How Your Mindset Impacts Your Pain

Mind

Most people think pain is a physical problem, because we feel it in our body.

Whilst this is not wrong, it is not completely right either.

This is because all pain has 3 components:

  1. “Bio” (biological – aka what is going on in the body)
  2. “Psycho” (psychological – what’s going on in the mind)
  3. “Social” (what’s going on in our environment)

You might be thinking, that doesn’t apply to me, “I strained my back shifting the couch, there’s nothing going on in my head or around me”.

That might be so, but, even if we strain out back moving furniture (an obvious physical cause to pain), by the time we experience pain, our brains have done a magnificent job of filtering the sensory information from our body via all our existing biases and preconceptions (“psycho” and “social”).

This simply means, if you’ve heard your grandfather complain about how getting old sucks because his back hurts, and if you’ve heard people talk about “wear and tear” or anything else about back pain, you brain, cool as it is, will consider this when deciding whether to produce pain that you feel “in your back”.

The fancy name to describe this, is a neurotag.

I like to think of it as a filing system in our brains.

When you see, hear, or read something about low back pain for instance, it goes in your “file” titled “low back pain”.

It doesn’t stop there. Neurotags, I mean, the filing cabinet in our brain, also cross reference.

So when your grandfather complains about being old and having low back pain, your brain files “low back pain” into the “old” file, and “old” into the “low back pain file”.

So, when you strain your back, causing the sensory nerves to start firing rapidly and bombard the spinal cord with messages of danger, your brain is pulling up all these files:

  • Danger is coming from the body
  • The danger seems to be around the low back
  • Low back pain
  • Old
  • Wear and tear
  • Can’t move
  • Never be the same

Or whatever else is stored in there. As you can imagine, over time, this could get pretty full.

All this means that even a “simple” low back strain is not so simple.

Some people are at a high risk of developing chronic pain, even from a relatively benign back strain. All because of the psycho-social factors involved. This is why it is important to always address all factors involved in your pain. After all, all chronic pain was acute at some stage. 

When it comes to treating pain, your mindset matters.

In general, there are two types mindsets that we can possess.  One can lead to a better recovery, while the other can actually impair your recovery.

The Two Types of Mindset

When it comes to our mindset, we either have a fixed mindset, or a growth mindset.

This concept was first described by a psychologist, Carol Dweck, who once had a teacher who arranged the seating order of the class by IQ. Whilst Dweck was actually in the number one position, she felt enormous pressure to maintain that position, whilst those lower in the order became resigned to their fate.

This teacher inspired Carol to conduct her own research, which lead her to conclude:

People with fixed mindsets believe that they were born with all the intelligence and talent they will ever have, and that this cannot change.

People with growth mindsets, as you might guess, believe that their abilities can expand and improve over time.

The vast majority of people who have had success in life, especially those who have had to overcome adversity, display characteristics of a growth mindset.

How Your Mindset Affects Pain

If you search for articles on “fixed vs growth mindset”, most of the results will be about personal development and business, but this concept can also apply to pain.

The easiest way to demonstrate this is with an example.

Let’s imagine two completely fictitious people, Danny and Danielle.

Danny

Danny, 30, is a rising star in the corporate world. He works his ass off every day to improve at his job – networking, learning persuasion and sales techniques, studying his field so he is on top of his game. He goes to the gym 5 times per week and ensures he eats well most of the time so he looks and feels good. On top of this, Danny has a daily ritual of visualising his success.

One day Danny starts to experience neck and shoulder pain. The onset wasn’t caused by anything in particular, but he did recall training extra hard that month.

Not wanting the pain to interrupt his life more than necessary, Danny seeks the help of an osteopath named Nick.

His osteopath formulates a treatment plan designed to get him back to full training in 4 weeks. In the mean time, Danny reads some articles Nick sent him and does some extra research on the topic from some trusted health sites he frequents.

