Does Sitting Cause Low Back Pain?

Sitting And Low Back Pain

Sitting is the new smoking. – everyone

You’ve heard it. You’ve read it. Somewhere in your brain is the meme that sitting is the new smoking.

Yes, sitting for long periods without moving is unhealthy, mostly from a metabolic point of view, but does sitting cause low back pain?

In reality, like all things related to pain, it’s complex, and as a result, the research seems to be mixed, which is a far cry from what you’ll read in most health articles posted online, in newspapers and magazines.

What Does The Popular Media Say?

It’s really common for articles in the popular media, both online and offline, to say that sitting causes low back pain. (1,2)

Most say that the incidence of low back pain has increased because of increased sitting time or via mal-adaptive processes (like muscle shortening) as a consequence of sitting.

You will read about how sitting shortens hip flexors and hamstrings, about how sitting compresses the spine and the discs and about how sitting weakens “the core”.

Because these mechanisms sound plausible, and because they are repeated so often, they are gradually accepted as fact, without much further questioning.

Unfortunately, what makes sense in theory doesn’t always pan out to work in the real world, which is why we use the scientific method to try and determine cause and effect.

This is important for two reasons:

  1. If we determine that sitting causes or doesn’t cause low back pain, then we can act on this information accordingly.
  2. If we determine a causal relationship between sitting and low back pain, we can then look at why this might be happening, in order to better treat it.

What Does The Research Say?

When we look at the research around sitting and low back pain, the results are mixed.

One study (3) took a group in 1993 and followed up at 5 year intervals until 2012. They looked at mental health, metabolic health and musculoskeletal health. They found no association with occupational sitting and low back pain.

Another study (4) I looked at objectively measured sitting time as a risk factor for low back pain. This is important, because most studies rely on self-reported data, which is typically inaccurate. The authors found that total sitting time (most studies just measure occupational sitting time) was associated with low back pain intensity, when other factors were controlled for. This means that the more these people sat, the more intense low back pain they experienced.

The third study (5) I looked at wasn’t a study, it was a review. A review is when researchers look at all the studies on a certain topic that meet certain criteria, and then compile their results.

Aside: a meta-review is when researchers review all the reviews on a topic to get an idea of what “works”. This is regarded as the best form of research evidence, because it is more robust and has more statistical power (is more likely to be correct).

In this review the authors reached the following conclusions:

Although occupational physical activities are suspected of causing LBP, findings from the eight SR reports did not support this hypothesis. This may be related to insufficient or poor quality scientific literature, as well as the difficulty of establishing causation of LBP. These population-level findings do not preclude the possibility that individuals may attribute their LBP to specific occupational physical activities.

So as you can see, from my small sample, one showed a link, another showed no link and the review found no link, but also acknowledged potential issues as to why this is so.

So, Does Sitting Cause Low Back Pain?

As you can see, the results were not conclusive. Even if increased sitting time is associated with low back pain, it doesn’t mean it causes low back pain.

This is because, pain is emergent, not dependent.

An emergent property is a property which a collection or complex system has, but which the individual members do not have. A failure to realize that a property is emergent, or supervenient, leads to the fallacy of division.

What this means, is that pain arises based on many factors, that are unpredictable, so to try and isolate one variable, like sitting, as the cause, is impossible.

No one thing causes pain.

A “More” Plausible Explanation?

If we look at why somebody might experience pain after sitting, we have to ask:

Was it the sitting, or something the sitting did?

Do people who experience low back pain from sitting also experience low back pain from other activities?

What about positions that replicate sitting, but aren’t sitting?

If they do, then what do these activities have in common?

Finally, is there ways they can sit that don’t cause them pain?

Most of the time, we will find that sitting is not the sole cause of low back pain, and when it is apparently so, it’s likely that there are still other factors at play.

One way to explain why we get pain in certain positions, is to understand the sensitivity of peripheral nerves.

