All posts in Uncategorized

What the NBN can teach us about injury rehab

tim-gouw-68319-unsplash

As I was trying to watch the Mandolorian the other night (at “peak” Netflix usage time) I was getting constantly frustrated with it pausing and buffering several times an episode (I know – first world problems). And I was again annoyed that now I finally have NBN it really isn’t significantly better than what we had before.

And the reason is this – as far as I can tell, the NBN is really only built to handle “average” usage. So I’m sure there was all this modelling and data somewhere that said “on average, the requirements for the NBN will be X, so as long as we build it to handle that, it will be all good”

The problem being we know that we don’t have regular average usage throughout the day… There are times of low demand (which the NBN can handle really well) and times of peak demand, which the NBN struggles to handle.

Now, putting aside my knowledge of telecommunications infrastructure, it got me thinking about how this applies to what we do when we rehabilitate injuries (or surgery).

A lot of the time, we see people who have had an injury, and only ever really got back to the capacity of “average” demand. Say they sprained their ankle, and now they can walk without pain, they can go up and down stairs and they can jog in a straight line. They are feeling “ok” so they are rehabilitated, yes???

The problem with that is – if they then are subject to a more “peak” demand that they haven’t returned their capacity to, there is a significant chance that this could exceed their capacity, and lead to pain or injury (How many times do we see people that return to sport after an injury and just get injured again? The answer is a lot more than we should)

The same goes for things like back pain. Yes you can touch your toes again, and sit without pain, but would you be able to move your fridge if you had to move house? Or lift the couch to vacuum underneath? Would you be able to carry your grandkids home because they are tired?

We know that there are going to be times when you have to do hard things, even if you don’t normally have to do hard things. If we ONLY rehabilitate your issue so you are just above your ability to do the average things, but we don’t build in the capacity for you to do the hard things, we are really setting you up to fail. At the same time, if you don’t continue to do some work to rebuild your capacity above just the “average” things you need to do – YOU are unfortunately setting yourself up to fail as well.

Everyone needs to have a buffer to how hard they can work. If you are working near 100% of your capacity all the time, you are going to start having some troubles (imagine you sprint everywhere you go rather than walk. Sure it’s quicker, but you can’t keep it up and eventually something will go bad).

Just like the NBN – if you are only built for average demand but you aren’t able to manage any peak demands, you will start to struggle, and potentially have issues.

We need to have more foresight than “whoever” designed the NBN in it’s current form, and ensure you have the ability to perform the peak demand activities as well, to keep you safe and healthy.

 

Julian Bowen

Julian is the Director and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries.

More

How pain works part 3: Your brain can ignore pain inputs

gi joe knowledge is half the battle

Did you know you are receiving input into your brain from EVERY receptor for EVERY sense ALL THE TIME!! Millions of inputs every minute for your brain to compute and focus on.

We don’t think about it, but it’s impossible for us to be consciously aware of all these things around us all the time, so our brain has to filter most of these inputs so that we only spend our limited focus on things that actually matter. This means that our brain actually ignores most of the inputs it receives.

I’ll give you some excellent examples…

Are you wearing a watch or a ring? Or earrings? I would bet that most of the time you aren’t aware of your watch on your wrist, or your jewellery. Sure, your brain is receiving inputs from those areas that something is touching you all the time, but most of the time your brain ignores it. It’s there all the time, and your brain knows it’s not an important thing to waste precious energy and focus on, so it just writes those inputs off. (But once you focused on them after I asked, you obviously could feel them again).

It’s the same for other senses. We know that we really can’t smell ourselves most of the time. Also we get used to normal smells around us, so we can’t smell them anymore. Most smokers can’t tell that they smell like smoke. We can’t smell our own houses because we are so used to it. (Have you ever come home from a long holiday and thought your house smelled different? Often this is because your brain has gotten out of the habit of ignoring those smells because you haven’t been around for a while, so you notice it again).

