All Hands On Deck

 

Bell Let’s Talk has come, with all it’s social media fanfare and buzz, then gone taking with it the conversation that hardly ever happens. In a few days, the social media world falls quiet again.

The awareness raising campaigns do their thing and for a brief window, it is hip and popular to pay lip service to mental health problems… meanwhile, people living with mental health disorders continue to live with these disorders, quietly, privately, knowing full well the reality of living with mental disorders does not go away after a day or two of token buzz.

At first, I wanted to try and get on board with the bandwagon, jump in when the chatter was hot but something didn’t feel quite right about it so I did not push it.

Maybe it is my own mental disorders I live with getting in the way, maybe it is an as-yet unarticulated sense of “this isn’t the way I want to do it” thing. Whatever it is, I did not write a blog, a series of blogs or long-winded post on social media about mental health and mental disorders.

Probably because it is so damn important to me; if I am going to write about it at all, I MUST do it justice.

You see, I’ve been wrestling with this thing for years, this feeling, this itch, in my career.

When I first chose this path, I couldn’t quite articulate it, but now, I can. I became a Massage Therapist because I want to comfort people when the shit hits the fan. I wanted to provide a space where a person could arrive with armfuls of pain, gritted teeth and hunched shoulders and just put that down for a minute or 90, have a moment where they could just… breathe.

No hard questions, no pushing for deep thinking, no demands for change or healing, only kindness, compassion, acceptance and attention. I wanted to help people find a sense of peace and safety in their bodies. I wanted to help people learn that their bodies could be nice places to be, that it was possible to feel good being in a body. To me it seemed obvious; that’s what Massage Therapists do.

Our scope of practice is clear; we treat the soft tissues of the body to relieve and prevent pain.

We now know that pain and mental health problems can and do travel together [1,3], that childhood traumas (ACEs) are a strong predictor of negative adult health outcomes [2]. And while I may be extrapolating a little bit here, I think it is fair to say that trauma can be an outcome of severe pain experiences, especially those that persist.  

Taking all of this into account, I can’t help but feel certain in my firm adoption of the idea that all healthcare providers, and especially those who choose to work within an evidence-based, biopsychosocial framework, need to learn how to navigate the therapeutic alliance with awareness for managing the intersections of psychological and somatic health problems.

Canadian Mental Health Stats

When I look at the numbers, I wish I could say my heart breaks but the fact is, I see myself in the stats. I see my friends and my family members.  

In any given year, ⅕ Canadians are living with a mental health problem [5], it could be anxiety or depression, it could be an addiction, bipolar disorder or schizophrenia, it could be PTSD.

Regardless of the diagnosis, it’s COMMON; 3.5 million Canadians seek services from hospitals and physicians for mood and anxiety disorders annually [4]. Mood and anxiety disorders are the most common mental illnesses in Canada and worldwide. The highest prevalence is among men and women aged 30-54, with the 55+ group bringing up a close second. Youth and adolescents are the most rapidly growing group of people affected by these disorders. Possibly most painful of all is the fact that an average of almost 11 people dies from suicide PER DAY.

After accidents, it is the 2nd leading cause of death among young people aged 15-24 [5].

Our Role In Human Health Care

So what is a Massage Therapist doing talking about these things, seemingly drifting from out of her lane?

I firmly believe that, currently, the mental illness crises our communities have been living with for decades (upon decades) demand an all hands on deck approach. We can no longer afford the luxury of letting it be someone else’s problem.

It’s a problem that affects us all.

1/5 Canadians will experience a mental disorder, including addiction, in their lifetimes. That means every single one of us knows someone who is presently – RIGHT NOW – dealing with something that can make everything else that much more difficult. And they are often trying to do it privately because either they don’t want to burden you OR they are afraid you will drop them.

Stigma prevents 40% of Canadians living with a mood disorder from seeking medical help [6] risking unnecessary consequences to their mental health. As an RMT, I am a front line health care provider. As a member of those professionals governed by the RHPA, I have a responsibility to care about all of the health of my patients.

As an RMT I may even have a better opportunity to note changes in the health presentations of my patients, including changes in mental health. This reality behooves us, all RMTs and other health care providers, to learn about mental disorders, pursue mental health first aid training, and to destigmatize our practices.

