Integrative Osteopathy

Osteopathy and Exercise Rehabilitation

  • Home
  • About
    • Dr Nick Efthimiou
  • Blog
  • Resources
  • Contact
You are here: Home / Archives for rehab

Your Body Is Not A Machine

January 11, 2018 By Nick

Back of man with arms elevated exposing machine internals.

What a machine!

Food is fuel!

The heart is a pump.

The brain is a computer. Inputs. Outputs. Processing.

Analogies likening the body to a machine have been around for centuries, if not longer.

They exist in almost every culture.

They shape the way people think about their bodies.

They are wrong.

Your body is not a machine, and that is an extremely good thing.

Your body is a biological entity, which adapts over time to the stimuli it is exposed to.

Moreover, your body is part of you and you are part of your body – the separation is an illusion of the mind.

Let’s look at this a little more deeply.

Why Do We Use Machine Analogies?

In a word: simplicity (even I succumbed to computer based analogies in this post – my understanding is better now).

Even the most complex machines are computers are created by, and hence can be understood by humans.

When it comes to our body, our brain, our mind – we really don’t know that much.

We are learning at an astounding rate, but almost all research in human biology and psychology ends with the dreaded statement more research is needed.

So, to simplify things, we use analogies of machines. To the non-technical minded person, machines are complex, but we have an idea about them because of our interaction with them in daily life.

But, in the process of simplifying, we have made things too simplistic, and as a result, our explanations lead to incorrect ideas.

Incorrect Ideas Lead To Poor Health Behaviours

Many people are afraid of activity due to a fear that they will “wear out” their body.

You hear doctors described arthritis as “wear and tear” all the time.

This leads people to stop doing the very things that would improve their condition – exercise.

We see similar problems with the “hardware/software” analogies used (I have been guilty of this in the past).

When people are told their brain is like a computer, it is very limiting.

Computers cannot create.

Computers cannot feel.

Computers cannot express themselves.

At this point in time, computers can only do what they are programmed to do.

If we think our brain is like a computer, then it is becomes a tool for processing information, rather than the core of our experience.

Additionally, a computer can be reset. While we all love the idea of a clean slate (new diet on Monday, new year’s resolutions etc), in reality, everything we have experienced in our lives shapes us in ways seen and unseen, which affects what we do, think and feel going forward, which shapes us further, in a big, ever expanding circular fashion.

What Kind Of Analogies Should We Use Instead?

When it comes to adaptation, which is the hallmark of living organisms, I like to use examples from nature, like this tree from a Facebook post I made a couple of years ago.

I love how, despite the challenges of an unfamiliar, urban environment presented to this tree, it manages to adapt and thrive. This is true across all of biology. Species, both plant and animal, will do whatever they can to adapt to their environment in order to survive and reproduce.

From an evolutionary biology perspective, this is what our primary purpose of life is.

Now, as humans, we have higher aims – creation, expression, fulfilment, enlightment etc – but deep down, these biological imperatives are still there.

Instead of saying “the body is a car that needs servicing and alignment”, why not say the body is like a tree, it grows until maturity, then it endures good seasons and bad throughout its lifespan, but it adapts and survives?

Instead of saying “the heart is like a pump”, why not describe it as a river that keeps flowing to maintain it’s own health – sometimes it flows faster, sometimes it flows slower, but it still flows?

Instead of saying “what a machine”, why not say what an amazing person?

Why It’s So Important To Get This Right

Imagine if, instead of being told that her sore knee is because of wear and tear, a doctor tells her patient that her knee pain is because her nervous system is being protective of it. 

Imagine this doctor then tells her patient that to deal with the pain she needs to become more adaptable and resilient, and that she can do this by improving her flexibility, strength and endurance with exercise and activity.

Imagine if this doctor also told her patient that stress and fear makes her pain worse, and that she not only needs to become more physically adaptable and resilient, but more mentally as well, and that this is possible because even into older age, the brain and nervous system can learn and change for the better!

Conclusions

Medical and allied health practitioners need to lead the charge towards healthier attitudes towards bodies, pain, injury and ageing.

More needs to be done to build confidence in people’s health, especially in the face of pain and ageing – two big drivers of fear.

