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Osteopathy & Pain Whilst Sleeping

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Andrew Terry

Andrew Terry

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Osteopathy & Pain Whilst Sleeping

Bad habits can impact sleep

Having pain whilst sleeping can have serious impacts on your health. It’s one of the reasons why when we’re not in pain we should make sure we’re doing it well. How often have you sacrificed a couple hours of sleep to squeeze in a few extra episodes of your favourite Netflix programme? Or gone into the early hours of the morning texting friends? Doing this occasionally is one thing, but if it becomes a habit it can start to have a negative impact on your mind and body. So what can we do to make sure we’re getting a good nights sleep? Is there an optimal sleeping position? Can we do things throughout the day to help get us to sleep at night? And what happens to us if we keep neglecting a good nights sleep?

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What begins to happen if we don’t get enough sleep?

Well at first, not too much. Our bodies are incredible and they are capable of adapting to a multitude of stresses. Missing a few hours for one night means that we’re just likely to feel a little sluggish throughout the day, and so long as you make sure you get a good nights sleep the following evening, the majority of us will feel absolutely fine. However as soon as this becomes a habit, these are some of the things you may start to notice.

You may start to become irritable

Sleeping is literally one of the main times are brain gets to clean itself. Scientists recently discovered a new system in our body called the glymphatic system. The role of the glymphatic system is to remove waste from the brain and central nervous system, and it may also have a part to play in the transmission of compounds such as glucose, amino acids and neurotransmitters to our brain. It almost solely activates during sleep and remains mostly disengaged whilst we are awake. Poor sleep can also disrupt our bodies release of certain hormones, such as melatonin and cortisol which tend to be regulated in line with our circadian rhythm (or 24 hour body cycle), which in turn impact on our ability to handle stress, and is why we may become more irritable throughout the day. Depression and other mental health issues are also linked with sleeping disorders. Estimates suggest that up to 90% of people who suffer from depression complain about their sleep quality.

Poor sleepers have a greater risk of heart disease and stroke:

A review of 15 studies found that those who do not get somewhere between 7-8 hours sleep a night are more likely to have a stroke or suffer from heart disease. It’s important to remember that whilst we may feel fine and are able to function well during the day, your body is still missing vital time to repair itself.

Repair:

Soon after falling asleep, our body dumps a huge amount of human growth hormone (HGH) into our system. Whilst HGH spurs growth in children and adolescents, it also helps regulate body composition, body fluids, muscle and bone growth, sugar and fat metabolism and may even play a part in cardiovascular health. If you’re someone who loves to exercise, then making sure you get enough sleep is vital to ensure your body can repair itself, and you can continue to exercise without causing damage.

You may start to gain weight:

You’ll be glad to know that the conclusions to most studies that delve into the relationship between sleep and weight gain are not definitive. There does seem to be a correlation between being over weight and lack of sleep, but this tends to mostly be with children and adolescents. However most studies seem to suggest that due to feeling more tired during the day, people tend to be less motivated to exercise, and therefore the less active lifestyle can lead to gaining weight, as well as negatively impacting our hormone regulation.

Sleep impacts immune function and is linked to increased inflammation:

When was the last time you had a cold? What was your schedule like before you picked it up? Had you been busy with work, or perhaps partying? Studies were carried out with healthy men and women who were given the cold, with some being sleep deprived and others who were allowed 7-8 hours of sleep. Those who were sleep deprived were far more likely to get ill than those who got a good nights sleep. It’s also linked with increased inflammation in the gut, to such an extent that those who suffer with conditions such as Chron’s disease and other inflammatory bowel disorders are recommended to have a look at their sleep hygiene in order to improve gut function.

So now that we know a little more about what can happen when we don’t get enough sleep, here are a few tips on the best sleeping positions and how to have good sleep hygiene.

Sleeping positions

How are we meant to sleep? Are some better than others? What are the best ways to stop snoring? We develop sleeping patterns over our lifetime, so breaking them can be difficult. Here is a little bit about the the good and bad of each of the sleeping positions, and some ideas on how you break some of your bad habits.