Often when discussing these ideas with my colleagues I encounter pushback; the worry about crossing a scope of practice line emerges, obstructing progress towards a health care system that is fully capable of addressing human health concerns. Our scope of practice is focused on the somatic experience. Given the relationship between mental health and physical health that is emerging, it is clear that, for some people, their ability to access care, follow through with home care plans and overcome the mental hurdles of dealing with a pain problem can be impeded by mental health problems.

Practitioners who work with the soma exclusively may need to consider these additional hurdles, ensuring that they are:

  1. not contributing to the fear of stigma or retraumatizing in their conduct and language and
  2. recognizing when a mental health problem may be a barrier or yellow flag to the patient’s ability to move forward with their pain management strategy, and when it might actually move them backward.

This is no easy task; stepping into a new level of discomfort, digging deep into your humanity to find compassion, understanding, and the ability to walk with your patient through the discomfort, fear, and shame that health problems, mental or physical, can bring requires a great deal of mental and emotional labour. It asks for empathy and boundaries held in close proximity and it asks us to be much better connected to the health care community we are oft surrounded by, but isolated from. And it asks us to address our own biases about mental health and pain and uncover the ugly heads of the stigma that exist within us and our practices.

The time for us to start giving a shit about these problems and SHOW UP to the table has come and gone, over and over again since the days of Freud. It’s time for All Hands On Deck, because we all, ALL of us, need each other if we’re gonna make it through this at all.

Resources

If you’re still with me here then thank you for reading. Below are resources I have been using to inform my own practice and dismantle the barriers of stigma and incompetence when working with mentally ill and traumatized populations. These resources are all free as of this writing.

Trauma + Trauma-Informed Practice:

Trauma Informed Practice Guide

Handbook on Sensitive Practice for Health Care Practitioners

Trauma and Recovery by Dr. Judith Herman M.D. (1992)

ACEs

Sexual Assault:

Addressing Past Sexual Assault in Clinical Settings

Recognizing and Responding to Commonly Misunderstood Reactions to Sexual Assault

Stigma:

Addressing Stigma – CAMH (scroll to the bottom)

References

  1. Currie, S. R., & Wang, J. (2004). Chronic back pain and major depression in the general Canadian population. Pain, 107(1), 54-60. doi:10.1016/j.pain.2003.09.015
  2. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245-258. doi:10.1016/s0749-3797(98)00017-8
  3. Mcwilliams, L. A., Goodwin, R. D., & Cox, B. J. (2004). Depression and anxiety associated with three pain conditions: Results from a nationally representative sample. Pain, 111(1), 77-83. doi:10.1016/j.pain.2004.06.002
  4. Report from the Canadian Chronic Disease Surveillance System: Mood and Anxiety Disorders in Canada, 2016
  5. Mental Illness and Addiction: Facts and Statistics; Centre for Addiction and Mental Health. (https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics) accessed February 2, 2019
  6. Addressing Stigma; Centre for Addiction and Mental Health. (https://www.camh.ca/en/driving-change/addressing-stigma) accessed February 2, 2019

 

Four Meaningful Ways To Work As A Massage Therapist During Tough Times

 

You’ve just gotten some terrible news, news that brings you to your knees, news that makes you unsure about the future, news that breaks you open.

Perhaps a loved one has died or been diagnosed with a disease. Maybe your partner has lost their job. Maybe you have had a miscarriage. Maybe your child was in an accident.

Life throws us challenges that bring us down and may cause many emotions: anger, fear, sadness, grief.

As Massage Therapists, we are told to always check our emotions at the door. To enter our treatment rooms with a kind heart and open ears. To provide space for our patients. 

But what if we don’t have space for ourselves? What if our devastating news has left us unable to have empathy or to listen to complaints that now seem trivial? How do we care for other people?

In September 2018, I was diagnosed with breast cancer. I was 36 years old, had a one-year-old daughter, and had just gotten married. I had a busy massage practice, had applied for grad school and had big plans. I was so angry.

I love being a Massage Therapist. I love to listen to people’s problems. I loved to hold space and allow them to speak. I love to help people to feel better or get them moving again. Suddenly, I didn’t want to go to work. I was struggling to fight back tears when someone was complaining about the weather. I didn’t feel empathy.