This can be achieved by stopping the use of machine based analogies and encouraging people to build strength and resilience in the face of pain, rather than retreat and avoid aggravation.

The evidence is clear: while short term rest in the case of tissue injury and post surgery is sometimes warranted, the sooner people resume activity, the better their outcomes.

We also know that expectations drive outcomes. This means more positive messages about recovery and less fear based mechanical analogies.

It’s time practice started reflecting the evidence, it’s been around for a while now.

Nick Efthimiou Osteopath

 

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.

 

 



 

 

Filed Under: Health, Uncategorized Tagged With: adaptation, cyborg, expectations, machine, outcomes, recovery, rehab, resilience

Achilles Tendinopathy? Treat The Whole For Better Results

December 1, 2017 By Nick

Statue of the Achilles, wounded by an arrow through his heel – Achillion Palace, Corfu island, Greece

The Achilles tendon is one of the coolest tendons in the body.

While many body parts are named in Latin or Ancient Greek, the Achilles tendon draws its name directly from Greek mythology.

For those who don’t know the story:

Achilles was a hero in Greek mythology and one of the main characters that participated in the Trojan War. He was also the protagonist of Homer’s epic, the Iliad. 

When Achilles was born, his mother wanted to make him immortal and thus, dipped him in the river Styx. However, she did not realise that his heel, by which she held him, was not touched by the waters, and so that was the only part of his body that remained mortal. (1)

Achilles was then struck down in battle by an arrow through his heel, or more accurately, his tendon, hence we name it the Achilles tendon.

The Achilles Tendon Is Strong

The job of a tendon is to transmit the force developed by a muscle to the bone to which it attaches. The Achilles tendon is one of the thickest and strongest in the body, and allows us to walk, run and jump efficiently. It’s almost like having our own springs in our legs. In fact, when we run, the Achilles tendon deals with forces up to 12.5 times our body weight – for me, currently weighing around 87 kg, that is 1087.5 kg!

But It Still Gets Injured

One of the most common forms of injury to the Achilles tendon is to develop an “overuse tendinopathy”.

An overuse tendinopathy, or more accurately, an overload tendinopathy, occurs when the loading on the tendon causes an increased rate of tissue breakdown, beyond which the body can keep up with. This results in inflammation, swelling and pain localised to the tendon.

Side note: all tissues in the body are in a constant state of breakdown and building, it’s when the rate of breakdown is increased beyond the body’s repair capacity, or the body’s repair capacity is impaired, that we see problems.

We Don’t Know Exactly Why

Researchers haven’t been able to isolate a single variable that causes Achilles tendinopathy (surprising eh?), but the following are implicated:

  • Running (recreationally and competitively)
  • Participation in other sports like track and field, racquet sports, volleyball and soccer
  • Use of certain antibiotics (fluoriquines)
  • Biomechanical issues at the feet
  • Age, gender, height and weight
  • Injury history, like previous ankle sprains

What we don’t know, is exactly what happens that makes the tendon painful.

We Don’t Even Know Why They Get Better

With Achilles tendinopathy, we will often see symptoms that correlate with structural changes early on in the clinical history, but as the condition progresses and goes on for longer, this correlation becomes weaker and weaker.

In fact, in many cases, it has been shown that diminished or even absent pain is accompanied by little to no structural change to the tendon!

We Do Know What NOT To Do

You’d think that simple rest would therefore be best for an Achilles tendinopathy, however, that’s not the case. Too much rest and we lose conditioning of the tissues, and thus our capacity is reduced, leading to recurrence, only this time it takes less and less loading to aggravate.

We also know that taking anti-inflammatory drugs is not the best approach either. Firstly, there isn’t strong evidence to suggest inflammation is the primary cause of pain. Secondly, anti-inflammatory drugs have side effects. Thirdly, anti-inflammatory drugs can impair healing.

Stretching tendons also gets a bad rap, though I’m not sure why this is a blanket no. Some tendon injuries respond to being stretched (it’s simply a form of load), while others do not. You’ll see why below.

We Also Know What Works

In the physiotherapy world, where much of the research on tendinopathies is done, load management strategies combined with targeted exercises are currently the treatment with the best supporting evidence.

