The de- medicalisation of Low back Pain - October 2019

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The majority of mechanical low back pain is not caused by a specific condition or injury, it is caused by stiffness, weakness and it is exacerbated by fear of movement, anxiety and emotion. The term nonspecific mechanical low back pain has become a diagnosis, it is the term used on a patient’s medical notes to describe back pain without a specific pathology or injury.
A small percentage of patients (some say as low as 1%) have a specific and significant diagnosis causing back pain, for this group early diagnosis and prompt treatment is often imperative, so investigation is important.
Historically society has tended to treat all low back pain in this way, however treating the majority in the way that helps the minority has proven to be detrimental, it increases anxiety, encourages over caution leading to further stiffness and weakness, often leading to chronic pain.
There is a call to de-medicalise nonspecific mechanical low back pain and render it more of a fitness problem, not a medical problem; pills and injections do not make you stronger and more flexible!
The National Institute for Clinical Excellence is realising this and is making appropriate recommendations. Please look at their website on the subject at https://www.nice.org.uk/guida…/ng59/chapter/Recommendations…
We still need low back pain patients to seek medical / Physical Therapy help so that the professions can triage their care, sorting out the medical condition from the nonspecific, but we need a line of that care to guide people to become stronger more flexible and less anxious about their problem, not X-rays, MRI scans, pills and injections!

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Endo-cannabinoids and the control of obesity - 2018

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It is estimated that a 9 stone (57kg) individual burns 180 Calories per hour walking at 3.5 MPH (That’s a fairly brisk walk)
It is estimated that a Sunday lunch has around 400 calories!
So if we are going to lose weight with exercise? Then simply counting calories appears to be soul destroying, it appears to be almost impossible to do enough exercise to burn off the calories we get from even moderate excess.
It is being suggested by the scientific community that even short bursts of exercise (3 bursts of 20 seconds, sandwiched between 1 minute gentle warm up type exercise, 3 times a week) can be enough to give us health benefits, including weight control, prevention of Diabetes, blood pressure and more.
How can this be when you need to walk briskly for over 2 hours to burn off your Sunday lunch?
It is being suggested that the body’s Endocannabinoid system is responsible for body fat control, this system is said to have an influence over sleep, appetite, digestion, hunger, mood, immune function, reproduction and fertility, pleasure and reward, pain, memory and temperature regulation. Other things affect this system, food being one of them, but exercise helps to produce these Endocannabinoid chemicals, they are a bi-product of using our muscles, even in short bursts.
So the message is do not ignore the calories, but remember there is a system that helps you to regulate your body fat, do not allow it to become dysfunctional, it is the body fat equivalent of a heating systems thermostat., that needs to be maintained by muscle activity.
Understanding this system is in its infancy, and needs more research, but understanding it more is an exciting prospect.

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Sarcopenia - 2018

Sarcopenia is a term to describe a reduction in muscle bulk with age, it was coined by Irwin Rosenberg of Tufts University Medford, Massachusetts in 1988.
Sarx: meaning flesh
Penia: meaning deficiency
The bad news is that this begins on average at 30 years of age.
It has been demonstrated that mature muscle fibres do not have the ability to divide, they are post mitotic. The job of muscle repair falls to muscle stem cells. In a young adult these comprise approximately 8% of our muscle bulk, it is estimated that this percentage drops to 0.8% by 75 years of age. Dramatically reducing our ability to repair and replace muscle tissue.
Muscle cells like many other cells contain a structure called mitochondria, these process the energy for the cell, and they also become dysfunctional with age.
Reducing hormones also have an effect upon muscle ageing.
It has been discovered that our muscles, when used, can behave a little like the glands in our so called Endocrine system (examples of Endocrine glands include the Thyroid, Pituitary, Pancreas, Adrenal and of course Ovaries and Testes) muscles release Myokines, there are many. One such Myokine is called Apelin; It has been demonstrated that Apelin has the ability to reduce the effects of aging in skeletal muscle, including improving the regeneration of Mitochondria and muscle stem cells.
So exercise produces a substance that has the ability to regenerate both the energy systems and the rebuilding systems of our muscles, as well as strength/endurance, good news as advancing years reduce them. Exercise it will not stop you getting older, but it will keep you strong, improve your ability to repair your muscles, and maintain the muscles energy systems.
That’s as good as it gets, you can’t stay young but you can stay strong.

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Foam Roller-ing, Does it work? - 2018

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The short answer is YES, but not in a manner that you might think, and not in a way the manufacturers claim!
So what is Foam Roller-ing?
Foam Roller-ing is the use of a dense foam roll, onto which a part of the body, (usually a leg) is pushed and moved forwards and backwards, creating a type of deep self-massage.
Manufacturers claim that this reduces scar tissue, breaks down adhesions, lengthens tissue, (muscles like the Hamstrings or the Quadriceps) and improves exercise recovery time.
The research says that this technique can increase the length of a muscle, increasing the range of movement available at the joint that the muscle acts upon. However the muscle on the opposite untreated side also increases in length; this strongly suggests that the response to the deep Roller-ing is in fact in the Nervous system not the muscle. The research also shows an increased pressure pain threshold, so muscles feel less tender when prodded, this is also believed to be an accommodation of the nervous system.
So it works but not as we have been imagining it, nor is it the reasons that we are being sold.
The suggestion is that this technique needs to be an adjunct to other therapeutic processes, for example therapeutic exercise and or functional movement; if not then the gain is simply lost again.
Similar effects can be obtained with simple sustained stretching exercises, but this has been shown to be associated with a temporary reduction in muscle performance, this reduction in performance is not demonstrated after foam Roller-ing! Thus giving Foam Roller-ing an advantage if peak performance after its application is required.

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