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Blog 9: The Role of Massage

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Today I want to explore massage and its role in ongoing lower back pain.

There is evidence to suggest that massage can be beneficial in reducing pain in chronic lower back pain however the underlying mechanisms are inconsistent across research. My question is, if massage was as beneficial as some studies claim, why isn’t massage solving the chronic back pain epidemic?

First of all I would like to highlight the point that everyone’s back pain is different and therefore there are no hard and fast rules or formulas of X minutes of massage over Y period of time to fix pain. We must also consider every massage therapist delivers massage differently, therefore it is difficult to determine the effectiveness of massage for chronic lower back pain, especially in large scale studies.

How does massage work? There are a lot of theories out there, some more credible than others including: increased blood flow, increased muscle relaxation, reduced cortisol levels and having a direct impact releasing muscles being over worked. And then there are some other less credible suggestions like removal of toxins however, I’ll leave that one for today. Even though research findings are inconsistent on the true benefits of massage, there is without doubt some benefit especially for reducing temporary pain through stimulation of what feels like knots in the muscle as well as benefits on mental health and the emotional value of touch. However, this is all temporary so is there a place for massage in chronic pain?

I write this blog as someone who used to get a weekly massage and who would feel severely increased pain and stiffness if I happened to miss a week. I became reliant on my weekly massage and looking back I know it was physiological why my pain miraculously got worse if I missed a week. It took my massage therapist going on a holiday for me to pull my finger out and actually start using some of the equipment gathering dust in my lounge room. I starting being consistent with my own self-management tools including foam rolling, stretching and using my good mate Spikey. (If you don’t know who Spikey is please look as the Tailored Health Facebook page!) I was more than capable of managing my own pain and not relying on an external source and a much more cost friendly way at that. My personal opinion is that if you feel you need a massage every week or fortnight to fix or help your pain, is this really managing your back pain?

I am all for a massage for acute injury and flare ups. I know I still get massages every now and then when I am feeling especially stiff because they do take the edge off, however I am a firm believer in learning how to self-manage. There are so many tools we can use which allow us to experience similar outcomes to massage without relying on another person and at a much lower cost. I find a combination of effective stretching, foam rolling and using my best mate Spikey the massage ball works just as well.

Next week I talk mobility and what is involved in an effective mobility routine.

Comments or questions? Please email me at: claire@tailoredhealth.com.au

Claire 🙂

Blog 7: Boom and Bust

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I get excited by being active. I have always loved netball, running around and pretending like I can do gymnastics, basketball, ballet, parkour, rock climbing or anything involving movement. Experiencing ongoing back pain has resulted in me learning how to pull back from and breakdown movements. I have used a number of different strategies to increase my fitness after stopping all sport however, I often found myself entering a cycle called the boom and bust cycle.

It is very common for anyone who experiences ongoing pain to do more on days when they feel good and less on days when feeling sore and stiff.  I know I do. Waking up feeling fantastic and pain free makes you want to get moving and do all of those activities and jobs you haven’t been doing due to pain. I’ll give you an example. One day I felt really good and completed a fun workout in a park including jumping over equipment, hanging from bars and finishing with all out sprints- the sort of stuff that I get really excited by. I did this kind of workout for 30 mins and felt good. I had one rest day with the normal soreness you would feel after exercise and decided to do it again the day after. When I woke up the next morning I could hardly get out of bed as my back has stiffened up so much that moving was the last thing I wanted to do. After this I was inactive for the next week doing only a few stretches in attempt to loosen my back. This is known as the boom (the exercise) and bust (the flare up). For my body the load of two high impact training sessions over 3 days was too much, resulting in a flare up.

A flare up, is a sudden onset of increased pain and stiffness, commonly occurring from exceeding your body’s load tolerance. This load or baseline which your body can tolerate is built up over time and also decreases during periods of rest. Periods of inactivity result in a reduced load tolerance, from decreased strength and fitness, therefore flare ups occur more easily.  These ‘bust’ periods then occur more frequently and the boom gets smaller and the bust gets bigger.  It’s like taking 2 steps forward and three steps backwards. However we know movement is good for ongoing pain so how do we avoid the boom and bust cycle?

