Standing Firm - Why it sometimes hurts to stand from sitting?
The sit-to-stand (STS) is a test used to measure lower-limb strength in older people or those with significant weakness (1).
It is considered an easy, quick and fairly valid measure, which involves measuring the time taken to stand from a seated position a certain number of times, or recording the number of repetitions you can do in a given period (2).
The findings of recent studies suggest performance in this test is influenced not just by factors associated with strength, but also balance and mobility, and a vast array of psychological factors (1).
But what about when sit-to-stand hurts?
Low back pain can reduce spine, hip and pelvic floor motion due to conscious or unconscious guarding associated with pain (3).
Multiple studies have shown there are changes in how energy is transferred between bone and soft tissue in the spine, pelvis, and legs associated with pain (4). And that inefficient energy flow or transfer then places more demand from everything. A cycle of back pain-altered biomechanics can start, creating more back pain. With all the changes in energy transfer and muscle power, everyday activities such as standing up from a sitting position can become difficult.
Muscle coordination, balance and mobility are affected, and psychological factors start to play in and effect our beliefs and so the cycle continues (1).
Stopping the cycle can be easy.
You just bypass your traditional route to standing and try something different altogether.
Try these simple tips. You may not need all of them:
RELAX before you start
WIDER STANCE - think SUMO wrestler
SLOW DOWN (TIMING) - move more slowly
HANDS ON KNEES
BREATHE OUT - this is a big one. The less compression in the container of the torso the better.
Many people are surprised they can suddenly sit-to-stand with no pain after weeks or months experiencing twinges and outright muscle spasms when trying to stand after sitting.
After a few days of pain free sit-to-stand, you can try heading back to your old ways as there is rarely a “right” way to do something. You can get up and down any way you choose, each one of them equally valid.
As a lot of research shows, the way you do something does start to matter. If you always get up and down via your arm on the desk, leaning forward to create momentum, it means the strengths necessary to do it another way are waning.
Can this help if I have pain elsewhere?
This can also break the cycle if you experience pain in hips, knees and feet.
references
1. J Gerontol A Biol Sci Med Sci. 2002 Aug;57(8):M539-43. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. Lord SR1, Murray SM, Chapman K, Munro B, Tiedemann A.
2. Exp Gerontol. 2018 Oct 2;112:38-43. doi: 10.1016/j.exger.2018.08.006. Epub 2018 Sep 1. The sit-to-stand muscle power test: An easy, inexpensive and portable procedure to assess muscle power in older people. Alcazar J1, Losa-Reyna J2, Rodriguez-Lopez C1, Alfaro-Acha A3, Rodriguez-Mañas L4, Ara I1, García-García FJ5, Alegre LM6.
3. Explain Pain Supercharged G. Lorimer Moseley and David S.
Butler. Adelaide City West: NOI Group Publishers, 2017. ISBN: 978-0-6480227-0-1
4. Gary L. Shum, PhD, et al. Energy Transfer Across the Lumbosacral and Lower-Extremity Joints in Patients with Low Back Pain During Sit-to-Stand. In Archives of Physical Medicine and Rehabilitation. January 2009. Vol. 90. No. 1. Pp. 127-135.
Morning, I'm Broken!
We all know we feel better physically, emotionally and psychologically if we’ve taken the time to exercise in the morning but how do we reduce the general ache and stiffness that many of us feel before we even get out of bed?
The main thing people consult an osteopath for is pain. Pain in their low back, between their shoulder blades and in their neck.
But a frequent complaint in practice is people reporting a general feeling of stiffness or ache in all sorts of places when they try to leave their beds of a morning. So while the good news is you aren’t woken with pain in the night, the moans and groans start when you haul yourself out of bed. And it can be enough to wake your partner, or the dog.
Is there any research on this?
There was nothing focused in the literature about whether stiffness improves with exercise, and certainly nothing as specific as morning stiffness. Although this may be because no one asked the question in an original study (i.e. it wasn’t set as a specific outcome for the population being studied).
An educated guess…
Waking with stiffness would be due mostly to your body trying to adapt to new behaviours or resting postures you’d get out of given the chance if you were awake.