When we occupy any position, particularly when pressure on the body is involved (sitting, lying etc), there is a compression of body tissues taking place, including the peripheral nerves.

When we apply pressure to peripheral nerves, they deform.

This deformation causes altered neural blood flow – rabbit models show a reduction of up to 70% of their blood flow when a strain of only 8.8% is applied.(6)

This could feasibly be a driver of nociception (bearing in mind that pain is produced by the brain, there are no “pain signals”) which could result in a pain experience.

So instead of thinking that sitting causes low back pain, it is probably better to look at the function of your body as to why you don’t have the capacity to sit for extended periods, and address those issues.

Conclusions

Just because sitting doesn’t necessarily cause low back pain, doesn’t make it harmless. Sitting has many pronounced negative effects on our metabolic functions, and movement has many pronounced benefits, including reduced incidences of pain (7).

Additionally, if you understand that no one thing causes pain, you will be in a much better position to deal with pain when it happens.

 

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) Heal your lower back pain with these 5 yoga poses

(2) Proper sitting

(3) Occupation sitting and cardiometabolic, mental and musculoskeletal health

(4) Sitting time (measured) and low back pain

(5) Occupational physical activity and low back pain

(6) Structure and biomechanics of nerves

(7) Physical activity and chronic pain (in mice)

Osteopathy for Headaches and Migraines

Woman with headache

Chronic headache is the most common neurological complaint presenting to GPs in Australia. (1)

This means it’s likely to be even more widespread than statistics suggest, as many people simply don’t seek medical treatment for chronic pain conditions.

So it’s safe to say, headaches and migraines are kind of a big deal.

Most people experience headache at some point in their life. If it is simply a one off, or infrequent, then most of the time, the best management involves either putting up with it, taking simple over the counter analgaesics or getting treatment from an osteopath (or similar).

However, when headaches are persistent, more targeted management is needed, and the first step is identifying the type of headache you have, which will influence the type of treatment accordingly.

Types of Headache

When it comes to headaches and migraines, there are two broad categories:

  1. Primary headaches, which the headache is the problem itself. These include migraine, tension type headache, cluster headache and other (less common) primary headaches.
  2. Secondary headaches, where the headache is a symptom of an underlying condition, including meningitis, brain tumours, aneurysms and brain bleeds. (2)

Because of the serious nature of the underlying conditions that cause secondary headaches, new headaches, particularly very intense or persistent ones, and those with other neurological symptoms like nausea, dizziness, visual changes and loss of balance should be examined by a medical professional.

This post will look at primary headaches and migraines, to give an understanding of the physiology involved as well as treatment options and self-management strategies.

The Headache Continuum

Primary headaches account for 90% of headaches, and are a common cause of visits to health professionals, including osteopaths.

The two most common form of primary headache are migraines and the tension type headache.

Understanding the difference between the two will help identify appropriate management strategies, so an accurate diagnosis is imperative (this means seeking out someone who went to university and studied medicine, not someone who watched an episode of House and wrote in an online forum).

A helpful way to understand the differences between tension type headaches and migraines is by the use of a continuum (3).

Health professionals love a good continuum, and I’m no exception. In the case of headaches, we have migraines on the far left and tension type headaches on the far right.

Headache-Migraine Continuum

In terms of the continuum, we have neuro-vascular involvement (migraines) at one end, and psycho-neuro-muscular involvement at the other (tension type headaches).

Though not officially recognised by the International Headache Society (IHS), there tends to be an agreeance amongst many clinicians and academics of the existence of mixed type headaches as well, which would exist about halfway along the continuum.

Finally, for this post, we will consider cervicogenic headaches, as commonly diagnosed by osteopaths and physical therapists, as well as GPs, to be similar to tension type headaches, in that the clinical features and physiology underpinning them is quite similar.

Migraines

Migraines are typically intense headaches that can last up to 3 days, often accompanied by other neurological symptoms such as photophobia (sensitivity to light) and dizziness. There are two main types of migraine – those with an aura and those without.