At 4 weeks, Danny is not only pain free, but he has learnt about injury management and knows how to improve his gym workouts so that the issue doesn’t recur. In essence, he has come back stronger than ever.

Danielle

Now, let’s have a look at Danielle, 35, who is a public servant. Danielle enjoys her life – she works from Monday to Friday and enjoys exploring galleries and cafes on the weekends with her partner. At work she does what she has to do, but no more, thinking “if I’m not paid to do it, it’s not my responsibility”. Danielle feels like her life is pretty good, but she has one eye on retirement.

One day at work, Danielle starts experiencing neck and shoulder pain, and she recalls her mother having something similar due to her work as a seamstress and thinks to herself that it “must be genetic”. After talking to a colleague whose partner, Danny, had a similar problem and was able to resolve it after consulting an osteopath, she books an appointment with the same osteopath.

When she arrives for her consult, they discuss a treatment plan and get started. After a few days, there has been no change and Danielle loses motivation to do her home based exercises. She continues treatment for a few more weeks, as she enjoys the way manual therapy feels, but she is disengaged. After 6 weeks there is no change, and she is convinced her original thoughts were correct, and that her pain is “genetic” and “there is nothing she can do”.

Your Mindset Affects Your Behaviour

It should be obvious who has the growth mindset, and who has the fixed mindset, and as you can see, your mindset permeates every aspect of your life, including pain.

Having a growth mindset meant that Danny saw his pain as something that could be changed, if he changed what he was doing and improved (his knowledge, his body etc).

Having a fixed mindset limited Danielle’s recovery, as she saw her pain as her destiny (genetic), and thus was not inclined to try and change or help herself.

While pain is never simple, there are so many unseen factors, we can control much of our reaction to pain and what we do in the future. If you have the belief that you can grow and improve throughout your life, that it is likely this will extend to your beliefs around pain.

Can You Change Your Mindset?

This is the trickiest question to answer. People with a growth mindset will believe so, but people with a fixed mindset may not.

The science is unequivocal – our brains are plastic and can continue to change as long as we are alive.

As we change our thoughts and behaviours, our brain structure changes too.

If you want to change your mindset (wanting to change is key), then the best way is via actions.

You see, our brains are funny.

When we sit idle and think, especially about the future, our brains can get very creative. This can be a positive if you start thinking about where you want to be in 5 years and what you have to do to get there, but not so much if all this thinking does is keep you idling in place for another 1/2/5/oh-shit-where-did-my-life-go years.

It’s even worse if you start getting into negative thought spirals.

However, if we take action, any action, then our brains can’t get carried away. And, if we are smart, and start small, then we achieve a little success, we build confidence and momentum. Repeat this process long enough and you become a different person.

This, in essence, is mindfulness, but let’s call it something else – let’s call it momentum. Create momentum by starting small and before you know it, you have changed.

Really, My Back Hurts, How Does This Help Me?

In essence, it all boils down to this: are you resigned to having pain or looking for someone else to solve your problem (fixed mindset), or, are you willing to adapt, change and do what it takes to help yourself?

Some conditions are very easy to recover from, others very hard. What doesn’t change though, is that if you have no doubt in your mind you will improve, no matter what it takes, then you probably will*.

 

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.

 



 

 

 

References

(1) Wikipedia – Carol Dweck: https://en.wikipedia.org/wiki/Carol_Dweck

(2) Stanford News Service – Fixed versus growth intelligencehttp://news.stanford.edu/pr/2007/pr-dweck-020707.html

(3) NY Times – If You’re Open To Growth, You Tend To Grow: http://www.nytimes.com/2008/07/06/business/06unbox.html

(4) Brain Plasticity and Behaviour – https://www.psychologicalscience.org/journals/cd/12_1/Kolb.cfm

 

*Please don’t take this the wrong way if you suffer from chronic pain. This isn’t meant to belittle your pain or say you are not trying. The recovery rate for chronic pain is quite low, but many people learn to live fulfilling lives and manage their pain quite well. In part this comes from re-shaping their thoughts, emotions and behaviours around pain. Cognitive Behavioural Therapy (CBT) is quite helpful in this regard.

