Stress and Feeling Old

“Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a little older.”

~ Hans Selye

I think the majority of patients coming along to our clinic would relate to this quote from the endocrinologist Hans Selye. When you’re struck down with an episode of severe low back pain and every simple movement becomes a monumental task you feel like you’ve aged over night. Actually, it doesn’t even have to be a really bad pain to make you feel elderly. Tight achy muscles that reduce your flexibility and which make getting out of a seat hard work will make you feel old.

Interestingly, although now-a-days  we commonly use the term ‘stress’ and are so used to describing work, lives, or situations as being ‘stressful’, Hans Selye first came up with the term in the 1930’s. ‘Stress’ is actually only about 80 years old! He came up with a model to describe the biological effects of stress on the body when he introduced his General Adaptation Syndrome in 1936.

We’re all surrounded by varying degrees of stress and our bodies are designed to react to stress.  In its purist form this is where the ‘fight or flight’ reaction kicks in when we’re faced with danger. We’re designed to run away from danger or fight back if we can’t run. Unfortunately it’s rarely as straight forward as that. Modern day stresses are not about running away from a tiger they’re more about low grade persist stress in the face of things like a bullying boss, an abusive partner, or financial insecurities.

It’s fair to say that a lot of patients that find themselves coming in to see us at Mulberry Osteopaths with some form of physical crisis will also have an ongoing stress factor in their lives. Stress will highlight the weak spots and make the body more vulnerable to injury. There’s never a good time for an acute episode of low back pain but don’t be surprised if it hits at the worst possible time when you’re moving house, you’ve just lost your job, or there’s a family bereavement.

As osteopaths part of our job is to work physically to help you on the road to feeling better and feeling less old but we also try to give you ideas as to why things have gone in to a meltdown moment. Recognising the stress factors is part of that process as well as possibly offering some advice as to how to cope with the stresses.

Yoga or Pilates?

There may still be a few folk out there amongst you that haven’t yet got into the swing of things on the exercise front for the New Year. Delaying that trip to the gym or exercise studio may even be a wise move as by now those New Years resolution people will be starting to fall by the wayside so creating more space.

It’s also possible that you’re simply not sure what sort of exercise to go for. Whatever it is you choose it has to be enjoyable.  There is no way you’ll keep it up week after week if you really don’t want to be there.

As an osteopath I am very keen to get my patients involved in their own recovery and that will include not just specific prescribed exercises but also encouragement to start or restart general exercise. I’ll often be asked whether I’d recommend Yoga or Pilates.  If you ask Google the same question you’ll get numerous articles full of ‘useful’ information and celebrity advice. If you want to get confused take a look through these:

 http://www.oprah.com/omagazine/Is-Yoga-or-Pilates-Better-for-You

http://www.active.com/fitness/articles/yoga-vs-pilates-which-one-is-right-for-you

http://www.theguardian.com/lifeandstyle/2007/sep/29/healthandwellbeing.fitness

http://www.chopra.com/ccl/whats-the-difference-between-yoga-and-pilates

As a huge generalisation I’ll often suggest that if you need to improve your flexibility go for yoga whereas if you’re looking for more strength and stability opt for the Pilates.  Having said that there are plenty of toning and strengthening poses used in yoga and Pilates will also help with your flexibility.  The bottom line is that if you get a good teacher and they manage to provide a good combination of exercises you’ll end up being a bit more bendy and a bit stronger regardless of what you call the class. And this is where we come back to the need to enjoy the exercise. If you like and trust the teacher you’ll enjoy it more.

Why not try both, have a test run and see which you like best and stick to that? Of course it may also be the case that neither yoga or Pilates is your cup of tea in which case pick something else . . .running, cycling, dancing, hillwalking, tennis, swimming.  The list is endless and if you do nothing else think about breathing! If you do it properly even breathing is an exercise and there is never an excuse not to breath.

The Archaeology of Osteopathy

I often use the concept of an archaeological dig when I’m treating patients.  When a new patient arrives at clinic for the first time, tells you the story of what happened to them, what brought them to me and what the problem is the digging begins.

More often than not there are a few things in a patients past medical history, in some cases there’s a huge list of stuff, all of which is relevant on some level. One of my jobs as an osteopath is to figure out what is the new stuff and how to untangle it from the old stuff.

Backed up with clues from what the patient has told me and what I feel under my fingers I get a sense of which tensions are fairly fresh and those that have been around a long, long time. I get an idea of which joints are a bit stiff because of recent strain or injury and which haven’t been moving for years. Tensions are layered on older tensions and new injuries are layered on old injuries.

Getting an idea of what came first, how one old injury may have influenced a newer problem and which problem is freshest is important for a number of reasons.  For a start the newer stuff should be easier to resolve as it’s not so imbedded into the structure of the body and we can normally give an indication as to how soon we would expect to see a change in a condition with treatment.

However, whilst we’re on our archaeological dig through the tension layers in the body we’ll often uncover stuff that has been sitting quietly in the background unnoticed.  It may be an old injury that was never fully resolved or part of a postural pattern that’s been around for a long time.  Whilst this silent problem may have been happily minding it’s own business for years there’s a chance that osteopathic treatment may disturb it. If that’s the case, as a patient it’s as well to be warned that this might happen.  It’s all very well going along to have one problem treated only to find that it seems to trigger another problem.

Also if the old problem was in some way related to the newer injury then to avoid a recurrence the older archaeology has to be accessed.

Let it go, let it go

Those of you with children of a certain age will be well aware of the impact of the Disney film Frozen and how it has encouraged bursting in to song with ‘Let it go, let it go’. It’s scary to admit that it’s even had an impact on my osteopathy as I often seem to find the tune running through my head during treatment sessions!

It never fails to amaze me how much tension some folk can hold in their body and be totally unaware of it. I’ll sometimes try to trigger some awareness of this by asking a patient that is lying on my treatment table to relax fully whilst I lift an arm or leg in the air. I’ll then let go the limb and see what happens. Of course a nicely relaxed arm or leg will flop back to the table but it’s not unusual to find that many limbs stay exactly where I put them. As far as the patient on the treatment table is concerned they are completely relaxed despite the fact that their arm is amazingly suspended in mid-air as if held up with invisible puppet strings. This is when the Frozen tune filters it’s way into my head as I think ‘Let it go, let it go’.

Given that the patient in this situation is actively trying to relax, if that’s not a contradiction in terms, imagine what’s going on when they’re not relaxing.  I’m sure most of us have experienced the effect of shoulders rising up towards the ears after sitting in front of a computer, especially if there’s an element of stress thrown in to the mix.  There are many people whose heads are permanently sucked in towards their shoulders with no awareness that it’s happening.

In this situation often the first signs of awareness will be a stiff neck and even a headache and this is where the osteopath comes.  Stage one is to encourage the body to ‘let it go’ with some hands-on treatment.  Stage two has to involve some degree of encouragement to get the patient to ‘let it go’ mentally which has to involve becoming aware that it’s happening. Osteopaths can’t do this alone, it has to be a partnership with the patient to achieve lasting results.

So please forgive your osteopath if he or she starts humming a song from Frozen during a quiet part of your treatment.  You could argue that it’s a good sign that they’re focusing hard on one of the goals of the treatment.

You Know It’s Good For You

This time of year we have a recipe that comes out at home which we simply call ‘The Mixture’. It consists of crushed garlic bulbs (as many as you like), the juice of half a lemon, a dollop of good honey, all topped up with warm water. It has to mature over a couple of hours and then it’s ready to combat the coughs, colds, and snots.  This is essential weaponry against the lurgy, especially in a household that has kids all too keen to share their secretions. It tastes horrible but as it passes over the tongue and down the back of the throat you just know it’s good for you.

That’s sometimes what bodywork, including osteopathy, is like. When an experienced therapist hits one of those bits that’s really sore you know that it hurts but you also just know it’s good for you.  Those fingers and thumbs can become like guided missiles searching through the knots and tensions tracking down trigger points, tender points, problem spots.

That’s not to say that osteopathy should be painful.  I struggle with the idea of a ‘good pain’. If you’re on the receiving end of a treatment and you’re in pain I would say that the pain is telling you they should stop. There’s a difference between pain and discomfort, although when a therapists hits one of those good spots it can be a bit of a fine line. However, if I sense a patient is tensing up beneath my fingers I know I’ve crossed the line in to pain and I need to take the pressure off.

Most of the soft tissue work I do on patients is aimed at creating space around an area and encouraging the body to release or let go of whatever it is that’s being naturally protected. Pain or injury naturally makes us tense up to protect the area that has been damaged. When it’s appropriate to do so, releasing that protective spasm and tightness will aid recovery. However, inflicting more pain is not the way forward. Working just deep enough to encourage the tissues to release and let go is the aim.

