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…

Demystifying Noisy Knees

Demystifying Noisy Knees: A Physiotherapist's Perspective

Noisy knees, characterized by sounds such as cracking, clicking, and popping, are a common phenomenon affecting up to 70% of the population.

Recent research conducted by La Trobe University has shed light on this prevalent issue, highlighting the impact of online misinformation on individuals' health choices.

In this blog, we will delve into the findings of this study, led by Dr. Danilo de Oliveira Silva, and explore the implications for both patients and healthcare professionals.

The Prevalence and Misconceptions of Knee Crepitus

Knee crepitus is a term used to describe the sounds that occur when the knee joint moves.

Despite its widespread occurrence, there is a significant lack of credible information available on the internet.

Dr. de Oliveira Silva and his team at the La Trobe Sport and Exercise Medicine Research Centre have found that many people are influenced by this misinformation, leading them to make poor health decisions.

The Impact of Online Misinformation

The internet is a go-to source for health information for many individuals.

However, the study conducted by La Trobe University reveals that over half of the websites evaluated did not provide evidence-based information.

This misinformation has led to a variety of misconceptions about knee crepitus, with some people believing that these sounds are harmful to their health or a cause for embarrassment.

The Research Findings

The research team conducted a comprehensive appraisal of the top 20 URLs from two popular search engines, Google and Bing. Out of 120 websites, 51 were evaluated for credibility, accuracy, and evidence support.

The results were alarming, with a significant number of websites providing information that was not backed by research evidence.

The study found that many websites suggested treatment options such as exercise, medication, passive treatments (brace, ice, splints), and rest, despite there being no research evidence to support these recommendations. This highlights the need for caution when seeking web-based information about knee crepitus.

Moving Forward

Dr. de Oliveira Silva emphasizes the importance of conducting further clinical studies to explore the impact of knee crepitus on individuals' health.

He advocates for the inclusion of patients and health professionals in designing research questions to ensure that the information provided is relevant and credible.

Take Home Message

As a physiotherapist, it is crucial to guide our patients towards evidence-based information and help them make informed decisions about their health.

The study conducted by La Trobe University serves as a reminder of the pervasive nature of online misinformation and the need for critical evaluation of web-based health information.

Let us commit to providing accurate, reliable, and evidence-based information to our patients, empowering them to take control of their health and well-being.

References:

Study in Science Direct: “My knee is cracking” – What information is available on the internet about it? A systematic appraisal of the credibility, readability and accuracy of online information about knee crepitus. Dr. Danilo de Oliveira Silva, La Trobe Sport and Exercise Medicine Research Centre.

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 Dry Needling Safe during Pregnancy?

Pregnancy is a time of numerous questions, especially when it comes to healthcare practices like dry needling.

Many individuals, upon discovering their pregnancy, may wonder whether they can continue or start dry needling treatments during this time.

To provide clarity, we will explore the safety of dry needling during pregnancy, keeping both clinicians and patients in mind.

Understanding Dry Needling during Pregnancy

First and foremost, it's essential to acknowledge that dry needling during the first trimester is considered contraindicated.

Although there is no concrete evidence that it would necessarily create harm, this trimester is characterized by the highest incidence of pregnancy complications.

A Closer Look at the First Trimester

The first trimester, spanning from conception to about 12 weeks, is a critical period of fetal development.

During this time, the risk of complications is comparatively higher, and it's essential to err on the side of caution.

As clinicians, our primary responsibility is the well-being of both the expecting mother and her developing child.

Given the limited research on the safety of dry needling during this phase, it's advisable to avoid it.

There are many other techniques that can be safely administered, apart from dry needling.

The Safety of Dry Needling in the Second Trimester

Conversely, there is some evidence to suggest that dry needling during the second trimester can be performed safely.

As the pregnancy progresses, many of the critical developments have already occurred, and the risks associated with certain complications decrease.

However, even during the second trimester, careful consideration is vital.

Dry needling should only be administered by a qualified practitioner who is well-versed in prenatal care and understands the unique needs of pregnant patients.

Conclusion

The safety of dry needling during pregnancy is a topic of concern for many patients and clinicians alike.

While the practice is generally discouraged during the first trimester due to the heightened risk of complications, the second trimester may offer a more suitable window for treatment.

However, safety should always be the guiding principle, and any decision to proceed with dry needling during pregnancy should be made in consultation with a knowledgeable healthcare provider.

Unraveling the Metabolic Basis for Tendon Pain

Tendon pain, particularly chronic Achilles tendinopathy, is a challenging condition that can disrupt an active lifestyle especially for runners.

In recent years, researchers have delved into the metabolic underpinnings of tendon pain, shedding light on the role of lactate concentrations.

The Lactate Connection

Lactate, a compound associated with muscle fatigue and soreness, has emerged as a crucial factor in the study of painful chronic Achilles tendinopathy.

A study utilizing microdialysis techniques revealed higher concentrations of lactate in Achilles tendons afflicted by tendinopathy compared to healthy, pain-free tendons.

The significance of this finding lies in the revelation of anaerobic conditions within the painful tendon area.

Understanding the Results

The study's results are a piece of the intricate puzzle of tendon pain.

Let's break down what we can glean from this research:

1. Lactate Accumulation: The higher concentrations of lactate in painful tendons suggest that anaerobic conditions prevail in the affected area. This accumulation of lactate reflects a metabolic imbalance within the tendon, which may contribute to pain perception.

2. Tendon Structure: The study noted structural changes and widening of the tendon in cases of tendinosis. These observations are vital in understanding the pathological processes at play in chronic Achilles tendon.

A Holistic Approach to Tendon Pain Management

Understanding the metabolic basis of tendon pain is just the first step.

To effectively manage and alleviate this pain, we must take a holistic approach:

1. Training Load and Periodization: In the world of sports and physical activity, it's essential to adopt a balanced training load. The 80/20 principle, where 80% of training is in zone 2 (aerobic), can help minimize the risk of overuse injuries like tendinopathy.

2. Lactate Clearance: Optimal lactate clearance is key. Encourage activities that enhance lactate clearance, such as low-intensity exercise, adequate recovery periods, and proper hydration.

3. Therapeutic Modalities: Various therapeutic modalities can play a role in tendon pain management. These include massage, dry needling, and foam rolling, which can aid in reducing muscle tension and promoting blood flow to the affected area.

4. Liver and Kidney Health: Metabolic health is crucial. Liver and kidney health is vital for efficient metabolite clearance, including lactate. Ensure a balanced diet, stay hydrated, and minimize excessive alcohol consumption to maintain these organs' well-being.

5. Hydration: Proper hydration is essential to support overall metabolic processes, including lactate clearance. Staying adequately hydrated aids in reducing the risk of metabolic imbalances contributing to tendon pain.

Conclusion

The metabolic basis for tendon pain, as revealed in the study, offers valuable insights into the pathogenesis of chronic Achilles tendinopathy.

However, it's only one piece of the puzzle. To effectively manage tendon pain, we must adopt a holistic approach.

This approach includes optimizing training load, prioritizing lactate clearance, and utilizing therapeutic modalities to promote pain relief.

Furthermore, maintaining overall metabolic health through hydration and balanced nutrition is paramount.

As we continue to unravel the intricate nature of tendon pain, adopting a holistic approach can help individuals regain their active lifestyles and harmonize with their bodies' natural healing mechanisms.

Research link: High intratendinous lactate levels in painful chronic Achilles tendinosis. An investigation using microdialysis technique