Migraines involve the activation of, or the perception of, the activation of the pain-producing innvervation (nerve supply) of the cranial blood vessels. (4)

Diagnosing migraines comes down to a careful history.

As migraines involve a heightened sensitivity to change in stimulus, with a careful history, often triggers can be identified and managed.

Although this is a tedius process, for those sufferers who can identify specific triggers through a process of elimination, managing migraines with lifestyle changes becomes a whole lot more viable.

In addition to lifestyle changes, there are medications which are effective in both the management of acute migraine and in the prevention/reduction of chronic migraine.

For acute migraines, one of the most effective interventions is to take 900 mg of aspirin along with 1000 mg paracetamol. (5)

In some people, NSAIDs (Naproxen, Ibuprofen etc) will have a better effect.

In many cases, there are more specific medications that will work better than those listed, though the list is long-ish, so it might take some trial and error to find out the specific medication and dosage that works for you. Again, work with your doctor, not a blog, to figure out the best approach for you.

Please understand, all medications (in fact, all interventions) have potential side effects, so before you go taking any medications, get medical advice.

Tension Type Headaches

Tension type headaches are mostly diagnosed on an exclusion basis – that is, they don’t have particular features that would classify them as another type of headache. They are the most prevalent form of headache, but often go untreated, as people don’t seek out assistance for them.

The specific patho-physiology of tension-type headaches isn’t clearly understood, but the name implies some form of mental or physical tension involvement, which is agreed upon by headache researchers.

The reason they exist at the opposite end of the continuum to migraines is the absence of vascular involvement. (6)

It is most important to get an accurate diagnosis, as these headaches, are quite a clinical challenge to treat. So if you actually suffer from migraines, but get diagnosed as suffering from tension type headaches, you are potentially missing out on efficacious treatments.

Many people with tension type headaches experience exacerbation in times of psychological or physical stress.

If this is you, pro-actively managing your stress is one of the best preventative treatments available.

Additionally, tension type headaches often have a muscular component – that is, physical tension produced by overactive muscles, usually across the face, head and neck.

Osteopathy For Headaches and Migraines

What is interesting about headaches, is that, in terms of nerve supply, facial and cranial areas are all supplied by the trigeminal nucleus.

So although the cause may differ between a migraine and a tension type headache, the origin, may be the same.

This is clinically significant, because the trigeminal nucleus blends with the nerves from C1, C2 and C3 (the upper part of the neck).

This means that treatment to influence these nerves, can, theoretically, influence all kinds of headache.

Unfortunately, theory doesn’t always translate to practice, but many osteopathic techniques to treat this area relatively safe and risk free, with the big exception being techniques that involve end range rotation of the neck, thus it may be worth exploring.

Additionally, for most people, osteopathic treatment can help relieve some of the systemic effects of headache, including an increased stress response and muscular tension.

Some of these systemic effects include:

            • Sympathetic inhibition via rib raising. The sympathetic nervous system is involved in the stress response, including blood vessel dilation/constriction, which can potentially affect migraines. (7)
            • Parasympathetic stimulation via manual therapy and breathing exercises (see the image below). The parasympathetic nervous system counteracts the sympathetic nervous system, and stimulation is involved relaxation and recovery from many stress mediated conditions. (8,9)

Take a deep breath.Chances are you’re not aware how breathing can improve your health and wellbeing (beyond keeping…

Posted by Integrative Osteopathy on Monday, 8 February 2016

These manual techniques can be quite effective, however, as previously mentioned, it is important to “treat the person, not the headache” and consider psycho-social variables as well.

An osteopath can help you recognise and deal with particular triggers of migraines or your response to stressors that might be contributing to your tension type headache and if there is further management required, an osteopath will work alongside your “health team” which may include your GP, neurologist and possibly a psychologist to optimise your management.

What Can You Do For A Headache?