Do You NEED To Exercise To Be Healthy?

Kids Exercise

Integrative Osteopathy is situated within a gym.

Our treatment process will often include exercise or exercise advice for many patients, who are often already gym goers or exercising in another way.

Exercise has many benefits to almost all aspects of health and well being. Does this mean everybody should exercise?

Often, patients will talk about how they “should” be exercising, despite not enjoying exercise in the past.

Part of the challenge of practice is finding exercise that people enjoy doing, as this is often the biggest factor in whether someone sustains the habit for the long term.

However, for some people, exercise is not an option, either because of physical limitation, time restrictions or lack of enjoyment.

For these people, and everyone else, this post explores whether you need exercise to be healthy.

The short answer is no, but it’s a lot more complicated than that.

What is exercise?

Exercise is any activity performed with a specific physical/health outcome in mind.

This is in comparison to activity that is incidental, or part of your normal daily life (including work).

Example: going for a walk for no other reason than to move your body and maintain your health (specific physical outcome) compared to walking to the local shop to buy something you need.

Whilst both are the same activity, it is the intention that defines whether something becomes exercise.

We have developed exercise to compensate for our ever decreasing activity levels in daily life, as well as for enjoyment and to derive specific.

To add to the mix, sport is a form of physical activity, but it is not necessarily exercise.

Sport is a competitive activity played with the objective of winning. Sport can be healthy and a form of exercise, particularly when pursued recreationally, with little/no care to the outcome, but as soon as the outcome is the driving factor, it is no longer exercise, as health is often sacrificed for increased performance.

To recap:

  • Exercise is an activity performed for a physical/health outcome.
  • Sport is a competitive activity performed with the objective of winning.
  • Incidental physical activity is that which occurs when performing your normal activities of daily living, researchers call this NEAT (Non Exercise Activity Thermogenesis).

What is health and fitness?

A discussion about health and fitness is useless if everyone has their own definition of what each is. The following are commonly used definitions, found via google dictionary.

Health = “the state of being free from illness or injury.”

Fitness = “the quality of being suitable to fulfil a particular role or task.”

Using these definitions, you can see that you don’t necessarily need to be healthy to be fit for a particular task.

It’s easier to understand with an example:

In 2003, Cameroon footballer Marc-Vivien Foe died in the middle of a competitive international fixture. It was later found, via autopsy, that he suffered from a genetic condition called hypertrophic cardiomyopathy (1), which made him susceptible to sudden death during exercise. Here was a highly fit man who had a serious health issue that ultimately lead to his premature death.

There are numerous other examples of extremely fit people suffering from serious health issues, enough so, that it is fair to say that fitness does not equal health.

The Effects of Exercise on Health and Fitness

We know that exercise can improve your fitness as measured by a number of different metrics.

We also know that exercise can improve your health, also measured by a number of different metrics.

What isn’t talked about as much, is that exercise can decrease your fitness and harm your health. 

Because exercise is such a broad term, it is very difficult to be specific with claims. What is important to understand, that how you exercise is almost as important as whether you exercise, or don’t.

When we look at the harmful effects of exercise, they generally stem from two issues:

  1. Poor quality (poor technique, leading to an increased injury risk)
  2. Too much (over training, causing systemic stress leading to a multitude of issues like increased injury risk, hormone dysregulation, immune suppression and chronic fatigue)

If you address these two issues, then there are definitely health benefits to be had, but it must always be remembered that when exercising for both health and fitness gains, there is a point of diminishing returns. That is, you have to work ever harder, doing more, for ever diminishing gains.

Additionally, the are also other reasons to exercise. Most of these involve quality of life – looking better, feeling stronger or more capable etc. These factors can indirectly improve your health and help you enjoy life more.

Done properly, exercise can improve your health and wellbeing. Done poorly, at best, exercise is a waste of time, at worst, it is leading to injuries or other health issues.