Your brain has habits just like we all do. If it is used to ignoring the watch on your wrist, then one day you forget to wear it you feel ‘funny’. People say they feel naked without it. This is because your brain is used to doing one thing (ignoring the input from your watch) but without the watch there it can’t do this anymore. This creates a DIFFERENCE that causes your brain to pay attention.

The same goes for pain… our brains can ignore pain when it wants to or when it needs to (but it’s very hard to do it consciously). We also have a hierarchy of needs, so if the risk of damage from pain isn’t the most important thing then your brain will also ignore it.

Have you ever been sore, but then you had to play sport or something, and once you start the pain seems to disappear? It may warm up, etc, but sometimes you just aren’t focusing on the pain, and your brain deems the activity (playing sport) more important so it diminishes the pain experience.  IF the pain isn’t considered harmful or a risk, it can be ignored.

Sometimes, even despite injury or severe pain, you can ignore the pain. Another extreme example – if you are in a life or death example (like you are being chased by a bear) and you sprain your ankle really badly… Despite the injury, the imminent risk of death far outweighs the risk to you from the ankle sprain, so your brain will generally ignore the ankle so you can run away from the bear.

We hear about this all the time – in war zones soldiers being shot and saying it didn’t hurt at all. Or we hear stories of people breaking bones and not even realising until later on. Sometimes this is described as ‘going into shock’ but often your brain’s hierarchy of needs means it ignores the pain input as that is not the most important thing to worry about. Needing to survive trumps the risk of damaging an injury further.

Understanding that you brain can focus on pain inputs or not based on needs and perceived risk helps people to manage their pain experience. If your brain perceives the thing causing pain as a threat to survival or further damage, you will feel pain. If it decides it’s not dangerous, then you may not. Understanding whether pain is dangerous or not can in many cases even reduce the pain you are experiencing. Sometimes knowledge is half the battle.

Julian Bowen

Julian is the Director and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries.

More

How Pain Works Part 2. Pain is a Warning system

evan-dennis-75563-unsplash

Over the last 5-10 years we have learned A LOT about pain and how it works, but a lot of this is completely foreign to most people, so we’ve decided to produce a series of articles to help people actually understand their pain and what is going on… Firstly because KNOWLEDGE IS POWER! And secondly because understanding why you feel how you feel is empowering and de-threatening (as they say – just knowing is half the battle)

This is part two of a 5-part series on learning how pain works!

PAIN IS A WARNING SYSTEM

The experience of pain is part of your body’s and brain’s warning and protective system. We’re incredibly smart when it comes to trying to stop our selves getting damaged or dying, so we have a whole host of systems built in to try and avoid us coming to grief.

Now often we think that pain = damage, but we now know that pain often occurs long before any damage actually occurs.

Did you ever get a “Chinese burn” from another kid at school? Hurt didn’t it? But any damage to your arm? Not at all.

Or a better example – have you ever touched something hot, and it HURT! So you automatically pulled away (something called a withdrawal reflex – another clever way we are designed to stop hurting ourselves).

You check your hand… but it looks ok. It hurt for a few seconds, and that settles down within 10-30 seconds. Lucky you!

This is a great example of pain without pathology, or damage. The pain you experienced (immediately and possibly severely) was a STRONG warning that you are at high risk of damage if you don’t change your behaviour (touching the hot thing). Because of the experience of pain you have managed to completely avoid any tissue damage at all (clever you). Your pain served as a perfect warning system.

Even when you have an issue, your experience of pain can still be part of your body’s protective systems. Your brain (and your body) will actually try to actively give you more pain to stop you doing things it may think are potentially more damaging.

As an evolutionary example: Say you’ve sprained your ankle, so you’re not able to run as fast as normal. This means that if you and your Neolithic buddies are out hunting woolly mammoths you could be more likely to get injured and killed (not to mention potentially do more damage to your ankle). By creating pain, which makes you unable to participate, your brain is actively trying to stop you getting killed.

This may be a bit of an extreme example, but it’s true. When you have an injury, there are chemicals released by the body (in the inflammatory fluid) that actually make your receptors more sensitive (so they will send signals to your brain that things that wouldn’t normally tell you there is pain NOW tell you there is pain.) Part of the injury process actually tries to make it MORE painful for you.

