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!

Why you might be feeling more niggles than ever

With all the uncertainty in the world, this months blog takes a broader view of health and wellness. I hope you get some value out of it and would appreciate any feedback in the comments section below.

Warning !

Pain can be coming from a red flag sign - things like a broken bone, inflammatory arthritis, cancer or organ disease.

Please ensure you have a full and thorough examination with your doctor and continue to follow up if your symptoms have not improved or don’t make sense to you.

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Another warning….

This blog is very long.

It could well have been a short book.

And I did consider dividing into 3 parts.

But in the age of Netflix binging, I decided to keep it as one long one.

Up to you if you want to read all in one go or break it up a bit.

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The 1 Minute Summary:

• you may be noticing more pain than usual lately since the COVID pandemic

• pain is related to the perceived threat of tissue damage, not actual tissue damage

• once a threshold of perceived threat is reached, pain is produced

• perceived threat can come from physical, mental and emotional sources

• just understanding and becoming aware of this process can be enough remove a significant part of your stress response and keep you under the threshold of pain

Who this blog is for:

Full disclosure, this blog isn’t for everyone.

But,

If you are someone who:

• experiences ongoing pain flare-ups and confused as to why

• experiences ongoing widespread muscle tension e.g. neck, back, jaw, hip flexors

• you’ve tried every stretch under the sun, and continually still feel tight

• had a thorough medical screening with your GP with no sign of any red flags

• is curious to learn the about the deep causes of ongoing pain and want to empower yourself with knowledge

• previously had a severe episode of pain and want to learn how to avoid in the future

• has seen many health care professionals over the years and only ever get short term relief from your symptoms

• has ongoing headaches, and especially if related to monthly cycles

Then please read on, the following information may help you steer back in the right direction.

One more thing…

If you prefer listening to podcasts or watching youtube clips, then please click HERE for some more options.

**As usual, this blog is for general information purposes and everything written below may not apply to your situation. If you have any specific questions, please talk with your health care professional for more specific advice.

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Why you might be feeling more niggles than ever

…(grab yourself a cuppa!)

My road to learning about more about pain

In 1997 I began studying Physiotherapy at the University of South Australia (yes…feeling a little old right now!).

Since then, my interest in the human body has grown exponentially. One thing I can say for sure is that we are incredibly well designed creatures.

The way everything works in harmony most of the time, without our awareness is a genuine miracle.

If you ponder the billions of processes that are going on to keep us healthy and alive, it really is amazing.

“There are two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.”

— Albert Einstein

It’s quite the humbling feeling when, the more you learn and experience, the more you realize how much you don’t know in the vast scheme of things.

“Sell your cleverness and purchase bewilderment”

— Rumi

And this thing we experience called pain is an amazing, complex and curious feeling that can help protect us from many dangers.

The feeling of curiosity about what is actually happening in your body can evoke a life changing journey of transformation.

Townsville

I am so old, this picture was taken in black and white!

My first job in private practice was up in Townsville.

I loved the work and thrived on the adventurous outdoors lifestyle, spending the weekends exploring the North QLD region.

I also meet lots of cool people - one of the them ended up being my wife!

Starting out in private practice is a steep learning curve for most Physio’s.

The undergraduate degree has a very broad education, so there is a lot to learn in your special area of interest after you graduate.

Back in the day, the teaching was mainly centered on a biomedical medical that focused on the tissues. I studyied at UniSA, where Geoff Maitland’s model of care, (based on manual therapy) was considered best practice.

I loved turning up to work everyday… and thank-fully most of my patients seemed to get better.

But there was a certain percentage of people who I wasn’t able to help (or even made worse).

People presenting with ongoing, complex pain made me feel completely out of my depth.

I felt frustrated and confused. This led me on a journey to learning more specifically about pain.

Lorimer Mosely - check out his entertaining talks on youtube

At the 2008 Australian Physiotherapy Conference in Cairns, I vividly remember plonking myself down in the audience, near the front of the stage, for the keynote speech on Day 1.

Lorimer Mosely was them first speaker and in under an hour was able to blow us away with his new and exciting on research about pain and how we can best serve our patients.

In then attended David Butler’s Explain Course at the Adelaide NOI headquarters. Again - some career changing information I learnt and helped give me the tools to have better understand complex pain presentations.

NOI headquarters in Adelaide, South Australia - one of the coolest Physio clinics you will ever visit

In 2019, I was fortunate to hear Lorimer speak again at the Physio Conference in Adelaide and it was great to hear him reflect on the journey of explaining pain - the highs and lows which I’ll touch more on later.

The things I have learnt about pain have changed the way I approach Physiotherapy - and provided a greater understanding of how the nervous system processes injury, disease and pain.

But it’s also helped me personally when I’ve had various pain episodes over the years.

This blog post is an attempt to articulate some key messages about pain to help you.

Full disclosure

Our current current scientific understanding of pain doesn’t have all the answers.

I certainly don’t either.

In fact I am a huge skeptic and critically analyse all information that is out there.

Nonetheless, we have to act on a certain level of uncertainty, based on the best current available evidence.

I will be regularly updating this blog, as relevant comes to light, so feel free to check back here regularly.

The current problem with pain

1 in 5 people live with persistent pain.

Less than 10% get the help they need to recover.

Aside from the staggering numbers, chronic pain has a visceral affect on our daily lives, in the form of lost social connections, missed days work, inability to play with grand-children and reduced physical and mental vitality.

Ongoing pain creates uncertainty about the future and can lead to increased feelings of anxiety and depression.

So then, where does Physio fit in?

When you have ongoing pain, it is confusing to know who you are supposed to go and see.

There are lot’s of options -

• GP

• Physio

• Chiro, Osteo, Acpuncturist, Massage therapist

• Psychologist

• Pain specialist

• Yoga, pilates, personal trainer e.t.c.

To make things even more complex, when you go and see a Physio, there is no standard specialty training for helping people with persistent pain.

Which means that each individual Physio has their own unique interests, biases and approach.

Essentially there are three main areas of Physiotherapy focus:

• manual therapy

• strength and conditioning

• education / pain science evidence based

Nowadays, many Physios have a specific focus on only one of these specialties, meaning that you may not be getting the most appropriate approach for your individual needs. If you’ve this blog before, you would see I’ve written about manual therapy/dry needing and building capacity.

So this blog post is focused squarely in the education section…so here we go…

Top down vs bottom up

Education could be considered a ‘top-down’ approach, compared with addressing the tissues directly with manual therapy and exercise - that would be considered a ‘bottom up’ approach.

Like with anything, if we can address an issue from multiple perspectives, we can usually reach a better outcome.

Learning about pain is so important because our mindset can be a powerful contributor to our experience.

“Accurate knowledge is the greatest pain and stress liberator”

Most of us have around 60,000-80,000 thoughts per day (less if you follow Port Power 🤣 ).

If you are carrying around inaccurate or outdated beliefs, you may be carting a lot of unnecessary baggage, without even realizing it.

