"Back to the Body": Charting a New Course in Physiotherapy

In the dynamic field of physiotherapy, a transformative wave is reshaping our traditional approaches to pain and injury.

This evolution, termed "Back to the Body," represents a significant departure from past practices, integrating modern science's revelations with a renewed focus on the body's intricate signals.

As we delve into this shift, it's essential to appreciate the context from which we're moving and the promising direction in which we're headed.

The Traditional Paradigm: A Focus on the Physical

Historically, physiotherapy has been deeply anchored in a biomedical model, concentrating on the body's physical aspects—its joints, muscles, and tissues.

This approach, while foundational, often adopted a reductive lens, aiming to "fix" what was perceived as broken or misaligned.

Diagnoses frequently highlighted deficiencies: a "weak" core, "tight" muscles, or "improper" posture.

While these assessments were made with the best intentions, they inadvertently introduced a nocebo effect, where the negative framing of conditions could exacerbate patients' perceptions of pain and disability, sometimes with minimal relevance to their actual experience of pain.

The Shift Toward Mind and Emotion

The field's expansion to encompass beliefs, emotions, and the broader neurocentric model—largely influenced by the pioneering work of researchers like Lorimer Moseley and David Butler—marked a significant leap.

This phase brought to light the brain's integral role in pain perception, advocating for a more comprehensive understanding that transcends mere physicality.

However, this shift, for all its merits, occasionally led to an overemphasis on the psychological at the expense of the physical.

Patients sometimes felt their pain was being dismissed as purely a construct of the brain, leaving them feeling invalidated and overlooked.

"Back to the Body": A Holistic Reintegration

Today, we stand at the precipice of a new era, inspired by Bud Craig's insights into homeostatic emotions and the complex interplay between mind and body.

"Back to the Body" advocates for a return to a more integrated approach, where pain is recognized as an interoceptive signal—a cue from our body indicating a need for attention and care.

This perspective sees pain not as a mere symptom to be eradicated but as a critical piece of feedback within our body's attempt to maintain balance.

With advancements in technology—such as heart rate variability monitors, blood glucose tracking, and sensors for lactate and inflammatory markers—we're now equipped to decode the body's signals with unprecedented clarity.

This technological leap, combined with principles of load management as outlined by Tim Gabbett, empowers us to identify and respond to the body's cues more effectively, fostering an environment where positive adaptations are more likely.

Empowering Through Understanding

This shift towards an integrated mind-body model is about empowerment and education.

It's about guiding patients to tune into their bodies' messages, recognizing the signals of overload and stress.

It encourages a response to discomfort informed by understanding and mindfulness, rather than fear or the pursuit of immediate fixes.

This approach demystifies the sensations we've labeled as pain, reframing them as part of our body's broader context of response.

Moving Forward

"Back to the Body" heralds a return to physiotherapy's roots, enriched by our journey through the realms of psychology and neuroscience.

It's a call to embrace the body's complexity, leveraging science and technology to deepen our connection with ourselves.

As we chart this new course, we embrace a model of care that is both empowering and educative, one that places the patient's experience at the forefront of the healing process.

In doing so, we not only address pain more effectively but also foster a holistic sense of well-being.

Daniel O’Grady

Could Qi Gong help with chronic pain?

As a physiotherapist, I'm always on the lookout for holistic approaches to complement traditional pain management techniques.

Qi Gong, an ancient Chinese practice that combines movement, breathing, and meditation, has shown remarkable benefits for individuals experiencing pain.

Here, I'll discuss three key benefits of Qi Gong that can be particularly helpful for those seeking relief from chronic pain conditions such as Fibromyalgia.

1. Enhanced Circulation: The Foundation of Healing

One of the primary principles of Qi Gong is the promotion of Qi, or life energy, throughout the body. This concept, while rooted in traditional Chinese medicine, parallels the Western understanding of the importance of circulation for health and healing.

The Qi Gong Approach to Circulation

Qi Gong exercises are designed to gently stimulate and encourage the flow of blood and lymphatic fluids. This is crucial because good circulation is essential for delivering nutrients to tissues and removing waste products that can contribute to pain and inflammation.

How It Helps with Pain

By enhancing circulation, Qi Gong can help reduce muscle stiffness and promote healing in injured tissues.

For individuals with conditions like arthritis or peripheral neuropathy, improved blood flow can lead to a reduction in pain and a greater range of motion.