The actual type and dosing of the exercises has not been fully established, though we do know that you can push the loading higher than you would expect, even if it is painful.

You can use different types of exercises:

  • Eccentric where you load the lengthening portion of movement
  • Isometric: where you load the tendon without lengthening or shortening it
  • Concentric/Eccentric: where you load the tendon in a full range of motion (lengthening and shortening)

To my knowledge, the best approach has not been established in research, and in my experience, different people respond better to different approaches.

This might have something to do with some recent research that suggests there are different types of tendinopathy: compressive, shear and friction, and tensile.

As the names suggest, these imply that the tendinopathy occurs as a result of different types of tendon loading, which makes sense to me. It also makes sense that if there are different aggravating loads, the exercises which have the most benefit will also differ.

The evidence suggests avoid those loading mechanisms which are aggravating (load management), whilst stimulating the tendon with loads that don’t aggravate it.

For most people, isometrics are a good, neutral, place to start.

You can do these in a variety of ways, but one of the most accessible is to sit with your thighs under a table and feet on a block, then press your thighs into the table by raising your heels. You want to be about 70% of your maximum contraction, at least to begin with. Hold that contraction for up to 45 seconds (though I will often break it down to 3×15 second holds per set). Over time you can increase the intensity of the contraction and then progress to dynamic loading.

Sometimes exercises will hurt while you do them. That’s okay. As long as your pain doesn’t spike, or get really bad afterwards, you are stressing the tissues in a positive way.

Hands On Treatment?

This is something I learnt from my colleague, osteopath Cameron Kealy who runs Recharge Osteopathy in Melbourne, along with teaching at Victoria University.

There aren’t any studies (to my knowledge on this), just clinical observations.

Cameron will treat Achilles tendinopathy with a localised technique. He will grasp the tendon and find a position where tension is relieved and hold it – often for 5-10 mins – waiting for a tissue texture change. He will then check and treat the pelvis and upper neck. Another osteopath, Walter McKone, has also suggested the key to relieving Achilles tendinopathy is optimising blood flow by treating the pelvis.

Success leaves clues, even when there aren’t studies.

Now, we know that manual therapy doesn’t change the structure of tissues.

What is happening is likely an effect of working with the sensory nerves around the tendon.

But if a person’s pain decreases, allowing them to load again and return to activity, I’m all for it.

This Makes It Work Even Better!


At the moment, one thing that all this focus on localised exercise for tendinopathy is doing, is forgetting that the injured and painful tendon is part of the body, which is considered a whole.

After all, the blood that supplies our tendons also supplies everything else.

The nervous system that perceives the tendon also perceives everything else.

The nutrients delivered to the tendon are, you guessed it, also the nutrients delivered to everything else.

Once we have labelled the tendinopathy, the more important thing to do is to look at the health of the person.

In fact, this is the premise of osteopathy: find the health within the person, and remove the barriers to that health being expressed.

After all, it isn’t lack of exercises that cause a tendinopathy, it is lack of capacity. Exercise can increase physical capacity, no doubt about it.

However, lack of capacity can be cause by sub-optimal physiological function, and not just poor load tolerance. For example, impaired blood flow.

And, as I have discussed before, it is often easier and more efficient to “remove the handbrakes” to performance/health, than it is trying to force adaptations.

Enter The ANS

The autonomic nervous system (ANS) regulates physiological function in our bodies.

It is controlled by lower brain centres – that means we don’t have direct conscious control over it. This is a good thing, as regulating all the systems in our body is a lot of work.

Having a balanced ANS is important for health. When the ANS is over or understimulated, so that it skews towards one state too much, health is affected.

This is where it gets really interesting.

The School Of Physiotherapy at The University of Otago has been doing some interesting research (and research that should be done by osteopathic schools, but that’s another issue altogether) on the effects of manual therapy and the ANS.

Recently, one of their PhD students looked at whether spinal manipulation, delivered to the thoracic spine (which is where many important ANS centres are located) would have any effect on recovery from Achilles tendinopathy.

First, they did a review on the effects of manipulation and the ANS. That is, they looked at all the research on the topic to see if manipulation affected ANS function in any way. They found a positive relationship.