Carrying around unhelpful beliefs can really start to wear you down after awhile!

I am sensitive to your current beliefs and this blog is attempt to become more explicit in expressing some of the concepts I’ve been trying to make sense over the past 20 years.

Pain is always a very personal experience.

It’s always real.

Talking about contributing factors to pain can be one of the most difficult conversations and challenging topics to address, without being disrespectful or condescending.

When beliefs are challenged, one of the first reactions is to put up a wall of defense.

When you’ve had pain for long enough (and nothing else has worked) sometimes this can force us into becoming a bit more open to hearing about new concepts.

If you’re able to read, digest and reflect on some of the concepts presented, and see how they fit into your own life, I would be really happy with that outcome.

Ultimately, you know your body best…trust and have faith in it.

“Absorb what is useful, reject what is useless, add what is essentially your own” - Bruce Lee

Know pain, know gain

A basic knowledge and understanding about pain is something I believe everyone should have.

In particular, it is much better to know about pain before you have an episode of pain.

As once you’re in the eye of the storm it can be difficult to find your way out sometimes.

“Everybody has a plan until they get punched in the mouth”

— Mike Tyson

Studies have shown it’s really hard to learn when you’re in pain, stressed and anxious - not really the ideal situation to learn about important topics like pain.

Understanding pain changes how we experience pain.

Knowing about pain changes how we think about it, talk about it and ultimately how we go about treating it.

When learning takes place at a deep level, you can feel a lot more confident in your ability to handle all of the challenges that life throws at you.

Letting go of the war on pain

One thing needs clarification from the outset.

Pain is a normal and (mostly) rational experience.

It’s an important motivator that gets our attention and helps us to act to protect ourselves.

People who don’t experience pain can end of doing damage to their bodies…not ideal!

So the first step in healing is to fully accept your pain.

Your body is well meaning and is always trying to protect you, but as we’ll find out, sometimes it can be a little over-protective.

Fighting your pain only increases stress and anxiety and puts you at war with yourself.

So please be kind, gentle and patient with yourself.

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We are powerful healing machines

Take a moment to think about the last time you cut your finger.

For me it was just last week, slicing a piece of salmon as I was about to throw it on the grill.

It was a deep cut. Luckily my wife was close by and she was able to get a band-aid and strap it up nice and tight.

Without ever thinking about it, three days later - I took the band-aid off.

The deep cut in my finger had completely healed.

If you stop and think just for a moment how amazing our bodies are at healing.

There are powerful processes working day and night to effectively heal us when we injure ourselves.

Injuries can take various lengths of time to heal, but generally 3-6 months is the longest it takes to fully heal (see table below).

We are incredibly resilient creatures

As more research is being done, we are finding out that our bodies are incredibly resilient.

Something I find fascinating is that we can have all manner of structural and degenerative changes in our bodies and not ever know about it, because it never registers as a painful feeling.

For example, the picture below shows the percentage of people who went in for an MRI scan of their body and were found to have structural issues - but absolutely no pain.

For example:

• 43% of adults aged over 40 have signs of knee osteoarthritis on MRI but have no pain

• 19% have a tear in the knee meniscus and have no pain

• 87% of people have some form of disc bulge with no pain

• 96% of us have shoulder abnormalities and have no pain

• 68% have hip labral tears and have no pain

This indicates that many of these features—particularly when found incidentally — should not be considered pathological and instead be regarded as normal age-related changes.

Another study showed degenerative disc disease was found in 40% of Olympians in the 2016 Rio Olympics.

But how could people with so many structural issues be able to perform at the highest level, and not feel any significant pain?

I am fascinated by this question, and the rest of this blog will explore in more detail.

We’ll giving you some practical examples and also dive into some philosophical talk.

Like in the movie The Matrix, I’m about to give you the red pill. 

Grab yourself a stiff drink…you will need it!

Assuming you’ve seen The Matrix?

Old school thinking

Our old way of thinking involves a direct linear relationship between tissue damage and pain.

But this line of thinking is not fully accurate.

Our experience of pain is way more complex than that.

In fact, the longer your pain is present, the weaker the relationship with the tissues.

Here are true stories to get you thinking…

Some curious stories about pain

There was a story published in the British Medical Journal about a man working on a construction site.

He had an unfortunate accident where a nail ended up going straight through his boot.

Understandably he felt incredible pain and was rushed to the emergency department.

He was in a world of agony and required intravenous sedation.

The interesting thing was once the doctors pulled off his boot, they discovered the nail had passed right between his toes - and there was absolutely no damage at all.

The man’s agonizing pain was elicited solely by his thoughts about what had happened.

Another story…

My kidney stone

Back in 2014 my wife and I were living in New York City, I was getting a lot of ongoing back pain. My doctor decided to order an MRI.

On the report, the MRI showed a likely kidney stone that was around 10mm in diameter. They suggested a follow-up ultrasound to confirm.

Unfortunately I was traveling the following week, so I had to wait until I was back to get the ultrasound.

Let me tell you, that was one of the longest and most uncomfortable weeks of my life!

Being relatively young and healthy, I wasn’t too sure what the deal was with kidney stones and so I jumped on ‘dr google’.

I was horrified….

According to all reports, to pass a kidney stone was likely be an extremely painful process.

And my only other memory of kidney stones is when Kramer had one in Seinfeld.

I used to lie awake at night doing more research and scaring myself half to death. The thing that really concerned me was, how could this happen to someone so young?

I was confused, scared, angry and in a hell of a lot of pain.

The the follow-up ultrasound came around.

Good news the sonographer said.

“There is no kidney stone”.

Upon reviewing the scan, another doctor pointed out that the object they thought was a kidney stone turned out to simply be a knot in the gown I was wearing.

What do these stories tell us?

You can have pain without a tissue injury

The point here is you can experience full blown pain without any form of tissue damage.

The reason for this is that pain is not an accurate measure of tissue damage.

In fact it would be more accurate to say pain is a measure of threat of damage.

For example, violinists who injure their fingers are more likely to feel pain than non-violinists because they feel threatened their livelihood is at stake.

Phantom limb pain

Another interesting example of feeling pain without tissue damage is a thing called ‘phantom limb pain’.

In this case, people with amputations can feel severe pain in a limb that is not even there.

This gives us a very clear message that pain is a product of our nervous systems, not the tissues themselves.

On the other hand,

You can sustain an severe injury, and feel zero pain

Have you ever discovered a bruise or a cut that you didn’t feel?

This is the most common example of experiencing tissue damage without pain.

Nail in the head - a true story

This report in the USA Today mentioned a construction worker who had unknowingly shot himself in the head with a nail gun (see pic below).

Somehow, he was unaware of the injury and thought it was just a toothache.

He presented to a dentist (6 days later!), where the cause of the ‘toothache’ was discovered.