2. Breathing: The Rhythm of Relief

Breathing is at the heart of Qi Gong practice.

The slow, deep, and intentional breaths characteristic of Qi Gong can have a profound impact on pain perception.

The Qi Gong Approach to Breathing

Qi Gong breathing techniques emphasize diaphragmatic breathing, which encourages full oxygen exchange and activates the parasympathetic nervous system, often referred to as the "rest and digest" system.

How It Helps with Pain

This type of breathing can help reduce the 'fight or flight' response, which is often heightened in people with chronic pain.

By promoting relaxation and reducing stress, Qi Gong breathing can help alleviate muscle tension and pain.

Additionally, the increased oxygenation of the blood can improve energy levels and facilitate the body's natural healing processes.

3. Regulating the Nervous System: The Path to Balance

Chronic pain is often associated with dys-regulation of the nervous system.

Qi Gong's meditative movements and focused breathing can help restore balance to the nervous system.

The Qi Gong Approach to Nervous System Regulation

Qi Gong practices encourage mindfulness and present-moment awareness, which can help shift the body away from the stress response and towards a state of equilibrium.

How It Helps with Pain

Regular Qi Gong practice can help downregulate the sympathetic nervous system (responsible for the 'fight or flight' response) and upregulate the parasympathetic nervous system, leading to a calming effect on the body.

This shift can be particularly beneficial for people with pain conditions, as it can reduce the sensation of pain, improve sleep quality, and enhance overall well-being.

The Intersection of Qi Gong and Fibromyalgia Management

Understanding Fibromyalgia and Autonomic Dysfunction

Fibromyalgia (FM) is a complex chronic condition characterized by widespread pain, fatigue, and a host of other symptoms that collectively degrade the quality of life.

Recognized in the early 1990s, FM is often seen alongside conditions like chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS), leading to the concept of central sensitivity syndromes (CSSs).

The underlying mechanisms of FM involve central pain pathway sensitization, stress response system dysregulation, genetic factors, and psychological influences.

The autonomic nervous system (ANS), which regulates vital functions like blood pressure and heart rate, has been implicated in FM due to its dysfunction.

Studies suggest a predominance of sympathetic nervous system (SNS) activity and a reduction in parasympathetic nervous system (PNS) activity in FM, which may contribute to the condition's symptomatology.

For individuals with FM, regular Qi Gong practice has shown consistent improvements in pain, sleep, and mental and physical function, with benefits persisting for months after the practice.

The Research on Qi Gong and FM

Research indicates that the benefits of Qi Gong are related to the amount of practice, with those adhering to a regular routine experiencing more significant improvements.

Systematic reviews and meta-analyses of Qi Gong for FM have been cautious but generally positive, although they often call for more stratification in trials based on the amount of practice.

Qi Gong's Mechanisms of Action

Contemporary theories suggest that Qi Gong may work through neurochemical, neuroendocrine, and neuroplastic changes, as well as through mind-body regulation within a biopsychosocial model.

Specifically, Qi Gong may regulate the ANS, enhancing PNS activity and sympatho-vagal balance.

Qi Gong and Vagal Nerve Activity

The vagus nerve, a crucial component of the PNS, plays a significant role in maintaining homeostasis and regulating pain and inflammation.

Qi Gong is thought to increase PNS activity and thus could potentially benefit the core symptoms of FM by interacting with the dysfunctional system.

Studies on vagal nerve stimulation (VNS) have shown promising results in FM, suggesting that Qi Gong's effects may be partly due to its influence on vagal activity.

Future Directions and Clinical Implications

The potential of Qi Gong to improve parasympathetic activity and autonomic function in FM is an exciting area for future research.

Studies should aim to assess the therapeutic regimens of Qi Gong on symptoms and autonomic parameters, exploring the durability of these effects and their clinical significance.

Conclusion

As a physiotherapist, I find Qi Gong to be a valuable addition to a pain management program.

Its focus on circulation, breathing, and nervous system regulation can provide a multi-faceted approach to pain relief.

For those living with pain, Qi Gong offers a gentle, yet powerful way to take control of their health and find relief.

It's a practice that not only eases the physical aspects of pain but also nourishes the mental and emotional sides, offering a comprehensive path to healing.

Want to try it for yourself?

One of my favourite online Qi Gong instructors is Jeff Chand. He has some simple youtube videos and he teaches in a very relatable and light hearted manner.