“Exercise as medicine”

Much recent research has focused on exercise interventions as medicine. This is because exercise, when properly controlled and administered, tends to have numerous positive effects, crossing multiple body systems, with minimal side effects.

Although the mechanisms of action are not all clear, they are continually being explored, and more is being learnt annually.

However, when viewing exercise as medicine, we have to accept that people needing medicine are already unhealthy in some way.

Thus, in this case, exercise is akin to taking a drug – it has a specific physiological effect. This is why we have seen the emergence of Accredited Exercise Physiologists (AEP) in Australia, to administer exercise to people with various diseases/health conditions.

And, just as we wouldn’t (shouldn’t) take drugs without a prescription, using exercise as medicine can also involve risks.

The other side of the coin is exercise as prophylactic medicine. Does exercising when you are already healthy, make you “more healthy”?

Very possibly. There is a lot of data to support the reduced risk of many conditions amongst those who exercise.

If health is defined as being free from illness and injury, we can use exercise to prolong our good health, by reducing risk factors for specific conditions. This is done by optimising certain physical qualities, based on statistical averages, in essence, becoming “more healthy”.

The confounding factor here, however, is that most data uses controls the reflect the average person. Research shows that the average person does not meet the physical activity guidelines as recommended by the government health authorities.

So the question becomes, do people experience more health benefits from exercise compared to those who are simply physically active, but don’t engage in formal exercise?

All the research we have come across suggests that the most important factor is to be physically active for at least 30 minutes per day, but it doesn’t matter if this is incidental activity like NEAT, formal exercise or anything in between.

Does exercise extend your life?

We have discussed how exercise can improve your health, and as a result of this, the quality of your life.

However, one issue that seems to be misunderstood is exercise’s role in extending (or not) our lifespan. After all, it’s only natural to want to live as well, and as long as possible.

The following factors influence our lifespan (4):

  • Genes
  • Environmental
    • Year of birth
    • Socio-economic status
    • Education
    • Occupation
    • Smoking
    • Alcohol
    • Body-mass index
    • Diet (?)
    • Physical activity (?)
    • Intra-uterine conditions
  • Medicines

Quiet the list.

One accepted view is that lifespan/longevitiy is predominantly predetermined by genetic factors, which are then influenced by our environment and lifestyle.

Thus if we have a healthy genetic base, living a certain lifestyle will help promote longevity.

Perhaps the most interesting work on this topic comes from the “Blue Zone” group, which started when National Geographic commissioned an article on longevity.

Author Dan Buettner came up with 9 different “lessons” that cover the lifestyle of people in the Blue Zones. They are:

  1. Moderate, regular physical activity.
  2. Life purpose.
  3. Stress reduction.
  4. Moderate calories intake.
  5. Plant-based diet.
  6. Moderate alcohol intake, especially wine.
  7. Engagement in spirituality or religion.
  8. Engagement in family life.
  9. Engagement in social life.

Although physical activity is on top of the list, an article in The New York Times covering the Blue Zones expands a little further:

In the United States, when it comes to improving health, people tend to focus on exercise and what we put into our mouths – organic foods, omega-3’s, micronutrients. We spend nearly $30 billion a year on vitamins and supplements alone. Yet in Ikaria and the other places like it, diet only partly explained higher life expectancy. Exercise – at least the way we think of it, as willful, dutiful, physical activity, played a small role at best.

What really matters though, in relation to this post, is whether exercise makes us live longer. A recent study out of Finland sought to answer that.

Without getting too complex, the authors stated:

Based on both our animal and human findings, we propose that genetic pleiotropy might partly explain the frequently observed associations between high baseline physical activity and later reduced mortality in humans.

What this means, is that there is one genetic component that influences physical activity levels, cardiorespiratory fitness and risk of death.

So it is not that exercising makes you live longer, but rather being active and your lifespan share the same genetic link. 