Other examples of when, despite serious tissue damage, there is no feeling of pain:

• Wim Hoff’s ability to sustain extreme cold and feel no pain

• women giving birth naturally without any pain medication

• 1989 footy grand final - Dermot Brereton getting hit in the opening seconds, sustaining 2 broken ribs, a bruised kidney and internal bleeding and managing to play on and kick 2 goals.

These stories fascinate me - examples of people undergoing severe stress and reporting no pain whatsoever.

With the above stories I hope I have convinced you that the relationship between pain and tissue damage is shaky, especially the longer you’ve been in pain.

I’d love to know…do you have a story that show pain and damage aren’t always linked?

I’d love to your story in the comments below.

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The biology of pain is never really straightforward, even when it appears to be

As pain persists, is thought more to do with a sensitive nervous system than the tissues themselves (see graph below).

“The longer the pain persists, the weaker the relationship between tissue damage and pain intensity”

— Lorimer Mosely

How the nervous system really works

Before we any further, I’d like you to take a look at the image below.

What do you see?

Are the circles REALLY moving? Look a little closer!!

If you are like most people, you can see the circles moving.

But when you look closely, this is an optical illusion and there is actually no movement happening.

This is an example of our brains making extremely quick decisions, based on the their perception of what is going on.

The brain is right to a certain extent - its reality is spinning circles.

But can you see how our brain can create an experience that isn’t actually there?

Some more examples:

How many circles do you see?

Pain and our nervous systems - Perception becomes reality

In these above visual examples, our brains take the information coming in from the eyes and then creates a story out of it (the visual illusion) in a split second, beyond our conscious awareness. 

The human brain is essentially an anticipation machine.

In chronic pain (that has persisted more than 6 months), this be a part of what happens.

The brain receives information from the bodily tissues, and creates the feeling of pain, based on the perception of threat in an instant in order to protect us.

The pain you feel ultimately comes back down to the amount of perceived of threat.

Beyond our conscious awareness, our nervous systems weigh up all of the credible evidence for safety and credible evidence for danger and makes a decision about whether to produce pain.

Persistent pain (beyond normal healing times) is an example of our brains perceiving and creating a reality that isn’t 100% accurate.

I would like to stress at this point, that pain is always real, but it is not always directly correlated to the damaged tissue. Rather it is a reflection of a heightened state of sensitivity in your system.

For optimal healing, you need a balance of sympathetic and para-sympathetic time

Sensation vs Perception

Our brains are continually receiving millions of sensations from our internal structures such as muscles, tendons, nerves and skin e.t.c.

Thankfully, 99% of the time, we aren’t aware of these sensations.

Importantly, we can have structural issues such as joint degeneration, tight muscles, cuts, bruises, disc bulges and nerve compression that are all feeding sensation back in the spinal cord and brain, and we don’t have any idea about them.

Here is where it gets interesting!

At the level of the spinal cord, there is a switch that can amplify the sensations coming into the brain.

What amplifies our sensation is dependent on the state of our nervous system.

And by nervous system, we are specifically referring to the autonomic nervous system that is made up of the sympathetic (fight or flight) and para-sympathetic (rest and digest).

When our sympathetic nervous system is activated to certain threshold - we feel an amplification of the incoming sensation - that is often felt as the feeling of pain (see picture below).

When our nervous systems are in a calm state - we will most likely still feel some pain from an injury.

But you would perceive it as a mild sensation, without fearing it and gradually return to normal life fairly quickly.

But when we our fight or flight system has been triggered, we can become more fearful of the pain, stop moving and become de-conditioned quickly.

If we get a scan early on after our injury, we can easily attach our pain to structural changes on our scans. Obviously this is very important for acute, traumatic injuries, but for persistent pain the lines becomes blurred.

It can sometimes be very hard to ‘un-see’ a scan and erase this pattern of negative belief about our bodies being damaged, vulnerable and weak.

Sensitive Alarms

To understand chronic pain more simply, think of a house with a security alarm set up.

After the house was burgled a few months ago, the owners decided to set the alarm’s sensitivity to high so they could detect an intruder.

Instead of an intruder though, every time the wind blew strongly it would - setting off the alarm system.

The owners woke up to the alarm and prepared for a ‘fight-flight’ situation.

But each time the alarm went off, they didn’t find anything wrong.

After an injury, the body is biologically wired to act like a sensitive alarm system - magnifying small normal niggles.

This is a normal and healthy protective response.

For some people though, while the original injury can heal (normally taking no longer than 3-6 months), this protective response (highly sensitive alarm system) can remain in place indefinitely.

This can lead to overwhelming sense of anxiety and fear, that can turn into a downward spiral of inactivity, de-conditioning and eventually more pain.

Pain spiral

Fearing structural damage can lead to a fear of movement, as every movement hurts.

Lack of movement leads to reduced blood flow.

This can lead to an imbalance in neuro-transmitters (no pain relieving endorphins) which can make you feel pretty lousy.

De-conditioning sets in quickly and it can lead to a loss of confidence.

A spiral is created and can sometimes spin out of control.

Some people turn to stronger and stronger medications that can help short-term, but long term have quite adverse outcomes.

A scary but very real documentary about the addiction to opioids can be viewed here (warning - footage is disturbing).

OK, we’ve introduced some rather heavy concepts, let’s lighten things up a little…

Have you ever felt ‘hangry’?

At the 2019 Australian Physio Conference, Dr Tasha Stanton gave the example of what happnes when you get cut off in traffic.

In normal circumstances, you will feel a bit peeved off, but brush it off pretty quickly.

But if you haven’t eaten for a few hours and you’re ‘hangry’ (hungry + angry) then all of sudden you really lose your temper and find yourself revved up for the rest of the drive home.

Obviously you’re not a bad person when you’re hangry.

It’s just that your system is on edge and sometimes a small trigger can make us explode.

The feeling of pain is much the same.

So back to our original question - why do some people feel pain in the presence of normal degenerative changes and others do not?

We know that it’s not the age-related changes in bodies that is the real issue.

An initial injury may have sparked a spot fire, but in people with ongoing pain, it is differences in their physiology (over-active sympathetic nervous system) that fuels the the raging fire.

The modifying factor is the state of the nervous system.

And ultimately, things hurt more when you aren’t sure if you’re safe.

What triggers the sympathetic nervous system?

The brain is constantly monitoring the internal and external environment for signs of danger.

The sympathetic nervous system becomes activated when the sum of the perceived threats reaches a certain threshold.

So what could be increasing perceived threat?

This is where it gets really interesting (see graph below).

Never forget this picture!

An overflowing bath tub

Imagine a bath tub that is full to the brim with water (your current life stress).

Then you add a bit of water that makes the bath overflow.

In terms of pain, the extra bit of water may have been a minor injury such as picking up something off the floor or sitting in the wrong chair. The underlying issues have been building up and often it’s the straw the breaks the camel’s back.

Unfortunately though many of us get distracted by the extra bit of water, rather than seeing the bigger picture of the underlying issues that may have been building up over months or years.

