of the most common symptoms I come across in clinic is patients waking up with pain or stiffness in the back.   Read on to find out why this might happen and how to relieve symptoms.

The spine throughout the day

Over the course of a day we lose height because the discs that sit between the vertebrae (spinal bones) lose fluid through the day. This fluid is replenished overnight as we sleep. as a consequence we are slightly taller in the morning and slightly shorter in the evening. It makes compelling argument for the importance of good sleep quantity and quality. For my top 10 tips on the best sleep ever (my most popular blog post) click here.

You may also wake with back pain from lying in an uncomfortable position for a long time and the muscles may just be feeling stiff and achy.

What happens when you sleep?

Sleep is when your body heals and recovers from the day’s events.  This includes the restoration of fluid in the discs between your vertebrae.  Sometimes discs The expansion of the discs with fluid can sometimes cause pressure on the nerves that run through the spine and this can cause discomfort on waking.

Nerves get on my discs

Nerves are sensitive creatures.  They like space and freedom to do their job.  When a disc expands over night from the intake of fluid it can reduce the space for the nerve and cause you to hurt when you wake up.

  When the body experiences pain especially around the spinal cord where your central nerves run through, the muscles surrounding the area may contract to stabilize the area.  The body knows that the nerves running through the spine are exceptionally important for function and survival and it will do anything to preserve their health.  In this case it means contracting and tightening up the surrounding area.

What can I do?

If you find this is a persistent symptom that is compromising the start of your day because of discomfort or stiffness and it is affecting your function for example dressing or showering you may benefit from a physio review.

Morning Mobilizations

You can also try Precision Movement’s morning mobilizations - gentle movements in a safe unloaded position that help ease the stiffness of the muscles and bring increased blood flow to the area.  You may find them useful as a stating point for management.

Precision Movement’s top 10 tips to reduce back pain at work

sitting oldies

sitting oldies

At Precision Movement I see so many clients with back pain who sit at a desk all day for their work.  Back pain, neck, shoulder and hip pain as well as RSI injuries are all very common amoungst those who are seated throughout the working day as the sitting position encourages us to adopt poor posture.  Also maintaining the same position for hours at a time is not good for your health of your back or body.  Here are Precision Movement’s top 10 must have adjustments to your workspace to minimize the risk of discomfort, pain and injury at work.

1. Awareness of alignment 

Slouching and poor sitting habits will contribute to back pain.  The longer you sit badly and pay no attention to your posture the more likely you are to incur discomfort, pain and injury.  Awareness and reminders throughout the day are a great start.  Set your computer screen saver to say SIT UP STRAIGHT or POSTURE PERFECT.  If you are on your phone throughout the day set your home screen with a similar message.

2. Chair/sit to stand desks 

Source a good chair for your work-space that supports your spine and deters you from slouching at work.  I like the range at www.back2.co.uk.  There is a fantastic product on the market that really helps with long periods of sitting – the sit to stand desk.  You can adjust the desk height easily throughout the day to alternate between sitting and standing.  I highly recommend this.

3.  Hand height

If you work at a computer then your forearms should be held at a 75-90 degree angle in relation to your upper arm.  The elbows and wrist can rest on the work surface if you regularly use telephones, calculators and write as this reduces strain through the shoulder and neck area.  For those that are drawing or designing at a drafting table angle the table up so you do not have to lean over your work.  A general rule of thumb is the closer your hands and eyes have to work together for a task the higher the desk height should be.

4. Height of chair 

Your chair height is determined by the height of your desk.  Ideally your knees should be at an angle of 90 degrees or slightly less and the feet should rest comfortably on the ground.  The backrest of your chair should sit right in the middle of your low back area.  The placement of the chair should be such that you do not have to lean over your desk to work or that you feel too cramped.

5. Seat pan 

You should be able to adjust the angle of the seat pan on your chair.  As a general rule if you read and write a lot then tilt your seat pan forwards which helps to maintain healthy spinal curves.  If you mostly sit in front of a computer screen then tilt your seat pan back (up to 5 degrees).  However, if you have a specific injury like a disc prolapse your seat pan position will be unique to you and I would advise taking expert advice – see the end of the article for more advice on this.