In the coming months, I had a mastectomy, appointments at the cancer clinic and another mastectomy. I had a toddler and an amazing husband to care for. I had massage patients to care for and lastly, myself to care for.

Four Strategies To Get Through A Workday

While I know that we as health care providers are supposed to be present in our treatments, I also know that during times of challenge it is near impossible. So I came up with four strategies to help me get through a workday.

1. Allow Yourself To Grieve

While this post is not about grief I think it’s important to acknowledge that you might feel shock, anger, fear or denial. There have been many days that I have cried the entire drive to work. Once I got to work I was able to move on with my day. 

Cry, yell, give yourself space to be mad and sad.

2. Do Something For Yourself Every Day

After my first mastectomy, I worked hard to regain strength and some form of normalcy in my life. I am a gym rat, I love to lift weights. I could just sit in a gym and feel good. 

So,  just a few days after surgery I was in the gym working on my range of motion exercises. It felt SO good, it felt normal. 

I added in body weight leg exercises and eventually more intense rehab movements. I was back to work after a month and lifting heavy weights within three months. Getting back to doing things you love is so important, it can give you a sense of normalcy during a time that is far from normal. Find one thing you can focus on for yourself and make a point to do it.

3. Find Support. Talk About It

At first, I didn’t want to tell anyone I had cancer because I didn’t want my problem to be bigger than anyone else’s. I quickly learned that people care. People want to help. As hard as it is, let them.

You don’t have to tell everyone what is going on in your life. But it is important to find support from people who can give you coping strategies.

I joined several online young women with breast cancer groups. It has been so nice to have others who completely understand what I was going through. Reading other’s stories and comments and asking questions has been extremely helpful.

There are online support groups for various conditions and stages of life, I highly recommend seeking them out.

4. Trust Your Hands

I recently attended a workshop where the instructor said, “your hands are your brains”. It was much more eloquent than that, but I related to that statement.

Some days after my cancer diagnosis I didn’t have a lot of focus, I was too concerned with how long I was going to have to be off work, and if I could even afford that. I was too sad that I was losing my breasts. Did I mention I was angry?! On those days, while I tried hard to be present, I also just let my hands work. They know what to do, so I let them. Give your mind a rest and let your hands do what they are meant to.

 

Real life is hard. Everyone has something going on. Many massage patients come to us not just for us to rub their skin, but to share the good and bad moments in their lives with us. It takes a lot of energy.

Try to allow yourself time to grieve, focus on an activity you enjoy, give yourself permission to talk to someone and believe in your knowledge and skill to get you through your workday.

 

Articles Of The Week April 14, 2019

 

People will do all sorts of popular treatments for different parts of their body. There is a new trend where women are getting laser therapy on their vagina for a variety of reasons, but is the treatment actually valid? Well…there is still research to be done.

“Do Vaginas Need Rejuvenating?” – Sandy Hilton

Patient education and communication is a crucial part of treatment, but how much of what we say do they remember? This is where effective communication may be using short simple messages to help with education retention.

“Pain Science Education” – Lynita White

When it comes to our mental health, it turns out exercise does more for it than money. Although I’m sure most of us would have guessed that, there’s actually research out of Yale and Oxford that prove it.

“Exercise Makes You Happier Than Money” – Ruqayyah Moynihan

Continuing with mental health, how about its relationship with food? If we were to include education on nutrition as part of mainstream healthcare is there a potential for real change? This article argues it would.

“Why Isn’t Nutritional Therapy A Primary Therapy For Mental Illness?” – Eirik Garnas

Research is showing us that one of the best things we can do for arthritis, is loading the affected joints. When loaded properly we can actually combat the effects arthritis has on the joints.

“Arthritis And Movement: Your Weightlifting Prescription” – Mike DeMille, DPT, and Erin Murray

Next Time You Treat Low Back Pain, Be Sure To Provide Reassurance

 

When the patient came into the treatment room, I sat down and welcomed them to do the same.

They refused, preferring to stand, as sitting hurt their lower back too much. When asked how long this pain had been going on, it was an astonishing two years.

Unfortunately, they had been run through the medical system for the previous two years, had seen every kind of practitioner and been given competing advice from all of these medical professionals. When asked what has worked well in the past, getting massage seemed to be the most beneficial. While this sounded great, there was still a lot of work to be done, which had nothing to do with what technique I could use to help ease the pain.