Our perceived stresses all add up

Sometimes it’s lots of small perceived stresses that add up or it can be one very large one.

Below are some examples of things that can activate the stress response.

Please be aware that uncovering some of your stresses may bring about some unwanted negative mental states. If feel you like need some support, please speak with your GP or call Lifeline on 13 11 14

Physical stress

• over-exercising causing an injury

• lack of movement - sitting too much

• sudden spikes in training load (too much or too little) can freak out the tendons - they hate change

• inadequate nutrition (lack of protein, carbohydrates or skipping meals causing low blood sugar)

• other nutritional deficiencies

• ill fitting clothing or equipment e.g. wearing overly worn or unsupportive footwear

• poor sleep is known to decrease pain threshold

• anemia

• taking medications such as opioids (can cause a long-term increase in pain)

• smoking

• inadequate core stability - the nervous system will perceive this a potential threat and tighten up your muscles instead

• poor aerobic capacity

• sub-optimal gut bacteria colony

• auto-immune dysfucntion

Mental stress

• feeling anxious about an injury - fear of doing more damage

• confusion of diagnosis - many different opinions leading to fear and anxiety about what is going on

• consulting Google with a minor niggle, and freaking yourself out with all of the extreme things that it could be

• scan findings not given in context (giving you the false belief that faulty structures are the cause of your pain). It is important to talk with your health care provider about the difference between a serious pathological change on scan vs a age-related change

• being told your hips are out of alignment or your ‘spine is out’ making you feel fragile and afraid - unfortunately there is a word for this and it’s called a ‘nocebo’. Be careful who you listen to. Well meaning clinicians can unknowingly set you up to fear moving your body.

• being told be a health care professional to strictly avoid certain movements e.g. never sit relaxed in a slump position. This can lead to constant ‘over-protective’ behaviour such as sitting up straight rigidly, overloading the muscles in the back

• fear your current injuries will get worse as you get older

• Lorimer Mosley at the 2019 APA conference was humble enough to admit the attempt to educate people on pain can back-fire e.g. after hearing a pain science education talk, a man was heard to say despondingly, “the disease has got into my brain now”. Not an ideal outcome at all. Words are extremely powerful and the stories we tell ourselves can have a huge impact on the quality of our lives

• financial hardship

• over-worked - no time to hear the messages your body is trying to communicate

• no down-time

• caring for young children or elderly parents

• parent or friend who had a similar injury and you’re worried about ending up in the same boat

• personality traits - e.g. perfectionism, type A personality, people pleaser, stoic, anxious, low self-esteem

• going on holidays - have you ever noticed your niggles seem to go away when you have a break from all of your daily stresses?

Emotional stress

• Lack of social connection

• poor quality relationships

• passing of a loved one

• divorce

• etc

Our ancient biology

We must remember our history and that our nervous systems are ancient.

We have bodies and minds that have evolved over 2 million years and have been shaped by the natural environment.

Imagine our human ancestors being plonked into our modern world and the stresses that are placed on them.

As Daniel Liebermann explains in his book, The Story of the Human Body, there is a mismatch between what our DNA is designed for and how we live our lives.  It is not hard to be overwhelmed with stress and tension that presents itself in many different ways.

The rapid and severe changes in our environment in the past 200 years have no doubt made our lives more livable.

But that has come at a cost of increased stress on our nervous systems:

• technology all pervasive

• increased work, lack of connection with nature

• highly competitive capitalistic society

• convenience of cars, elevators e.t.c meaning we are generally less active

• junk food and many toxic chemicals in our environment

All of these add a tax of load that must factor into the equation as to why we have a chronic pain epidemic going on in our society.

We have to over-ride our instincts here and know even like it looks like the circles are moving, they are not.

When it comes to pain, everything matters

Pain can become persistent because perceived threats can often lurk in hard to find places.

Even memories can trigger a stress response.

For more info, I would encourage to read the excellent book, The Protectometer.

Let’s take a pause for a moment…

How are you feeling? Please take a moment to reflect and write down anything you have learned.


I know it’s a lot to take in.

We are on the home stretch, I promise…

deep breaths!

Why you are feeling more pain during COVID

Back to the point of this blog - the current situation with COVID is increasing our perceived threat levels to a huge degree, sensitizing our nervous systems so that mild niggles turn into more intrusive pain.

In terms of COVID, it’s not hard to see how we have had a spike in perceived stress and threats which may include:

• social restrictions - not seeing friends and family

• financial hardship and job insecurity

• relationship stress - higher divorce rates

• 24 hours alarmist news cycles

• constant adaptation to new changes in our lives

• fear of becoming seriously ill with a virus we can’t see

One study suggests the number of people displaying symptoms of anxiety, stress and depression in the community have risen between 13 and 21 per cent, while the other finds roughly one person in every five is now experiencing clinically-relevant depression symptoms.

Going back to our graph our above, we can see that this additional block of perceived stress puts our nervous systems ‘on edge’.

You can see how our normal niggles can re-appear, even if we haven’t changed anything else.

And if you happen to sustain a new injury, there is a chance you will be feel more pain than usual.

Let’s take a look at one of the biggest perceived threats that have come about since the COVID lockdown…

People feel more pain when they are feeling lonely

“To the brain, social pain feels a lot like physical pain”

Social connection is huge, and many of us have had to socially isolate for extended periods of time.

Studies have shown social isolation sets off responses in the body linked to survival tactics from thousands of years ago, proving that our bodies perceive loneliness as a life or death situation.

Having strong social bonds is as good for you as quitting smoking.

Connecting with other people, even in the most basic ways, also makes you happier—especially when you know they need your help.

Social connections are as important to our survival and flourishing as the need for food, safety, and shelter.

“To be kept in solitude is to be kept in pain”

— E Wilson

Other medical perspectives

When we look at some traditional medical perspectives, they can seem like they had this stuff figured out a long time ago.

For example, in Ayurvedic medicine which is 2000 years old, it is thought the nervous system correlates with the vata dosha being out of balance.

According to this research paper, the vata dosha correlates with fear, anxiety and pain.

Ayurveda links a healthy vata dosha with functions governing basic survival and homeostasis.

If you are unfamiliar with ayurveda, I would recommend you investigate some more, as it can be very interesting to see the body from a very holistic perspective. There’s a great book, Ayurveda and the mind, written by Dr David Frawley.

Becoming aware of when you are in sympathetic dominant state:

Signs of increased sympathetic activation can include:

• widespread, ongoing pain and muscle tightness

• jaw clenching

• neck and back pain with no relief from treatment

• inability to feel relaxed

• upper chest breathing, fast and shallow breaths or holding breath sub-consciously

• poor sleep - waking during the night and having trouble getting back to sleep

• IBS, immune related issues

• typical emotions in the early stages —> stressed, nervous and anxious

• typical emotions in the latter stages —> depression, mood swings, irritability, anger, frustration

• social withdrawal

• fatigue, memory changes, poor concentration, brain fog

• core and glute muscles stabilisers become inhibited

• tinnitus, vertigo and poor balance

Is there more to pain than damage?