Starting any kind of physical activity whether it be purposeful exercise or doing chores around the house needs to be built up gradually, especially after periods of rest. But where to begin? Start with finding your baseline. This could be as simple as doing a particular chore for 1 minute or for me it was adding one set of jumping exercise to my normal gym routine. The baseline activity can seem really easy on good days, but the most important part in determining the baseline is being able to complete it on bad days. From the baseline the gradual exposure journey begins, however I will go into this further in my next blog.

Remember, slow and steady wins the race every time!

Any questions or comments? Hit me up!

claire@tailoredhealth.com.au

Blog 6: Just Move

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An all too frequent situation when someone talks about their back pain is to focus on what movements they can’t do. This leads to FEAR AVOIDANCE. Fear avoidance is the devil! The fear of re injury, turns into a fear of movement and this is what stops individuals participating in activities and movements. It makes sense how fear avoidance happens. Back pain is flared up with certain movements or activities so this becomes the point of focus when you think of your back. The problem is, these movements become part of your back injury, so that means you have a sore back and you have a sore squat movement and a sore bending to pick up something from the floor movement. It sounds a little silly when you say it like that but that’s how your brain views it.

A popular approach to rehabilitating lower back pain is to focus on activating and strengthening individual muscles ie. the glutes or more specifically the glut med. Activating and strengthening your gluteus medius will assist in improving overall glute activation and stability when standing on one leg, however this alone will not fix back pain. The main focus should be on training the movement. Functional body movements completed in a stress free, relaxed way is the key. Once you can train your body to move freely, you start unlocking the fear avoidance behaviors development and the sensitivity to certain situations. It’s almost like meditation for your back.

I have a proposition…What would happen if everyone with back pain changed their focus away from what they can’t do and use it as an opportunity to find cool new movements they can do? There are so many cool things we can do with our bodies, all you need to do is find one movement which can be completed stress and anxiety free. Be creative! Today I re-visited my ballet days from 20 years ago as a way to explore new movements. If you feel stuck and need suggestions I am more than happy to help you find new cool movements that don’t flare up your back.

Building up a base of movements will give you a safe zone and creates a conditioning experience for your body. Once this is achieved the next goal is training movements which are currently being avoided through gradual exposure. However, this is something I will break down more in my next blog.

Keep moving, your body will love you for it 🙂

I would love to hear about any cool movements you can come up with.

Send through any comments or questions to claire@tailoredhealth.com.au

Blog 5: The Plastic Brain

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The brain has been discovered to be plastic. Not Tupperware plastic but neuroplastic meaning the brain has the ability to change and form new pathways over the course of a person’s life. We can train our brain in the direction we desire, hence why everyone is keeping their brains active doing daily Sodukos to avoid deterioration and risk of Alzheimer’s disorders. The plastic nature of our brain can result in negative outcomes however, like in chronic pain. Our brain rewires based off our own experiences and if these experiences involved danger, damage and risk the brain insures you respond in a way that is protective ie. Pain and fear avoidance.

Let’s use the back as an example. Any past experience associated with your back contributes to the way your back is today. In my own example, my brain remembers I hurt my back on a rowing ergo so every time I sit on a rowing ergo my back starts to ache and tighten up- that’s before I even start rowing. Kind of annoying really knowing my back should be able to tolerate the load since the injury was years ago and I can run, jump and squat, meaning my back can definitely tolerate the load of using a rowing machine for a few minutes. This demonstrates the power of the brain and how this past experience has created strong neural pathways to prevent me from rowing in the future. So how do we change this?

We know how brain is plastic so surely we can reverse these strong negative ties caused by our previous experiences. I propose two actions to help do this.