Luckily nowadays we don’t have to fight for our lives, so a lot of this is fairly redundant. But that doesn’t stop it from happening. So, more pain doesn’t necessarily equal more damage. If anything, it just indicates more warning from your brain and body.

So when it comes to our aches, pains and injuries… It’s good to know that pain is your body’s rudimentary warning system that something bad MIGHT happen, not that there is already damage. Knowing this helps us know that if sometimes our pain is worse, it doesn’t mean you are MORE damaged. It might just be your brain paying more attention for some reason.

Stay tuned for Part 3 of our ” How pain works”  series – and learn how your brain can choose to ignore sensory inputs (like pain) so you don’t feel them

 

Julian Bowen

Julian is the Director and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries.

More

The problem with ergonomics

The problem with ergonomics

If you work on a computer at all, chances are you may have experienced some neck or back pain while toiling away at that keyboard. If you work in a large organisation or for the government, you’ve also probably had a workstation assessment done at some point. Occupational pain is a massive problem – studies show about 1/3 of all computer workers experience neck or back pain every year. In Australia alone that’s millions of people suffering because of their computer work!

Companies are trying their best (and rightly so) to look after their employees and this often involves ergonomics assessments of the workstation and appropriate adjustments. The main aim of this is simple – reduce the workload and effort required to do the work, so you reduce the strain the worker’s body is under. Easier work = less pain, right?

BUT, there’s one big problem with this – the evidence that ergonomics interventions work is inconsistent and contradictory. Just as many people DON’T get better with workstation adjustment as those that do. Chances are some of you out there are in this exact situation. You’ve got the perfect chair and the perfect computer and workstation setup, you’re sitting in the perfect position – but you’re STILL getting headaches, or neck pain, or back pain.

And in my opinion, here’s why:

“We spend so much time and money modifying the work environment and task to suit the individual, but we put zero effort into modifying the individual to suit the task.”

Now I’m not saying that ergonomic intervention isn’t important – it definitely is. Providing a safe and appropriate work environment is very important to keep workers safe and reduce the risk of injury. Ergonomic changes reduce the total workload that the worker is under (hopefully). My gripe with ergonomics is that this seems to be the only intervention. The assumption that once we place the worker in a “perfect” position and ensure they don’t deviate from that, then everything should be fine. The problem is it’s not.

Here’s a few other reasons why you might be in pain even if you’ve already had the perfect workstation set-up:

  1. You don’t have adequate physical capacity to perform the tasks.

This is the biggest contributing factor that we see in practice daily. You don’t have the strength, or postural endurance to manage the tasks you are doing all day. As the days wears on, (and the days and weeks) you get more and more fatigued with the workload – which can lead to a whole range of pain issues. This can even include just sitting in one position for long periods of time.

As an experiment try holding your arms out in front of you (like a zombie) and not moving for five minutes. Chances are after 1 minutes you’ll be starting to fatigue, and not many of you out there will last a full five minutes. It’s too tiring and too sore. Now this was only holding one position for 5 minutes. If you’re working on a computer, you’re in the one position for up to 8 hours per day. If you don’t adequate postural endurance for your muscles to hold you in these positions all day, no wonder you’ll be getting sore.

A recent study even showed that strength training was the most effective form of treatment to reduce neck pain in office and computer workers. More effective than adjusting workstation setups, more effective than fancy chairs, even more effective than standing desks! Improving muscle capacity was the best way to reduce pain. By INCREASING the worker’s endurance and strength, their muscles fatigued less and they experienced less pain!

Now I know that if I was working as a roof carpenter (for example), I wouldn’t last one day without back pain. The main reason for this is I’m not conditioned to that type of work. Conditioning for the required tasks is imperative for all physical activities. We know that poor conditioning is a massive risk factor for injuries on the sporting field, and the workplace is no different. You need to have the physical capacity to do the required tasks, for the required duration and to back that up every day.