Our nervous systems are originally wired to equate pain with tissue damage.

Think about when you are very young and first touch a hot surface - your nervous system reacts with a split second spasm to protect you.

From an early age, the nervous system is conditioned to think there is a direct link between tissue damage and pain.

So it can come as a surprise to learn that the pain you feel is often not due to tissue damage.

Here are three examples:

Muscles

This is a big topic, and will be a the subject of a future blog, so I will be brief here…

The muscle system is the largest single organ in the body and measures around 50% of our body weight.

When we’re in a sympathetic dominant state, our muscles are prepared to ‘fight or flight’.

We have 2 types of muscles:

• the fight / flight muscles that become full of tension preparing for battle. These would include the traps, hip flexors, lower back, ITB, jaw, pecs, SCM

• the deep stabilisers that aren’t really important in an emergency such as the deep core muscles, glutes and shoulder stabilisers tend to become inhibited

When our fight or flight muscles are contracted for ongoing periods of time (e.g. when the sympathetic system is continually being activated), then they start to tighten up and remain tight.

This eventually leads to a lack of blood flow and oxygen that sensitizes the muscle and can quickly lead to a spiral and pain and tightness.

Muscle tightness can be very painful, but it is completely harmless, as there is no structural damage, only a decrease in blood flow and oxygen, causing the pain. 

“Pain from the muscles is an often neglected but major cause of pain and dysfunction in the largest organ of our body ”

— Travell & Simons

Professor Janda originally proposed the theory of crossed syndromes (see below).

Diagnosis of muscular imbalances can follow basic patterns such as above.

But everyone has their unique movement signature, based on all of the subtle (and not so subtle) muscle system's reactions to injury, pain and activities over their lifetime.

A personalised assessment is the fastest way find about your particular patterns and get on the road to transfomation.

Inflammation

Inflammation around joints - especially the knees, ankles and shoulders can be a very common cause of pain.

It is quite amazing, even if you’ve had knee pain for some time, if you are able to decrease the inflammation by using ice and compression around the joint how you decrease the amount of pain your are in.

Stiffness / lack of blood flow

The belief that you are structurally broken or somehow defective lies at the heart of the chronic pain sufferer.

No wonder why you would be afraid to move, if every time you believe you might be somehow contributing to more structural damage.

Unfortunately not moving enough leads to stiffness in the muscles and joints.

And if you do decide to start moving again, it’s probably not going to be a very fun experience.

And most importantly not moving because of fear sends a strong message to your nervous system that you have to be even more careful and I mentioned already a spiral can develop.

Lack of blood flow means reduced oxygen to the muscles, nerves, organs and brain.

Getting moving again

One of the most powerful things you can do if you are in pain is to get creative and find a way to get moving.

The WHO recommends 30-60 mins of aerobic exercise / movement per day and this would be an excellent goal to gradually build towards.

It doesn’t matter what body part is affected.

There is always a way you get moving to get some blood flowing (and here is where you might need the guidance here of an experienced physio to help you choose an appropriate activity).

Here is where some appropriate guidance around pain during activity comes in handy.

Some people expect to feel no pain ever, and that can be a huge barrier to return to normal.

As you’re getting back into some activity after a break, we expect you to feel some niggles as the muscles and joints kick back into gear.

Using a traffic light analogy can be helpful:

RED LIGHT: STOP / ADJUST 7-10 pain level (0-10 scale). Danger zone. Potentially damaging to tissues and delay rehab. Pain can persist after you stop for hours, days or weeks. Get checked out immediately with health care professional.

ORANGE LIGHT: CAUTION - SLOW DOWN - MONITOR 4-7 pain level during activity (0-10 scale). Often done too much, too soon. Monitor the 24 hour response and if symptoms worse you may need to adjust intensity or volume. If no increase in symptoms over 24 hours, continue the course. Be prepared to use flare-up plan e.g. ice, rest, physio. Stay positive as entering this zone means you are making progress. Avoid negative words and thoughts.

GREEN LIGHT: CONTINUE 0-3 pain level (0-10 scale). Normal everyday niggles during activity. No worse over the 24 hour period. Safe to continue or gradually increase load.

Endorphins

As you increase your activity levels (with hopefully something you enjoy - with friends and perhaps some cheesy motivational music on spotify), all of a sudden you get a surge of endorphins.

Eye of the tiger…CRANK it!!!

Endorphins are your happy hormones and are actually much stronger than opioid medication (without the side effects).

Access your endorphins also helps to burn away the stress hormones such as cortisol and adrenaline that can keep you in a state of fight / flight.

There is hope

Here’s the thing - once you understand your pain, you can remove a large chunk of stress. And in an instant put you under the threshold of experiencing pain.

Confusion about your symptoms can cause a lot of fear, anxiety and stress.

Receiving an adequate explanation for why you hurt can instill emotions such as understanding, acceptance and clarity.

Where to from home - 3 key take away messages:

1. Understand that our experience of pain is gloriously complex and involves many systems, not just purely injured body parts. The context of injury is important as well as what you think, feel, say and what you do in your environment

2. Identify all the perceived stresses your life and deal with them as best you can. Sometimes it can be overwhelming when we initially learn about all of the stresses. Be patient with yourself and seek guidance - there is support out there.

   Most importantly, just becoming aware of your stresses and how they impact your pain levels can decrease the perceived threats and get you out of a chronic pain state.

   It’s the perceived threats that are living in hard to find places that can do you the most harm. These are often best explored with an experienced clinician with experience in this area.

3. With guidance from your Physio, gradually increase the physical activity you are doing - WHO recommends 30-60 mins of aerobic exercise daily and x 2 strength sessions per week. This will help keep your body moving, fit and healthy.

“Respect pain, don’t fear pain”

Pain and the nervous system

The curious thing is just becoming aware of how your nervous system works and knowing that you are structurally OK can help get you our of a chronic pain state.

Sure, identifying all of your perceived stresses and trying to do something about them can help.

But quite often we can’t do much about our daily stressors- for example if you parents to new children or caring for elderly parents, or in a stressful work situation everyday.

So you don’t have to get rid of them - just knowing about the real source of your pain and knowing that you are safe to move is important.

Here’s where a well rounded doctor and physio can work with you as part of your support team to properly educate you and gradually get you moving again to re-build your confidence and capacity.

There’s an old saying, “Whatever doesn’t kill us makes us stronger”.

We’re never going to be completely stress free.

But as long as we are aware of what is really going on, the pain we feel can have less power of us and most importantly still allow us to pursue our strongest values in life.

I want to stress again the importance of getting yourself fully checked out and examined for any red flag signs if you have any ongoing symptoms.

Damaged tissues are an important part of the story, but it’s not the full story.

