The word ‘mindfulness’ means compassionate and lucid awareness, a sense of knowing what is happening in the external and internal world as it is happening.  In its more common usage in recent clinical literature, it has come to mean intentionally paying attention to moment by moment events as they unfold, noticing habitual reactions to such events, often characterized by aversion or attachment, and cultivating the ability to respond to events with an attitude of open curiosity and compassion.

Mindfulness is traditionally cultivated by the practice of meditation in which people learn to pay attention to each moment with full intentionality and with friendly interest.

There are a number of mindfulness techniques that are utilized as part of MBCT including meditation, body scan exercises, mindfulness practices and yoga.  People might also be taught the ‘three minute breathing space technique’ which focuses on three steps, each one minute in duration.  Firstly, observing your experience (how are you doing right now?).  Secondly, focusing on your breath and thirdly, attending to your body and other physical sensations.

BENEFITS OF MBCT

A primary assumption of cognitive therapy is that thoughts precede moods and false self-beliefs lead to negative emotions such as depression.  MBCT utilizes elements of cognitive therapy to help you recognize and reassess your patterns of stress inducing thoughts and replace them with calming thoughts.  This approach helps people review their thoughts without getting caught up in them.  The combination of mindfulness and cognitive therapy is what makes MBCT so effective.  Mindfulness helps you observe and identify your feelings while cognitive therapy teaches you to interrupt automatic thought processes and work through feelings in a healthy way.

MBCT is also helpful in managing pain, particularly with helping the body to relax and to use calming thoughts as opposed to ones that may increase the subjective experience of pain.

Research has shown that Mindfulness-Based Cognitive Therapy can be effective for helping individuals who have experienced multiple episodes of depression and has also proved to be helpful with a wide range of mental health concerns such as anxiety disorders, low mood, bipolar disorder and depression associated with medical illnesses or trauma.  However, because it is a relatively new treatment modality, the long term benefits of this approach may not yet be fully determinable and further research may provide greater support for its effectiveness when treating bipolar, eating disorders, psychosis and other conditions.

KEEPING ACTIVE AND WELL

It is important for the patient to stay both physically and mentally healthy while they wait for their surgery as this will help them get the best results from their treatment in the long term.  There are many online tools and resources available to help them keep active and to support their mental health.  Some specific treatments that might help patients include:

Pain Medication and anti-inflammatories          Painkillers and anti-inflammatories can help significantly in terms of allowing people to cope with their daily activities, remain mobile and getting a good night’s sleep. Use of any pain relief medication should be carefully controlled.  Steroid injections can help to ease the pain of osteoarthritis but the likelihood of a steroid injection working can be highly variable depending on the damage to the knee or hip.  Steroids also mask a patient’s symptoms but without addressing the actual underlying cause of the symptoms, thus fooling the patient  into thinking that their knee or hip is better, when it is not resulting in further damage occurring to the joint.

Physiotherapy and Chiropractic            Physiotherapy or chiropractic are recommended by NICE as part of the treatment pathway for knee and hip arthritis.  Appropriate treatment prior to surgery can improve a patient’s mobility and build strength and fitness levels and increasing the likelihood of a successful outcome from the replacement joint surgery.

Non-impact cardio fitness exercise       Exercise programmes can be helpful providing the patient with specific exercises and hands-on supervised guidance.  Cardio fitness exercise is something the patient can do for themselves.  The best exercises for patients with arthritis are those that are light and gentle on the joints such as walking, cycling and swimming.  Performing regular cardio exercise causes the body to produce endorphins helping to raise the patient’s natural pain threshold.

IN SUMMARY

With NHS waiting lists for knee and hip replacement surgery getting longer,  there will be a greater need for patients to consider alternative treatment options in order to delay the need for surgery,  to help them cope while waiting for surgery and to ensure that they are in the best possible shape when they undergo their operation.

USEFUL LINKS

whileyouwait.org       Provides additional information, support and resources to help patients while they are waiting for hospital care.

escape-pain.org  Provides a group rehabilitation programme for people with chronic joint pain that integrates educational self-management and coping strategies with an individualized exercise regimen.