Back

In general, this is the one I recommend to most of my patients if they can. It’s great at keeping your head, neck, and spine aligned which is what we want to promote. Whether or not you need a pillow or not depends mostly on your body shape, and the pillow should be a thickness that keeps your skull inline with your body. If you’re someone who suffers from acid reflux (heartburn), then a slightly larger pillow can help alleviate this. However, if you’re a snorer, then sleeping on your back is not recommended as it can promote snoring and sleep apnoea which can be detrimental in the long run.

Side

This is the second best position… so long as you use your pillows wisely. I recommend that those who sleep on their side get a slightly larger pillow, one that is roughly the size of their shoulder so that it supports your head whilst keeping your neck in line with your spine. Sleeping on your side is great if you have back or neck pain, and it’s also good at reducing your chances of snoring. Whether or not it reduces acid reflux or not is up for debate, as some scientists believe that sleeping on your right side can loosen your lower oesophageal sphincter, which are involuntary muscles that prevent acid from using out of your stomach and into your throat. This may also be a bad position for you if you have an issue with your shoulders or hips, as you are going to compress the area. If this sleep position works for you though, then there is no need to think about changing unless you start experiencing pain.

Fetal

This one is not recommended at all, unless you’re pregnant. It can lead to ligament and muscle adaptations over time and may lead to headaches, neck, back and hip pain.

Stomach

Despite the fact that so many of us sleep on our front, it is another position that isn’t great for us, with the only real benefit being that it also helps to stop us snoring. The bad side of sleeping on your stomach is that it alters the alignment of your neck, spine and often your shoulders depending on whether or not you raise your arm. You may also get muscle or joint pain as you turn your head whilst sleeping to allow yourself to breathe. If you are a stomach sleeper, then I recommend using as flat a pillow as possible to reduce the strain put on your neck. You may also want to put a thin one under your stomach to help keep your back straight.

Here's a guide for where to place your pillows if you are suffering with back pain

For those that want to try and learn how to sleep on your back, one way is to use pillows to keep you in place. By placing a couple by your side, and another under your knees, this can prevent you from turning in your sleep. This may take some time getting used to, but in the long run will grateful reduce the chances of muscle and joint strains, as well as aiding in recovery from injuries you may have got from day to day activities.

Last but by no means least…. Sleep hygiene

It’s not just your sleeping position that helps give you a good nights sleep, but also your activities (or lack of) throughout the day. If you find that you’re not waking up feeling rested, here are some tips to improve your sleep hygiene:

·       Reduce or eliminate daytime naps

·       Stick to a regular bedtime and wake-up time

·       Avoid alcohol and caffeine before bed (for as much as 4 to 6 hours, depending on your body’s response to them)

·       Establish a pre bedtime ritual

·       Block out all loud noises and lights from your bedroom (especially device and TV screens)

·       Set a comfortable bedroom temperature

If you haven’t fallen asleep yet from reading this, how about reading my other blog that delves deeper into good sleep hygiene, and what we can do to make sure we get that really good nights sleep.

ZZZzzzzzzzzzzz

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Andrew Terry Registered Osteopath

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Categories
Myth Busting Pain

I’m in pain because of my posture… and other flawed language

At Health Blogs

Andrew Terry

Andrew Terry

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I’m in pain because of my posture… and other flawed language

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why is language in pain important?

I want to talk a little about language today, and why it has such an important role on the journey out of pain. Medical professionals (osteopaths included), have often been so keen to explain to patients their findings that they can leave them with a feeling of dread about their body. We show them scans, talk about their “bad posture” (more on this later), and things being out of place (as if somehow a body part can be lost within its own body) that even if they manage to get them out of pain initially, the patient is left with the feeling that something was really wrong and can often become fixated with their diagnosis. They may seek constant treatments to fix their perceived ailment, or be on the lookout for future pain. The problem with this is, and patients who come to see me know I say this a lot, is that pain comes from the brain, so if you’re on the hunt for pain within your body, more often than not you will find it. Understanding of this intricate link between our psychology and pain is growing by the day, with more and more studies suggesting that negative pain beliefs have a direct correlation with our levels of pain. 