There was now an education and confidence building process that had to take place.

This person was so scared of their pain, they were afraid to sit (even though they had just comfortably driven their vehicle to the clinic).

How could I help this person? What kind of education would help? Would I be able to help?

Clinical Guidelines For Low Back Pain

Looking at the studies on the clinical guidelines for low back pain,  they revolve around primary care settings, which can be described as the “first point of contact regarding patient care”, so generally thought of as doctors in medical clinics or hospitals.

Fortunately, there is a lot of good advice about managing both acute and chronic low back pain.

Unfortunately, when we look at the European guidelines it says “they cannot recommend massage therapy” for the management of low back pain. But when we dig a little deeper when it refers to treatments they cannot recommend “it is owing to lack of/conflicting evidence of effectiveness” and while many of these treatments may be effective, they require the use of more studies to prove their effect (which is a big reason we need more research on massage therapy to be done, we know it’s effective).

But, massage isn’t alone in these studies as the modalities that “aren’t recommended”, there is quite a long list of things they would not recommend which we see used quite regularly:

  • Radiographic imaging for chronic non-specific low back pain.
  • MRI, CT, or facet blocks for diagnosis of facet joint pain, or discographies for discogenic pain.
  • EMG as a diagnostic procedure.
  • Wearing lumbar support.
  • Ultrasound.
  • Laser Therapy.
  • Traction.
  • TENS machines.
  • Acupuncture.
  • Nerve blockers, or corticosteroids.
  • Injections

However, it does recommend:

  • Looking at: work-related factors, psychosocial distress, and patient expectations.
  • Supervised exercise therapy.
  • Exercise programs that do not require expensive training machines.
  • Group exercise.
  • A short course of spinal manipulation for chronic low back pain.
  • Brief educational interventions.
  • Mulitdisiplinary biopsychosocial rehabilitation.

What the article doesn’t really mention is the interaction between the massage therapist and the patient.

While the above information is from the European guidelines when we look at the updated overview of international clinical guidelines they are consistent in recommending a focus on the identification of red flags (which we have written about HERE) and ruling out specific diseases. The only time medical imaging is recommended is when a serious pathology is suspected.

However, consistently across all of the recommendations is that patients should be reassured they don’t have a serious issue, and they should remain active.

Beliefs Regarding Pain

Sometimes it can be difficult to convince a patient they need to remain active, as they become fearful of moving because they associate it with pain.

In fact, there is a hypothesis where those experiencing low back pain fall into two different classifications: confrontation or avoidance, and this is determined by a persons fear of pain.

Those who confront their pain view it as a nuisance and are quite motivated to get back to normal activities. Whereas those who fall into an avoidance response tend to reduce physical and social activities, have a more prolonged disability and have adverse physical and psychological consequences. There is actually a correlation between avoiding activities because of the expectation of pain rather than actual experience or feeling of pain during activities.

There is even speculation that fear avoidance during an acute episode of low back pain can be a prognostic tool in identifying those who are more prone to developing chronic pain and may be the most important factor in determining the transition from acute to chronic low back pain. 

These fear-avoidance beliefs are even consistent for patients with work-related low back pain and the time it takes for them to get back on the job. Most return within one to two months after injury, but those who take longer are less likely to return to work.

Before I became an RMT, I was an industrial first aid attendant in a sawmill and I can remember having discussions with WCB (workman’s compensation) rep about employees returning to work. He told me their studies had shown if someone went 18 months without returning to work post-injury, they were likely never to return to work (I’m citing this from memory, I have no data to back it up other than remembering a conversation). So, looking back, this conversation makes a lot more sense to me now as many people returning to work were worried they would get reinjured on the job again.

Part of what contributes to fear avoidance beliefs is well…us.

All too often it is the messages patients get from health care providers who still rely strictly on explanations around pain being the result of tissue damage along with structural, anatomical, or biomechanical problems (yes these still play a role but there are other factors to consider as well). This is further reinforced by practitioners who confidently express their methods and services are the only way to relieve pain. 

So, we then have to consider how we can better help our patients with this increasingly common issue. The first step is; reassurance.

Providing Reassurance

As we have been discussing, peoples perception of pain has a massive effect on how they deal with pain.

One study shows that reduced feelings like helplessness, catastrophizing, pain being harmful and disabling, along with increased belief in control over pain can predict positive treatment outcomes.

