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Management Strategies For Chronic Itch

Nick

Scratch

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

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

There are a few reasons:

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

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

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

Itch Physiology

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

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

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

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

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

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

There are 4 classifications of itch:

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

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

Why does it feel good to scratch?

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

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

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

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

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

Chronic Itch Is More Than Skin Deep

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

There are two kinds of dermal itch:

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

Histamine mediated itching

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

This also occurs with conditions like hayfever.

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

Non-histamine mediated itching

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

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

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

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

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

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

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

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

– Dietary
– Gastrointestinal distress
– Psychological stress
– Environment exposures

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

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

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

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

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

How To Treat Itch

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

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

Conclusions

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

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

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

 

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

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

 



 

References

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

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

Stop Blaming People For Their Pain

Nick

Blame

This post is directed at the friends, families and health professionals of chronic pain sufferers: stop blaming people for their pain.

It is really common, whether overt or subtle, for people suffering from chronic pain to be blamed for their pain.

I would argue that this stems from a lack of visibility (you can’t see low back pain or migraines) and a lack of understanding, which I’m hoping to change.

Previously I have posted about both personal responsibility and pain as well as mindset and pain.

In these posts, I am not blaming people for being in pain.

Rather, I am urging people to take responsibility for their actions in the face of their pain, because that is the only way things will ever improve for them.

Chronic Pain Is Nobody’s “Fault”

Whilst you can definitely contribute to, or even cause your pain in certain circumstances, when it comes to chronic pain, it isn’t anyone’s fault that they have become “victims of their own nervous system”.

Let’s look at how most chronic pain arises:

  • Post surgical
  • Post physical trauma
  • Post major stressful event
  • Secondary to disease (e.g. rheumatoid arthritis, cancer, dengue fever etc.)

Now, we don’t know why certain people develop chronic pain whilst others don’t, despite having the same experience.

All we know is that each person has a unique psychological, emotional and physical makeup.

And that there is something about the event’s effect on that individual that sets their nervous system off on a path of persistent pain.

We can look at factors that are correlated with chronic pain, but again, very little is predictive.

In fact, in terms of pain epidemiology (which is the study of health and diseases across populations), it seems the two biggest correlates are out of anyone’s control:

  • Age
  • Gender (females suffer from more chronic pain than males)

So whilst we can definitely control how we act and react in the face of pain, we can’t control the onset or presence of chronic pain.

It’s Human To Judge

It is a human instinct to judge others, based on our own perceptions of the world and experiences with people.

Equally, it is important to recognise that all of us have limited experiences, and our judgements are made on limited (if any) factual information, and lots of assumptions.

We have evolved this way for survival reasons, but it can often get us into trouble when dealing with humans – we don’t know what’s going on in our own “unconscious mind”, let alone others’.

Considering this, it is easy for our brains to lump people into categories and assign blame – it makes our worldview “neater” and simpler, but it does so at the cost of making things simplistic, when often that is not the case.

Whilst you can’t (and shouldn’t) stop judging, you have to acknowledge the limitations that are inherent within our judgements and use your cognition (yes, you’ll have to think), before you act and speak.

What To Do Instead

You’re probably thinking, “gosh, this is hard, I’m going to feel like I’m walking on eggshells any time I have to talk to someone with pain”.

When someone is constantly complaining about their pain, they are expressing a need.

This need can be for attention, care, acknowledgement or reassurance.

Pain is rooted in fear; our brains have decided that there is danger (real or not), and that pain is the best motivator for change.

Unfortunately, chronic pain is the dark side of neuroplasticity (the ability of the brain to change), where the brain has become more efficient and skilled in the pain response, and so pain is not indicative of any damage within the body, but rather a heightened sensitivity to normal stimuli.

Instead of blaming someone with pain, try practicing empathy – that is, understanding what that person is experiencing, from their point of view.

It could be a loss of independence, a frustration at lost capabilities, a fear for the future, a combination of all three or something else entirely.

Conclusions

Pain is a normal part of the human experience.

We will all experience pain at different points in our life, and we hope that it is brief and not serious.

However, for many people, pain is not brief, but daily and ongoing, and a great disruption to their lives and their personality.

The vast majority of sufferers of pain have not done anything to “deserve it”, and so should not be blamed for their condition.

Instead, practicing empathy and acknowledging someone’s suffering is a better approach, without dwelling on pain and making it a focal point of your interaction.

 

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

(2) Chronic pain epidemiology and its clinical relevance

(3) Preventing chronic pain following acute pain: risk factors, preventative strategies and their efficacy

(4) Risk factors associated with the onset of persistent pain

Aging, Fitness and Flexibility

Nick 1 Comment

van Damme Volvo Splits

Two of the biggest physical issues we face as we age are:

  1. Loss of strength and power (1,2)
  2. Loss of mobility and flexibility (3)

For most people, exercise is a means to improve and maintain their health and well-being (including aesthetic goals).