Best practice for the treatment of painful conditions involves what is term an “active approach“, that is, an approach where you are engaged in you care and actively participating to achieve a result.

i.e. “doing something”, as opposed to merely showing up and receiving treatment passively, or having something “done to you”.

This means, if you are suffering from headaches you can definitely do a few things that may help relieve or reduce the incidence:

                          • Educate yourself. Understanding a problem can help you deal with it better. Understanding alone doesn’t seem to improve pain outcomes, but when combined with other active therapies (as listed below) and incorporated into your medical management, it makes a big difference.
                          • Increase your physical activity. If you don’t meet the guidelines (>30 mins daily of moderate activity), then increasing your activity by walking more will have general health benefits that may improve your headaches.
                          • Practice mindfulness. Mindfulness helps you deal with stressful situations better. It also “strengthens” your brain, building neural links that are often negatively impacted with pain.
                          • Sleep better. Improve your sleep hygiene – take electronic devices out of your room, use black out curtains and keep the room slightly cooler than the rest of the house. Additionally, build a bed time routine so that you fall asleep more easily. Fatigue can increase neural sensitivity, and the only way to combat fatigue is with adequate high quality sleep.
                          • Talk to people. Chronic pain, including headaches, can be quite debilitating, as well as isolating. Talking to others who suffer from headaches/migraines in support groups, or a professional counsellor can help with some of the negative thoughts and feelings that develop around pain and often times make it worse.

The best thing about all of these things, are that they are either free, easy to do or both.

Conclusions

Headaches are debilitating, yet with a proper diagnosis, treatment and management is possible.

This treatment must incorporate biological (physical) as well as psycho-social factors.

Looking at the research on osteopathy/manual therapy and headaches, it can seem that often times “nothing much can be done about them”.

However, when you look at physiological plausible mechanisms of treatment, and apply these to both the causes and origins of headaches, the picture seems more promising.

As always, there is no holy grail, and getting on top of things takes a team effort between yourself and your practitioner(s).

Additionally, there is much you can do for yourself, which, while it may not be “headache specific” can greatly improve your health, wellbeing and potentially your headaches.

 

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

(1,2, 3) RACGP – Management of Chronic Headache

(4,5,6) Wall and Melzack’s Textbook of Pain

(7) Rib raising and autonomic activity – http://www.ncbi.nlm.nih.gov/pubmed/20606239

(8) Osteopathic Manipulative Therapy and HRV – unpublished research from London School of Osteopathy

(9) Deep breathing, pain and autonomic activity – http://www.ncbi.nlm.nih.gov/pubmed/21939499

(10) Relationship between rcpm and dura – http://www.ncbi.nlm.nih.gov/pubmed/8610241

 

7 Effective Ways To Avoid Injury Exercising

Group Exercise @ Healthy Fit, Fitzroy North

Supervised group training at Healthy Fit – professional supervision is a great way to reduce injury risk whilst exercising.

There are numerous benefits to exercise, but what’s often not mentioned in all the pro-exercise publicity, is that there are also risks involved, chiefly the risk of injury.

Many people, despite their best intentions to get healthier and feel better, actually end up unhealthier and feeling worse after injuring themselves pursuing their fitness goals.

Recently, I polled my personal Facebook account for stories of injury whilst exercising.

It didn’t take too long for my notifications to start pinging like crazy. Here are some of the responses I got:

went for a 7-8km run then stupidly tried to do a back session whilst fatigued. deadlifting with no energy then gave me a slipped disc and a very shitty year ahead.

it still niggles. its probably at about 85%. back in the gym but i never lift at more than about 60%. also trying footy again this year but am a little worried about getting a big bump. long car trips are also a horrible experience if i dont have a rolled uo towel to place on my lower back.

I was doing weight training and now my knees are stuffed!

Sore left glute early on in hockey season. Hockey is a right handed game (seriously) and a lot of players tend to develop niggles on the left side.

Buggered knee from years of over exertion bad form and bad knees

Yes many times mainly due to my strength being far superior than my mobility and flexibility at the particular time.