Learning deep breathing techniques is one of the most effective strategies for coping with the symptoms of stress and anxiety.  By breathing slower and more deeply from your stomach, you signal your parasympathetic nervous system to produce a state of calmness.  Diaphragmatic breathing enables more air to flow into your body, calming your nerves, improving your attention span and lowering pain levels.

WHAT IS DEEP BREATHING?

The use and benefits of deep breathing can be traced back to ancient traditions including yoga, tai chi, qi gong and meditation disciplines. In yoga, for instance, breath is a key element of the practice.  Pranayama, or breath regulation, refers to the extension of the vital energy through the breath and can be understood as an umbrella term for different breathing techniques, including deep breathing.   More recently, science has delved into this topic, accumulating a considerable body of research supporting the effectiveness of these techniques.

Also known as yogic breathing, deep breathing is the voluntary regulation of breath by consciously and actively using the diaphragm to increase the depth and slow down the inflow and outflow of air.  The diaphragm is the muscle separating the abdomen and chest cavity.  Attached to the base of the lungs, the diaphragm is rarely activated when breathing unconsciously.  This translates into a shallow breathing pattern leading to poor ventilation.  On the other hand, when breathing deeply, you engage this muscle by allowing your belly to rise and drop freely, facilitating a greater.  This allows an array of positive physiological and psychological processes to take place.

BENEFITS OF DEEP BREATHING

Scientific reviews have shown that deep breathing techniques can improve symptoms in sick patients, and they are also beneficial in enhancing wellbeing in healthy people.  Different emotions have been associated with varying patterns of breathing, heart activity and activation of either the sympathetic or parasympathetic nervous system.  Evidence suggests that it can also inhibit sympathetic (anxiety) activity and increases a parasympathetic (happiness) response which translates to experiencing less distressing and more positive emotions.

Abdominal breathing for 20-30 minutes each day will produce a state of relaxation, reduce stress and anxiety and will help you to feel more connected to your body bringing your awareness away from the worries in your head and helping to quiet the mind.

There are about twenty different types of endorphin, the best known being beta-endorphin associated with ‘runner’s high’.  They are also es involved in pain management and have the ability to block nerve cells from releasing pain signals to the brain .  In the peripheral nervous system, they produce analgesia by binding to opioid receptors.

How to Release Natural Endorphins

There are many ways to release natural endorphins including exercise, laughter, acupuncture, being in nature and meditation.

Exercise:     Since 2008, with the use of PET scans, researchers have been able to measure the release of endorphins in an athlete’s brain before and after exercise.  After exercise, they found a significant increase.  As exercise has been proven to boost mood, some medical professionals prescribe regular exercise as a treatment for mild to moderate depression and anxiety.

Meditation:   When you are stressed, your body triggers the release of stress hormones causing inflammation and increasing pain.  Meditation helps to shift your focus to something quiet and calming, helping your brain to release endorphins.  One study showed that mindfulness based stress reduction which combines meditation and yoga, was more effective than drugs and surgery for alleviating chronic low back pain.  With practice, meditation can increase your pain tolerance, lower hypertension and deepen respiration.

Acupuncture:   Placing fine needles into the skin at specific points around the body (acupoints) helps trigger the release of pain relieving endorphins.

Laughter:    Laughter is the best medicine as it also releases other ‘feel good’ hormones such as dopamine and serotonin and suppresses stress hormones to improve mood, reduce pain and support a stronger immune system.

Chiropractic: Research has shown that chiropractic manipulation stimulates the release of endorphins in the brain. This may explain the feeling of well-being patients claim to experience immediately after treatment.

The science of human endorphin levels is still evolving as researchers continue to study this chemical and how it affects our overall health.  In addition to decreased feelings of pain, their secretion leads to feelings of euphoria, modulation in appetite, release of sex hormones and enhancement of the immune response.  With high levels, we feel less pain and fewer negative effects of stress.