In summary our old definition of pain might sound something like this:

“Pain is a distressing feeling often caused by a damaging stimuli”

And our new definition more like this:

“Pain is not a sensory signal or marker of tissue state, but an inference based on many factors - a feeling produced by the brain to make you take protective action”.

The purpose of pain is protection of tissues, not detection of tissue damage.

When you can ‘re-think’ your pain, you can re-engage with high value activities such as building physical capacity.

Then you can get a genuine sense that recovery is back on the table.

I am hoping you’ve found this blog useful and possibly even had a few ‘aha’ moments.

Congratulations if you made it this far, I know I tend to ramble and not make much sense sometimes.

In all fairness, most of this has been written in short bursts in the time of COVID lock down with 2

(slightly crazy) toddlers running around the place.

If you have any questions or concerns, please leave them in the comments below, I’d love to hear from you.

Part 2 of this blog will look at other strategies to help calm a sensitive nervous system.

Recommended reading

The Protectometer - NOI Group

Painful Yarns

Explain Pain

Mind-Body Prescription

Full Catastophe Living

The Brain That Changes Itself

Can the vagus nerve serve as biomarker for vata dosha activity?

Donate

Get To Know Your Muscles: Upper Trapezius

Get To Know Your Muscles: Upper Trapezius

Upper trapezius trigger points are the primary muscles responsible for neck pain and headaches. The upper traps are also the most reactive muscles in your body to emotional stress.

This blog post discusses:

• how the traps gets overloaded

• symptoms of an overloaded upper traps

• self-care tips

• how Physio can help

QUICK ANATOMY REVIEW:

The traps is the most superficial muscle of the upper back and runs from the base of your skull, along to the tip of your shoulder, all the way down to the middle of your back, (see image below).

FUNCTION OF THE TRAPS:

The trapezius muscle consists of three parts that all have different functions:

• upper part helps raise the shoulder

• middle fibers retracts the scapula

• lower fibers lower the scapula

This blog post will focus on the upper traps.

HOW TRAPS BECOMES OVERLOADED:

The traps can become overloaded from the following situations:

• excessive sitting / computer use

• whiplash (car accident, falling on your head, or any sudden jerk of the head)

• tensing your shoulders

• constantly pulling the shoulders down attempting to have a ‘good posture’

• carrying small children around a lot

• sitting with a chair without armrests, or the armrests are too high

• extended car trips

• looking down constantly at your phone

• any profession or activity that requires you to look down for extended periods (i.e.. dentists/hygienists, architects/draftsmen, and secretaries/computer users)

• bra straps that are too tight (either the shoulder straps or the torso strap)

• a hand-bag or backpack that is too heavy

• anxiety

• recent surgery

• unresolved emotional trauma e.g. PTSD

SYMPTOMS:

The upper traps has an interesting referral pattern, as shown in red in the diagram below.

The upper traps is often the ‘key’ muscle that can trigger other areas such as jaw pain and headaches.

Symptoms of upper traps over-load include:

Upper Traps Referral Pattern (areas marked in red).

• severe neck pain

• a stiff neck

• facial, temple, or jaw pain

• pain behind the eye

• headaches on the temples / "tension" headaches

• dizziness or vertigo (in conjunction with the sternocleidomastoid muscle)

• intolerance to weight on your shoulders

• sinus pain
  
  
  
  

TREATMENT APPROACH:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your traps issue.

Some common manual therapy treatment approaches can include:

• joint mobilisation to the neck and upper back

• dry needling and massage to the traps to stimulate deep blood flow and release the tightness

• addressing any biomechanical issues with stretching, strengthening and foam rolling

SELF-CARE TIPS

• avoid extended periods of sitting

• Think about ‘time in the posture’ vs trying to find a perfect posture e.g. have a short break every 20 minutes

• consider a standing desk

• avoid constantly looking down at your phone

• apply heat to the traps 10 minutes each day to encourage blood flow

• ensure you are getting enough cardio-vascular exercise each day (30 mins minimum)

• take regular breaks on long car trips and consider using a pillow or support under your arm to take the strain off the traps

• learn to breathe through your diaphragm and manage your stress

• Wear bras that fit properly

• If you suffer with anxiety, seek help through your GP or a take a free online course

Some of the following exercises you may find useful:

Pecs stretch - feel the stretch at the front of the shoulder and hold 30 secs

Thoracic foam roller - release your upper back with a few rolls up and down

Upper traps stretch - hold gently 10-15 secs

Diaphragm breathing with legs at 90/90 - helps calm your nervous system

Building capacity in the upper body

Constantly focusing on relaxing and releasing the upper traps can be counter-productive because it isn’t always getting to the root cause.

Focusing on the pain and tightness can keep your body stuck in the ‘zone of stress’ (see picture below).

The only way to get better in the long term, is to gradually start building your physical capacity with a personalised program, so you can create a ‘zone of relaxation’ where you have the capacity to handle all of your daily life without the muscles becoming overloaded.

The trick is to build up gradually - step by step. As soon as you push too far you risk re-activating the tightness by over-loading the muscle.

In the beginning it is best to be conservative.

As your work with your body more, you will get to know and respect your bodies limits.

Some of the exercises you could include would be:

• push-ups

• bicep curls

• triceps

• bent over row

• lat pull downs

• core work

• increasing cardio fitness

Acknowledging underlying emotional issues in chronic pain

When your neck symptoms are chronic, one of the most concerning things is the ongoing pain, which can sometimes go on for months or years, despite seeing multiple health care practitioners and trying different medications.

Understandably, this can create a lot of fear and anxiety about the underlying cause of the symptoms which can keep you in a state of fight or flight (see picture below).

For some people, when they experience pain or injury it may be associated with anxiety and catastrophizing about the pain, like for example whether or not it will ever go away and if it will get worse if they move too much.

Some people become fearful of exercising and being active (known as ‘fear avoidance behaviour' and 'kinesiophobia') and might rely solely on passive treatment and resting, which can have some adverse effects and may lead to decreased function and a lower load threshold which could result in more pain.

As you can imagine, a downward spiral of fear, lack of movement, weakness and de-conditioning can result (see picture below) and become very difficult to break.

Examples of factors that may contribute to dysfunction in the upper trapezius Reference

You are not your scan !

Often there have been some scans showing some damage to a structure such as a disc or nerve issue.

Injuries and structural issues certainly do cause pain initially.

Unfortunately, sometimes the patient is not given a broader context in which to interpret the significance of the results.

The body has a tremendous capacity to heal, and generally tissue damage takes no more than six to twelve months to occur.

If you are still getting pain after this time (and you have been thoroughly investigated by your health care team), your pain is more likely to be coming from a sensitized nervous system (see picture below) than an damaged structural fault.

Maybe the most important picture to understand if you’ve had pain lasting more than six months.

Pain that lasts more than six months is generally related to an overly sensitive nervous system rather than a specific issue in the tissues

(Picture credit: Explain Pain - Butler & Mosely)

One thing is very clear with the recent research is that you can have structural abnormality and have no pain whatsoever (see picture below).

