Hurt Doesn't Always Equal Harm

Hurt doesn’t always mean harm. “Hurt” is a protective mechanism produced by the brain to warn us when we are in danger. “Harm” we will define as disease or bodily tissue damage. We typically assume if we experience pain we have injured our bodies and, vice versa, if we see an injury we expect to feel some pain. However, this is often not the case. For instance, the lifetime prevalence of lower back pain (LBP) is reported to be as high as 84% (1). That means that as much as 84% of the population will experience lower back pain at one point in their life. Imaging findings are weakly related to LBP symptoms. In one cross-sectional study of asymptomatic persons aged 60 years or older, 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc (2) .

Pain is normal and is what your brain judges to be threatening. Even in the presence of tissue damage, if your brain doesn’t determine it to be threatening you will not experience pain. In the exact same way, in the absence of any tissue damage, the brain may protect you (with pain) from what it judges to be dangerous. Non-specific lower back pain (NSLBP), back pain that has no identifiable pain generator, is a common example of this. Recurrent pain (say, months after an injury) doesn’t demand that there has been a reinjury of the tissue. It is often your brain recognizing familiar cues and signals from your body that it then judges to be threatening.

There are four “essential pain facts”. 1.) Pain protects us and promotes healing. It provides a “safety buffer” from going beyond tissue tolerance (i.e., burning yourself, getting a cut, tearing a ligaments or tendon) As soon as you have an injury, the “safety buffer” becomes much larger and so you experience pain with, perhaps, any movement. 2.) Persistent pain overprotects us and prevents recovery. Your brain and spinal cord “learn” to be more protective or hypersensitive so that the “safety buffer” remains very large. This must be treated very differently from an acute injury. The aim of treatment and therapy is to return the safety buffer towards normal 3.) Many factors influence pain. Pain can be influenced by psychological factors, such as stress, depression, and/or anxiety (3). Life circumstances (living situation, socio-economic status, etc) can affect your ability to deal with and treat pain upstream of an injury 4.) There are many ways to reduce pain and promote recovery. One effective way to reduce pain is to understand your pain and can help you identify how you can influence your own system.

If you suffer from pain, acute or chronic, and need help, please find a therapist who can help guide you through recovery. Also, enjoy the video below about pain and injury. Take care and be well.

1. Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91. doi: 10.1016/S0140-6736(11)60610-7. Epub 2011 Oct 6. PMID: 21982256.

2. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Mar;72(3):403-8. PMID: 2312537.

3. Besen E, Young AE, Shaw WS. Returning to work following low back pain: towards a model of individual psychosocial factors. J Occup Rehabil. 2015 Mar;25(1):25-37. doi: 10.1007/s10926-014-9522-9. PMID: 24846078; PMCID: PMC4333236.

Schedule Online Today!

Hi! I just wanted to post a quick note to let everyone know that online scheduling is now available on the website. All you need to do is click the “Schedule An Appointment” button and you will be directed to the scheduling site where you will be able to pick a date and time. You also have to input credit card information (you will not be charged) in order to reserve the appointment.

I hope you have a great day and I look forward to seeing you in the future!

Covid-19 Update

It has been a while since my last post so I wanted to take some time to let you know all the things going on with me and Pro-Motion Chiropractic. To begin, I contracted covid-19 back in mid-January. My symptoms were mild but present and I did not require any further medical attention. After my symptoms subsided and my quarantine ended I kept the office closed for another week because one of my sons had tested positive as well (he had no symptoms to speak of). After five weeks of “togetherness” in quarantine with my family I received an email from public health about getting vaccinated, so less than one month after testing positive, I was eligible for vaccination which I did. I’m happy to report that as of Monday, March 8th, I am fully vaccinated!

The next big “happening” with Pro-Motion, is that it has moved locations. I am still in the same building as the Teton Sports Club, but now am on the north side of the building instead of the south side. The new space is great for the practice. I no longer share a space but continue to have an entrance to the outside of the building as well as to the gym, so you may enter from either direction. I also no longer get to enjoy the loud noises of people working out from upstairs, so that’s nice. I currently don’t have any signs up, but that will soon change.

Lastly, I am maintaining the same safety protocols as I have from the start of the pandemic and have incorporated some new ones. Those are, patients (and I) must wear a mask during the appointments, patient visits will be spaced throughout the day to allow for the transfer of air and all surfaces will be disinfected between patient visits. Lastly, a patient was generous enough to lend me an “air scrubber” to use in the office. An air scrubber uses several filters to clean the air of contaminants. When used properly, air cleaners and HVAC filters can help reduce airborne contaminants including viruses in a building or small space. I’m just doing my best to reduce the risk of any transmission of covid-19.

Thank you for your support through all of this, I wish you all health and happiness, take care!