So it makes absolute sense to focus on preventing or minimising the loss of these physical qualities as much as possible, in order to maximise health and well-being for as long as possible.

One of the best things about the rise in popularity of Crossfit and functional training is the emphasis on explosive movements to develop power.

However, despite this increased popularity, it is still rare to see people in gyms, fitness groups and sports clubs (martial artists and dancers excepted) doing any dedicated and meaningful flexibility work (a couple of quick toe touches before a workout don’t count).

I think this stems from a few different reasons:

  • Flexibility work is hard to monetise (there is no equipment to sell for example, outside of maybe a mat and a strap).
  • Stretching well takes time – people have been sold on 30 minute fitness, which is great, I love short sessions, but not at the expense of what you need.
  • Most people don’t know how to stretch well, so they don’t feel any lasting benefits from doing it and give up.
  • Misinterpretation of the research surround stretching, especially around pre-exercise stretching and force production which has seen a preference for dynamic mobility over more traditional flexibility work.

Use It Or Lose It

Almost everyone will agree that “prevention is better than cure”, and this is especially true with flexibility training.

Like every physical quality, flexibility exists on a “use it or lose it basis”, so if you live a modern life like I do (lots of sitting, very little physically taxing work outside of exercise), then it is very easy to lose.

To combat this, it is essential to work on your flexibility pro-actively.

Optimal Vs Reality

Understanding what is optimal for physical health and fitness, and what can be realistically achieved by someone for whom fitness is a small component of their life is quite important.

For the person who exercises because they have to in order to maintain their health, but they don’t necessarily derive any pleasure from it, the minimal effective dose for flexibility is all that is needed.

This person can regain flexibility by stretching (4), can then maintain it with almost any activity that requires range of motion – for example, a gym based exercise program or tai chi practice.

Additionally, if they make an effort to squat, bend, reach and generally move more in day to day life, then maintenance is that much easier.

Fitness Enthusiasts

For people who spend a lot of time and energy into improving their physical fitness, a specific focus on stretching will be beneficial.

This can take place as part of the warm up, cool down or separate session, as there a pros and cons to each.

For the fitness enthusiast, recreational or even professional athlete, a prime focus on flexibility and it’s associated qualities – motor control and joint stability – is even more important, due to the high loads placed on the body consistently from training and competition.

I believe that stretching is the only physical quality that in relation to it’s training, the saying ‘more is better applies. – physical preparation coach Ian King, whom I have mentioned on this blog previously. (5)

Again, this is a contentious area, as most research doesn’t show a cause-effect relationship when it comes to stretching and injury prevention, but there are many contributing factors, of which flexibility is just one.

Conclusions

You don’t need to turn yourself into Jean Claude van Damme (pictured above at age 53 in a Volvo commercial), but you do need enough flexibility to reach up overhead comfortably, bend down without strain and essentially move without restriction doing the things you do in your day to day life.

If you don’t lead a physically active life, then it is more important to increase your activity – even if you don’t exercise – than worry about specific stretching.

Once you are active, a focus on stretching can really complement whatever it is you are doing.

 

This post is a re-worked version of my May 2016 newsletter. You can sign up below to receive all future editions, plus my upcoming (and FREE) guide to stretching.

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) Strength and muscle loss with aging process

(2) Age associated loss of upper extremity strength and power

(3) Flexibility of older adults and the influence of physical activity

(4) Purely my opinion, eccentric exercises can also be very helpful.

(5) King, I., Legacy – Ian King’s training innovations, King Sports International

Pain and Personal Responsibility

Nick 1 Comment

The Mind Is Key

When it comes to persistent/chronic pain, taking responsibility for your thoughts, emotions and actions is paramount to achieving any semblance of a normal life.

If you’ve ever experienced any intense or lasting pain, there’s a big chance you’ve said to yourself at least once “I don’t deserve this”.

Unfortunately, the world is not a fair place, and bad things happen to good people, but, viewing yourself as a victim of pain helps no one, least of all yourself.

This post isn’t about blaming your (or anyone for your pain), but rather to encourage you to take responsibility for the things you can control, in order to give yourself the best possible chance of living a fulfilling and meaningful life.

Is It Your Fault You Are In Pain?

The most commonly accepted model of pain is Melzack’s “neuromatrix model” (1). This model says that pain is an output of the brain, based on multiple sensory inputs, including:

  • Cognitive: memories, attention, meaning and anxiety
  • Sensory: inputs from skin, musculoskeletal tissues and the viscera (organs)
  • Emotive: inputs from the limb system

With this in mind, it is fair to say that any time you experience pain, you probably aren’t at fault based on anything you were consciously aware you were doing, because so much of the pain experience is generated unconsciously.