Examples of the types of things that might cause stiffness in your neck:
Stomach sleeping
Bingeing on Netflix in bed with a laptop
Long long hours at a computer
Long drives on straight roads
Examples of the types of things that might cause stiffness in your low back:
See above
Examples of the types of things that might cause stiffness in your feet and achilles:
Standing for long periods (cooking, ironing, gallery walking)
New exercises or an increase to new exercises (skipping, golfing, new shoes)
Or just good old DOMS the day or two after a workout at the gym
What exactly will you be mobilising?
There is no exactly about it….you’ll be mobilising nerves, muscles, tubes, connective tissue, all manner of fluids including sparking up your brain juices.
A word of caution in the mornings.
Your nervous system is a bit protective of itself when we first wake up, as anyone who has ever done yoga before 6am will attest. That burning tightness behind your knees is not your hamstrings it’s actually your sciatic nerve letting you know it does not appreciate being pulled quite so aggressively before the sun has even risen.
Give it a fortnight.
It might take a while to tell if your body is going to love a new regime but in the meantime you can reward your mornings with these mobilisations:
ACHILLES and FEET stiff when you stand on them in the mornings?
Prancing with straight legs
Heel to toe
Holding onto the door frame squat
If your low back stiff in the mornings?
Try this series of movements:
LB twist
Knees to chest
Cat/Camel
Child Pose with Lateral Flexion
UPPER BACK and NECK stiffness in the mornings?
Sidelying bow and arrow
Neck slider/shoulder shrugs
All our mobilisations will be available on our BLOG this month.
So make yourself a morning routine that suits you.
Share these tips and tricks to put some spring in someone else’s step this August.
Jaws 42 - The Curse of TMD (Temporomandibular Joint Disorder)
All credit of this image go to Steven Spielberg and novelist Peter Benchley. Also to Zanuck/Brown Productions and Universal Pictures.
It has been nearly 42 years since the legendary movie "Jaws" was released. It was a cinema masterpiece of its time with bucket loads of suspense and horror that managed to scare everyone from swimming in the ocean for years afterward. Well, so I'm told. With the clever use of animatronics, images of bloody big dorsal fins and spooky music it left movie goers nursing tense and sore jaws from clenching their teeth through anxiety and fear. Segue complete. See that? Jaws and jaw pain?
Jaw pain is a pretty common issue affecting 33% of the general population at some time in life (1). Of that population there seems to be more significant spike in the age range of 20-40 year olds, with a significant portion of that number needing to seek treatment from a health professional. Anxiety is a key contributor to jaw pain but it is not the only reason people experience pain in/around the jaw or temporomandibular joint (TMJ). We commonly refer to pain around the TMJ as Temporomandibular Joint Disorder or TMD. It is actually not one single disorder but representative of multiple sub groups of issues. They are typically categorised as muscle problems or joint problems.
WHAT CAN YOUR OSTEOPATH DO?
At Fairfield Osteopathic Clinic we take into account the whole person when dealing with the treatment of TMD. In other words we need to understand the underlying causal factors, which may range from mechanical joint factors, emotional stress or functional overuse issues (think Australian gum-chewing cricketer). There are also direct links between neck pain and TMD and any assessment will recognise the connection. There is plenty of evidence both clinically and through peer reviewed research to suggest that the neck and jaw are pretty tight in their relationship with one another (pardon the pun). One paper suggesting that 70% of TMD sufferers also experience neck pain (2).
A worthy TMD assessment will always encompass an actual physical assessment of the muscles around the jaw and the joint movement itself. This will guide treatment options. As osteopaths we use lots of direct and indirect techniques to modulate pain, but without addressing underlying causal factors that impact the jaw then relief may not last for long. These irritating causal factors might include chewing gum, chewing meals on one side of the mouth, specific dental issues, night time bruxism or teeth grinding and habitual jaw clenching (a lot of people don't realise they clench until they actively relax their jaw muscles). There are simple relaxation exercises for the jaw that are easy to practice and master. Head down to the end of the BLOG for some ideas.
SELF MANAGEMENT
Self management strategies are essential in dealing with any long term TMD. A large study published in November 2016 attempted to collate as much data on self management strategies and form a best practice management strategy for longterm TMD. These strategies include:
1. Education - a bit of positivity is a good start as pain is usually self-limiting. Understanding the anatomy and usual function of the TMJ complex and associated musculature can be helpful too. Other ideas include improved sleep hygiene (don't watch Jaws before bed), sensible and time-limited use of analgesia, avoidance of OTC splints bought without consultation with a dentist, limit caffeine usage, ‘doctor shopping’ won't help.
2. Self exercise therapy - gentle stretches for the jaw muscles and relaxation exercises, which are best explained by your osteopath.
3. Heat treatment - usually heat for sore jaw muscles is best. Ice treatment is best avoided due to the sensitivity of the nerves that innervate the area (remember ice-cream headaches)
4. Self massage therapy - there are very simple self massage techniques for the main jaw muscles and upper neck muscles. Again these are best explained in person as a little goes a long way.
5. Diet and Nutrition - it's important to establish a pain-free diet for at least three weeks. That means avoiding excessive chewing or hard-to-chew foods. In other words TMD sufferers may need to establish a "soft diet" until sensitivity decreases.
6. Parafunctional behaviour - this is the tricky one. There are often habits that irritate the jaw that we seem to not have as much control over e.g. grinding teeth or jaw clenching during sleep, which is called nocturnal bruxism. This may require some other modalities of therapy or medication to help. Reflecting on coping strategies for stress and anxiety may be pivotal to changing some of these nocturnal habits (3).
EASY EXERCISE
Stand in front of a mirror.
Hold your palms gently on the side of your face - covering your cheeks.
Let your lower jaw fall into your hands. In other words relax it and let it go all loose.
Now practice that again without using yours hands on your face. Make as long a face as possible.
If you are having trouble mouth the sound "Bah". It lets your lower jaw fall open. Repeat that until you get a sense of your jaw relaxing.
If you practice this in the mirror then when you are at work throughout the day you can put your hands on your face and use that as a trigger for your face and jaw to relax. You are creating awareness around the difference between tension and ease.
Good luck and don't hesitate to make a booking to see us if things are a bit out of control.
References
1. Wright, Edward F., and Sarah L. North. "Management and treatment of temporomandibular disorders: a clinical perspective." Journal of Manual & Manipulative Therapy 17.4 (2009): 247-254.
2. Silveira, A., et al. "Jaw dysfunction is associated with neck disability and muscle tenderness in subjects with and without chronic temporomandibular disorders." BioMed research international 2015 (2015).
3. Durham, Justin, et al. "Self‐management programmes in temporomandibular disorders: results from an international Delphi process." Journal of Oral Rehabilitation 43.12 (2016): 929-936.
Bridging the Gap on Men's Health
If you hadn't noticed it's Movember and Men's Health is in the spotlight. In particular Mental Health, Prostate Cancer and Testicular Cancer. Three aspects of Men's Health that contribute significantly to men's mortality. The saddest part of this statistic is that they are, to a great extent, preventable causes of death with early intervention.
In the course of my career I have taken many a phone call from the wife or partner of a man to make a booking on their behalf. Often unbeknownst to the man! This gives a small insight into men's health behaviour that is quite curious. Men will often avoid seeking attention for health related issues.
Why don't men ask for health help?
A study from the International Journal of Consumer Behaviours (1) found some interesting reasons why men do not seek health care assistance when they clearly should. These were broken down into broad themes that included:
1. Health-seeking behaviour was seen as a more female trait and not one associated with male self-reliance (I think this might be code for "I'm too scared to find out what's wrong with me")
2. Expressions of underlying fear and fatalism (at least they're being honest!)
3. Feelings of disconnection from health providers (talking about how I feel with a stranger is just not cool)
There is no good age to be a man
At the pointy end, the life expectancy of a man is on average 4.5 years less than a woman.
Perhaps more alarming, across the lifespan, just being a man means you're more likely to die than a woman. And that's in all major age groups! This is in part due to men being biologically driven to partake in more risky behaviour (with sometimes devastating consequences). However the stark difference across the lifespan points more directly at men's lack of attention to detail in maintaining their own health and well-being (2).