If I Go Once, Do I have to Keep Going?

False—mostly. Like many things in life, this isn’t a black and white issue. Chiropractic can be used as a short-term acute treatment or as part of a long-term preventative and health maintenance protocol.
Sometimes a person may get injured, which can result in pain or limited performance. This can happen due to a car accident, lifting heavy objects in an awkward manner, or perhaps taking a hard hit while playing sports. This can result in debilitating pain that prevents the ability to continue with the same lifestyle that existed prior to injury—whether that means having to modify one’s occupation, an exercise routine, hobbies, or a specific daily routine. Chiropractic treatments are an excellent means to correct acute issues related to the spine. It is possible that a very short-term stint of care will properly address the pain or performance issue and result in healing for the patient that requires no follow-up.

I often have patients come in bent over in excruciating pain who are able to walk out of the office with little to no pain. Neither surgery nor medicine was required to make this patient well. These examples powerfully depicts how chiropractic is able to immediately resolve functional issues, eliminate pain, and get the patient back to the life they love to live.
While there are instances where chiropractic can be used as an isolated treatment option there is also a tremendous benefit to consistently using adjustments to maintain excellent health, manage and eliminate pain, and enjoy top physical performance. Many professional athletes such as Olympic hopefuls and NFL players include chiropractic as part of their training regimens. They know that their bodies perform optimally when their spine, joints, and nervous system are carefully maintained with chiropractic adjustments.
Think about it, you probably visit the dentist annually or semi-annually to ensure your pearly whites are in tip-top shape with a checkup and cleaning. Keeping a close watch on your spinal health and getting regular “check-up” adjustments or treatments is an excellent proactive step towards ensuring optimal spinal health. Some studies have shown that regular chiropractic treatments promote increased lung capacity, visual acuity, reaction time, balance, and cardiovascular health. The spine has an impact on all other bodily systems and therefore should be a priority for routine maintenance and wellness.
Discuss your health goals and concerns with your chiropractor to determine if they will best be met by consistent care over time or if perhaps reaching your goals will require a shorter duration of care.

5 Tips for Staying Active at Work

Don’t Let Your Job Stand in the Way of Physical Fitness

Sitting for hours every day at work can take its toll on your health and fitness. Taking stretch breaks at your desk is one way to help stay active and improve your physical fitness at the office.
We all know the importance of physical fitness, and many of us would love to spend more time at the gym, or workout and play more in the beautiful summer weather. But for so many of us, our jobs get in the way, especially when home demands and commuting time are added to the hours spent actually making a living.
For those whose jobs require long hours sitting at a desk or workbench, fitness is a particular concern, especially in light of recent studies showing the dangers of being sedentary for too many hours a day.
A research review by the University Health Network in Canada that appeared in the Annals of Internal Medicine found that sitting for long periods every day increases your risk for heart disease, cancer, diabetes and death.
Sitting with bad posture can do a number on your health, too. Slouching, slumping the shoulders, and tipping the neck forward place excess weight on the spine, causing joint pain and disc injuries that can lead to chronic back pain.
If we can’t just quit our jobs to get more active, what can we do during work hours to get moving and improve our physical fitness?

1) Don’t Sit Still

Limit sitting as much as you can. Consider getting a standing desk. If you must sit at your desk, take breaks every 20 - 30 minutes. Stand when you can stand instead of sitting, for instance when taking phone calls. Walk when you can walk instead of standing — instead of sending an email, walk to a colleague’s office to deliver a message.

2) Exercise at the Office

Beyond these changes, there are workouts you can integrate into your workday that include stretching, aerobics, resistance, and isometric exercise. Here are a few examples of exercises you can do at the office:

• Stretch at your desk. Try stretching your arms above your head, tilting your ears to your shoulders, and putting your hand on the back of your chair and twisting your torso.

• Find an open office or step outside for a quick cardio workout. Jogging in place, taking a lap around the parking lot, jumping jacks, lunges and squats are just a few ideas for quick exercises that won’t get you too sweaty and in need of a change of clothes.

• For increasing muscular strength, you can use dumbbells, resistance bands or tubes at your desk or body weight exercises. They tone muscles by using the resistance of gravity, as well as isometric, or squeezing, exercises.

3) Walk or Bike to Work

If you live close enough to your office, try walking or biking to work instead of driving or taking public transportation. In addition, the physical fitness benefits, walking to work can also help get you in the right mindset for a productive work day. If walking or biking to work isn’t feasible, force yourself to walk more by parking farther away or taking the stairs rather than the elevator.

4) Get Active During Lunch

With a busy work schedule, it’s very easy to fall into the trap of dropping into a nearby restaurant or fast food joint or ordering delivery. This usually means an unhealthy meal and a lunch break without any extra time for yourself. Bringing lunch to work will not only make for a more nutritious meal, but it will also save you the time of waiting in line and ordering food. Use that time to go for a walk or even to the gym.