6. Foot position

Allow your feet to rest evening on the ground ideally with a 90 degree bend at the knee.  If your feet do not touch the ground when you are sitting in your chair then use a footrest and this should ideally be angled up at 15 degrees.  If you wear high heels I would advise that you work in flats when seated at your desk.  The increase angle through the ankle can lead to injury even when you are not weight bearing.  You can always quickly change into your heels to walk to a meeting although ideally flat shoes are better for you whether you are walking or sitting!

7. Computer screen height 

Set your computer screen height so that it is horizontal with your eyeline.  You definitely do not want to be looking down as this will encourage slumping forwards which strains the shoulder and neck area.

8. Computer screen distance 

The ideal distance between your eyes and the screen is 14-30 inches or 35-75cm.  If you screen is too close it will strain your eyes and if it is too far away it will encourage you to lean forwards thus pulling you out of alignment.

9. Headset  

Use a headset or a hands free kit if you are on the phone for much of the day.  If you are seated at a desk infront of a computer or need to hold documents while you are speaking you are more likely to hold the phone between your ear and shoulder which over time will most certainly lead to discomfort and potential injury.  A headset will enable you to work effectively without compromising your alignment.

10. Getting up through the day

The most important advice I can give you is to get up out of your chair throughout the day.  Not only will your back and body thank you for this but it will allow your mind to rest briefly before returning to the work you are doing.  Make a cup of tea, walk to the water cooler, walk to another floor for a meeting, definitely get out of the office for lunch.  If you can frame your work day with exercise such as cycling to work or hitting the gym even better.

KT at Precision Movement can provide bespoke ergonomic assessments and adjustments to your work space.  KT can also provide advice on ergonomic aids if your workspace is not as adjustable as it can be.  For more information email KT@precisionmovement.co.uk.

Precision Movement's top 10 essentials for super slumber

cat sleeping

cat sleeping

Sleep is an essential part of healing and recovery from injury and equally essential to your performance throughout the waking hours!  It is very easy to make changes to maximise the rest and recvoery you get whilst sleeping.  Whether you think you sleep well or not, implementing these top tips will ensure that you get a good nights sleep every night for the rest of your life.

1.Quantity

It is recommended that you sleep between 7-9 hours per night.  I aim for 8 hours.  Try to be in bed by 10pm for lights out at 1030pm.  Your physical recovery takes place between the hours of 10pm-2am and your mental recovery from 2am-6am.  If you miss any of this your recovery will be impaired and your performance the next day may be impacted.  Recently some experts have said that you can recover sleep debt from the weekdays at the weekend.  I would advise getting into a routine during the week as recent research has also found that varying your bedtimes is akin to the effects of travelling through different time zones.  If you've travelled to Asia or Australia you'll know what that does to your body!  Even a 1 or 2 hour time change frequently can have an unsettling effect on your sleep quality.

2.  Electromagnetic interference

Reduce and ideally eliminate exposure to TV, ipad, smartphone, computer 2 hours before bed.  The light from these screens stimulates the retinae and set off a hormonal response that it is still daylight.  This will not calm you down in preparation for sleep.  Take the TV out of your bedroom and any electrical items that are plugged in.  Electromagnetic stress will disturb your sleep quality.

3.   Dim the lights

If possible spend the last 2 hours of your day in lower lighting.  This gradually prepares the body for sleep.  When  light sources to your eyes are reduced it increases the production of melatonin the sleep hormone and your body then starts its preparation of slowing down to sleep.

4.  Black out your room

Black out all sources of light from your room.  If you live in a city you'll need to black out your windows.  A great product I have come across recently is

Lights Out Blinds

- black out blinds that are easy to put up, take down and travel with.

5.  Silence!

Quiet your sleep chamber.  Our body and brain responds to sound even when we are asleep.  The quieter your sleep time the better quality you'll enjoy!  Use ear plugs if you are in a noisy area of town - just make sure you can still here your alarm in the morning.

6.  Night time routine

The best way to prepare for sleep is do just that - prepare.  I recommend a bath in low light.  Scents like lavender and rose are calming and soothing.  You can replace watching TV or surfing online for reading.  Read something that will calm you - that means no work documents or scary stories.  Choose something escapist and fantastical.  You could also do some light stretching - if you have been given a daily corrective exercise programme by Precision Movement we encourage clients to do 10-20 minutes of this as a wind down before going to sleep.