  1. Your work posture isn’t your biggest risk factor for developing pain.

Studies looking into causes of occupational pain due to computing found the biggest risk factors for pain were:

  • Working more than 7 hours per day at the computer
  • Poor job satisfaction/sense of control
  • Never or infrequent breaks
  • Poor sleep (less than 6 hours per night)

So, what this tells us is how long you do the tasks (in particular how long at one go without a break) is a strong predictor for pain. This also relates back to my first point regarding muscle fatigue. Frequent breaks mean you get a chance to recover and perform different movements and positions, reducing fatigue and sustained postural load. It also tells us (which has also been shown with mountains of research) is that people who are happy/satisfied at work are less likely to experience pain.

Poor sleep means more fatigue. It also increases injury rates across sports and in the workplace. Unfortunately, sleep isn’t a work issue, but a personal one. If you’re struggling with pain at work and you average less than 6-7 hours sleep a night, you should probably get to bed a little earlier.

  1. Changing behaviours is more important than changing workstation setup.

Everybody who works in an office has heard that they should be taking regular breaks, stretching and moving around more to reduce the risk of pain. Unfortunately, the large majority of people just don’t do it. Now I know you’re busy, and it’s annoying to stop what you’re doing in the middle of something. However, it’s a lot more inconvenient to miss work because your headaches are getting too much. In a lot of companies, the culture is to tough it out and work hard – which doesn’t look after employees’ health at all.

Some larger organisations have computer programs that stop the worker every hour to remind them to have a break, but you can over-ride them. Most people I talk to with these programs find them annoying too, and turn them off whenever they can. It’s great to have these tools, but if they are not used properly they are really no good to anyone.

Unfortunately, people do need to take some responsibility for themselves (yes, even when they are at work). If you aren’t following OHS procedures (like pre-start/warm-ups, or regular breaks as prescribed) then maybe this is the place to start with addressing your issues. If you are up all night watching Netflix, and you’re tired and sore at work, then you should probably go to bed earlier. If you don’t have the physical capacity to do your job, then no amount of fancy chairs and keyboards are going to improve that. You need to go out and exercise, or get to the gym, or start doing Pilates, or get some expert advice on what you need to improve to stop your issues.

Take away messages

  • Despite my ranting, ergonomic assessment is a very useful tool and changing workstation setup can go a long way to reducing the load and strain on your body. If you have a shocking workstation, and your posture while working is terrible, then maybe changing the ergonomics of your work setup is a good idea. Just remember that this is only one part of the solution.
  • If your workstation isn’t too bad, you really should look at your behaviours. Are you taking regular breaks? Do you spend more than 7 hours per day stuck in front of the screen? Are you getting enough sleep? Do you do anything else to counteract all that sitting in front of the computer?
  • If you are having problems (particularly is it gets worse as the day progresses) you should really look at implementing some strengthening into your life. 2-3 times a week for 12 weeks will do you a lot of good (focusing on your neck and shoulder of course).
  • If you keep having problems despite proper OHS (and a lot of you are) you probably need to look at improving your physical capacity for your work. If you struggle with maintaining your posture during the day, or you are getting tired or sore, you probably need to start improving your strength, endurance (and maybe mobility). Improving your body’s tolerance to work mean the work you do is easier in comparison. Being stronger is one of the best injury prevention strategies. Being stronger makes life easier.

 

Julian Bowen

Julian is a Director and Senior Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he has performed close to 40,000 individual treatments in that time. He has worked with everyone from Paralympians,  elite athletes, WAFL Footballers, the Defence Forces and weekend warriors, to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries. 