Degeneration, disc issues and arthritis are very common in asymptomatic individuals (i.e. who have no pain - see picture below).

Reference: Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015 Mar 15;40(6):392–8

The ongoing nature of the pain is more often to do with tight muscles with restricted and oxygen blood flow.

Just understanding this process can go along way to resolving your ongoing pain issues, but you will need an experienced GP and Physio to work with to help you diagnose and get you back on the fast track.

Get relief from your neck pain or headaches

We have a special interest in helping people overcome their neck pain / headaches and get back to what they love.

If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment.  If you would prefer to speak to us directly,  call us 1300 657 813

Neck Pain Triggers and How to Avoid Them

Persistent neck pain can be really frustrating but it’s very common.

One of the main issues is that neck pain can be triggered quite easily.

You can have the best treatment and exercise program in the world, but if you inadvertently trigger it day after day, it simply will not get better.

This goal of this blog post is to help identify some common triggers of neck pain.

If you can identify the main triggers, you will get to the root cause of the problem and reduce the likelihood of getting a flare-up.

Who gets neck pain?

Studies have shown around 65% of us will experience an episode of neck pain every year.

Once you’ve had an episode of neck pain, it’s common (about 50% the time) to experience further flare-ups down the track.

The research shows neck pain is more common in:

• office and computer workers

• women aged between 30-50 years old

For some people, the pain can last a few weeks and is only a minor inconvenience.

For others though, the pain can last many months and develop into a chronic pain cycle of pain, weakness and fear of ongoing damage.

First things first: Get Yourself Checked Out

If you’ve had ongoing neck pain for sometime, you will need to get a check-up with your GP or Physio to rule out red flags.

Red flags make up about 1% of neck problems and can include things such as:

• nerve impingement

• disc related pain

• inflammatory pain

• auto-immune disorders

• hyper-mobility

• arthritis

• cancer

We tend to fear neck pain more than other pain

Ideally, the neck is highly mobile that allows us to see in all directions.

Evolutionary speaking, if we are unable to see potential dangers around us, our nervous system goes into a strong protective response.

This may include:

• increased muscle tension

• increased anxiety

• increased pain and perception of threat

Some of the neck pain you feel may be related to this increased nervous system sensitivity.

It’s important to be aware of this extra sensitivity, otherwise you will mistake the pain for ongoing tissue damage.

Left unchecked, these ongoing negative thoughts about the body can do much harm in the form of fear, avoidance of movement and increased anxiety and depression.

If you have ongoing neck pain and you’ve been assessed by a Physio / Doctor and found to have no red flags or structural issues, it’s important to understand that most neck pain is coming from the muscles.

Muscles of the neck

The neck is designed for movement and is made up of 44 muscles which help control movement of the head.

When the muscles become overloaded, they become tight and reduced movement results.

Lack of movement means the muscles have a reduced blood and oxygen supply.

If the muscles continues to get overloaded for long enough, the muscle fibres form a trigger point / knot that can cause ongoing pain.

Each muscle has a typical referral pattern, where the pain spreads into a different part of the body (see picture below of the common trigger point in the upper traps).

The most common trigger point in the Upper Trapezius muscle that refers up to the temple and behind the eyes.

A note about imaging findings

If you’ve had x-rays or a CT/MRI of your neck, it most likely picked up some findings in the neck such as disc bulges, degeneration and spurring.

Whilst these things can definitely trigger off a pain response initially, it is unlikely to be the major cause of ongoing pain.

The good news:

Many people have these changes on scans, but most people have minimal or no pain (see table below).

The majority of the degenerative features are likely part of normal aging process and unassociated with pain.

As you can see in the study below, disk degeneration is present in 68% of 40 year olds who are completely asymptomatic.

As you get older, the chance of having a disc bulge around 70% by the age of 60.

Once again, this is in a group of people who don’t have any pain.

Be careful who you listen to in terms of how you’re scan results are being interpreted.

Source: Brinjikji W et al

The most common triggers of neck pain and how to avoid them:

1. Lifting heavy / awkward things that increase the strain on your neck

Lifting heavier things that you’re used to can cause overload of your neck muscles and joints.

This might be at the gym, carrying groceries in from the car or lifting young children.

Just to clarify, you can still lift heavy things, especially if you have a good capacity built up gradually over the years.

It’s just best to avoid carrying heavy things that you are not accustomed to.

“It’s not the load that breaks you down, it’s that load you’re not prepared for” - Tim Gabbett

So take care in the gym, and know your limitations. If you need to, have some sessions with a trainer who who help show you the right technique.

I know it’s a hassle, but take a bit of extra time to make a couple of trips (or ask someone to help) to carry your groceries. It can make a world of difference to the health of your neck.

2. Sustained Positions

One thing the neck hates is being is locked in one position for than 20 minutes at a time.

Holding sustained positions for long periods of time tends to increase the tightness in muscles such as the upper trapezius (top of your shoulder) and sub-occipital muscles (base of your skull).

The most common sustained position is from looking down at your phone constantly.

We know (from the picture above) that the further down you look, the bigger the strain on your neck (up to 30kg of pressure when looking right down). Our necks are simply not designed for this.

Make sure to bring your phone up to eye level, otherwise you will place considerable strain on your neck muscles.

What is the best sitting posture?

A key point to keep in mind, is there is no one perfect posture.

Don't get fooled into thinking you have to always have a perfectly upright posture all the time.

Some people who follow this line of thinking get very anxious if they don’t have perfect posture.

This anxiety can further increase the muscle tension and pain in the neck.

Rather than focus on finding the one perfect posture, always remember:

“The best posture is your next posture”.

Meaning that you need to keep yourself moving and changing positions frequently.

If much of your work is based around a computer, a sit to stand desk would be a very good investment.

3. Inefficient Breathing patterns

Test your breathing patterns. Place one hand on your upper chest and one hand lower. Take 3 deep breaths and notice which hands lifts up first.

We take approx. 21,000 breaths per day.

Each one sending a message to your nervous system - either a message of 'safety' or 'danger', depending on the pattern.

Habitual shallow breathing and subconscious holding of the breath can maintain a sympathetic (fight/flight) dominant state.

This is common in people who have neck pain - and they tend to breathe more using the upper chest muscles. These are known as the accessory breathing muscles.

These accessory breathing muscles are the scalenes, sternocleidomastoid, pecs and lats that attach from the ribs to the spine.

If they are constantly working through upper chest breathing, they become overly tight and can cause the neck to become tight and painful.

Learning how to breathe efficiently through the diaphragm is the foundation of optimal movement and recovery.

Take your hands around the bottom of your rib cage and as you breathe in expand outwards, like you’re trying to blow up a balloon.

Feel your lower ribs expand from the front, back and sides - that is your diaphragm muscle.

If you’re feeling a lot of neck pain, try taking 5 deep breaths into your diaphragm.

Breathe in for 5 seconds and then out for 5 seconds.