  • Start to associate your back with positive experiences. Think of all the awesome things you do where your back feels good. Eg. A social activity where you are distracted and don’t notice the pain or a purposeful activity aimed at relaxation or pain relief like massage, spa or a heat pack. If you start to associate your back with all of these positive experiences, new neural pathways will be created and strengthened which can only improve future outcomes in back pain.
  • Desensitise the situations you associated your back negatively towards. De-sensitising could be as simple as taking a deep breath to increase relaxation prior to the activity, using gradual exposure, playing calming music or doing the activity with a friend. In my case, I used my best mate Spikey to massage my back muscles prior to using the rowing machine and gradually built up my time from 30 second intervals- which I have now built up to 10 minutes with zero back pain.

Make the most of the plastic nature of our brain and start flooding your brain with positive experiences associated with your source of pain- you can’t change what has happened in the past but you sure can take actions to control the future.

Please hit me up if you have any questions or comments. This stuff fascinates me and would love to chat to anyone who feels the same.

Claire Samanna

E: claire@tailoredhealth.com.au

Blog 4: The Brain

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A big part of taking control and managing my own ongoing pain was to understand how pain occurs from a physiological point of view.  Opposed to what I once thought, level of pain and severity of injury do not have a linear relationship. One person can have a disc buldge in their lower back and not experience any symptoms and then another person can have exactly the same disc buldge and be experience debilitating ongoing chronic pain- injury is not equal to pain.

Have you ever heard that saying: ’It’s all in your head’?

When it comes to pain, it’s true! The sensation of having pain is all in your head. This doesn’t mean pain isn’t real. Pain is so real and very present but the truth is, it’s all in your head.

We know skeletal muscle is always adapting to changes in the physical environment however, if a mechanical stress exceeds the muscles adaptability, an acute injury occurs. Exposure to a new mechanical stress is how acute injury occurs and often results in muscle cell membrane damage. This leaves the muscles more vulnerable to increased damage and in order to prevent further injury the body goes into defence mode. This results in inflammation, pain and stiffness all to protect and begin the repair process at the site of damage. This all seems very biological but it is important to understand that the body’s repair and protection systems result in the physical symptoms of inflammation and pain at the site of injury opposed to the injury itself.

As a side note let’s take a moment to appreciate how good our bodies are at repairing themselves. When you break a bone in your arm, you might be in a cast for 6-8 weeks. Why is it then that a strain in the back can result in years of chronic pain? Is the back still strained after all these years?

In chronic pain, the acute injury process becomes over sensitised. Even though the cell membrane is no longer damaged there continues to be protective mechanisms in place. The brain detects the inflammation and sends out the pain response to the site as it would with any acute injury. This is where chronic pain develops, escalated by our own conscious protection thoughts ie. ‘I can’t bend down as I have a sore back mentality’-(see lasts weeks blog!) There is no such thing as pain receptors. The brain detects information ie. Inflammation and responds with a pain message. If you can change how your body interprets these signals then you can change how it responds. I will talk about this next blog and how the experiences we have influence on the pain we feel.

Hit me up with comments and questions: claire @tailoredhealth.com.au

Until next time 🙂

Volume 7

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3: The Cycle

In order to explain a version of the chronic pain cycle, I am going by start talking about how helpful, friends and family are when their loved ones are having difficulties. In struggling with my ongoing lower back pain, I noticed how friends and family around me empathised and wanted to help in any way they could.

However, how do you tell your loved ones, that by helping you, they are not actually helping you get any better? -Huh? How does that make sense? Now this doesn’t apply to everything but, I will share with you my personal experience and I am sure anyone who has experienced chronic pain can also relate.

I’ll give you an example. I occasionally helped my mum carry the shopping from the boot of the car to inside the house. A relatively easy task. However, once my mum knew I was having ongoing back pain, she would insist on carrying the one semi-heavy box full of fruit and vegetables and leave me carrying a cartoon of eggs. This is just one example, however if this principle is applied to a number of activities across the day in order to “PROTECT” the back, this results in an overall reduction in physical activities. Continuing this for a period of time has two outcomes.