Check out the link below:

What’s been your experience with Qi Gong? I’d love to hear from you in the comments below…

Expanding Your Perspective: The Power of Aerobic Exercise in Alleviating Neck Pain

Introduction

Imagine you're faced with a classic puzzle known as the "9-dot problem” (see below).

The challenge is to connect nine dots arranged in 4 straight lines without lifting your pen.

Give up? See the solution below…

Most people struggle with this task because they attempt to solve it within the confined boundaries of the grid.

But here's the twist: the solution requires you to think outside the box, literally!

Thinking Outside the Box

This concept of "thinking outside the box" translates beautifully to another common problem: persistent neck pain.

Instead of merely zooming in on the neck itself, we'll explore a groundbreaking study that shows how incorporating aerobic exercise – a step outside the box – can lead to significant relief.

The Neck Pain Conundrum

Neck pain affects a substantial portion of the population, and the quest for a solution is often met with frustration.

Individuals dealing with neck pain might find themselves in a never-ending loop of shot term quick fixes that, at best, offer temporary relief.

However, the key to solving this puzzle for good might actually be to stop focusing exclusively on the "pain area."

The Study Setup

In March 2020, a study was conducted to assess the impact of aerobic exercise in conjunction with neck-specific exercises for individuals suffering from neck pain.

This prospective double-blind randomized controlled trial was carried out in physiotherapy outpatient clinics, involving patients with nonspecific neck pain.

The Intervention: Inside and Outside the Box

Participants were randomly divided into two groups:

1. The first group underwent a six-week regimen of neck-specific exercises. This represents the conventional "inside the box" approach.

2. The second group received the same neck-specific exercises, but with an intriguing twist – they also incorporated aerobic exercise (AE). This represents the "outside the box" thinking, looking beyond the neck alone.

   The Aerobic Exercise (AE) program consisted of a moderate cycling exercise x 2 per week (60% of the age-predicted maximum heart rate) for 20 min during the first week, 30 min during the second week, and 45 min during the third to sixth weeks

Measuring Success: Multiple Angles

To evaluate the effectiveness of these treatments, an array of outcome measures was used, including the Visual Analogue Scale (VAS) to assess pain intensity, the Neck Disability Index (NDI) to evaluate how neck pain affects daily activities, the Fear Avoidance Beliefs Questionnaire (FABQ) to assess the impact of fear on pain-related behaviors and beliefs, and an evaluation of cervicogenic headaches.

These assessments were conducted at three crucial time points: at six weeks, then at three months, and again at six months post-interventions.

Astounding Outcomes

The results? They're nothing short of astounding!

• The group that performed Aerobic Exercise achieved a whopping 77.4% success rate at the six-month follow-up, in stark contrast to just 40% in the control group.

• A substantial reduction in VAS scores was observed in the AE group, plummeting from 6.73 to 1.89, while the control group's improvement was less pronounced, with scores moving from 6.65 to 3.32.

• The AE group showcased remarkable improvements in NDI and FABQ scores within the first six weeks. For NDI, scores decreased from 16.10 to 7.78 in the AE group, compared to 17.01 to 11.09 in the control group.

• FABQ scores exhibited a similar trend, dropping from 33.53 to 20.94 in the AE group and from 33.45 to 26.83 in the control group within the same timeframe.

• Cervicogenic headaches, a common issue among those with neck pain, also saw a significant reduction in the AE group from baseline to six months.

The Game-Changing Conclusion

This groundbreaking study concludes that adding aerobic exercise to long-term neck-specific exercises is an effective and promising treatment for reducing neck pain and related headaches in patients with nonspecific neck pain.

The key takeaway here is the power of thinking beyond the immediate problem area and embracing a holistic approach to solving the puzzle of neck pain.

Zooming Out for a Holistic Solution

Much like the "9-dot problem," which demands expanding your perspective to find the solution, neck pain requires a broader approach.

Instead of focusing solely on the neck, a combination of neck-specific exercises and aerobic exercise yields outstanding results, offering hope for those grappling with neck pain.

Whilst this study the participants all used cycling as a form of aerobic exercise - the beauty is you could choose any form of exercise you enjoy - whether it’s jogging, walking, swimming, lawn bowls, hiking, gardening or pickleball.

The key is trying to get your body into a low to moderate intensity - around the Zone 2 mark.

You can measure this with a heart rate, RPE or use the ‘talk test’ as a guide.