High volume squats. Poor form with my wrist. – sprain which eventually led to avascular necrosis of the lunate.
Heavy tb deadlift pb. Not enough food tat day and lifted too heavy given a lack of conditioning (hadn’t lifted heavy in 3 months) back injury – 6 months.

Back is fully recovered, wrist is permanently injured.

 

Not all injuries are created equally, however, and there were many stories involving accidents and trauma which I haven’t shared. Whilst little can be done to eliminate accidents, setting yourself up to exercise as safely as possible can greatly reduce your risk of injuries like the ones described above.

In my years of practice, and especially now being an osteopath based in a gym, along with almost a decade of personal training experience , I’ve learnt a few things about why people get injured exercising. A lot of the time, there is the perfect storm of preventable factors that combine to result in injury.

With that in mind, I’ve listed 7 ways to prevent injuries whilst exercising:

 

1. Make sure you want to exercise in the first place

Most people don’t think things through properly before they start.

When it comes to exercise, before you start, you have to know why.

Without a good reason to exercise, you won’t put in the effort to do things properly, which is a sure-fire route to getting injured, or you will, but the effort will be such a stress that it negatively impacts other aspects of your life.

Deciding to exercise will either have a positive or negative motivation behind it.

Positive: I want to be healthy and feel strong so that I can live a full life.

Negative: I don’t want to end up weak and frail and isolated in a nursing home.

Neither is right or wrong, but from experience, negative motivation only lasts so long. If it gets you going, great, but be aware that those that stick to exercise for life tend to have positive motivations for doing so. Don’t worry though, chances are you’re reasons for starting will be different to your reasons for sicking to it.

Exercise is fantastic, most people should be engaging in some form, but it is not essential to exercise to be healthy.

So if you chose to do so, know your reasons.

 

2. Learn to move well

This was almost going to be number 1, because, even if you don’t “exercise”, chances are you move.

Learning to move well is both simple and complex at the same time.

The knowledge behind the process is actually quite complex, but what you have to do is relatively simple. The key is to seek out an expert who has the complex knowledge but can provide you with simple, actionable steps to get you to move well.

Whether it’s an osteopath, a personal trainer or both, the initial investment in learning to move well will pay you dividends for life.

 

3. Know your weaknesses (and address them)

We all have strengths and weaknesses. Naturally, we gravitate towards our strengths.

Big strong people tend to like to lift heavy things. Tall and lean people tend to like to run, row or ride.

Of course, these are just generalisations, but the point is, if we only ever focus on our strengths, chances are we will limit our potential achievements and increase our risk of injury, as our bodies become ever more efficient at compensating until they can no longer.

Identifying your weaknesses is a tough thing to do. Most of us a terrible at looking at ourselves objectively. This is where it pays to hire a professional to tell you what you need to work on.

Not only will address your weaknesses make you more resilient, but your biggest fitness gains will come from improving your limiting factors.

 

4. Progress intelligently

One of the biggest predictors of injury is the ratio of acute to chronic training volume.

What the heck does that mean?

It means when you see a big increase in the amount of work done in the short term, relative to the amount of work done in the long term, then injury is more likely.

Put another way, you have to build up your tolerance to large training loads.

That means starting well within your capabilities and progressing gradually.

The 10% rule – not increasing total training volume by more than 10% per week – is a good general guideline to go by.

Start with an assessment to work out your current abilities, and then progress gradually, using different means of progression. Intensity, volume, frequency, rest, density and even activity/exercise selection are all variables that can be manipulated to provide progressions.

You should have certain indicators that help you identify when you are ready to progress – whether they are qualitative (rating of perceived exertion (RPE) scales) or quantitative (biofeedback like heart rate or power output). (1)

This will prevent your ego getting in the way and causing you to make to big of a jump too soon, which is a massive cause of injury.

 

5. Prioritise recovery

Everyone loves to train hard, not many people like to put in the effort to recover well. However, your ability to exercise is determined by your ability to recover.