Unfortunately, a lot of these feelings are due to things people have been told in the past (often by practitioners) that their back is ‘weak from a past injury’ or their pain is a result of genetics, lifestyle, or some other physical trait. These beliefs also bring about concerns they will reinjure or damage their back even more with activity.

There is strong evidence that these views are directly related to interactions with clinicians who also have high levels of fear-avoidance beliefs. Part of the difficulty with this is when patients go see multiple practitioners and are getting a different story from each one, this results in more frustration and an increase in those negative beliefs.

However, if we start to use language and descriptions that reassure and empower the patient, we can start to positively influence their pain beliefs. 

Once red flags are ruled out we can reassure the patient how things should get better over the next few weeks because the symptoms are benign in nature and this issue quite often resolves itself. More importantly, reassure that they do not have a serious disease! Along with this, we should endeavor to offer some level of education to the patient about their pain and how to self manage, otherwise, a dependence on the therapist could develop, where the patient always needs to be taken care of.

We need to start changing the narrative patients are given. 

When someone comes in who has had an x-ray or MRI and is stressed about the results I like to say something to the effect of:

“Don’t let that freak you out too much, if they took an x-ray of me right now it would probably look similar, yet I’m not experiencing any pain, your back is just sensitized right now and we just need to calm it down”.

Or when someone with chronic pain comes in I’ll say something like:

“Since we know pain is a safety and protection mechanism, your tissues have been protected for a long time now, which puts them in a safe place, your chances of re-injury is minimal”.

Now, this isn’t always going to be easy because they could be getting different messages from different practitioners. So, it may take a while to get your message across. But, for that patient who is afraid to sit down because they fear re-injuring their back, this is a good start.

While these are just a couple of examples I have used with people, they are just examples and won’t necessarily work for everyone. We need to tailor our message for each individual according to their beliefs and relationship with pain. We also need to build up our therapeutic relationship with them and provide appropriate homecare to decrease their dependence on us while reinforcing self-efficacy. These patients are wanting to be heard, have a better rapport with their practitioner, be given reassurance and education, so they know they are going to be okay. These are things rarely given by ‘primary care’ practitioners because they are given such a small amount of time with them, so this creates a valuable opportunity for those of us fortunate enough who get to spend on average an hour with each patient. Even though the clinical guidelines on low back pain could not recommend massage therapy, when we look at what they do recommend, Massage Therapist should be at the top of the list.

Leave a comment below with the language you use, or things you say to reassure your patients, we’d love to hear from you.

When The Holidays Aren’t Happy; How Do We Help Our Patients?

Last week I was working with a patient when she started getting emotional about the upcoming holiday season.  She was struggling enjoying her 8 month old’s first holidays and the sadness that she was also feeling.  “Why am I not just happy and enjoying this time?” she asked me.

I perked up for a variety of reasons.

One, I knew she struggled with postpartum depression immediately after her daughter’s birth.

Two, it is not unusual for people to have feelings of sadness and stress during the holidays, and then guilt for feeling that way!

So I listened; why was she feeling this way?  She was overwhelmed by demands from family to see the baby, juggling an infant’s sleep schedule while keeping them happy, and starting traditions of her own.  I told her this was completely normal, but also reminded her that she only needs to be responsible to herself, her daughter and her husband.

“How do I do that?!?” she responded a bit exasperated at the idea of telling the in-laws that no, they were not staying for 12 hours on Thanksgiving Day.

Every year I have similar conversations with patients. 

So what do we tell them?  While we all need to stay in our scope of practice, and our own comfort zone, the following will help us navigate the conversation.

There are many reasons why people experience a range of anxiety/depression/stress during the holidays.  Symptoms can be anywhere on the spectrum from “holiday blues” to a more serious depression.  The good news is, the vast majority of people will have a mild case of the blues.  In spite of long-held beliefs and even occasional media coverage, suicide rate and depression-related hospital admissions do not go up during the holiday season.  The U.S. Center for Health Statistics shows that November, December, and January actually have the lowest daily suicide rate.  However, that does not mean that the holiday blues are not a real concern.  

No systematic reviews exist regarding mental health around the holidays. 