1: Physically, the body becomes deconditioned, losing muscular strength from doing less and resulting in the body having a lower load tolerance.

2: If someone is saying, “you CAN’T lift that” over and over, then it will rub off on your personal beliefs of your own abilities. This ultimately results in you too believing you CAN’T, causing you to physically not be able to complete the task anymore.

These outcomes feed in the chronic pain cycle. Your back hurts >>>>> you avoid loading activities to protect your back >>>>> resulting in increased levels of inactivity >>>>> you become more deconditioned >>>>> your pain gets worse >>>>> you do even less and round you go again.

When my lower back pain was at its worse and I stopped all the sport I was playing, I also ensured I wasn’t doing any movement which may have resulted in a back injury. For example vacuuming, making my bed, carrying heavier shopping bags and I avoided bending where possible, all to PROTECT my back. With all of this preventative action, my back did not get any better, surprise, surprise. So now my next question is, how do you keep doing activities and tasks which involve bending, lifting or anything that makes you think twice, due to visions of getting a back injury?

Now, the below advice is only relevant for chronic pain where there is no acute physical injury, with pain present for > 3 months.

In my experience, not once did I re-do a back injury from doing daily tasks around the house involving movements of bending, lifting and twisting. The only time I did re injure my back was when I wasn’t concentrating, moving too quickly or doing something silly. If there is a task which you would normally complete, however feel worried about re injuring your back, think, I used to do this all the time without injuring my back, if I focus on the movement and bend my knees correctly I will be fine. You need to give yourself CONFIDENCE that you CAN and focus on the task at hand!

I stopped running in circles the moment I realised I CAN! I can carry that box of fruit and vegetables from the car and I can vacuum.. Great, now I have no excuse to not do my chores!!

Beat the chronic pain cycle and say I CAN do it! I just need to take my time, concentrate and stop running in circles!

In my next blog, I will explore how the brain contributes to why a back that has no physical acute injury can be in so much pain.

Until then, happy moving everyone.

Feel like you can relate? I would love to hear from you.

Email me @: claire@tailoredhealth.com.au

Claire Samanna 🙂

Volume 6

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#2: HOW IT ALL STARTED?

Chronic pain. Just the word ‘chronic’ makes me cringe. The definition of chronic is longer than 3 months. At the age of 18, this concept didn’t cross my mind. I had multiple back injuries, extending well over a 3 month period but there was no way I was labelling myself as chronic as that age. So, how did this all happen?

Initially, I hurt my back at the age of 18 when I joined a rowing team. I was on an ergo in the gym when I felt this almighty pain shoot through the right side of my lower back. I could hardly move- I wasn’t sure I would be able to get myself home. After 5 minutes, I eventually worked out how to stand up. This was like no other injury I had had before- this scared me. After a couple of days the intense pain wore off and I resumed life as normal with a slightly unhappy lower back.

Since the injury I have never returned to rowing as I was too scared that I would redo the same injury. This didn’t bother me too much though, as netball was my number one sport. What concerned me was that in that same year, I re-injured my back 3 times during games of netball. This bothered me. Over the whole year I sat out for 9 games of netball and played another 8 half games. My lower back was stopping me from doing the thing I loved to do the most.

My team mates would ask me, what is wrong with your back?  I didn’t know. A couple of diagnoses were thrown around by health professionals like facet joint jam or muscle strain, but nothing definite.  After every re-injury I would seek professional help, where I would be given stretches, a quick massage and I was sent on my way. The line, ‘You’re young and active. You will be fine in a few weeks’ was often mentioned.  The only problem was I wasn’t being active when my back was injured. How could I convince myself to do exercise when I had a back injury?  My immediate reaction was to rest, protecting my back from any further damage. I planned to strengthen my back and core when the injury healed and the pain left. However it never left and therefore I continued to wait before doing these exercises.