All this suggests, is that there are people who exercise that live both long and short lives, and there are people who don’t exercise who live both long and short lives.

So if you are exercising to live longer, you might want to consider your entire lifestyle, and even then, reconsider.

Decide to exercise because you enjoy it and its effects, not because you want to live longer.

So do you need to exercise?

So far it has taken almost two thousand words to get to the point where we can answer the original question.

You should now have an understanding that such a question does not have a clear cut answer.

It really comes down to the reasoning, i.e. why you want to exercise, and the execution, i.e. how you exercise.

Only you can decide if you need to exercise, but our recommendations are:

You should exercise if:

  • You enjoy exercising
  • You lead a relatively sedentary life, so exercise is your main form of activity
  • You have certain health conditions that would benefit from exercise
  • You are looking to improve certain fitness qualities
  • Your quality of life improves with exercise, be it for physical, psychological or social reasons

You do not need to exercise if:

  • You do not enjoy exercising
  • You lead an active life, i.e. you incur lots of incidental activity (walking, lifting etc) in your occupation and/or activities of daily living
  • You are already healthy, and happy with your current fitness levels

You should not exercise if:

  • You have underlying health risks that may be affected by exercise (if in doubt see you doctor and ask about a referral to an exercise physiologist).

Conclusions

At Integrative Osteopathy, we believe in leading a healthy and happy life.

The definition of health is universal, and the code to healthy living has generally been cracked. Physical activity is a big part of that. What isn’t universal is the need for formal exercise, if you are already very active in your day to day life. In fact, exercise can play a part in increasing physical activity, but it doesn’t substitute for regular physical activity in an otherwise sedentary individual.

The often overlooked factor in much heath research is happiness, which is a very individual thing.

Happiness and satisfaction in life are gained from engaging in meaningful pursuits – whether it be working to create things, grow or support a family, hobbies that express your creative side, physical pursuits that challenge your body and mind or whatever else.

We know the benefits of physical activity, but the recommendations from health bodies only talk about the type and amount. They don’t mention intangibles like enjoyment and meaning, and that’s fine, they’re not meant to, they’re public health recommendations, not personal health recommendations.

Whilst your doctor might suggest otherwise, the only person who can really say if you need to exercise, is you.

 

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.

 



 

 

References

(1) Wikipedia:https://en.wikipedia.org/wiki/Marc-Vivien_Fo%C3%A9

(2) Exercise as medicine: http://www.ncbi.nlm.nih.gov/pubmed/26606383

(3) Exercise is medicine, at any dose?: http://jama.jamanetwork.com/article.aspx?articleid=2468899

(4) Determinants of longevitiy: http://user.demogr.mpg.de/jwv/pdf/Vaupel-JIM-240-1996-6.pdf

(5) Blue Zones: https://www.bluezones.com/

(6) The Island Where People Forget To Die – http://www.nytimes.com/2012/10/28/magazine/the-island-where-people-forget-to-die.html

Rethink Pain: Osteoarthritis

Knee X-ray

In the first post of the Rethink Pain series, Moving Beyond Muscles and Bones, we discussed shifting your view of pain away from body tissues like muscles and bones towards a more accurate one, of pain as a protective neurological process.

This post will take that concept and apply it to one of the most prevalent and debilitating chronic conditions in the world today, arthritis.

Nearly everyone has heard of arthritis. Arthritis is actually a group of conditions that affect the joints, encompassing a variety of conditions from autoimmune to inflammatory. This post is going to focus on the most common form, osteoarthritis (OA). 

There is a lot of misinformation surrounding arthritis, spread by cultural memes and well meaning family and friends. This leads to erroneous thinking that is likely causing a nocebo effect (the opposite of the placebo effect).

What is Osteoarthritis?

Described as “wear and tear”, osteoarthritis is, more correctly, a condition of joint cartilage degradation and reactive bone growth.

Cartilage covers the surface of most of our movable joints, creating a smooth and gliding surface, as well as providing shock absorption.