References:

  1. Kari Babski-Reeves, Jennifer Stanfield, Laura Hughes, Assessment of video display workstation set up on risk factors associated with the development of low back and neck discomfort, International Journal of Industrial Ergonomics, Volume 35, Issue 7, 2005, Pages 593-604, ISSN 0169-8141.
  2. Brewer, S., Eerd, D.V., Amick III, B.C. et al. J Occup Rehabil (2006) 16: 317. Workplace interventions to prevent musculoskeletal and visual symptoms and disorders among computer users: A systematic review. doi:10.1007/s10926-006-9031-6
  3. Demure, Bernard MD; Luippold, Rose S. MS; Bigelow, Carol PhD; Ali, Danielle RN; Mundt, Kenneth A. PhD; Liese, Bernhard MD. Journal of Occupational & Environmental Medicine: August 2000 – Volume 42 – Issue 8 – pp 783-791 Video Display Terminal Workstation Improvement Program: I. Baseline Associations Between Musculoskeletal Discomfort and Ergonomic Features of Workstations
  4. Xiaoqi Chen, Brooke K Coombes, Gisela Sjøgaard, Deokhoon Jun, Shaun O’Leary, Venerina Johnston; Workplace-Based Interventions for Neck Pain in Office Workers: Systematic Review and Meta-Analysis, Physical Therapy, Volume 98, Issue 1, 1 January 2018, Pages 40–62, https://doi.org/10.1093/ptj/pzx101
More

The ONE thing I recommend for everyone!

The ONE thing I recommend for everyone!

Someone asked me the other day “what is the one thing you would recommend that would benefit everyone the most?” What could everyone do that would help them avoid injury and pain, or help them stop having pain?

Now most people think the answer is going to be stretching, but they’re wrong!

If there was just one thing that I could recommend EVERYONE should be doing (I guess besides eating healthily/managing an appropriate weight) …

Strength Training!

That right! Resistance training…. Lifting weight…. Developing greater muscular strength and endurance.

I’ll tell you why:

Being stronger makes life easier by comparison. It builds resilience in your body to be able to better withstand whatever life throws at you. There’s also a massive amount of health benefits of improving your lean muscle mass, from reducing your risk of many diseases, fractures and injuries, to even reducing your risk of premature death!

Not to mention that there is so much research now that has proven strengthening helps you to reduce pain (such as with arthritis, chronic back and neck pain etc) and reduce your risk of injury. Studies have found strength training reduces the rate of non-contact injuries in sport by 50%! Strength training was more effective than stretching, ergonomics changes or fancy chairs at reducing neck pain in office workers.

Exercise and resistance training has been shown time and again to be as effective (or more effective) than surgery for the management of mild to moderate knee and hip arthritis, degenerative (read: wear and tear) rotator cuff issues, bursitis, tendinopathy… the list goes on!

(Yes sometimes surgery is the best option, but even if you do need surgery, strength training beforehand means quicker recoveries and a much higher chance of full recovery)

In fact, did you know the World Health Organisation guidelines for MINIMUM levels of physical exercise includes 2 or more resistance training sessions per week? (You can read it here)

Now this doesn’t necessarily mean you have to join a gym and buy matching lululemon tights (but that’s perfectly fine if you want to). The gym is an excellent place because it has all the equipment you need to be able to achieve what you want.

But there’s heaps of exercise you can do at your own home with either just your bodyweight or light weights or household items that will get you started.

The key is just to start! Anything you do is better than nothing, and if you do it consistently you will see the benefits. Exercise is a very simple science. Do the work consistently at the correct amount and you will definitely improve. The benefits from any exercise require consistent effort over time. You won’t feel the benefits straight away but give it a few weeks of consistent work and you’ll definitely start to notice the difference. Suddenly you’ll realise it didn’t hurt walking up the stairs for a change. Or you managed to work at the computer for 2 hours without starting to feel a headache coming on.

If you don’t know where to start, or what to do – then find someone who does. Start with exercises that address multiple muscles and large muscle groups (like squats and push ups). If you have problems or issues that may limit your ability to exercise (or you’re worried it might do some harm) then see a professional and have them guide you on what you can do. Even people without legs can do strength training so we could definitely work out ways to train without upsetting your dodgy knee (even though – as mentioned above, strength training at the right level and intensity will actually do it the world of good).

Work at getting stronger and life gets easier.

And start today! 2-3 times per week is all you need.

Happy lifting!

Julian Bowen

Julian is the Director and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries. 

 

More