7.  Meditate

This can be a controversial one but the act of focussing on one thing helps quiet the mind and prepare the body and brain for sleep.  I use a meditation CD as I like to be guided.  My favourite CDs are by Deepak Chopra but there are many prodcuts out there that work.  If you struggle to drift off after all this preparation then I would recommend a sleep CD.  There are some amazing products out there which I have used myself.  My favourite one that always send me sweetly off is Pzizz from

Pzizz.com

.  As well as a guided meditation style speaker they have music and tones that activate theta brain waves - theta is the frequency our brain waves vibrate at when we sleep.

8.  Gratitude x 10 + 3Qs

Sounds like an equation?  Well let's call it the sleep equation!  This is my favourite one and I love getting ready for bed just to complete this task. List 10 things you are grateful for that day.  Then answer the following 3 questions -who did you help today?  Who helped you?  What did you learn?

9.  Anyone for tea?

Limit and ideally eliminate caffeine after 12pm.  Your body has a natural hormone rhythm that gets you up and puts you to bed.  Caffeine really interferes with this and in turn interrupts your sleep quality.  Use herbal teas before bed.  Look out for special sleep blends and ingredients such as camomile, valerian root and fennel.  My favourite sleepy tea is

Bedtime Yogi Tea

.

10.  Don't you worry don't worry child!

If your head is flooded with worries and things you forgot to do today, then keep a journal by your bed.  Write everything down that is bothering you.  This act of transferring it out and into your 'to do' book will calm your mind so you can prepare to rest.

The key to making this work for you is to get into a routine.  That is why I have designed a sleep chart for you to fill in.  Download it here and track your progress over 30 days.  Let me know how you do on Facebook or Twitter.  And with that said I feel a yawn coming on.  Wishing you a super sleep every night of your life.

5 top must-have tips for a long healthy career

kid superhero

kid superhero

If you are in business and or climbing the corporate ladder you'll know all too well that feeling of invincibility. It's a divine trait and can also be equally as detrimental - unsuspectingly to your spine and your heart.

Clients come to me in their mid-30s to mid-40s with back, neck and shoulder pain and in their mid forties to fifties with heart trouble. One way or another, a life time of stress will get you. And when it does you will have to stop completely to heal and recover. There is nothing more soul destroying than being close to the height of your career and having to take 6 months or longer off because you can't get out of bed.  It's probably not something you think about at all - and I am with you that you shouldn't have to. An awareness and application of a few basic support systems can minimise the risk of present or future work related back pain and injury. Here are my top 5 counteractions to minimise the risk of irreparable damage to your spine so you don't have to think about it!

1. Your state of mind. No one is invincible. If you are striving to achieve a top job it is an endurance race not a sprint. Pace yourself and take time out. The first step is to rethink the invincibility cloak - save it for dress up with the kids!

2. Your body heals and recovers from the stress you put it through daily when you sleep. Sleep is not an option for minimising injury and illness prevention in the future - it is a necessity. Both quality and quantity are important. Aim to sleep for 8 hours a night ideally between 10pm and 6am. Take out any electronics from your bedroom and switch off lights at the mains. Your room should be pitch black and as quiet as possible for a really good quality of sleep.

3. The food you put in your body becomes you. If you eat sugary processed foods your body will be starved of the nutrients that heal and restore from daily stressors. Also not eating enough will cause stress and impair effective recovery. Every cell in your body is renewed over 7 years. So short term fixes will not work well for injury and illness prevention in the future. Make a commitment to yourself to make a change for life - feed your success by eating what nature grows for you.

4. Movement is absolutely essential for injury prevention. If you sit at a desk during your working day you MUST make an effort to move either in the morning or in the evening. Exercise plays a direct role in maintaining good posture and keeping your joints strong and stable. A balance of high intensity and restorative exercise is also important. Too much high intensity will stress you out and could lead to an over-training injury. The quality of movement has a huge impact on how successful it becomes for injury prevention. If you turn up the gym and have a go on what looks good or manageable I would suggest seeking advice. At the very least find a good trainer or corrective exercise specialist with experience, top qualifications and a passion for their job to design and regularly upgrade a programme for you.

5. Strive for a balanced life. Spread your energy and interests wide. This idea is about giving your brain a new stimulus - a chance to work in another way. It is said that a change is as good as a rest right? So change your stimulus to give your brain a rest. Mental stress is as detrimental to your body as physical. This will mean stepping away from the office - and the blackberry.

Implementing and making a habit of these 5 suggestions helps to optimise your health to give you the best possible opportunity to enjoy a long, healthy and successful career.