Tissues are constantly being “broken down” and then “rebuilt” in our bodies. This is a completely normal process which allows us to grow, heal and adapt.

When someone has osteoarthritis, this rate of degradation is accelerated and not matched by an increase in the rate of cartilage regeneration.

Here’s a simple analogy:

Imagine you are spending $1000 per week and making $25 per hour. To break even, you must work 40 hours.

Next, imagine after a few years your spending increased to $1250, yet you are still making $25 per hour – you now have to work 50 hours per week to cover your costs.

A few more years pass, and your spending increases yet again, lets say to $1500 per week. This time, however, your hourly wage drops to $20 per hour – you now have to work 75 hours to break even.

Eventually, if this process continues you will not be able to keep up. This is similar to what happens in OA – the rate of cartilage regeneration cannot keep up with the rate of degradation.

What Causes Arthritis?

There is no singular causal factor for arthritis. There is a large genetic component along with the combination of other factors (1).

Some of these factors include:

  • Tissue susceptibility/genetics. Cartilage is slow regenerating tissue at best, due to both is structure and its low blood supply. Some people have slower regenerative rates or are more susceptible to increased degradation.
  • Aging. Rates of regeneration decrease as we age, arthritis is more common in older people, and we have an aging population.
  • Chronic systemic stress. Stress hormones are catabolic – they increase tissue breakdown. Stress levels seem to be higher these days, as a result of both economic and cultural/lifestyle changes taking place across the globe.
  • Obesity. People are heavier, on average, and obesity has a correlation to arthritis via two mechanisms: increased mechanical stress on joints and increased inflammatory mediators in the bloodstream (secreted by fat cells).
  • Mechanical stress/”overuse”. We’ll discuss this further below, as “wear and tear” or “overuse” is one of the most common throwaway descriptions of arthritis.

One factor that’s often cited by medical/health practitioners is mechanical stress, commonly termed overuse or wear and tear.

There are a few problems with this language.

First, what is overuse, and how do we measure it?

Second, it doesn’t take into account that different ways of using your body have different effects.

In the case of arthritis, full range of motion through the joints stimulates cells called synovites, which secrete joint fluid to provide nutrition and have a protective effect on the joints.

Limited and repetitive range of motion activities tend to create uneven joint stresses, causing reactive bone growth, and an increased firing of the nerves, which affects joint mechanics and can increase sensitivity and pain.

So yes, certain activities can increase the likelihood of arthritis in susceptible people, but simply using your body does not cause arthritis. This has been demonstrated in runners (2), for example, who have no more arthritis than non runners, despite the myth that “running is bad for your knees”.

 Arthritis Pain

The biggest problem with arthritis is the associated pain. Most people don’t consult a doctor or allied health professional for anything else related to arthritis.

Pain doesn’t correlate well with imaging findings or the severity of joint degradation (my emphasis):

Patients largely present with pain and disability after significant loss of cartilage has occurred, but it is estimated that up to 40% of individuals with radiological damage have no pain. (3)

This kind of blows the “damage causes pain” thought process out the window, doesn’t it?

So how might this be?

Pain is a perception created by our brains in response to a variety of different sensory “inputs” including:

  • “Danger signals” from peripheral nerves in joints, muscles and other body tissues
  • Thoughts and expectations
  • Emotions
  • Brain and body chemistry – for example, hormonal status

We can divide these into central factors (brain and spinal cord related) and peripheral factors (everything else).

One of the most important central factors is called sensitisation. Basically, this means that the spinal cord and brain become more sensitive and produce pain in response to less and less stimuli.

This mechanism is proposed to be largely involved in arthritis related pain.

This then triggers a positive feedback loop whereby the pain causes negative emotions, reduction or avoidance of movement and an increase in stress hormones which then further aggravates the pain.

An example of a positive feedback loop between pain, cognition and emotions.

An example of a positive feedback loop between pain, cognition and emotions.

In addition to the central factors described above, there are peripheral factors that likely contribute to arthritis pain as well.