Many years later, after undergraduate and master’s qualifications in exercise sciences, seeing a number of health professionals, as well as my own self-directed research, I can see how very wrong I was. One day google pointed me in the direction of chronic lower back pain- a criterion which matched my story to a T. This is the point I stopped treating my lower back as an injury which needed to be diagnosed and rested, but as chronic pain, which needed to be managed.  This marks the beginning of my self-management journey. A journey, like any with highs and lows and one I will be exploring more in future blogs.

For today, I want to make the point that accepting I had chronic pain allowed me to stop playing the waiting game. Instead, I was able to get on with other aspects of my life, while my back pain was still present. I can compare it to waiting for good weather to do something fun. The perfect day may arrive, but for some reason you wait for a sunnier day. So why not start today!

In my next blog I will talk more about the chronic pain cycle and how this circular motion had me running in circles for a very long time.

Until next time ☺

Please post any comments or questions below.

Feel like you can relate to my story? I’d love to hear from you.

Email me @: claire@tailoredhealth.com.au

Claire Samanna

Volume 5

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Hi, I’m Claire. I’m the newest addition to the Tailored Health team.  You might have seen my face pop up on Facebook or even met me if you have come in to Tailored Health in the past few weeks. I want to share my story with you. The story of why am I here working as an Exercise Physiologist at Tailored Health. I want to share with you, my why!

Ben asked me during the week, ‘What is the one job you would want to do every day even if you didn’t get paid for doing it. The reason you get out of bed in the morning and basically your dream job.’ Initially my first though was, no money? What? Haha, just kidding. In all honesty, I felt I couldn’t answer that question right then and there. This was something I needed to spend some time reflecting on. So I answered with, ‘Good question, I’ll get back to you.’

Now that I have thought about it, I have worked out I am exactly where I want to be. Exercise Physiology became an interest of mine when, as a very sporty individual I managed to get injured all the time. It seemed to be one of my best talents. Never any broken bones, all little niggly things like sprained ankles, strained hamstrings, strained necks and then the big winner a sore back. I have had chronic lower back pain since the age of 18 which has motivated me to search for answers for the past 7 years.

Have I worked out the answer to chronic lower back pain? No.

Have I worked out how to manage my chronic lower back pain? I can now say, yes!

This brings me to my WHY. I want to share with others, everything I have learnt along my own journey with lower back pain. My dream job is to be an Exercise Physiologist who specialises in empowering individuals who experience chronic pain and to do everything in my power to help them take control and 100% manage their pain.

This is blog number 1 and my first step to sharing everything I have worked out so far on chronic pain. Stay tuned for my fortnightly updates of this ongoing journey.

If you have any questions I’d love to hear from you so feel free to get in touch.

Claire Samanna

claire@tailoredhealth.com.au

Volume 4

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driving

Where are you driving?

Do you know the destination?

Do you need to know the destination to achieve success?

Let’s take a closer look. If I asked you to drive to Brisbane (from Melbourne), how would you do it? Look at a map, pack some supplies, fill up the petrol tank, let your friends and family know you’re going on a journey? Even if you didn’t know the exact name of all the roads, would you be able to make a start in the right direction? Could you then work out the specifics of your journey as you go? This is exactly how your long term health goals work. Always start out with the destination in mind, not just the intended plan for the next day.

It doesn’t matter if you are unsure of exactly how you’ll get to your long term goal. In fact this is a good thing as it requires you to get creative with your thinking and apply some action. Who can help? What do I need? Who do I need to be? For example, at Tailored Health do you think I know exactly how I’m going to empower people on 1,000,000 occasions by 2025? The answer is “No” or “Not yet!” However, having this ambitious long term goal helps motivate me to get out of bed every morning and take actions NOW in the right direction. What would be a big goal that would do the same for you? This goal could be in any area of your life and would ideally be something that you’re passionate about. If you aren’t passionate about your goal please keep re-writing your goal until you find that it motivates you and you can answer why you are doing it.