However, the American Psychological Association has conducted surveys with some interesting information:

  • While the majority of people report feeling happy, loved and in high spirits during the holidays, they also report feeling fatigue, stress, and irritability.
  • 38% of the people said their stress level increased during the holidays.
  • 56% of people said their stress was the worst at work, while only 29% said the stress was experienced at home.
  • 53% of people said their stress had a financial component. 

So what do we tell our patients? The American Psychological Association recommend several coping strategies:

  • Most importantly, remember the holiday season does not banish reasons for feeling sad or lonely. There is room for all feelings and anything the person is feeling should be acknowledged and validated.
  • If they have experienced a recent loss or a loss around the holidays, grieving may be strong and surprising, even years later.  Reassure them all feelings are valid and sharing them is the best way to positively grieve.  Encourage them to share with trusted friends or a counselor and prepare to celebrate their loved one’s life in a positive manner.
  • Spend time with supportive and caring people.
  • Save time to take care of themselves. No guilt. Do whatever activity they wish.
  • Be aware of excessive drinking and excessive junk food.  There isn’t consistent evidence that one particular food staves off depression, but there is some research to suggest an overall healthy diet is helpful in treating depression.
  • Go to bed! Getting plenty of sleep will help manage anxiety and stress.
  • Get some light. Exposure to light, especially in the morning is important to anybody at risk for depression.
  • Exercise.  There is a lot of research that movement, any kind, can help with general mood.
  • Identify the source of the pressure and make priority lists. Don’t feel bad if something doesn’t make the list. 
  • Don’t be afraid to say “No” if occasions are not on your priority list.  Or say “Yes, but” as in “Yes I would love to see you but right now is not a good time and I really want to be fully engaged. How about we arrange that end of January?”
  • If feeling lonely, reach out or try other activities to make friends.
  • Finances are often the source of stress.  Set a budget, communicate intentions well ahead of time with loved ones and concentrate the larger reasons for the seasons.  Do a group outing or volunteer for a charity as a family instead of focusing on gifts.

It is important we know and recognize the signs for a more serious depression.  Past posts on The Massage Therapist Development Centre have done an excellent job of describing the signs and what we can do.  Find the link here.  For most of our patients, listening, validating, and giving them permission to be a priority will help them thrive, not just survive the holidays.  Reassuring them all feelings are normal and the stress is short-lived goes a long way to have the happiest of holidays.  And remember—that goes for us caregivers as well!  Remember to not just take care of your patients, but take care of yourselves and have the happiest of holidays!

References:

https://www.apa.org/helpcenter/holiday-stress.aspx

https://www.apa.org/pi/women/resources/news/holiday-blues.aspx

Day-Calder M  How to beat the post-holiday blues. Nurs Stand. 2016 Sep 14;31(3):37-38.

Hirthler MA  Change of shift. Holiday Blues.  Ann Emerg Med 2010 Dec, 56(6);690

10 Evidence Based Reasons Why You & Your Patients Should Exercise

Exercise is great, we know this, right?

Well, sort of.

Many people know exercise is good for us on a general level, but the question is, do they know it’s right for them on an individual level and is it the right fix for their problem?

This is an entirely different proposition, applying that general information to the person. This idea that these things are good for us can be quite vague, one of those things we may have glanced over in a newspaper or half-hearted on the news whilst eating our corn flakes.

People also build up ideas about what is the correct treatment for them. This can be from their own in-depth research on the internet (right!), what they have picked up from friends and family or from previous treatment with a therapist. This can lead to some pretty strong ideas about what should and perhaps should not be done to help them.

These beliefs don’t always align with the best available data we have about interventions. A prime example of this is the belief that exercise risks outweigh the benefits with back pain (55% of folk in New Zealand). This stat was taken from this Darlow paper in 2016 HERE. 

We know that exercise can be effective with back pain, certainly not a magic bullet, but one of the best things we have at our disposable within a comprehensive treatment plan, especially as it is low cost and low risk too.

Beliefs And Expectations

Our beliefs drive our expectations and actions. Predicted expectations are gaining weight as a prognostic factor in recovery over the past decade. They may influence my participation and behaviour in a treatment plan that will ultimately affect the outcome.  If I don’t believe in something I am much less likely to do it.