Then, to look at whether this would affect recovery from Achilles tendinopathy, the researchers created two groups: a control, which received usual care for Achilles tendinopathy (read: exercises) and the intervention group, which received usual care plus spinal manipulation.

The group receiving the spinal manipulation made better improvements in both pain and function compared to the usual care group.

Whilst only a pilot study, this is promising. It suggests that improving whole body, or rather whole person, health and function, is the most optimal way to treat Achilles tendinopathy.

Future studies will need to look at whether this was a specific effect of spinal manipulation, or a general effect of manual therapy, however, my gut feeling is that the researchers are onto something.

Don’t Forget The One Percenters

Finally, when we are really seeking above average results, we can add the extras, which can help take things from good to great.

These extras wouldn’t be classed as treatment on their own, but they enhance what you are doing already.

In my opinion, these extras are what should define private healthcare. This is what you are paying for. Not just “usual care”, which is offered by the public health system, but exceptional care, with exceptional results to match.

Some of these “one percenters” can include:

  • A tailored, not generic exercise plan
  • Specific nutritional strategies, including supplementation advice
  • Behavioural and mindset coaching (we know that mindset is an important factor in recovery from injury)

These are not specific to Achilles tendinopathy, but they can definitely play a role in addition to the treatments mentioned above.

Conclusions

If you are suffering from Achilles tendinopathy, the two most important things you can do to manage/treat it are:

  1. Load management: avoiding/reducing aggravating movements initially
  2. Build capacity: use loading/exercise strategies to build capacity in the tissue and inhibit pain

However, while these strategies would give you the majority of benefits, if you are looking to optimise your recovery, then there are more options available.

I’ve outlined some of these options, which you give you a clue as to how you can really enhance your recovery from an Achilles tendinopathy injury.

As with everything, it comes down to you.

The two big questions any osteopath worth their salt should ask are: what do you want, and what can you do to achieve it?

Some interventions are not realistic because of cost, availability or other reasons. Whatever your situation, your treatment approach should be optimised for you.

That means treatment for Achilles tendinopathy should have a whole person focus, and not just a tendon focus.

Nick Efthimiou Osteopath

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) Achilles

(2) Throw Away The Anti-Inflammatories & Start Loading Your Damaged Tendons

(3) Infographic – Tendinopathy – Thou shalt load. But how? With Dr Ebonie Rio

(4) Exploring the changes in pain, function and sympathetic activity when a thoracic spine manipulation is used as an adjunct to the treatemnt of Achilles tendinopathy

Further Reading

Why Achilles Tendon Problems Don’t Heal

Recharge Osteopathic Clinic

Filed Under: Injury Tagged With: achilles tendinopathy, ANS, eccentric exercise, eccentrics, holistic, injury, isometric exercise, isometrics, load management, manipulation, rehab, tendinopathy

Recent posts

  • It’s Not About The Pain
  • How To Recover From Any Injury
  • Your Body Is Not A Machine
  • 3 Unconventional Reasons To Stretch
  • Achilles Tendinopathy? Treat The Whole For Better Results

Search

Archives

  • March 2018 (1)
  • February 2018 (1)
  • January 2018 (1)
  • December 2017 (2)
  • November 2017 (1)
  • August 2017 (1)
  • June 2017 (1)
  • May 2017 (1)
  • March 2017 (2)
  • February 2017 (1)
  • January 2017 (1)
  • December 2016 (1)
  • November 2016 (1)
  • October 2016 (1)
  • September 2016 (2)
  • August 2016 (2)
  • July 2016 (1)
  • June 2016 (3)
  • May 2016 (2)
  • April 2016 (2)
  • March 2016 (3)
  • February 2016 (3)
  • January 2016 (2)
  • December 2015 (1)
  • November 2015 (2)
  • October 2015 (1)
  • August 2015 (1)
  • July 2015 (1)
  • April 2015 (1)
  • Facebook
  • Google+
  • Instagram
  • Medium
  • Snapchat
  • Twitter

Where to find us:

Nick Efthimiou (Osteopath) is currently consulting from Coburg Osteopathy & Heath Services.

Copyright © 2018 Integrative Osteopathy  |   Website by Weblicious Solutions