Some of these peripheral factors would include:

  • Impaired fluid dynamics of the joint
  • Inflammation
  • Mechanical strain

All these factors would likely increase the frequency and intensity of nociception, the transmission of “danger signals” from the nerves in the joints, causing the brain to produce a protective response of pain and stiffness.

If this cycle continues for long enough, then the peripheral nerves can also become sensitised, leading them to start firing at lower thresholds, much in the way central sensitisation works.

For a more in depth understanding of these processes, read Pain Science BasicsIt describes in easy to understand detail what is actually happening when we experience pain.

Osteopathy For Arthritis

The osteopath’s way of thinking is to look backwards from the presenting symptoms to try to work out why the body would “adapt” in such a way.

In the case of osteoarthritis, we would want to know the answer to the following questions:

  1. What has lead to the increased rate of cartilage degeneration in this person, in this joint?
  2. What has lead to a decrease in the rate of cartilage regeneration in this person?
  3. What potential factors may be contributing to this person’s pain?

As a result of these questions, two different people with knee osteoarthritis may end up with differing treatments, based on their primary causative factors.

Of course, the disease process is common, so there will be a lot of overlap, but treatment will always be tailored to your individual’s needs.

If you were suffering from OA and came for treatment, we would want you to feel a part of the process and be engaged in your care.

This means we’d place a large emphasis on educating you so that you fully understand what is happening, why it is happening and the implications for your life presently and in the future.

We would also present you with your treatment options, their risk, benefits, cost and the likely results of not doing anything.

We would then, use manual therapy to mobilise the entire body. Why the entire body? For starters, if your osteoarthritis is the result of, in part, altered biomechanics, treating the entire body is the only way to restore balance.

You see, whilst there may be altered loading of the affected joint(s), this may be the result of a protective response by the nervous system resulting from adverse tension elsewhere, in other words, your body is compensating for another issue.

Additionally, it is important to recognise that separation of the body exists only in our minds. Our knees are served by the same organs that serve our shoulders and everything is integrated by the one brain. This means it only makes sense to treat the entire body – we are, after all, not body parts, but people.

Our osteopathic treatment for osteoarthritis is gentle, slow and rhythmic, allowing for the body to self correct with movement/relaxation of muscle and joint tension, all the while helping with fluid dynamics throughout the body. It shouldn’t be painful, as we don’t want to increase any sensitisation that may be present.

Further, in addition to manual osteopathic techniques, we would show you how to manage or improve your condition with lifestyle changes, which we will discuss further below.

What Can You Do To Help Yourself?

Although genetic predisposition can play a large role in the development of OA, for most people, it is complex interaction between genetics and environment that leads to the onset of physical changes to the affected joint(s), and an even more complex interaction that leads to the onset of pain.

With this in mind, you can definitely take action to help prevent/delay/manage the onset of osteoarthritis in your life.

Things that you can do include:

Maintain an optimal body weight for your frame

Every body is different. Some people have a large skeletal frame, others are more compact. Some people are naturally lean, others tend to carry more body fat.

What is undeniable, however, is that from a medical point of view, there is an optimal weight range for your frame.

At this weight, you are not so big that there is increased stress on your joints and organs, but not so small you compromise your lean body mass and hormones.

In terms of osteoarthritis, increased weight, as mentioned earlier, is a risk factor both biomechanically and chemically as a result of increased systemic inflammation.

The BMI is a good general guide to maintaining a healthy weight, but it does not take into account body composition (muscle vs fat), only total body weight.

Waist measurements are another good guide to whether you are storing a lot of risky visceral fat (the fat that sits on your organs and leads to conditions like diabetes and heart disease).

If you are overweight, it’s a good idea to speak to your doctor as a starting point, to get blood work done and then any referrals you need to other health professionals who specialise in weight loss, because, aside from OA, there are many other health conditions made worse by being over weight.

Lead an active lifestyle

Some people love to exercise, others don’t. That is completely fine.