The goal is to challenge the heart and lungs to continue to feed muscles with nutrients for longer periods of time (20 minutes to an hour or longer).

By considering a more holistic approach, we can finally connect the dots and find relief beyond the box we've been stuck in.

Always consult a healthcare professional before starting any exercise program, especially when dealing with pain or injury.

Wanting to get started on your journey to find relief from neck pain?

#NeckPainRelief #AerobicExercise #HolisticApproach

Research Link

The effectiveness of an aerobic exercise training on patients with neck pain during a short- and long-term follow-up: a prospective double-blind randomized controlled trial

**Solution - ONE of the possible solutions to the 9 dot puzzle:

Is there a perfect posture?

“Our bodies love to relax” - Professor Peter O’Sullivan

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A really interesting conversation where the topic of ‘good’ posture while sitting is discussed.

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(Important) take home message

Don’t let anyone tell you there is a thing such as a ‘perfect’ posture.

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Regular change of position (including sitting back and relaxing in your chair) is an important part of having a healthy spine Listen to your body for its cue that it’s time to move.

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If you’ve had persistent back pain this podcast episode is absolute must!

5 Ergonomic Tips To Get Your Home Setup Correct

With many of us working from home, now would be a good time to get you set-up correct.

Avoid the common neck and back strains that we commonly see in the clinic.

Prevention is better than cure!

1. Monitor at eye level

• Adjust the monitor height so that the top of the screen is at—or slightly below—eye level.

• Your eyes should look slightly downward when viewing the middle of the screen.

• Position the monitor about an arm's length distance from your eyes.

2. If you’re sitting, find a decent chair

• Adjustability - Check to see that seat height is adjustable.

• Seat height range - Ideally, sit with your feet on the floor or on a footrest

• Backrest - The chair should have a reasonably firm backrest and is of an appropriate height and width to provide support.

• Seat surface – The seat surface should be comfortable, usually made of breathable materials that minimize heat and moisture buildup.

• Armrests – armrests should provide support and evenly support the arms.

• Stability - Check for the stability of the chair; a five-point base is recommended.

If you are keen to be more active, here are some other options you could try out:

3. Identify the early warning signs of pain caused by long periods without moving

One of the keys to staying pain-free is learn to sense when the muscles in the body are starting to get tense.

Muscular pain is most often caused by a mild oxygen deficit, brought about by staying in one position for too long, with a subsequent drop in blood flow and oxygen.

A completely harmless situation, but can still can be very painful and un-nerving.

If you can identify the early phases of this process and take action (e.g. taking a break and regaining some blood flow), you can then avoid the full blown cascade of seriously aggravated muscle.

To sum it up, the longer we ignore our bodies and the longer we abuse our muscles through prolonged inactivity - the harder it is to get them back into a state of balance and harmony.

Some tips for sensing the early stages of muscle tightness:

• mild soreness in the muscle

• mild headache

• mild pins and needles

• poor concentration

Other ways that can help refine your sensing capabilty:

• getting a regular massage

• foam roller daily to release the muscles and joints (especially upper back)

• do yoga, pilates or gym/running and pay attention the sensations you feel without judging, labeling or analyzing.

4. Movement Snacks

The World Health Organisation recommends a three minute break every 30 minutes.

You can get creative and try some of the games below.

If you want to try and basic Pilates workout, below is a 7 minute workout —>

5. Don’t worry about ‘bad’ posture

It may be surprising, but there is little evidence to suggest there is a ‘perfect ergonomic posture’.

Research has shown that sitting in a slumped (but relaxed and comfortable) position for short periods can actually relieve pressure and stress off the lumbar discs.

Becoming stressed about trying to find the perfect posture may lead to excessive tension and pain.

Instead, try and stay relaxed, no matter what position you may find yourself in, and remember to change positions frequently.

Already in pain?

If you are in the unfortunate situation of already having pain it is recommended that you address all the above steps as a priority.

It is also advised that you use heat packs to increase blood flow to tight muscles.

Most importantly, if your pain continues, please seek a personalised physiotherapy management plan that will may include specific stretches and strengthening exercises, adjustments to your desk and correction of your posture.

Physiotherapy can also provide you with some hands on treatment which may include soft tissue massage, joint mobilisation and dry needling to help settle the pain.

Early intervention is the key to ensuring your pain is managed effectively and will normally mean less physiotherapy treatment is required in the long run.

Please don’t hesitate to contact us dan@kinfolkwellness.com.au

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