So I want to talk about some of the flawed language you may have heard in relation to pain. Whilst I’m not going to sit here and say that these hold no importance at all, their perceived importance and actual importance are often further apart than you think.

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1. I need to strengthen my core

Another version of this is “I am in pain because I have a weak core.” I often wonder how this one started. I would imagine it’s because of the huge prevalence of back pain in Western culture and our need to find a common cause. There are a few problems I have with this statement, like, “why do so many people with a “weak core” have no back pain?” Or on the other end of the spectrum “why do so many people with strong cores have back pain? “At what point is a core considered weak?” And “why if a strong core is so important (it’s not), is this not important for other parts of the body?”

But most importantly, it’s the fact that those who feel they have a weak core then think that their back is weak and fragile. Even worse, you may even stop moving about as much because you’re worried that your back will let you down. So let me say this now, your back is AMAZING. It’s incredibly adaptive and strong, and in my years of practice I can probably count on one hand the number of times I have said weak muscles in the back may have been a contributing factor towards their pain. In fact I would say I spend more time fixing tight muscles in backs than I do weak ones. The studies that have gone into comparing exercises that stabilise core muscles in comparison to general exercise or manual therapy have shown that they have little affect, and only marginally better than placebo (Ferreira, Ferreira et al. 2006, Ferreira, Ferreira et al. 2007, Costa, Maher et al. 2009). So please, do not stress about your core, just make sure you move around as much as pos

2. "My back goes out of place every now and then"

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You can add to this, “my hip pops out,” “I have a slipped disc” and “my <insert body part here> is out of place.” My usual response to this is “where did it go?” Now I’m aware that this is a common phrase related to having back pain (or whichever body part you’re referring to) that reoccurs, and I also know this pain might be excruciating. But I want to reassure you that your hip or back didn’t actually pop out. It might have felt like that, you may have heard something click and you felt pain, but it hasn’t literally slipped out of place (Palsson, Hirata et al. 2014). Again this might seem like I’m being a bit of a pedant in my use of language, but this is what this article is all about, how language influences your pain. You’ve injured yourself. That’s it. Some of these may be more serious than others, but you do not need to go down the path of thinking that your body has given up on you or it’s broken. The anxiety of thinking that parts of your body may pop out when you move can lead to. It’s why I always tell my patients that I am an osteopath that believes in homework. I want to reassure them that their body is fine, and that the most important thing they can do is to keep moving within pain-free levels, or what I like to sometimes call, comfortably uncomfortable ranges of movement. The best route out of pain is an active one. 

3. "I know I'm In pain because of my bad posture"

I actually like my patients to have good posture, but it’s probably not for the reasons you think, and this is definitely one of those ones where perceived importance and actual importance are much further apart than you realise.

The reason I like my patients to have good posture is actually partly down to aesthetics. If you think you look good and enjoy having good posture, then it’s likely you’re going to have a more positive relationship with your body, and I want to promote that as much as possible. But in reality the most important thing in regards to posture, is to not be in the same position for extended periods of time.

Our body is constantly repairing itself, and these new tissues get aligned through movement. The key word here is movement. If you have perfect posture all the time, but don’t move much, then you’re still going to develop restrictions, which mean you’re likely to be less dynamic and are then much more likely to experience pain. In fact you’re just as likely to experience pain if you have perfect posture but don’t move, as someone who has poor posture and doesn’t move. Our bodies are a bit like pumps. Changes in pressure are occurring all the time, through a mixture of breathing, movement and other clever processes that allow everything to flow throughout your body, from blood to lymph, and keeping this flow healthy is extremely important in helping us reduce the chances of pain and discomfort. So the next time you’re worried about poor posture, just get yourself up and about rather than stressing about the best position you should be in. There is no poor posture, only a body that lacks movement.

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4. "I've had a scan which shows degeneration so I know I will always have a certain level of pain"

As modern medicine has progressed, our eagerness to use scans as a means to get a diagnosis have increased. The problem with this is that even scans can throw up a few problems of their own (if you’d like to read more on scans you can read one of our other blogs). Let’s dissect a couple of the most common issues. 