Keep your upper chest and shoulders relaxed.

“As you become more mindful of your breathing, you will find you become more present, gather all your scattered aspects back into yourself and become whole”. ~ Sogyal Rinpoche.

4. Stress

Aside from injuries and poor posture, stress also plays a big role in ongoing neck issues. 

When we get stressed, the 'fight or flight' system is activated in our bodies, sending messages to our muscles to contract. 

As this muscle tension becomes chronic, the tightness reduces our flexibility and produces pain.

Stress can come from many sources such as:

• relationship probems

• financial strain

• lack of close support networks

• poor nutrition

• not getting enough exercise

• not understanding why you’re in pain and being constantly worried about it

If you are feeling anxious or stressed in other areas of your life, this can increase the sensitivity of your nervous system.

Like a magnifying glass, it amplifies the sensation you feel.

If you have a lot of underlying stress in your life, sometimes a minor twinge in your neck can be perceived as extremely painful.

Your capacity for dealing with muscular tension issues can be dramatically reduced.

The way to move forwards from this is to take note of all your stressors and try and address them as best as you can.

Very often some support from a qualified psychologist can be extremely helpful and you could speak to your GP about getting a referral.

Other tips for decreasing stress in your life:

• take time for you - everyday - to do something you enjoy

• exercise more - at least 30 - 60 minutes per day of vigorous exercise

• eat well - take the time to prepare healthy meals at home

• get out in nature as much as you can

• ask for support from those around you - don’t be a martyr

• see the bigger picture - there’s always someone worse off that you and life is too short to not be enjoying it every day
  

5. Poor Quality Sleep

It's important to invest in a good mattress and pillow, as we spend one third of our lives in bed.

These pillows are recommended by the Australian Physiotherapy Association:

Finding the right pillow is a very individual process so you may need to experiment with a few different types in order to find the one that fits you best.

Check the distance between the side of your neck and your shoulder. That gives you an idea of the pillow height you need to keep your head and neck supported when you sleep on your side.

Getting enough sleep is important.

If you’re burning the candle at both ends, you can’t expect your body to be able to re-charge and perform optimally.

If you have insomnia related to an ongoing pain issue, follow these sleep hygiene tips:

• wake up early (no later than 6am) and get moving by exercising for 45 -60 minutes. Find an exercise that you can do that increases your heart rate without stressing your body too much. It might be swimming, hiking or jogging.

• don’t nap during the day as you’re trying to build your ‘sleep pressure’ so when your head hits the pillow at night, you will go straight to sleep

• avoid caffeine after midday

• take a warm bath an hour before bed

• don’t drink and fluids after 7pm to avoid bathroom breaks in the middle of the night

• get into bed around 9pm and quietly wind down so you’re feeling sleepy at 10pm
  

Physio treatment of neck pain - what works?

Our approach is to resolve acute neck pain quickly and return to doing what you enjoy, but we also have a focus on getting to the root cause of the problem and limit recurrence.

Personalised Exercise Programs

Exercise is beneficial in people with neck pain.

There is good evidence to show that exercise and building capacity is the best approach to helping reduce neck pain in the long-term.

The best exercise is based on our personalised assessment with a Physiotherapist.

A comprehensive program will involve a combination of stretching, strengthening and improving joint mobility.

Some PDF of some common neck stretches we prescribe can be downloaded for free here.

Dry Needling

This study recommended dry needling for immediate pain reduction in upper body myofascial trigger point dysfunction. It certainly can be quite intense and can take a few days to work itself out, but we find dry needing to get the most effective release of the muscles.

Using heat on the neck via a wheat pack is really helpful, especially in the evening before bed.

Prognosis: What To Expect

In an ideal world, pain would get better progressively step by step.

Reality though can be very different, and more often than not, we see a two step forward, one step back sort of pattern (or a bit more dramatic as in the picture below).

The thing to keep in mind is staying positive, (and it can help to lower your expectations a little).

Life can easily get in the way of stopping you from doing what you need to do to get better.

If you’re really committed to overcoming your neck pain, make getting better a priority in your life, (for at least for a 3 month period).

Often that is about the right amount of time to significantly build your foundation and capacity.

“Long term consistency trumps short term intensity” - Bruce Lee

Conclusion

With the right management plan in place, neck pain is very manageable.

If you’ve had neck pain for a long term, we expect there will always be some ups and downs.

But overall you should be very hopeful of making a significant recovery and getting back to enjoying life again.

If you’re after some more personalised advice and treatment for your neck and you wish to get some relief right away, use our simple online booking system to make an appointment. 

If you would prefer to speak to us directly,  call us 1300 657 813

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Neck pain? Try these 4 simple exercsies

Neck pain is really common. 

Thankfully, most neck pain is not related to anything structurally wrong, but more a warning sign from your body telling you, "it's time to move".

Your muscles don't like stagnant conditions, as the blood flow is restricted and creates acidic conditions in the tissues which contributes to the pain experience. 

If you can, pay close attention and become aware of the early stages of stiffness building up in your neck and shoulders. 

If you can get moving as soon as possible, there's a good chance you can avoid the downward spiral that often involves more intense neck pain, restricted movement and headaches.

These set of four exercises targets the upper back (thoracic spine), which is often very stiff in people who experience frequent bouts of neck pain. 

Cat-Cow

Start on your hands and knees with your back in a neutral position.
Arch your back, lifting your head up and pushing your tail bone out, making a dish with your spine.
Hold this position for one breath.

Next, arch your upper back by tucking your head and tail bone in and pulling your belly button in towards your spine, making a curve through your back.  Exhale completely as you activate your deep core stabilisers.
Repeat x 10 times

Thread The Needle

Bring yourself up onto your hands and knees.
Your hands should be under your shoulders and your hips over your knees.
Take one hand off the floor and reach in and through between your other hand and leg on that side.
Allow your shoulder and head to follow, moving down towards the floor as your hand reaches through.
Allow your upper back to twist and rest your head gently on the mat. 
You should feel a stretch in your upper back and shoulder blade.
Hold for 30 seconds and then repeat on the other side. 

Push-Up To Side Plank

Push yourself up into a plank position with your hands under your shoulders and
Perform a half push up.

As you're coming up, rotate your body, turning one arm up towards the ceiling.
Allow your head and body to follow the movement.
Your may rotate a little on the balls of your feet.
Return your hand to the floor and repeat on the other side. Repeat x 3 each side.

Thoracic Mobilisation On The Foam Roller

Lie with a foam roller in your mid-back, and hug your arms across your chest to open up the upper back.
Lift your hips off the mat, and roll back and forth for about 30 seconds, pushing with your legs.  You may feel a few cracks and pops which is a great sign your are releasing the joint stiffness.

Try spending 5 mins every morning and night and see how it helps your neck pain.

If you have any questions please contact us dan@kinfolkwellness.com.au

If you'd like to get a more personal assessment and treatment of your neck pain, please use our easy online booking system below to make an appointment: