Brain Training That Works

Brain Training

Brain training has become popular in the last few years, but does it live up to the hype?

No. (1)

Unfortunately, playing games on your phone doesn’t do much for your brain, aside from make you better at playing those games. (2)

Does that mean you are doomed to suffer from declining cognitive function as you age?

Not necessarily.

There are activities which have demonstrated positive effects on both brain structure and function.

Despite what advertisers tell you, these are not found in your app store.

So what can you do to “train your brain” and make it (and the rest of you) healthier?

Learn A Language

Learning a language is one of the best things you can do for your brain, and your life.

Learning a language opens up your world, from business to social and travel opportunities.

The added bonus is that it reshapes your brain, improving both the structure and function, and potentially helping stave off Alzheimer’s. (3, 4)

In this case, apps can be helpful, but nothing beats engaging in conversations – you are challenged to think in a different language, which is fantastic for cognitive function.

What’s great is that whilst becoming fluent is great for the brain (and your life), the act of learning a language, even if you struggle, still yields improvements.

Learn an Instrument

Learning an instrument has similar effects on the brain to learning a language.

Both the structure of the brain as well as the function are affected positively.

It seems that in the case of musical instruments, the longer you have played them, the better. (5, 6, 7) This doesn’t mean you shouldn’t bother if you are “older”, it simply means, once you start, keep it up, the benefits are well worth the effort!

One of the more interesting findings made by researchers, is that playing an instrument can help mitigate hearing decline due to ageing as well!

This occurs because we “hear” with our brain. Our ears translate vibrations of the air to electrical impulses that our brains decipher as sounds, and it is thought that playing an instrument helps enhance “meaning” associated with sound, allowing better function when hearing.


Exercise is probably the best brain training activity of them all, because it offers so many benefits not only to your brain, but body and soul as well.

It makes sense that moving is so good for our brain, given how much real estate in our heads is allocated to performing and controlling movement.

The list of studied effects of exercise on brain training includes:

  • Structural growth via increased signalling of various growth factors.
  • Improved memory and cognitive function.
  • Delayed onset of neuro-degenerative diseases.

So what’s the best exercise for your brain?

There is research on cardio exercise (running, cycling, walking etc) and strength training, but not much on complex functional movements.

I would hypothesise, that the best form of exercise for your brain is a circuit style workout that challenges you to move in 3 dimensions, pushing, pulling and carrying different loads over different levels – from the ground to standing.

Crossing midline (imagine a line vertically through your body, cutting it into two halves) movements are super charged brain boosting exercises (they use low level versions of these movements in neuro-rehab).

Examples of movements that cross midline:

  • Crawling
  • Skipping
  • Juggling (8)
  • Alternate single leg/arm movements
  • Rolling
  • Rotational movements

Of course, if this sounds too much, just get some vigorous walking in, the research is still positive – move it or lose it (brain function that is).


Meditation has been getting a lot of attention from scientists lately.

Research is showing positive changes to brain areas involved in stress and pain, along with global improvements to brain structure and function.

A while back I wrote an article on mindfulness for pain management – the principles described in it are relevant to brain health too.

Whether you do focused meditation, pray or simply spend time quietly contemplating, it is a fair assumption to say that inward focused practices can all have a positive affect on your brain.

Drink Coffee

Not everyone responds to coffee positively, but if you respond well, enjoy it or are addicted to it (not the greatest thing mind you), then there is some positive news.

Drinking u coffee a day can be neuroprotective (9).

I’m not sure it makes your brain better, but it can help stave off neurodegenerative diseases, which I guess, makes your brain better simply by virtue of not getting worse.

Of course, coffee has adverse effects that are more pronounced in some people, so exercise good judgement when deciding whether coffee “works” for you.


Brain training apps don’t work to make you smarter or improve the structure and function of your brain.

In fact, not much can make you more intelligent, as psychologists have been trying for almost 100 years to do, with very little success.

There are many things you can do to improve your brain health and potentially protect yourself against neurodegenerative diseases.

Like all biological cells, the brain responds to stimuli, and if you use your brain for challenging stimuli, it responds positively, growing new neural connections, increasing in density and improving in function.

Ideally, you will have a coffee before you exercise with your trainer who speaks to you in a new language, followed by an evening meditation before you play your instrument of choice.


Nick Efthimiou OsteopathThis blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

Integrative Osteopathy is an osteopathic practice located in the heart of Fitzroy North, within the reputable Healthy Fit gym. With a focus on education, manual therapy, and active rehabilitation, Integrative Osteopathy offers individual solutions to various painful problems.

If you liked this article, and would like to learn more about maintaining brain and body health throughout your life, call 0448 052 754 to have a chat with Nick, or, to make an appointment online, click here.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.






(1) Consensus on Brain Training

(2) Putting Brain Training to the Test

(3) Language Learning Makes the Brain Grow

(4) Growth of Brain Areas After Foreign Language Learning

(5) Effects of Music Lessons on Aging Brain

(6) Brain Structures Differ Between Musicians and Non-musicians

(7) Effects of Musical Training on Structural Brain Development

(8) Juggling Enhances Connections in the Brain

(9) Neuroprotective and Anti-inflammatory Properties of Coffee


The Truth About “Muscle Imbalances”

Running man muscles anatomy system

With almost a decade of experience working in a gym as a personal trainer and osteopath, muscle imbalances are a familiar topic to me.

Courses abound claiming to teach trainers and therapists how to “assess” for muscle imbalances and then “correct” these imbalances with specific stretches or exercises or treatment techniques.

The notion of muscle imbalances that need to be corrected feeds into the idea of an all-knowing practitioner, who can identify the problem causing your pain and then give you the tools to resolve it. I have previously bought into such notions. I was wrong.

Luckily, mistakes are simply lessons, and now I can share my lessons with you.

In the post, I want to outline what a “muscle imbalance” is, why they occur and their relationship to pain. By understanding all of this, you will be able to know exactly what to do about any muscle imbalances you have.

What Is A “Muscle Imbalance”?

Like many questionable concepts in the training and treatment world, there is no clear consensus on what a muscle imbalance actually is. Here are a few examples from page 1 of google:

To summarise, muscular imbalance is seen when the muscles that surround a joint provide different values of tension, sometimes weaker or tighter than normal, thus limiting the joint movement. – Wikipedia

The most common abnormal muscle condition in active and inactive people alike is muscle imbalance, which occurs when two or more muscles don’t contract and relax as they should. This type of problem is referred to as neuromuscular imbalance. – Phil Maffetone, PhD

Simply put, muscle imbalances occur when one muscle is stronger than its opposing muscle. – Dailyburn

What we can deduce, is that a muscle imbalance is a difference in muscle length and or/strength between two or more muscles acting on the same joint.

Why Do Muscle Imbalances Occur?

Are muscle imbalances the problem, or a solution?

If you see muscle imbalances as a problem, in and of themselves, then you will try and correct them with interventions targeted at those muscles.

If you see muscle imbalances as a solution, as I do, then you will try and consider why these “imbalances” exist – if you argue that these imbalances are a solution the body has come up with, then they are not exactly imbalances, but rather adaptations.

So how can a muscle imbalance be a solution?

Well, if we start with the premise that the body, being a biological organism, has an innate mechanism for survival, and will strive to do so above all else, for the sake of procreation (which ensures the long term survival of the species).

We can then deduce that these imbalances are a survival mechanism, or adaptation, aka a solution to a problem.

Back in high school math, my teacher always urged the class to show our working on a problem. If we happened to stumble upon the solution accidentally, then the solution wasn’t that great. Additionally, if we made a mistake early on in the process, but continued with the correct methodology to land at an incorrect solution, then we were awarded consequential marks.

The body is like a math problem.

It’s goal is survival, and execution of tasks (the solution), it doesn’t care how it performs these tasks (working), nor does it care if these “faulty” solutions lead to issues either elsewhere in the body or in the future (consequential marking).

So, if we get back to topic – muscle imbalances are a solution to a problem, which can then be a problem in and of themselves.

What is the problem?

Usually, it boils down to a lack of stability, somewhere in the body.

Now, a lack of stability can co-exist with a lack of mobility within a joint segment – you can’t exactly stabilise/control movement if there is nothing to control, can you?

Why would you lose mobility/stability at a joint?


As mentioned, the body is continually adapting in a way that best serves it, in that moment (however long the moment is), based on the overall exposures to different stimuli.

Thus, a young tradesman who works 50+ hours per week will have a different body to his twin brother who is a uni student who has 12 contact hours and spends another 20 or so reading and using a computer (assuming all other variables are equal, which is very unlikely).

So, What Should I Do Then?

Acceptance is the first step.

Accepting that muscle imbalances happen, and will continue to do so, no matter what. They are often a good thing, as they allow you to accomplish your day to day and recreational tasks more efficiently.

Imagine if you were a recreational runner. Your muscles will adapt, forming “imbalances”, related to your running pattern, in order to make running more efficient for you.

Is this bad? Not always.

Is it good? Not always.

However, if your muscle imbalances are related to another issue – pain, poor function (i.e. you can’t do what you want to do), then you need to assess your environment, your activities and lifestyle and your overall health status.

This will give you an insight to your ability to adapt and deal with said environment and lifestyle, and why such imbalances may be occurring.

Essentially we want to know:

  • What you can currently do – ie your absolute ability, in this case, as it pertains to movement. We do this by testing and assessing.
  • What you do regularly – your lifestyle and regular activities, that would contribute to your current ability. This is done by having a conversation (history taking).
  • What you aspire to do, or cannot not currently (the problem).

If there is a gap between what you aspire to do and what you can currently do, we seek to find out why.

If the problem is something the testing and assessing has revealed, then we can address those findings, within the context that the current state of the body isn’t necessarily a “problem”, but a “solution” to your current situation – sum of lifestyle, environment, your healthy status and health history.

So, that means, if a muscle is “tight” and another is “weak”, but this is because it is more efficient to be this way, we have to regress to progress.

That is, go backwards to go forwards by reducing the complexity of the movement and increasing the stability, so the movement is more easily performed without compensation.

Once mastery in a regressed position is achieved, we can progress.

In essence, you are addressing the muscle imbalance by addressing total body function, that is, the sum of our body’s mobility, stability and capacity, expressed in context.

This means, if you are having issues sitting, then we must improve your ability to demonstrate good function in sitting, but also your overall function, as your functional ability to sit is a subset of your overall function.

Simply put, improve function, and you improve the muscle imbalances.

However, the inverse is not true, if you improve the muscle imbalances, there are no guarantees you will improve function of the body.


Muscle imbalances are real, in that they are described consistently by different people.

They are not, as consistently described, problems that need addressing.

Muscle imbalances occur as a way for the body to adapt (poorly) to a stimulus over time.

In order to resolve a muscle imbalance, we must determine what our bodies are capable of, what we are asking of it and whether there is a gap between the two.

The size of this gap gives us insight as to how and why the body might be adapting/compensating.

We then address this gap by improving global function – that is total body mobility, stability and capacity – in a systematic way, allowing the body to “re-learn” optimal movement patterns that are stored in the brain.


This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.






Sapolsky, R., Introduction to Human Behavioural Biology

Wikipedia – Muscle Imbalance 

Dailyburrn – Muscle Imbalances and Functional Movement Screen

Phil Maffetone – Muscle Imbalance, Part 1

Phil Maffetone – Muscline Imbalance, Part 2

The Role Of Movement In The Treatment Of Pain


What is the role of movement in the treatment and management of pain?

We know physiotherapists have long time incorporated exercise(s) into their practice, but now osteopaths, chiropractors and other remedial therapists have started introducing exercise and movement as part of their treatment approach to pain.

Does this improve outcomes for people in pain?

As someone who has an exercise background, and a practice based in a gym (with a large number of patients who are active themselves), I’m a big proponent of empowering people with active management strategies to both help manage pain and improve health and fitness.

Large scale research projects have confirmed that an active, movement based approach is superior to a passive treatment approach for the management and treatment of many pain conditions.

Whilst the many benefits of exercise and movement are commonly known and widely promoted, the message can be misconstrued when context is not provided.

To understand the role of movement in the treatment of pain requires an understanding of pain.

Unfortunately, many people do not learn about pain when they seek treatment for pain, which leads to incorrect ideas and beliefs, that can make their pain worse.

The Dark Side of Exercise Therapy for Pain

In general, encouraging people to take an active role in their recovery from pain is a good thing.

Problems arise when exercise and movement is billed as being the treatment or “fix” for pain.

Unfortunately, nothing can “fix” pain, not manual therapy, not exercise, not medication, not surgery.

The reason being, pain is not a thing, pain is an experience, an active process. All of those methods create a change within your body and brain, so that your brain can resolve things.

So, as always, the context in which anything, including movement, is performed to help with pain is paramount.

What’s the big deal?

Many times, I have seen people who have been told to stand/walk/move in a certain way, because if they don’t “their pain will get worse”.

Others, rightly or wrongly, interpret their failure to improve as their fault, if they have been made to believe that exercise is what is needed to fix their pain, due to poor compliance. I often view poor compliance as not as the fault of the client, but of the therapist.

If someone can’t do something, then what has been given to them is too much for them at that point in time.

And yes, people still need to take responsibility for their actions, but the job of a health practitioner is to show the path in actionable steps, not unload a volume of information onto their patients (they could use google for that).

What’s In A Name?

Throughout this post, I have used “movement” and “exercise” interchangeably.

Whilst it is true that exercise is movement, it is also true that not all movement is exercise.

Exercise is purposeful physical exertion/activity performed to create a physical adaptation.

Movement is a preferred term, because it doesn’t have the connotations to exertion.

You shouldn’t need to exert yourself (physically) to overcome pain.

Mechanisms of Movement in the Treatment of Pain

We don’t actually know exactly what happens when pain resolves.

To clarify, we know that pain is an emergent property, that is, it has biological, psychological and social/environmental components, but it is not any one of these, nor does 1+1 = 2.

This means, that treatments for pain can be specific only up to a certain point.

Why does spinal surgery improve outcomes for some people, but not all? If pain were only physical, then surgery would always work, but we are not bodies, but people, and this needs to be considered in the treatment of pain.

That’s not to say we have no idea what helps pain, we do, generally, but what helps pain for any specific person at any specific time is going to vary.

One thing we do know, is that “all pain is neurogenic”, that is, all pain originates in the nervous system.

So for any intervention to help in the resolution of pain, it must have some effect on the nervous system.

Thankfully, we know that movement has a great effect on the nervous system.

Novel Input

Our brains crave novel sensory input. It is why we are generally attracted to “new and shiny”.

When we experience pain, it is an output of the brain, based on all the current sensory inputs from both the body and the brain itself (confusing? read this).

In theory, by providing novel sensory inputs, we can alter the outputs, including pain.

With movement, if we can “show” the brain a different way, then sometimes that is what is needed to “teach” it how to produce the desired output.

For example, let’s say you experienced low back pain that hurt when you bent forward.

If we change the context of your bending by having your feet in a split position and bending to the side, that might be enough of a different sensory input to change the output of pain.

Cortical Mapping

Our body is in our brain. We have a “map” of our body within our brain, such that when certain peripheral nerves are stimulated, a corresponding brain area is activated.

Conversely, stimulating that brain area with electrodes will cause a vague sensation in that region of the body.

When we have pain, we know that our “body map” is impaired. That is, we can’t clearly recognise our affected body parts like we can the unaffected ones.

Deliberate movement can help with cortical mapping, once again, by increasing the amount of information coming from an affected area.

Touch can help, but we seem to have a better response to active movement, likely because more brain areas are involved, resulting in a more pronounced stimulus.

Neural Mobilisation

This is little bit easier to understand for many people, because it is more of a direct mechanical effect.

Nerves are everywhere in our body. We have km’s of them.

They pass through “tunnels” of soft tissue all over the body.

They can get stuck or deformed.

When they are stuck of deformed, they will fire more rapidly and strongly.

Movement, can either directly, or indirectly mobilise the nervous system, freeing up your nerves to slide and glide freely, which is exactly what they want to do.

Descending Modulation

Our brains are pretty cool.

In addition to being able to recognise a bunch of pixels lit up on a screen into shapes (letters) as meaningful, they can produce a whole host of chemicals that can block pain at the level of the spine.

Aside: there are 3 levels where you can block pain. Peripheral, spinal and brain.

Movement can facilitate the production of pain relieveing chemicals, like endogenous opoidids. Much better than buying them at the pharmacy, because your brain is never going to get the dose wrong.

Improved Mood

There is a correlation between mood disorders like anxierty and depression and pain.

Regular and meaningful movement is correlated with improved moods, as is exercise.

You can probably see where I’m going with this.

So Movement is Medicine After All?


But just as taking the right medication, in the right dose for the right problem is paramount, using movement as an intervention for pain is the same.

More is not better if all you are doing is reinforcing the same behaviours that lead to or maintain your pain.

Think of it like this: there is the skill to perform a movement, and the capacity to perform it. If you have the skill, but limited capacity, you need to improve your capacity and vice versa.


Movement is important in treatment of mechanical pain.

Active movement is superior to passive movement in most cases.

The mechanisms of how movement affects pain are not specifically known, but there are plausible ideas, all of which must involve the nervous system.

These effects are what would be called “non-specific effects”. Whilst there are potentially “specific effects” occurring as well, we don’t know enough as yet to harness these more precisely.

In terms of pain: inputs + processing = output (pain).

To change pain, we are attempting to change our inputs, be it movement, education, cognitive behavioural therapy, manual therapy or something else.

Whatever it takes to get a change is what “works” for that person, in that moment.


This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.





Coming soon!

Lessons From The Precision Nutrition Level 1 Certification

PN Certified Coach Level 1

Back in October 2014 I did two big things:

  1. I started Integrative Osteopathy
  2. I signed up for the Precision Nutrition Level 1 Certification

Since then, only one of them had been getting the attention required to make it a success.

Until recently.

A couple of months back, I decided it was time to do the work and learn something, to benefit both myself and my patients and clients.

So a couple of months ago I started knuckling down, and this week I finally completed the Precision Nutrition Level 1 Certification.

For those of you who are unfamiliar with PN, it is a coaching and education company based in Toronto, Canada.

Founded by John Berardi, PhD., and his business partner Phil, who does the tech side of things, they are industry leaders in nutritional coaching and education for health and fitness professionals.

The level 1 course is broken up into two sections:

  1. Nutritional science
  2. Nutritional coaching

Having studied nutrition for a semester at university, along with physiology and biochemistry, I was more interested in the coaching side of things, but brushing up on the basics is never a bad thing.

I was hoping to learn how to become a better coach, and then apply that knowledge to my practice as an osteopath, in order to be able to better serve my patients.

Here are some of the major lessons I learnt:

1. Knowledge Is Key

Even though I had studied nutrition before, covering the ground again reinforced and enhance my knowledge on the topic.

It might be tedious, especially when starting out, but understanding what is happening at a cellular/biochemical level separates great nutritional coaches from the “Instagram macro coach” crowd.

If you understand what’s happening, then you can modify things for an individual when things don’t go to plan.

You can also experiment intelligently to get that “extra edge”, once the basics have been implemented.

As an osteopath, it has never been enough for me to just “know” that my patients get better.

Firstly, some don’t, but secondly, I wanted to know why this was the case.

Why do some people get better, whilst some don’t?

And, what can I do so that more people fall into the former, rather than the latter category?

2. Define The Goal

Defining a goal means understanding the “why” behind the “what”, and to be honest, it takes skill and experience to be able to elicit this from someone in a way that feels “natural”.

This was probably the biggest mistake I made in my first year of practice as an osteopath.

I would see someone, and not clarify their goals, their reasons for seeing me in the first place.

I made assumptions, and as a result, I’d often do too much or too little for someone, meaning they didn’t get the outcome they were looking for.

Once the why is clear, to both patient and practitioner, the what becomes easy.

3. Assess, Intervene, Reassess, Modify

What gets measured, gets managed. – Michael Drucker

If a person is asking for help to change, then it is important to know exactly where they are at, so you can map out the path for them to get to where they want.

The beginning of any coaching relationship should be all about information gathering.

A coach needs to know what a client needs, but also how to gauge progress.

In practice, I have intermittently used objective measures of assessment along with more subjective measures.

The problem is, there is no clear way to gauge progress, or lack thereof.

Now, pain being what it is (invisible and complex), it is hard to measure it directly, but we can strive to measure function and disability in an objective manner.

To do so, I have taken courses by the Functional Movement Group, and will undertake further study with Functional Movement Systems.

In addition to these movement based assessments, I will systematically use outcome measures more regularly.

4. Behaviours, Not Outcomes

One thing PN is huge on, is that we are all human, our lives are varied and whilst we may have different goals, it is what we do that gets us to our goals.

If you set a goal of having $500,000 of investments in 10 years time, then how much of that is in your control?

Realistically, you can’t control the global markets or economy.

What you can control is your income (to an extent) and how much of that you save and invest.

Nutrition and health coaching is similar.

Whilst you may want to lose weight, feel better or get stronger, you can’t control when or by how much.

What you can control, are you behaviours.

If your behaviours are in line with becoming leaner, healthier etc., then you undoubtedly will. It might happen sooner or it might happen later, but it will happen.

5. Judge on Results

At the end of the day, people hire me for an outcome.

That usually means they want to feel better (less pain), improve their quality of life (less disability) or improve their performance (move better).

I can write the best blogs, produce the most popular social media content and follow the “best practice guidelines to a T”, but if I don’t get the results people want, they won’t come back or refer people to me, and I will go out of business.

Getting good results is a culmination of the above points:

  1. Clearly defining a patient’s goal.
  2. Knowing what they need to do to achieve it.
  3. Translating that into behaviours.
  4. Reassessing and modifying along the way.


We are entering a new age in healthcare.

It is no longer the practitioner on one side of the table with all the power and information.

Now, patient and practitioner sit side by side, with access to more information than ever before.

It is not information that separates the best from the average, but the appropriate delivery and application of information.

When it comes to the body, things are always changing. A year from now you will be different. Thus, your needs will be different.

For a long time, healthcare has been moving towards “standardised care”.

The way I see things, that is just the beginning.

Standardised care, or best practice, is simply the foundation from which to achieve outstanding results.

Outstanding results, will be achieved with the help of outstanding coaching.


This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.


Management Strategies For Chronic Itch


Chronic itch is a frustrating experience. Sufferers of skin conditions like eczema know this all too well.

I know what you’re thinking. Why the hell is an osteopath writing about itch? Shouldn’t they stick to their scope of practice?

There are a few reasons:

  • We treat people manually, usually to exposed skin, so we often come across people with skin conditions who aren’t managing them well, or are suffering from a persistent itch.
  • Itching associated has a lot of parallels to pain. Both pain and itch are outputs of the brain and both can be caused by either peripheral causes (in the skin), central causes (in the nervous system), or a combination of both.
  • Many of the general recommendations surrounding itch are within the scope of practice of an osteopath to recommend.

If you suffer from chronic itch, it is important to consult with your GP, and possibly a dermatologist, in order to get a diagnosis of your condition.

Your itch/skin condition could be the symptom of some underlying pathology that gets worse because you tried to self-treat.

Itch Physiology

We’ve all had an itch that needed scratching at some point in our lives.

Whether it was after being bitten by an insect or due to social contagion – like yawning, we tend to scratch ourselves when we see others doing it – or some other reason.

For some people though, itching is a daily occurrence, and the desire to scratch is often so strong that sufferers of chronic itch cause damage to their skin trying to find relief.

It used to be thought that itching was a sub-group of pain, but it’s now understood to be a separate entity, though they share many similar traits physiologically.

There are different mechanisms of itch, which we can classify as peripheral or central, just like pain.

This is an important concept to grasp, because most medical treatments are only directed at peripheral drivers of chronic itch.

There are 4 classifications of itch:

  • Dermal or pruriceptive itch: refers to an itch that results from activation of itch receptors in the skin. This activation is often caused by histamine (which is also the main driver of hayfever).
  • Neurogenic itch: is an itch that originates in the central nervous system, where itch-mediating pathways are activated. This can occur with the spinal application of opioid medications, or more commonly in skin conditions, inflammation within or affecting the central nervous system.
  • Neuropathic itch: also originates in the central nervous system, but is caused by diseases of the nervous system.
  • Psychogenic itch: is related to illusional states.

When it comes to itch associated with eczema and other similar skin conditions, we want to focus on dermal itch and neurogenic itch, as these are the mechanisms involved.

Why does it feel good to scratch?

Normally, when we are exposed to a scratching stimulus, we withdraw, as we perceive it as either painful or unpleasant.

However, when we are itchy, we welcome the scratching sensation as relieving.

When we scratch an itch, there are multiple brain areas that are active, including areas involved in both pleasure and pain.

Both active (scratching yourself) and passive (having someone else scratch you) forms of scratching have been shown to relieve itch.

Interestingly, scratching nearby to the site of the itch also relieves the itch, suggesting a central inhibitory effect, rather than a local effect from scratching.

Chronic Itch Is More Than Skin Deep

Dermal/pruriceptive itch is mostly mediated by sensory nerves that are embedded in the skin called C-fibres.

There are two kinds of dermal itch:

  1. Histamine mediated.
  2. Non-histamine mediated.

Histamine mediated itching

This typically occurs when we are bitten or scratched, and there is a release of local histamines as part of the immune response.

This also occurs with conditions like hayfever.

With chronic itch related to skin conditions, this is often managed with topical steriods and over the counter anti-histamine tablets (the same ones you would take for hayfever).

Non-histamine mediated itching

This occurs in people with certain diseases (cancer, HIV/AIDS, liver disease) and as a side effect of certain medications.

It is also a big feature of the itch associated with chronic skin conditions, like eczema, though it’s not commonly discussed.

This type of itching is a massive issue – it’s difficult to treat and causes lots of distress for the suffer.

One key feature of this form of itch seems to be neurogenic inflammation. Mentioned above, this is itch that originates in the nervous system.

Setting off positive feedback loops, this inflammation is self perpetuating, as long as the stimulus is in place.

Topical treatments don’t work well for this, which is why many eczema sufferers get short term relief from creams, but in the long term may continue to suffer.

In order to get lasting relief, the root cause of the neurogenic inflammation must be addressed.

This could be down to a number of factors (or combination of), including:

– Dietary
– Gastrointestinal distress
– Psychological stress
– Environment exposures

Considering the systemic nature of most chronic skin conditions, and their relationship to other conditions (such as asthma and hayfever in eczema sufferers), it makes sense that there is an underlying physiological dysfunction that is common to all.

One such proposal is the relationship between cellular energy and inflammation. Cellular energy is needed on a constant basis for our cells to function and reproduce optimally.

It is increasingly apparent that bioenergetic function and inflammation are interdependent processes. (2)

This simply means, when cellular energy is low, due to lifestyle factors or illness, inflammation results.

Without addressing lifestyle factors that could be contributing to chronic inflammation, most sufferers of chronic itch related to skin conditions will not get complete respite from their itch.

How To Treat Itch

The best approach to resolving a chronic itch associated with a condition like eczema would be multi-modal and address all the causative factors.

  • Topicals as directed by a dermatologist, to provide symptomatic relief and manage flare ups.
  • Anti-histamines to address the histamine component of the itch (usually in eczema the two kinds exist in tandem).
  • Dietary modification: detection and elimination of dietary irritants, which can be determined by performing an elimination diet with the assistance of a dietitian other qualified health practitioner.
  • Supplements as directed by a health practitioner based on testing, to address any nutritional deficiencies (commonly Vit D and magnesium when it comes to neurogenic inflammation).
  • Meditation/mindfulness or relaxation to alleviate and manage psychological stress. Alternatively, go for a walk in nature, which has proven stress relieving effects.


Like most chronic conditions, there is no single cure-all for chronic itch, thus a multi-modal approach works best.

Whilst most medical approaches can work well for symptomatic relief, there is yet to be any treatment approach that delivers a change to the underlying pathology.

With this in mind, long term strategies to deal with neurogenic itch related to skin conditions should address factors related to both chronic lifestyle related inflammation as well as local skin irritation.


This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.




(1) McMahon, S.B., et al, Wall and Melzack’s Textbook of Pain, Elsevier Saunders, Philadelphia, 2006

(2) Bioenergetic dysfunction and inflammation in Alzheimer’s disease: a possible connection.