Our bones support us and allow us to move. They protect our brain, heart and other organs from injury. Our bones also store minerals such as calcium and phosphorus.  Just a few reasons why bone health is so essential to your wellbeing.

Made mostly of collagen, bone is living, growing tissue. Collagen is a protein that provides a soft frame work and calcium phosphate is a mineral that adds strength and hardens the framework. This combination of collagen and calcium makes bone strong and flexible enough to withstand stress. More than 99% of the body’s calcium is contained in the bones and teeth. Good sources of calcium include milk, cheese and other dairy products, green leafy vegetables soya beans and nuts. Good sources of vitamin D include oily fish, eggs yolks, fortified foods such as breakfast cereals and sunshine. You also need to be careful of eating foods that can be bad for your bone health such as Cola

Poor bone health can lead to conditions such as rickets and osteoporosis and an increased risk of breaking a bone from a fall later in life. Insufficient levels of calcium and vitamin D ( essential for calcium absorption ) can lead to a reduction in bone density and an increased risk of osteoporosis. In older people, the gut absorbs less calcium.  Vitamin D levels also tend to decrease reducing the amount of calcium available for the bones.

How to Strengthen Bones in Old Age

There are many things that we can do to keep our bones healthy and strong as we age such as eating foods rich in calcium and vitamin D and exercising regularly. Exercise is important for preserving bone density and some of the best exercises include weight bearing activities such as walking, using free weights, resistance training, and hiking, climbing stairs or dancing. If you have osteoporosis, avoid activities that involve twisting your spine or bending from the waist such as sit-ups, toe touches or swinging a golf club. Always consult your health care provider before engaging in any strenuous activities.

The fear of falling becomes more common as people age and may lead older persons to avoid being active. Overcoming this fear can help maintain your health and prevent future falls.

It’s true that our bones lose strength as we get older, but even in later years there are many things we can do to prevent falls and fractures. Remaining active along with a healthy diet will prevent your bones from losing strength

Biotensegrity offers a unique way of examining the human body in the light of new understanding about functional anatomy. It is an overriding concept that describes a relationship between every part of the organism and the mechanics that integrate them into a complete functional unit.
This concept can be attributed to the work of Orthopaedic surgeon, Dr. Stephen Levin MD who says that the body is made up of many bones and structures and that, if one applies an external force, the entire shape “adapts” or changes according to the applied force, up until a breaking point is reached. The level of force applied to individual joint structures will affect the function of the joint or how it moves. Too much force may a restrict a particular movement or cause pain and too little force can make a joint unstable or prone to injury.  As the body adapts to poor movement at individual joints, pain can manifest in locations distant from the source of dysfunction

Individual Joints

The tensile structures surrounding each joint hold the joint surfaces apart, so that in a well-functioning joint there is no pressure on the bones as they move. This has significant implications for joints such as the hip and knee which are well known to wear out and need replacement. It is also important in spinal care; traditionally the discs in between vertebrae are thought of as shock absorbers, but in the Biotensegrity model, when the spine is well aligned with correct tension in the surrounding muscles and ligaments, there is no pressure on the discs. As you can see in the picture, the red and blue cords, which represent spinal ligaments, are tensioned so that the vertebral box are held apart from each other.

Biotensegrity and Pregnancy

A particularly good example of Biotensegrity at work is during pregnancy due to the change in the centre of gravity. During pregnancy, the hormone relaxin is released which results in a loosening of ligaments and joint structures throughout the body. These changes are gradual and occur over the entire nine months of pregnancy. Structure and function are inextricably linked as the skeletal frame has a direct impact on joint function. Differences in tensile and compressive forces throughout pregnancy can often lead to aches and pains as the body adapts. However, after the baby is delivered, there is an instantaneous change in forces affecting both structure and function. Relaxin stops being secreted  causing ligaments to start tightening up again. This is a good time to assess the functioning of the musculoskeletal system to avoid misalignments.

Biotensegrity recognizes that interactions between different components of the body follow basic principles of self-organisation and it recognizes the wholeness of the human body.

The piriformis muscle is a flat band-like muscle in the buttocks near the top of the hip joint.  This muscle is important in lower body movement as it stabilizes the hip joint and lifts and rotates the thigh away from the body.  Piriformis syndrome occurs when this muscle presses on your sciatic nerve that goes from the spinal cord and down the back of each leg.  This can cause pain and numbness in your lower body and leg.  Sciatica may start as an intense burning pain or an ache deep inside the buttocks and the pain gets worse during activities that cause the piriformis muscle to press against the sciatic nerve.

WHAT IRRITATES THE PIRIFORMIS MUSCLE?

Piriformis syndrome can develop from everyday activities such as sitting for long periods, climbing stairs, walking or running.  It can also develop after a traumatic event such as a car accident or fall.

HOW CAN PIRIFORMIS SYNDROME BE PREVENTED OR AVOIDED?

To prevent piriformis syndrome developing, regular exercise can help but make sure you stretch and warm up first.  Maintain good posture when sitting, driving or standing.  Do not lit by bending over but bend your knees and squat to pick up heavy objects.  Keep the back straight and hold the object close to the body.  Avoid twisting the body when lifting.  Avoid sitting or lying down for long periods of time in a position that puts too much pressure on the buttocks.

TREATMENT FOR PIRIFORMIS SYNDROME

Piriformis syndrome is often caused by imbalance in the pelvis and this is easily treated with chiropractic manipulation. Most people who have piriformis syndrome get better with treatment and lifestyle changes.  Failure to treat this condition can lead to permanent nerve damage.  Therefore be sure to follow the advice of your healthcare provider.  Self care tips include the following:

1. Use cold and warm packs on the affected area.
2. Taking a non-steroidal anti-inflammatory (NSAID)
3. Doing exercises that stretch the piriformis muscle.
4. Take regular breaks to walk around and stretch if you have to sit for a long period of time.

If your pain does not improve with self treatment, your doctor may refer you to a chiropractor or inject a steroid medicine where the piriformis muscle and sciatic nerve meet.

The immune system is made up of a network of cells, tissues and organs that work together to protect the body against infection and maintain overall health. The lymphatic system is a key part of the immune system and consists of a network of vessels spread throughout the body which are responsible for carrying a fluid called lymph. Lymph has a variety of roles, such as the transport of pathogens to the lymph nodes which act as a filter, trapping or destroying anything harmful that the body does not need. There are white blood cells inside the lymph nodes which attack and break down bacteria, viruses, damaged cells or cancer cells. The lymph fluid carries the waste products and destroyed bacteria back into the bloodstream where the liver, kidneys or spleen remove them from the blood. The body then passes them out with other waste.

Our immune systems are also responsible for repairing damage to our bodies. This covers a wide range of responses from fixing a small cut, relieving bruising, healing a broken bone or removing cancer cells. The immune system recognises that tissue has been damaged or that cells are not functioning correctly and triggers a series of processes to repair or remove the damage.

Your skin is the very first line of defence in the immune system. It forms a physical barrier preventing pathogens from getting inside the body. Natural secretions such as sweat and oil also create an environment that inhibits bacterial growth. However, if the skin is broken, then pathogens can get inside the body and trigger an immune response.

Stress can affect the way your immune system works as it can cause increased levels of cortisol, a hormone that is important for overall function of the body. Too much of it can lead to decreased immunity. Some research suggests that, along with a healthy lifestyle, optimism can make your immune system work better because it short circuits stress. Environmental factors can cause stress and this may be amplified by worry and negative thinking. If you hope for a positive outcome and put your thought into achieving that, there will be no room for catastrophising thoughts that increase your stress and suppress your immune system.

So don’t let those negative thoughts rule your life. Replace them with positive ones which will not only make you feel better, they may improve your health and longevity.