Leading an active lifestyle doesn’t mean you must spend hours every week in the gym or running the streets. If you don’t like exercising, and you otherwise have a sedentary lifestyle, it is in your interests to increase your activity levels.

This could be as simple as walking or cycling more as a means of transport.

Incorporating some form of work with resistance is also important for health, again, if you don’t like the gym, this could be doing physical work in the garden or around the house that involves lifting, pushing and pulling.

Now, if you are suffering from OA pain, this can be hard to do, so as always, prevention is better than cure. However, there are generally ways you can increase your activity, even with OA.

Live with purpose

As humans, we need meaning in our lives. This meaning, or purpose, gives us reason to get out of bed a do things each day. Without it, we waste away, mentally and physically.

Everyone will have different things that give them meaning, this doesn’t matter, it’s what makes us great. What does matter, is living with purpose.

Research is unequivocal – those who live with purpose have longer and healthier lives in almost every meaningful measure, including pain.

Maintain strong social networks

Whether you have a huge family or a strong network of good friends and acquaintances, maintaining social ties is not only linked to better health and wellbeing, but less pain.

Whilst living in pain can feel isolating, living without social contact is quite bad for us in both the long and short terms.

One study showed that adolescents in isolation demonstrated increased levels on inflammatory mediators in their blood, which affected their physiology for their entire lifespan! (6)

Open up to your existing friends and family more, reach out to those you’ve lost contact with and get engaged with like minded people to make more connections.

The internet has make connecting so much easier, but staring at a social network on a screen does not replace face to face interaction.

Increase Your “Physiological Buffer Zone”

The physiological buffer zone is a concept described by Patrick Ward, MS, an American sports scientist currently working with the Seattle Sounders FC.

In simple terms, it is basically the buffer you have between physiological stress and the onset of injuries and symptoms.

To increase this, an analysis of your physical status is required and then a prescription of exercise, lifestyle, nutritional and recovery advice is given, aiming to improve your resilience.

Whilst this concept was developed for athletes, it is certainly applicable to everyday people with everyday pain.

Medications

Medications to help manage arthritis pain do exist, but most are not very effective. Some relief can be expected, but it is very rare for medications to provide complete relief from osteoarthritis pain.

One medication that seems to be promising, is topical capsaicin. Capsaicin is the active ingredient in chillies. Extracts in topical creams stimulate particular nerves that have been shown to decrease pain. (8) The promise with capsaicin is that the side effects are quite minimal, unlike other many other common medications used to manage osteoarthritis pain.

You should consult your doctor for options about medications, asking about their effectiveness along with their side effects.

Conclusions

Osteoarthritis is a multi-factorial condition that affects a large number of people. By far the most common complaint is pain, which doesn’t seem to be directly caused by the extent of joint changes, but rather by increased sensitivity, both centrally and within the joints.

In general, the best way to treat/manage osteoarthritis long term is to strive to improve your health in all aspects whilst utilising specific treatments to reduce your pain and other symptoms.

Together with right environmental factors, you give yourself the best chance to lead a full life.

If you suffer from OA and would like to add anything, we’d love to hear your story in the comments below.

 

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.

 

 

References

(1) Kumar, et al, Robbins and Cotran Pathologic Basis of Disease,  Elsevier Saunders, 2005, PA

(2) Running and osteoarthritis: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556152/

(3) What makes osteoarthritis painful?: http://rheumatology.oxfordjournals.org/content/50/12/2157.long?view=long&pmid=21954151

(4) Positive feedback loop in pain : http://www.nature.com/nrn/journal/v14/n7/fig_tab/nrn3516_F1.html

(5) Obesity and arthritis: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406287/

(6) Obesity and arthritis: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2573886/

(7) Social networks and long term health: http://www.pnas.org/content/early/2016/01/02/1511085112

(8) Social networks and pain: http://www.ncbi.nlm.nih.gov/pubmed/15561396

(9) Topical capsaicin for pain: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169333/