Health behaviour change and the time it takes
One of the major benefits of seeing an osteopath at Fairfield Osteopathic Clinic is the time we take with our patients. An initial consultation is usually around one hour and all subsequent consults are around 30mins. There is always opportunity to get to know the patient in front of us. Of course we'll take a detailed medical history and perform the appropriate physical examination. But more than that it is chatting to the patient about their life, family, work, hobbies, exercise routine, friendships - all the stuff that makes them who they are. Obviously this doesn't all happen in one consultation, it will often take a while to build a therapeutic relationship with a patient and trust is not something that can be afforded lightly. Often this chat can reveal something about them that needs a little more attention. This might work a little better with men who are more reserved about revealing too much about their health history.
So a shout out to the men out there. Don't put that appointment off with the osteopath because you think that it's not "manly" to see someone about your aches and pains. This goes double for those things that you should see the GP about e.g. a spot that has changed on your skin, a lump that has developed somewhere it shouldn't, or you just aren't feeling your "manly" self.
Taking ownership of your health
Influencing health behaviour's is usually a pretty subtle science, even as a health professional. In recent times initiatives like Movember have done terrific work in highlighting the need for men to take ownership of their health. Likewise the RUOK group have done great work in clearing the lines of communication to help men (and women) open up about struggles with mental health. Always keep in mind that your health professional is a confidential source for anyone to talk about their health problems. As osteopaths we always are aware of our professional boundaries and scope of practice and will refer you on as necessary.
(1) Buckley, Joan, and Seamus Ó Tuama. "‘I send the wife to the doctor’–Men's behaviour as health consumers." International Journal of Consumer Studies34.5 (2010): 587-595.
(2)http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/LookupAttach/4102.0Publication30.06.104/$File/41020_MensHealth.pdf
The Massage "Affect" on Anxiety and Depression
JUST GET A MASSAGE
I know many people feel that booking in for a massage is an indulgence. They wait for a gift voucher from a loved one, or save up once a year for their birthday.
Many benefits of massage are still disconcertingly uncertain but while everyone is discussing those, a somewhat proven benefit is its positive effects on mood (1).
Massage has been shown to:
1. reduce depression
2. reduce anxiety
ANXIETY AND PAIN
How often have you noticed your neck pain is at it's worst when you're under a lot of stress? It will build up and up until you finally lean over to pick up your toothbrush and 'bam' you can't move your neck.
Anxiety is a potent factor in all types of pain. And in the case of lower grade anxiety and depression, the kind we all seem to be living with every day, massage can make a valuable contribution to your well being.
MASSAGE TO INTERRUPT THE CYCLE OF PAIN AND IT'S EFFECT ON MOOD
Although the neurophysiological effects are complex, the simple negative cycle that emerges when people are depressed or anxious, is that it's hard for them to do anything when they feel miserable. As you continue to feel miserable, this leads to doing less, which in turn, leads to feeling worse.
There is a boatload of evidence to support enjoyable movement and exercise to improve mood but how about not getting to the point of feeling miserable or trying to find someone to help you crawl out of that hole?
Most massage therapists are pretty nurturing types of humans. They can provide a therapeutic support role through 'recovery' and encourage paced activity to incorporate self-management.
IS MORE MASSAGE BETTER?
A leading researcher in this field is Christopher Moyer PhD who is a behavioural scientist primarily interested in the role of massage therapy on anxiety and depression or the human affect.
I'll let him speak about the research he has accumulated on the subject about whether more massage is better:
"We made an interesting discovery concerning the effect of the treatment on the state of anxiety. When a series of massage therapy sessions was administered, the first session in the series provided significant reductions in anxiety, but the last session in the same series provided reductions that were almost twice as large. This pattern was consistent across every study we were able to examine, which strongly suggests that experience with massage therapy is an important predictor of its success, at least where anxiety is concerned. To put it another way, it is possible that the greatest benefits come about only when a person has learned how to receive massage therapy." (2)
SO STOP FEELING GUILTY
You can all stop feeling guilty. If you enjoy getting a massage then book one now and do something good for your mental health. Give yourself a pat on the back for being proactive about your wellbeing. Well done you!
(1) Christopher A. Moyer, PhD, Research Section Editor, IJTMB, Assistant Professor, Int Journal Therapeutic Massage and Bodywork. 2008; 1(2): 3–5. Published online 2008 Dec 15.