The spine is designed to move. Each vertebra is connected to the next by a disc and 2 facet joints. It is similar to a snake, which is not surprising as we evolved from the same source. For optimum health our backs should be mobile at every joint. Our spines should be as fluid and flexible as a snake. However, they are not. This may, in part, be due to our upright posture which puts more stress on the spinal muscles and joints.

You may have noticed that young people are flexible while older people are more stiff. The older we get the more our backs stiffen up. This is because the fibres that cover our spinal joints get thicker and more brittle over time. These fibres are a kind of scar tissue and those parts of the spine that get more stress on them due to our habitual postures or repetitive work activity, tend to develop more scar tissue. This is called “wear and tear” by some people and may be the first stage of arthritis.

Chiropractic treatment releases the adhesions that form on people’s spines giving them more mobility. When you have a more mobile spine you suffer less pain. Many people think that a chiropractor’s job is about relieving back pain. It is not. It is about restoring mobility.  Reduced pain is a by-product of chiropractic treatment

The first stage in restoring health to your back is to improve mobility. When your back is more mobile it is important to work on your core strength. Core stability exercises, such as taught in a Pilates class, help to strengthen the muscles that support the spine. They also help to develop neurological control over these muscles so that they contract to protect the back at the right time. (It doesn’t matter how strong a muscle is, if it contracts at the wrong time it is useless!)

A mobile spine and strong core are the two essential components of a healthy back. One without the other is insufficient. If you spinal joints are inflexible  your spine is like a solid broom handle. The muscles around it, that move the vertebrae, are ineffective if the joints cannot move. On the other hand a flexible back without a strong core is unstable.

When your back is flexible, strong and stable then all you have to do is to use your back the way it is meant to be used. That is to be active in your daily life; Keep your whole body moving as much as possible. The beauty of being pain-free is that you don’t have to think about your back, you can just get on with the things you want to.

The first thing you should do, if you are experiencing recurring pain, is to get it checked out professionally. If you have nothing seriously wrong, and the problem is mechanical (i.e. bones muscles and joints) a visit to the chiropractor will probably sort it out.

However, many people find that the pain may recur in the future. Why? There can be many reasons. Here are some of them:

1.       Repetitive stress at work.
2.       Poor posture.
3.       The tissues become weakened and prone to re-injury.
4.       Stress or anxiety cause ongoing muscle tension.
5.       Loss of tissue resilience due to ageing.

A combination of these and other factors often lead to tissue damage. It may take a course of treatment and rehabilitation exercises to heal, but it can be difficult to remove all the causes of the problem. For example. You may be putting a lot of stress on your shoulder because of your job as a builder. Or you may be sitting for hours on end over the computer. You cannot just quit your job so the strain on your body is going to continue.

I teach my patients exercises and tricks to help avoid the worst excesses of posture, but with the best will in the world… this might not be enough; For some people, the painful symptoms will return and there is nothing they can do about it.

Well, actually there is; You can reframe pain.

As I have said, if the pain is severe and ongoing, you need to see a professional. Let’s assume you have done this. You have had some treatment the pain has gone away. But now you feel it starting to come back. This can be frustrating and upsetting especially if you thought you had got on top of it.

Firstly, you need to stop the negative thoughts, let go of the frustration and upset, and think about what you can do. You must do this because negative thinking will make the pain feel worse. Remember the pain is not as bad as it was originally; it is just starting to return, don’t catastrophize; it is not going to be as bad as it was before because you are going to take control.

See the pain as a reminder to take special care of yourself. It is like the oil indicator light in your car; There is no need to panic if the light comes on; It comes on long before your engine has run out of oil. You have plenty of time to top it up.

By the time you have been through a course of treatment you will have learnt the main causes of your pain. So you know what to do. Have you been working too hard, are you under a lot of stress, have you been sitting round in poor posture? It is simple, change what you have been doing and the pain will go away. The original injury will not return.

This is the reframe then: Originally pain was your enemy; it ruled your life and it was unbearable. Now the pain is your friend. It is your warning light. You can say “thankyou” to your body for giving you this warning before injury comes. Do what you need to take the strain from your body, and the pain will go away.