They show you everything that has happened to your body:

There have been numerous studies into abnormalities found on scans in asymptomatic people. One found that 37% of 20 year olds, and 96% of 80 year olds had some form of disc degeneration. What’s important to remember in this study is not how many people have some form of disc degeneration, but how many people have something show up in a scan but have no pain at all. If so many of us have degeneration but no pain, how useful is it to be told that degeneration is the cause of your pain?

You might get a different diagnosis from different physicians from the same scan. 

When you go and get a scan you would expect a degree of consistency. After all it’s just an image. However different diagnosis from the same scan can vary dramatically. Take a study of a 63 year old woman with chronic low She had 10 different scans at 10 different facilities, with the result yielding 49 distinct findings. So is one right and the rest wrong? Or are all of them right? How would you feel if you were given 49 different diagnosis? Scans are of course a really important part of modern medicine, but we might be overusing them. Pain is complicated and it’s important we don’t associate our levels of pain with scan results.

5. "My glutes aren't firing"

If you’re able to walk, then your glutes are “firing” just fine. This term has become dramatically oversimplified, and is often linked with running or squats. Running, and even squats are actually rather complicated movements for the body, with chains of muscles working together. For any number of reasons, sometimes these chains can become out of sync, but this doesn’t mean that something isn’t working properly, it just needs a little guidance in getting back in sync, either through treatment, dynamic exercises or ideally a bit of both. 

6. "I've been told it's all in my mind"

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This is something that you may get told after you’ve had scans that have yielded no meaningful results. And whilst technically it’s accurate, how useful is this information unless you’re given an explanation as to why this might be happening, coupled with guidance in how you might overcome it. Just because it might be “all in the mind,” doesn’t make your pain any less real. Our job as primary healthcare practitioners should be to explain to you how and why the brain creates pain, and then offer you support so you can begin to make the steps towards being pain free. 

Here’s a great Ted Talk by the amazing Lorimer Mosely who explains this better than I ever could.

If you would like to know more about your pain, what might be happening, and how you can go about getting pain free then please don’t hesitate to get in touch. 

You can call us on 0208 088 0533 or book online and have a chat with one of our osteopaths. 

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Pain

Empowerment… and other reasons you should get to know your local osteopath

At Health Blogs

Andrew Terry

Andrew Terry

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Empowerment… and other reasons you should get to know your local osteopath

How to feel better in your body

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The first question I ask new patients that come through my door is, “Have you seen an osteopath before?” If the answer is no, then my follow up question is, “do you know what osteopathy is?” I am constantly surprised at how many people answer no to this question, or are at least unsure. This is our fault as a profession, because there are thousands of osteopaths in the UK who go about working silent miracles on their patients every day, and we should be doing a better job at explaining how we can help you. In this article I want to do just that, explain to you a little bit about who we are and why you should consider finding out who your local osteopath is so they can help you and your loved ones. 

  1. What are osteopaths?

Osteopaths are Allied Healthcare Practitioners and primary healthcare practitioners who specialise in the musculoskeletal system. For those of you who aren’t sure what primary healthcare practitioners are, they are healthcare specialists who can be your first port of call for your every day medical problems. Our training lasts 4-5 years and during that time we learn physiology, pathology, anatomy, clinical medicine and technique. It’s because of this training we’re capable of giving you a working diagnosis for your complaint. On the occasions where we’re unable to, most osteopaths have a network of other medical professionals who they can refer you on to so that you can find out exactly what your specific ailment may be as quickly as possible and you continue to receive the highest standard of care.

  1. What should I expect in an osteopathic consultation?

Because of our ability to diagnose, osteopaths need to take a detailed case history as well as will ask you questions about your symptoms, medical history and your daily habits and/or routines. We do this because not only do we want to find out what is going on, but perhaps more importantly why it is happening so that we can make sure that once we’ve got you better, you stay that way. Once we have worked out what is happening, we use a variety of different manual therapy techniques to treat you. Some of these techniques include high velocity thrusts (also known as manipulations or adjustments), articulation of joints and soft tissue work (massage) to name but a few. It’s important that you know that you are always in control of what techniques we use. Whilst we screen you for every single technique we use so that we know that it is safe, we also are aware that you may be nervous, especially in your first session. If you’re nervous or unsure, or simply don’t want us to do a certain technique, just let us know. We have plenty of tools to help you at our disposal and we will find one that you are happy with.

