Slow and steady wins the race
The simple solution for the complex problem
When pain hangs around for longer than expected this can be immensely frustrating for patients. But when problems are complex and recalcitrant they can also be frustrating for practitioners.
A complex problem requires patience from both parties. If a patient has a story of brokenness, then it takes the right information, at the right time provided in the right way for that person to help turn that story into one of hope.
So many of us are pressed for time and aren't we all searching for the simple, immediate solution to any problem?
Often a simple and effective solution can be manual therapy. Good practitioners can be really good at providing an immediate relief for pain. Whether it lasts is another story and the transient relief for patients can be at once addictive and ultimately frustrating.
A good practitioner will combine manual therapy and education. Education comes in multiple forms, knowledge about why it hurts, and information about pain can help redirect the assumption of brokenness.
Education can also be advice about unhelpful behaviours, thoughts or beliefs. And it most certainly should involve having a discussion about the true
A good clinician will help find your baseline for activities and armed with good knowledge, your brain and body will know you're safe even if you experience some discomfort.
A fair amount of frustration exists around trying to increase physical activity, which as we know from the literature (and the media) is a magic bullet (1). But many people have the experience that simply increasing the amount they move increases their pain. Often, they'll take the weekend warrior approach. They join a gym and do a body balance class and end up crawling in for pain relief as their low back and neck are screaming at them. If the alarm bells are ringing and you're getting negative feedback from every part of you it's hard to make the connection that it's a) good for you, and b) we need to do more of it and finally c) do it forever.
A good clinician will help find your baseline for activities and armed with good knowledge, your brain and body will know you're safe even if you experience some discomfort.
I listened recently to a great podcast with Neil Pearson, who is a physical therapist in Canada, who uses graded exposure to therapeutic yoga to help people with complex pain problems. But it doesn't have to be yoga that gets you there. The simple and free option is walking.
What is graded exposure?
Graded exposure is a fancy way of saying that you need to start with a small amount of something that threatens you and as your brain and body tolerate it, add in a bit more the next day until you can participate in an activity you enjoy without a backlash.
So what does a graded exposure program to walking look like?
Start with a baseline of 10 minutes per day at around 65% of your maximum heart rate. In the range of comfortably carrying on a conversation. Up the benefits and go with a friend.
You need to assess how you feel afterward. If you have any adverse effects, ask yourself, do they last five minutes, five hours or five days? Depending on the answer, you need to increase or decrease the amount of time and effort you are making with walking. As a guide, anything more than a three hour increase in discomfort means you're overdoing it. Remember though to pay attention to your response AFTER your walk, not during, as this is a better indicator of how irritable your body and brain is.
If you don't overdo it, you'll improve so rapidly that after only a week you'll want to start increasing the amount of time, slowly now, to get to the point where you can walk for 45-60 minutes. It might take eight weeks or it might take six months, depending on how your body responds.
When you reach the 60 minute range, you'll be improving brain health, fighting Alzheimers, etc, you'll definitely be burning fat, if that's your extra goal achieved.
When you can comfortably walk in this time range with no negative repercussions, you can add in some moderate intensity exercise, like a 30 second jog, and then another 30 second jog later in the walk around 75% of your maximum heart rate. Once you've worked up to 6 x one minute jogs, then you're ready to add in some additional activities that take your fancy.
Strength work, flexibility and high intensity exercise come after all this preparation. You'll be so much more connected to what your body might want to achieve and what you might enjoy. If you enjoy being out in the sunshine, then there are myriad options at your disposal. Do something you like, do it with a friend and do it for your mental health, as well as to improve your pain.
1. http://www.canberratimes.com.au/act-news/exercise-could-be-the-answer-to-solving-one-of-australias-biggest-health-burdens-20160809-gqo8bi.html
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.