There's quite a few reasons, here are the most common ones:
- Returning to an activity too soon after an acute injury
An acute flare-up usually takes 2 to 3 weeks to resolve fully and we advise our patients to rest or modify their activity until then. However, sometimes they feel so much better and think that they are ready before their bodies actually are.
- Bad posture, desk or repetitive work
For many of us, work is sedentary and the human body is just not made for sitting all day! We sit in front of a computer, sit in our car to get home, then sit on the couch to relax. And do it again tomorrow. No wonder we get sore necks and backs after a few weeks. As for posture, you have two types of muscle fibres, fast twitch and slow twitch. Slow twitch fibres are postural muscles like your core, which are designed to keep you upright with minimal effort. Fast twitch fibres are your big mover muscles like the hamstrings or the trapezius, which are designed to move your limbs quickly and powerfully. If you use fast twitch muscles to do the work of your postural muscles, they tire quickly and ache, which is what we find in patients with poor posture.
Stress changes the way we stand and move. Imagine facing off a tiger just a metre away, you can feel your shoulders clenching, your legs getting ready to run away. Now imagine the same tiger but behind a glass wall. Feel your muscles relax? Stress also affects the way our bodies compensate after injury. No one is perfectly symmetrical, pain happens when the body is no longer able to compensate.
- Chronic or progressive conditions
In some cases, the body is never going to return to its pre-injury state. For example, some forms of arthritis, disc injury, joint replacement surgery. Often, these patients have to work harder to be pain free, be more careful about how they move and remember to do regular exercises/stretches. Osteopathic treatment is aimed at maintaining their level of function or slowing down their disease progression.
- Increased nerve sensitisation
In chronic pain, the nerves start to behave differently in that they respond to lower and lower levels of stimulation, such that they go straight to alarm mode even with normal stimulus. According to Professor Lorimer Moseley, speaking at TedXAdelaide: "Pain is an output of the brain designed to protect you. Pain isn't actually coming from the tissues in the body." If you don't believe this, check out the experiments done with an artificial limb. The more neurons run pain, the better they get at it, so a smaller number of neurons can produce the same level of pain. The networks also become less specific, so the pain spreads, becoming unhelpful and uninformative. Prof Mosley, a clinical and research neuroscientist at the University of South Australia, added that chronic pain can be reduced by training the brain to better recognise, imagine and move the affected limb.
- Other reasons
Pain can be merely physical, or it can have a deeper emotional or spiritual component. It can have its roots in a old strain from a trauma/fall that did not get addressed at the time. Often, the start of the healing is accepting that there are other reasons for the physical pain to persist.
More than half of terminally ill blood cancer patients experienced complete remission in early clinical trials using modified cells from their immune system, reported The Guardian last week.
Speaking at the annual meeting for the American Association for the Advancement for Science (AAAS), researcher Stanley Riddell said: “This is unprecedented in medicine, to be honest, to get response rates in this range in these very advanced patients.”
Many of the patients in the trials had been given 2 to 5 months to live and exhausted all other options. To administer the T-cell therapy, doctors remove immune cells from patients, tagging them with “receptor” molecules that target a specific cancer, as other T-cells target the flu or infections. They then infuse the cells back in the body to let them do what they are supposed to do originally - recognise and destroy foreign matter in the body.
In one study, 94% of participants with acute lymphoblastic leukaemia (ALL) saw symptoms vanish completely. Patients with other blood cancers had response rates greater than 80%, and more than half experienced complete remission.
“T-cells are a living drug, and in particular they have the potential to persist in our body for our whole lives,” said researcher Chiara Bonini, a haematologist at San Raffaele University in Milan.
However, at present, T-cell therapy is considered an option of last resort because reprogramming the immune system can come with dangerous side-effects, including cytokine release syndrome (sCRS) – and overload defense cells. Twenty patients suffered symptoms of fever, hypotension and neurotoxicity due to sCRS, and 2 died, but the researchers noted that chemotherapy had failed in all the patients who participated in the new trials.
I found an amazing resource that shows the muscle you are stretching. These illustrations were created by Vicky Timón, a yoga expert and author of “Encyclopedia of Pilates Exercises,” and James Kilgallon, CSCS, creator of Mazlo’s Body Maintenance Program.
And remember, a stretch should be pain-free and you need to hold it for at least 30 seconds. Stretch after exercise, not before.
This pectoral stretch (29) has to be the one I give the most often, it helps reverse "desk posture" where the shoulders are hunched forward. I find this to be the cause of many instances of upper back and neck pain, as well as contribute to headaches, RSI and carpal tunnel syndrome.
What's the magic formula for a long lasting relationship (like Ellie and Carl in Pixar's movie Up)? Science says generosity and kindness rule.
For over 40 years, psychologist John Gottman studied thousands of couples in a quest to figure out what makes relationships work. In 1986, he set up a “The Love Lab” at the University of Washington where scientists hooked newlyweds up to electrodes and asked the couples to speak about their relationship, how they met, a major conflict they were facing together, and a positive memory they had. As they spoke, the electrodes measured the subjects' blood flow, heart rates, and how much they sweat they produced. The researchers sent the couples home and followed up with them six years later to see if they were still together.
From the data they gathered, Gottman separated the couples into two major groups: The masters and the disasters. The masters were still happily together after six years. The disasters had either broken up or were chronically unhappy in their marriages. The more physiologically active the couples were in the lab -faster heart rates, more active sweat glands - the quicker their relationships deteriorated over time.