  1. Why would I see an osteopath?

The first and most obvious is if you’re in pain that is related to the musculoskeletal system. This means if you have discomfort in your muscles, connective tissue, joints, ligaments, tendons and/or bones then there is a strong chance we can help you on your path to being pain free. Another reason is the speed at which we can see you. The majority of people who want to see an osteopath can be seen within a few days. So if you’re in agony because of back pain, or are unsure how to sort out your sprained ankle, then osteopathy is for you as we can see you quickly, give you a diagnosis and help begin to alleviate that pain of yours.

However you don’t have to wait until you’re in pain to see your osteopath. Some of my patients choose to come in every couple of months just for a check up. We will assess and find points of restriction and remove them before they become painful. 

  1. I’ve seen manual therapists before for my pain and it’s always come back? Why is osteopathy different?

It’s this part that makes me love my job more than anything. Our role is not just to help reduce your pain, our main role is to help you build a healthier relationship and understanding of your body. It’s easy to think that we’re starting to fall apart or something is drastically wrong when we experience pain. “Have I done permanent damage?” “Do I have to live with this forever?” and “Why now?” are all common questions that I get asked in clinic. Our job is to allay your concerns by explaining clearly what is happening in as simple a way as possible,and then give you the education and tools (through advice and exercises) to try and limit as much as possible the chances of your complaint happening again. There is a reason why people walk away from an osteopathy session with that feel good feeling. It’s not just because we’ve helped get rid of their pain, it’s because they walk away (when they might have hobbled in) with a feeling of empowerment. You will know what has happened, why it has happened, how to help prevent it from happening again, but perhaps most significantly you won’t worry if it happens again, as you will know what to do to get better. Who doesn’t love the feeling of empowerment? 

If you would like to find out more about osteopathy and how we can help you, please feel free to give us a call or perhaps book in for one of our free 15 minute consultations?

0208 088 0533

www.athealth.london/bookings

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Categories
Myth Busting Pain

Pain Is An Opinion

At Health Blogs

Andrew Terry

Andrew Terry

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Pain is an opinion, and like an opinion, it can be changed

The Builder & The Nail

Take a moment and imagine a 15cm nail. That’s a pretty big nail. Now picture jumping off a wall, onto the nail, and watching the nail go completely through your work boots. For one unlucky 29 year old builder, he didn’t have to imagine this scenario as he watched the nail go right through his boot just next to his steel toecap. Being in agony, the man rushed himself to hospital. As the smallest movement was too painful for the man to take, he was sedated, and the nail was removed from his boot. What happened next appeared to be a miracle. As they took off his boot to look at and then treat the wound, there was none. The nail had gone right in between his toes, he was completely uninjured.

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Pain Doesn't Always Equal Damage

This is what is meant by the phrase “pain is just an opinion.” The man landed on the nail, watched and likely felt the nail go through his boot, and then his subconscious brain took over. His brain analysed the situation, processed the fact that it had just witnessed a nail go “into his foot,” likely sensed the cold nail between his toes, and his brain came to the opinion that in order to protect his foot further, a pain response was required. This sort of reaction, although extreme, is actually not as uncommon as you think. Have you ever been walking along and bumped your leg or arm into something, and just shrugged it off as nothing serious. You then maybe catch a glance of it later on in the day, perhaps as you remove an item of clothes that was covering the area, and you notice there is a big cut or bruise covering the area. A few things might happen upon noticing this. You may just carry on doing whatever it was you were doing and just be surprised that there is now this big cut or bruise and wonder where you got it from, OR, it might suddenly start really hurting as you become acutely aware of the injured area.

Through research we now know that pain, 100% of the time, is created in the brain. We know there is no such thing as a pain receptor or a pain pathway, and we know that whilst there is sometimes a correlation between an injured body part and a pain response, we also know that just like the case of the 29 year old builder, we can have a pain response when there is no injured body part at all.