5) Challenge Yourself

Last but not least, don’t forget to set goals, whether that means walking a specific number of steps a day, doing desk exercises for a set number of minutes, or even bringing your lunch a certain number of days a week. It’s easy to get lost in the status quo of your work day. Challenge yourself to be active as much as possible, and set realistic goals to hold yourself accountable.
You’ll be glad you did.

Iliotibial Band Foam Rolling

I often hear from people that they foam roll their IT bands often and then how much it hurts, but that they need to do it to help their knees or hips or back. While the foam roller is an effective tool for certain things, lengthening the iliotibial band doesn't appear to be one of them. Fascia has been found to be very difficult to deform or change. Muscular tissue, however, isn't as difficult. A recent study found that foam rolling to the gluteal muscle group was more effective at increasing hip ROM than was foam rolling the IT band. So, next time focus more on those butt muscles when foam rolling to improve your hip and knee troubles.

THE EFFECTS OF AN ACUTE BOUT OF FOAM ROLLING ON HIP RANGE OF MOTION ON DIFFERENT TISSUES

Why Do We Hurt?

Chronic pain is any pain that lasts for more than three months. At that point in time, any tissue that might have been damaged at the onset of injury will have healed and therefore, should no longer be painful. So why do we hurt?

Pain is an output of the brain. The possibility of pain starts when nerve fibers that transmit pain signals (nociception) send information to the brain. Then the brain decides if it is important or not, and what to do about it. To make this decision the brain incorporates all the information you have about pain and all the context around you (your environment). That context could include your beliefs and thoughts about your back (you think it’s weak, unstable, degenerative, etc), your history of injuries, memories of others who have had back injuries, the smell in the room, or the amount of lighting. Any credible evidence of danger to your body will modulate pain (a dark room will upregulate a pain response). If the brain determines there are more “danger cues” than there are “safe cues”, then the brain will say “yeah, we’re gonna make that hurt”.

After pain has been present for an extended time a couple things happen: 1. There is increased sensitivity to that area. In effect, your brain becomes better at creating pain, and 2.) There is decreased precision in deciphering the location of the pain whereby the pain starts to spread, move around, or changes in how it feels (achy, stabbing, etc.). These changes represent real and significant changes in the circuitry of your brain. It may be difficult for people with chronic pain to believe because their pain is 100% real but it no longer accurately signals damage to the tissues.

There is significant evidence that when people in pain are taught about the pain mechanisms of the body and brain, their pain will decrease. There is significant evidence that the brain can regain precision in the areas of chronic pain. The brain is plastic and does change and even the circuitry of pain can be retrained. “Movement is king” with retraining the brain to reduce pain. I often use a “stop light” analogy to guide patients. If there is no pain when doing an activity you have the “green light”. If you have some awareness or pain while doing an activity but there is no residual pain after doing the activity, you have the “yellow light” and can proceed with caution. If you have pain while doing an activity and residual pain after the activity, that is a “red light” and you should avoid that activity until a later time.

If you have questions or want to learn more feel free to contact Pro-Motion Chiropractic. Or, here are some links you may find helpful.

https://www.tamethebeast.org/

TedX talk with Lorimer Moseley

Central Sensitisation

I often have people come into my office who have been dealing with pain for a long time. These people suffering from chronic pain are often frustrated, depressed and anxious. Anything they do may set off their pain, they’ve tried “everything” and sometimes they feel there is no hope and that they just have to “live with it”. In the article “Where pain lives” the author discusses how science is learning that chronic pain isn’t just “acute pain that goes on and on”.

There are several possible mechanisms of how chronic pain starts, propagates and persists, but they all take into account that pain doesn’t equal tissue damage. Meaning that patients with chronic pain no longer have injured or damaged tissue (muscles, ligaments, discs, nerves) that might’ve have long ago been a mechanism for pain, but suffer from the brain creating “circuits” that constant re-live the pain or becoming hypersensitive to any form of stimuli, known as “central sensitisation”.

It is important for people living with chronic pain to understand what they are going through and the specific brain changes that have allowed their pain to continue and then take steps to rehab and strengthen their body knowing that “hurt does not typically mean harm”. There are no pharmaceutical means to treat this type of pain yet but there has been a lot of success using “Cognitive Behavioral Therapy” and graded “non-pain contingent” exercises. I have always said that my “ideal” practice includes a pain psychologist for this reason.

This article contains a lot more detailed information and deserves a read. I hope you will take the time and learn something from it and if you have more questions please feel free to contact me at Pro-Motion Chiropractic.

https://aeon.co/essays/to-treat-back-pain-look-to-the-brain-not-the-spine