The problem was that for the disasters, having a conversation sitting next to their spouse was, to their bodies, like facing off with a saber-toothed tiger. Even when they were talking about pleasant or mundane facets of their relationships, they were prepared to attack and be attacked. This sent their heart rates soaring and made them more aggressive toward each other.
The masters, by contrast, showed low physiological arousal. They felt calm and connected together, which translated into warm and affectionate behavior, even when they fought. It’s not that the masters had, by default, a better physiological make-up than the disasters; it’s that masters had created a climate of trust and intimacy that made both of them more emotionally and thus physically comfortable.
So how do you create such a climate of trust?
Gottman said masters respond to their partner's requests for connection, what he calls “bids.” For example, say that the husband is a bird enthusiast and notices a goldfinch fly across the yard. He might say to his wife, “Look at that beautiful bird outside!” He’s not just commenting on the bird here: he’s requesting a response from his wife—a sign of interest or support—hoping they’ll connect, however momentarily, over the bird.
The wife now has a choice. She can respond by either “turning toward” or “turning away” from her husband, as Gottman puts it. Though the bird-bid might seem minor and silly, it can actually reveal a lot about the health of the relationship. The husband thought the bird was important enough to bring it up in conversation and the question is whether his wife recognizes and respects that.
These bidding interactions had profound effects on marital well-being. Couples who had divorced after a six-year follow up had “turn-toward bids” 33 percent of the time. Only three in ten of their bids for emotional connection were met with intimacy. The couples who were still together after six years had “turn-toward bids” 87 percent of the time. Nine times out of ten, they were meeting their partner’s emotional needs.
“There’s a habit of mind that the masters have,” Gottman explained, “which is this: they are scanning social environment for things they can appreciate and say thank you for. They are building this culture of respect and appreciation very purposefully. Disasters are scanning the social environment for partners’ mistakes.”
Contempt, they have found, is the number one factor that tears couples apart. People who are focused on criticizing their partners miss a whopping 50 percent of positive things their partners are doing and they see negativity when it’s not there. People who give their partner the cold shoulder—deliberately ignoring the partner or responding minimally—damage the relationship by making their partner feel worthless and invisible, as if they’re not there, not valued. And people who treat their partners with contempt and criticize them not only kill the love in the relationship, but they also kill their partner's ability to fight off viruses and cancers. Being mean is the death knell of relationships.
Kindness, on the other hand, glues couples together. Research has shown that kindness (along with emotional stability) is the most important predictor of satisfaction and stability in a marriage. Kindness makes each partner feel cared for, understood, and validated—feel loved. “My bounty is as boundless as the sea,” says Shakespeare’s Juliet. “My love as deep; the more I give to thee, / The more I have, for both are infinite.” That’s how kindness works too: there’s a great deal of evidence showing the more someone receives or witnesses kindness, the more they will be kind themselves, which leads to upward spirals of love and generosity in a relationship.
If your partner expresses a need,” explained Gottman's wife Julie, also a psychologist, “and you are tired, stressed, or distracted, then the generous spirit comes in when a partner makes a bid, and you still turn toward your partner.” In that moment, the easy response may be to turn away from your partner and focus on your iPad or your book or the television, to mumble “Uh huh” and move on with your life, but neglecting small moments of emotional connection will slowly wear away at your relationship. Neglect creates distance between partners and breeds resentment in the one who is being ignored.
The hardest time to practice kindness is, of course, during a fight—but this is also the most important time to be kind. Letting contempt and aggression spiral out of control during a conflict can inflict irrevocable damage on a relationship. “Kindness doesn’t mean that we don’t express our anger,” Julie Gottman explained, “but the kindness informs how we choose to express the anger. You can throw spears at your partner. Or you can explain why you’re hurt and angry, and that’s the kinder path.”
A lot of times, a partner is trying to do the right thing even if it's executed poorly. So appreciate the intent." - psychologist Ty Tashiro
It's a month since music legend David Bowie passed away from his battle with cancer and lots of famous and not so famous people have been writing touching tributes. One of the more unusual ones that went viral was an open letter by a palliative care doctor in the UK.
In it, Dr Mark Taubert thanked the singer for opening up a discussion about end of life care with a patient of his who had received a terminal diagnosis. He writes:
"So back to the conversation I had with the lady who had recently received the news that she had advanced cancer that had spread, and that she would probably not live much longer than a year or so. She talked about you and loved your music, but for some reason was not impressed by your Ziggy Stardust outfit (she was not sure whether you were a boy or a girl). She too, had memories of places and events for which you provided an idiosyncratic soundtrack.
"And then we talked about a good death, the dying moments and what these typically look like. And we talked about palliative care and how it can help. She told me about her mother’s and her father’s death, and that she wanted to be at home when things progressed, not in a hospital or emergency room, but that she’d happily transfer to the local hospice should her symptoms be too challenging to treat at home.
"We both wondered who may have been around you when you took your last breath and whether anyone was holding your hand. I believe this was an aspect of the vision she had of her own dying moments that was of utmost importance to her, and you gave her a way of expressing this most personal longing to me, a relative stranger.
Dr Taubert also took the opportunity in his letter to raise awareness of what palliative care can do and the importance of advance care planning - planning heath and care decisions prior to things getting worse and before becoming unable to express them. While these sorts of discussions may not be pleasant for the person who is sick or for their family, it is just as important to die well as it is to live well.
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All entries complied by osteopath Dr Wei Chua unless otherwise stated.