It is also fair to say that you can influence your pain based on what you think and do when you experience it.

So, to answer the question, in general, the answer is no, it’s not your fault you’re in pain.

However, as always, there are a few exceptions:

  • Acute pain is your fault if it stems from an injury that occurred because you did something stupid – think alcohol related injuries or playing a game of pick-up football knowing you haven’t been active in years.
  • Gradual onset pain stemming from overuse type injury (work, exercise etc) is very preventable with appropriate workload management.
  • Acute, non-specific pain is often the result of psycho-emotional components, more so than any tissue trauma, thus if you constantly put yourself in stressful situations and don’t know how to manage your thoughts and emotions, then you are probably playing a big role in your pain.

No One Can “Fix” You

One of the biggest examples of not taking personal responsibility for your pain, is the misguided notion that someone, or something, will fix you.

There is a growing body of research demonstrating that people with the highest expectations about making a recovery from pain do so. (2)

Combined with the large (and growing) body of research that suggests passive approaches to managing chronic pain aren’t very effective, it is obvious to see that there is a big role for you to play in your own recovery.

This doesn’t mean more passive therapies are useless. It just means the appropriate context has to be set.

What we can boil this down to is as follows: if you can find a knowledgeable practitioner that your like and connect with on some level, who inspires confidence in your ability to recover and gets you involved in the process, then you probably will.

Now, before you think that you have found and done all of that and you’re still in pain, it’s important to define “recovery”.

Defining Recovery

Most of the data on chronic pain comes from specialist chronic pain clinics. These are often public funded and run in, or in association with hospitals. They are typically “end of the line” treatments for people who have not responded to any other form of pain management.

The results these clinics achieve are “fair” when taken objectively, often decreasing a persons self-rated pain by a couple of points on a 10 point scale.

But, when we take into account that nothing has worked before, this improvement is quite impressive.

Additionally, when people are asked to rate their quality of life, measuring things like anxiety, depression and fear of the future, things are generally even more positive.

This gives us good insight into what is realistic for chronic pain sufferers.

If “end of the line” sufferers can improve this much, then good management earlier in the timeline can theoretically achieve even better results.

One of the biggest differences between those who succeed in managing their pain and those who don’t, is that they take action despite their pain.

Don’t Wait For Your Pain to Get Better to Start Living Well

In personal finance circles, there is a lot of talk about developing the habit of saving money, no matter your income.

That is, if you are on the minimum wage, and can only afford to save a few dollars each week, it is still important to do so, even though the amount across a year might not be very much, the habit developed carries on with you throughout life, as you (hopefully) increase your income.

A similar approach can be taken when you are in pain.

Instead of thinking “when I feel better, I can finally do x”, try shifting your mindset to “how can I find a way to do x, despite my pain”.

Now this is often easier said than done, but a good practitioner will be able to guide you through the process. Many times the limitations are self imposed, and a graded exposure approach can work wonders.

What Can You Do About Your Pain?

  • Accept your circumstances, rather than looking for someone or something to blame.
  • Seek out an excellent health practitioner to work alongside you and help build a team around you.
    • Don’t be afraid of medications. Used appropriately, they can be life changing. It goes without saying that you should talk to your doctor before starting or stopping any medications for your pain.
    • Consider working with a psychologist who specialises in chronic pain, in Australia there is an excellent Medicare rebate for psychology – discuss it with your doctor.
  • Outline functional based goals, rather than pain based goals. For example, saying “I’d like to walk my dog for 45 minutes” as opposed to saying “I’d like to walk completely pain free”.
  • Focus on processes, rather than outcomes. Processes are the things you do, outcomes happen based on what you do, but they are always variable (because of factors beyond your control).
  • Start small and build up slowly. 
  • Don’t “let pain be your guide”. Chronic pain is an unreliable guide of what to do or not do. Some days or weeks are worse than others. The challenge is to persist through the bad weeks as much as you can, and enjoy the good weeks without being fearful.
  • Stay positive. I know this can sound like throaway type advice, but there is evidence to suggest that if you can get through your pain, your brain returns to normal – the changes associated with pain are not permanent! (3)

Conclusions

It can seem like an impossible journey at times, and a completely isolating one, but you are definitely not alone.

People have gone before you and conquered pain. Others going on to live full lives despite their pain. Both, in no small part, due to their determination to make their lives better.

This doesn’t mean that you can will yourself better, but it does mean that there is hope.

There are dedicate professionals out there who study hard and work even harder to help people in pain live better lives.

Sometimes you have to work to find them. Sometimes you have to travel to reach them.

But you must, you owe it to yourself, because, the right advice, the right words at the right time, the right actions in the right amount, can change your life.

 

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) Melzack and Katz, Pain

(2) Expectation and low back pain recovery

(3) Brain structure during and after pain

 

Does Sitting Cause Low Back Pain?

Nick

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)