Recovering means more than time off training. It means actively taking steps to relax and regenerate both your body and mind.

That means your nutrition and sleep must be on point, but also, your workload and personal life must be taken into consideration of your exercise load.

There are a few ways you can monitor you recovery.

Old school: keep a journal, track your mood and a RPE for each session. If your RPE is going up and your mood is going down, it’s a good sign you’re not recovering enough.

New school: Heart rate variability (HRV) apps. HRV is a way to measure your autonomic nervous system activity, which is a good marker of how stressed you are. You can download various free apps which will sync up with a chest heart rate monitor, whilst at least one can use your smart phone’s camera to measure your heart rate via your finger tip.

Recommended HRV apps*: EliteHRV,  ithlete, HRV4training (iPhone only) (2)

The best approach, which is also the most effort, is to combine a journal, RPE scale and HRV data. Initially, it won’t tell you much, but over a longer period of time, you’ll gain valuable insight to your physical and mental state, which will allow you to know when to push hard and when to back off.

Even if you don’t monitor your recovery status, simply allocating time for active recovery techniques is doing better than 95% of people.

 

6. Balance your training over time

Depending on your individual goals and personal characteristics, you will train in a way which builds particular physical qualities.

However, it is important for health and longevity to build all physical qualities to some degree – flexibility, mobility, power, strength and endurance.

Even if you are a highly specialised athlete, outside of your sport, all training is general in nature, and thus you should aim to improve a range of general physical qualities to minimise injury and maximise performance. If your sport is “the game of life”, then this only adds to the need to exercise a broad range of attributes.

Balance is more than being well rounded; you want balance between periods of hard training and periods of consolidation, which goes back to prioritising recovery.

 

7. Don’t chase fatigue

Anyone can make you TIRED. It takes a skilled professional to make you BETTER.

One of the biggest mistakes people make when exercising, whatever their motivation for doing so, is “chasing fatigue”.

This is a problem, because whilst how we feel on any given day is important, it gives us no insight into whether we are actually improving.

Additionally, chasing fatigue often results in compromising your movement in order to complete a given task, which is risky business to say the least.

This occurs because people associate with certain feelings, and a common association, often perpetuated by the mainstream media is that a workout has to be hard to be effective.

Now, of course, some exercise sessions will be tiring, that’s completely okay, but fatigue should be a by product of exercise, not a goal in and of itself.

You don’t always have to improve from session to session, or even in a straight line (pro tip: neither happen in the real world anyway), but, over a long enough period of time, you should improve at what you are doing.

The best way to know this is to keep a training journal, but if that’s too tedious, having “milestones” throughout the year where you test yourself are a good way to keep track on a macro scale.

8. (BONUS) Fit the exercise to your body, not your body to the exercise

Not everyone is built to run long distances or squat heavy weights with a barbell.

This goes back to knowing your weaknesses (and strengths), but you should choose activities and techniques that suit your body type and abilities.

If you like to run, that’s fine, but maybe marathons on roads don’t agree with your body, so instead, you try shorter distances or trail running.

Likewise, if the gym is your thing, build your program around exercises that suit your body, not what some article online says is the best “butt builder”.

Final Thoughts

Injuries can still happen, despite your best intentions, but there are lots of things you can do to minimise your risk, the above list covers 7 very important elements to consider.

A lot of them have overlap – doing too much too soon and not getting enough rest – and are generally brought about by not knowing any better (forgiveable) or getting emotional/letting your ego guide your decisions (not-so forgiveable).

Exercising should be enjoyable, not a chore, and this list isn’t meant to take the fun out of exercise, but rather, help keep you injury free so that you can continue to exercise in a way that you enjoy.

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.

 



Notes

(1) To read about a simple, easy to use RPE scale, as used by the Australian Institute of Sport, read this.

(2) I’ve only used EliteHRV, but the other two come highly recommended from other professionals I trust.

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