The difference between dreams and goals in my opinion, is that a goal is written down with actionable steps in place whereas a dream is exactly that, all still in your head. We know that writing down goals will ensure you are 42% more likely to achieve them compared to those who don’t as Dr. Gail Matthews, psychology professor, discovered in her research (link below).

Let’s take a look at the alternative. If I asked you to jump in your car RIGHT NOW and drive, what would you do? Where would you go? How would you know if you were on the right track? Are you making progress or are you going in circles driving past the same location for the tenth time. Are you living “ground hog” day?

It’s always possible to work backwards from a goal set in the future and take repeated actions towards the goal, day in and day out. No matter how big or distant. However, it would only be by complete chance if you were to take a step in the right direction towards a “dream” of yours. Even then, it would be easy for you to drift off track back towards where you started or worse, further away from where you started!

I know which situation I’d rather. What about you? What are your big goals?

Feel free to let me know what you think about this post and if you would like to get more help to create big health goals or to break down your big health goals into bite size chunks contact me on ben@tailoredhealth.com.au or comment on this blog.

Link: http://www.dominican.edu/dominicannews/study-highlights-strategies-for-achieving-goals

Volume 3

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What do you want to achieve-

If you have a big goal or perhaps a New Year resolution, how are you going? Are you progressing towards your big goal? How do you know if you are on track? We are already in March with the New Year a distant memory so I’d like to look a little deeper into achieving goals and give you some tips that have helped me and many others.

The biggest first step you can take is to simply write down your goals. I often find that people can describe their goals to me verbally in a general manner. However, this often not enough if you want to succeed. Dr. Gail Matthews, a psychology professor, proved in a study with 267 participants that by writing down your goals you are 42% more likely to achieve them as those who do not. I have personally found that when I write down my goals the following happens:

  1. It forces you to clarify exactly what you want. Imagine you start a trip with no particular destination in mind. What do you need to pack? What path will you take? How do you know when you have arrived?  Picking a destination and working backwards will help bring clarity to what you really want to achieve, big or small, short or long term.
  2. It motivates you to take action.The plan to achieve your goal is written down and it’s now time for ACTION! Reviewing your  goals regularly can help you to continue to persist with action. Often this can be the missing ingredient to achieving your goal. It may be the size or complexity of the goal along with many other reasons as to why action never happens. An Exercise Physiologist or coach like figure can help you split up your goals into achievable pieces one step at a time and offer the support you need to get started. Research has shown you are 77% more likely to achieve your goals by simply sharing your written down goals with another person. This adds to you a whole new level of accountability and support towards your goal.
  3. Helps you provide a filter for other opportunities. There is no doubt that there will be distractions and temptations along the pathway to your destination. Aim to use your goal to filter the distractions by asking “Will this distraction move me closer or further from my goal?” The decision is then yours to say YES or NO. The greater planning and desire behind your list of written goals the easier it will be to make decisions about temptations along the way.
  4. It will help you overcome resistance. Every meaningful dream or goal encounters resistance. From the moment you set a goal, you will begin to feel it. Focus on the goal and the momentum will start to gather. In contrast, if focus on the resistance it will only get stronger.
  5. So you can see and celebrate your progress. Life can be hard. Particularly when you aren’t seeing progress. By checking in with your written down goals you can measure your progress. You can see how far you have come and how far you need to go. Written goals are like the road signs on a highway counting down to your destination. Seize these as opportunities at each road sign and celebrate as you go. Come up with your own rewards system as you tick off the milestones along the way. Get creative and see what can you come up with. In time you will pass your final road sign and arrive at GOAL ACHIEVED!!!

I am not saying that committing to writing down your goals is the end-game, but it’ll put your far ahead of those who don’t.

I’d love to hear what are you aiming for? When have successfully achieved a goal? What techniques did you use to achieve your goal?

Until my next post have a great week 🙂

Ben Taylor

ben@tailoredhealth.com.au

0434 451 226