Of course if tissues are encouraged to release and we create space it also means that everything that passes through those tissues will be less compressed. Now here’s how osteopathy can actually be seen to back up the work of ‘The Mixture’ mentioned above. If your head is full of mucous, be it a bad cold or an attack of sinusitis, having an osteopath work on your neck and upper back will effectively open up all the drainage pathways to allow for some of the sticky gunk to get away from the head.

Winter is a time of coughs and colds, it’s the time to brew up a batch of ‘The Mixture’ and it’s the time to visit an osteopath.  You’ll just know it’s good for you!

Osteopathy - Better than Diazepam

Here’s a quick reminder that osteopaths don’t just treat backs!

I had an interesting patient in recently who’s been coming along to Mulberry Osteopaths on and off for almost 10 years, so she’s pretty much aware of what osteopaths treat and how effective the treatment can be. We’ve treated her through the stresses and strains of motherhood, sporting injuries, and the effects of spending too long stuck at a desk for work. However, this time she came along with something a bit different from her usual problems.

Although I had treated her over the summer with a netball induced injury she didn’t think to mention at the time that she’d been having problems with tightness in her throat for a number of months. This eventually got to the point where she decided to see her GP who essentially decided that it was ‘just a muscular problem’ and probably ‘stress related’, so the way forward would be to prescribe diazepam.

Diazepam was prescribed quite commonly when I first started off in practice and it was often added to the prescription of pain killers for it’s muscle relaxant effects.  It still gets used now-a-days for low back problems associated with muscle spasm, but only for short periods because of the risk of getting hooked.

This particular patient wasn’t especially keen on the idea of taking diazepam but the mention of a ‘muscular problem’ made her think that maybe osteopathy could help.  Sure enough after a couple of treatments the problem that had been annoying her for about 8 months had more or less cleared. This just proves the fact that osteopathy is better than diazepam . . . at least in this case.  In this instance most of the tightness focused on a couple of muscles called the scalenes which run from the sides of the vertebrae within the neck and extend down to attach to the first couple of ribs. Not the most comfortable of muscle groups to be worked on but given that the treatment worked so well it was worth a bit of short term discomfort.

So I suppose one of the things to remember is to mention anything that is going on with your health when you are in for treatment.  It may well be that some osteopathic input can work even if you don’t necessarily think there’s a link.

Windy Back Pain

What’s the link between low back pain and a grumbly, windy gut? If you suffer from both have you even considered that the two might be linked? It could all be down to a tricky old muscle to treat called the iliopoas muscle.

Here’s the anatomy bit and you’ll have to use your imagination here as we’re talking about a muscle that isn’t visible on the surface because it lies deep within the abdomen. Don’t panic, I’ll keep it simple.  We have an iliopsoas muscle on both sides of the body and it runs from the front of the lumbar spine in the low back, underneath the intestines, then into the pelvis to eventually attach to the groin area.

Mechanically speaking it’s referred to as a hip flexor and if there are problems with this muscle it can lead to low back pain or hip pain.  However, it can also lead to a grumbling gut as a result of the muscle pushing forward into the intestine and generally compressing the passage of the gut. So this is why the achy back can also be accompanied by bloating and abdominal discomfort.

The other thing to bear in mind is that we have to think about this in a wholistic way by considering that whilst the iliopsoas might affect the gut the gut can also affect the iliopsoas.  If you have irritable bowel type symptoms this might in turn irritate the iliopsoas and cause it to spasm leading to an achy back.

Either way, from an osteopathic point of view we need to treat the muscle and the areas it attaches to. Given that it’s path is actually deep in the abdomen and beneath the gut you can appreciate that it’s not necessarily the easiest muscle to get to . . . Especially in those individuals with a touch of extra padding over the gut! However, it can still be worked on by working on the low back, pelvis and the hips.

It’s also good to find a stretch to reach the muscle to back up the osteopathic treatment to stop it from tightening up again.  This is where a nice deep hip flexor stretch is useful, especially in a kneeling lunge position. And you have to be prepared to hold the lunge for a while so as to get past the pull on the more superficial hip flexors like the quadriceps before it gets down to the iliopsoas.

So next time you’ve got a touch of wind along with your sore low back you might get the connection.