So what does this information mean for you as a person in pain, particularly for someone in chronic pain? The first thing that should hopefully give you comfort is that because ALL pain is created in the brain, if you’re experiencing pain, it is real 100% of the time. It does NOT mean you are just making it up, or “it’s all in your head” (I mean technically this is true, but it’s a very unhelpful comment to make). People who say “it’s all in your head” tend to be implying that your pain isn’t real and that you just need get on with it, which is the opposite of what you should be doing.

If you’re experiencing pain, it’s because your brain has come to the opinion that it needs to protect you from something. If you get told, “it’s all in your head,” and you must go about your day without having first tried to change your brains opinion on why you need protecting, then it can get stubborn and turn up the pain dial as it hasn’t been convinced that you don’t need protection. Whilst extremely frustrating, this is a very normal and healthy response, but also a response that shouldn’t just get ignored by being told to get on with it.

Keeping up? Give yourself a high five!

Hopefully now you can grasp the idea that we can have pain, without an actual injury. I want to try and explain to you two pain responses to injuries that are more common than you think. I’m going to use a pulled muscle in your back as an example.

You pull a muscle in your back when bending to pick something up. This is extremely painful and so you lie still and don’t move, or move very little, over the next couple of days. A weird thing now happens. Your back heals, just like your skin heals after a paper cut to your finger. However because you haven’t been moving, and your brain hasn’t been receiving any feedback to let it know it’s ok, it will still create a pain response. Crazy right? I like using the analogy of a highway at night. Your brain hasn’t been told it’s daytime, and all the lights are turned up bright in order to protect you so you don’t crash. We need to tell the brain that it’s daytime and that it can turn everything down.

The second scenario is similar. You pull your muscle in your back when bending to pick something up. Again you’re in agony, but this time you move around and begin to feel better. Your back heals, just like the paper cut to your finger. You then go about your normal day, go to pick something up, and you suddenly find yourself in agony again. However what has happened on this occasion is that your brain has come to another incorrect opinion. It’s remembered that the last time you went to pick something up, you hurt yourself, and in order to stop you from hurting yourself again, causes a pain response. You haven’t actually done any damage to your body, it’s just a form of protection carried out subconsciously by your brain.

how do you change the brain's opinion?

So what do you do when this happens? How do you stop yourself experiencing pain when there hasn’t even been any damage? The first thing you should do is seek advice from a professional, and depending on the situation you want to see someone who has detailed knowledge of pain science and rehabilitation. Education and reassurance plays a huge part in the reduction of pain. It’s how you begin to change the brain’s opinion. The next thing is rehabilitation. Depending on the processes behind your pain, your therapist may try a number of different techniques. These may vary from getting you to use the opposite body part to the one that has been injured (if you’ve hurt your right foot then they may ask you to start using your left foot at first) as this can begin to start firing neurological pathways in your injured foot, which can begin to tell the brain it’s ok. They might also suggest imagined movements. This might seem odd but is actually a useful step in the rehabilitation process, particularly those who are suffering from chronic pain. Have you heard of a football or rugby player talk about how they imagine hitting the ball and it going in before they actually hit it? When they do this, in the background their brain and nervous system are prepping the body for all the different movements that are about to take place.

These same techniques can be used to trick the brain when it comes to pain. Another common technique is known as pacing. With pacing the aim is to take things slowly. Whatever you think you’re capable of doing, you do half of that, and then you monitor how you feel the next day, and even the day after. This is because there is something called pain latency. We don’t always experience pain immediately, often because the brain can be preoccupied in getting you through whatever it is you’re doing and then it decides to play catch up. Working out what is likely to cause you discomfort, and trying to organise your days around things that are highly stressful and easier on the body are really useful here. Some people use a traffic light system.

The most important thing to keep in mind is that there is a way to begin turning down your pain and changing your brain’s opinion. It can be a slow task, with highs and lows along the way, but it can be done with support from a medical professional.

If you suffer from chronic pain and would like to learn more about what can be done for you please don’t hesitate to contact us.

0208 088 0533

www.athealth.london

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