(2) Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3–18.
Five tips for a better night's sleep.
Sleep is a tricky topic. How many hours should we get? Seven, eight or nine? What has been the impact of television/screens/ipads? Should we sleep more like our ancestors in two big chunks (Bi-modal sleep)?
The overwhelming response from most people would be that they'd really just like a bit more of it.
Here's my top five tips to get a better night's sleep:
1. Stop unhealthy habits before bed
Finish eating or drinking at least two hours before you try to lie down.
Get off that computer or off the couch at least one hour before bed - seriously.
Check any nighttime medications* don't have caffeine in them.
2. Clear your bedroom of unhelpful items (make a checklist)
Get a blackout curtain if a street light shines in (it's not just for toddlers).
Is your room too warm or too cold?
Get rid of your shining alarm clock. No one needs to see the time in neon.
Turn off your mobile phone. I mean it.
Children and pets are warm, nurturing creatures but they don't always need to share the bed with you. We often get shoved into a cold corner of the bed to accommodate them. Restore your boundaries.
Is your mattress more than 8-10 years old? It might be time for an upgrade.
Do you love your pillow? (see my post on pillows)
Covers too heavy or restrictive?
Spouse or partner that is restless, noisy, or generates too much heat - um, acceptance?
Some medical conditions❡ interfere with sleep.
3. Do you love a daytime nap?
Do not daytime nap for more than 45 minutes
No napping after 3 pm
4. Exercise
A few surprises. A 2010 (1) study found people with no previous sleep difficulties slept better the night following exercise. But for people who had been diagnosed with insomnia, a fairly comprehensive study from 2013 (2) found people had to exercise daily and consistently for up to four months before there was a measurable benefit.
Put simply:
Consistently do a bit more physical activity during the day.
Expose yourself to bright light on waking – tell your body it's daytime.
Expose yourself to bright light in the afternoon to keep your body awake longer.
5. Consistency of sleep habits
Wake up at the same time every day - almost the hardest one to implement for anyone, especially an insomniac.
Develop a flexible before bed routine. It might include a warm shower or bath, meditation or a calming book.
In-bed routines - breathing techniques, progressive muscle relaxations (that's a whole other BLOG)
Reduce fluid consumption in the evening to avoid the need to wee all night.
(1) Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. Oct 2010; 11 (9): 934-940. Kathryn J. Reid, PhD, Kelly Glazer Baron, PhD, Brandon Lu, MD, Erik Naylor, PhD, Lisa Wolfe, MD, and Phyllis C. Zee, MD, PhD
(2) J Clin Sleep Med. 2013 Aug 15;9(8):819-24. Exercise to improve sleep in insomnia: exploration of the bidirectional effects. Baron KG1, Reid KJ, Zee PC.
* Some medications that can interfere with sleep:
- Antihistamines: Benadryl (daytime drowsiness)
- Sympathomimetic Amines: bronchodilators and decongestants
- Antihypertensives and Beta blockers: Clonidine, Aldomet, Reserpine (daytime drowsiness)
- Steroids: Prednisone, dexamethasone
- Thyroid medications:
- Anti-epileptics and antipsychotics (daytime drowsiness)
- Parkinson medications: (daytime drowsiness)
- Stimulants for ADHD
- Anticholinesterase drugs for Alzheimer's
- Antidepressants: Prozac, Fluoxetine
- Analgesics: opiates, Tramadol, Ultram
- Chemotherapeutics: (nausea and vomiting)
- Diuretics: (frequency at night)
❡ Some medical conditions that can interfere with sleep:
- Respiratory disorders
- Cardiovascular disorders
- Gastrointestinal disorders
- Musculoskeletal pain and dysfunction (Book Online)
- Diabetes
- Renal disorders
- Prostate problems and small bladder causing urinary frequency
- Cancer
- Dementia
- Dental disorders
- Restless leg syndrome or Periodic Limb Movement Disorder (PLMD)
- Fibromyalgia (alpha wave intrusion)
NOTE: People who do shift work have special challenges as they consistently interrupt their diurnal rhythms. It is outside the scope of this post.