How can we combat this? Well, in my opinion, the best tool we have is good quality information we can use to combat the beliefs that may hold people back. A key to start affecting beliefs, again, in my opinion, is not to challenge too firmly, but inform people using well-evidenced information. One of my favourite one-liners is “That’s what we used to think but we are learning new things all the time, the latest research suggests…”

Here are some small tidbits of information that we can use to start informing our patients and clients about the role of exercise in pain AND health, which of course ultimately affects pain too!

Remember that giving people information is really designed to change behaviour rather than just show how smart you are so monitoring what happens is pretty important.

1. Exercise Is One Of The Best Evidence-Based Interventions We Have For MSK Pain

This paper HERE from 2017 in PLOS one shows moderate to strong effectiveness of exercise as an intervention for many MSK issues. This is in contrast to the belief that things need to be zapped, needled or popped back into place.

My therapist only gave me some exercises. Yep. Because they followed the evidence!

2. Exercise Won’t Make Your Body Worse

So many people see the body as a bit of machinery. The more it works the more the parts need replacing. Is this true? Absolutely NOT. The body is an organic organism that adapts both positively and negatively to stimulus. The more active we are (within reason) the stronger we become. The less active, well…

A classic common belief is that our intervertebral discs wear out the more we use them. This classic study from Battie HERE (2009) looked at twins to determine the major contributors to disc degeneration. They suggest that the “commonly held view that disc degeneration is primarily a result of ageing and ‘wear and tear’ from mechanical insults and injuries, was not supported by this series of studies”.

This study HERE from 2017 found that if you have a rotator cuff tear, the tear getting worse did not appear to be simply related to activity levels. In fact, they suggest pain development is actually associated with LOWER activity levels. If I had a pound for every time it has been suggested to me that running damages the knees then I would be a rich man. A study of marathon runners HERE showed that they had LESS meniscal abnormalities than non-runners.

3. Exercise Might Actually Make The Discs In Your Back Healthier!

Two recent studies have shown a POSITIVE effect of activity on intervertebral discs. Firstly this study HERE from 2017 showed that MORE vigorous activity was associated with BETTER disc health on MRI. Secondly, in this paper from 2016 HERE. Runners were shown to have intervertebral discs that had increase hypertrophy compared to the non-athletic group. The authors suggest that running actually strengthens the discs, whether we can infer a causal relationship here is unclear but this goes against activity causing wear and tear which is a common belief.

4. Activity Is A Pain Killer

This study HERE showed that older adults who were MORE active also had better endogenous pain inhibitory mechanisms when their conditioned pain modulation (CPM) was tested. Simply put, this means the more active the better their natural pain-killing mechanisms were. Which of course is super cool.

5. Exercise Is An Anti Inflammatory

This study HERE showed that regular physical activity caused an increase in interleukin -10 which is an anti-inflammatory cytokine that can reduce nociceptor sensitisation.

Now the caveat here is this study was performed in an animal population but as we know that there are associations between inactivity and both acute and chronic pain in humans it is a linked that potentially needs to be better explored.

6. Lack Of Exercise Is Associated With Chronic Pain

This large study HERE looked at the relationship between recreational exercise and chronic pain. Both older and younger folk were studied and the researchers found that for both groups exercise participation was associated with reduced chronic pain. A relationship was also present for the frequency, duration and intensity of that exercise.

7. Lack Of Exercise As A Major Cause Of Chronic Diseases

This comprehensive paper HERE makes a case for a lack of exercise being a primary prevention against 35 chronic conditions suffered by us poor humans. This goes beyond what most of us involved in the musculoskeletal field would have to deal with but also shows the importance of exercise for systemic health too.

8. It’s Involved In Mental Health As Well

We are understanding more and more that the mind and the body cannot really be separated. Physical health and mental health are interlinked in the human being and guess what…..exercise plays a role in improving mental health too. This paper HERE explores the mechanisms that may relate to mental health and exercise.

This randomised control trial looked at aerobic exercise and a variety of measures of psychological health HERE. The authors found significant group differences that favoured the exercise group.

9. You Want To Live Longer Right?

Strength training in this paper HERE was found to have a significant association with decreased mortality in adults over 65. But only a minority of this age group actually meet the current guidelines.

10. Have A Healthier Heart

This prospective study of 15 years duration HERE found that physical activity was a predictor of cardiovascular disease.

Summing Up

There are a whole bunch of others studies that relate to these topics but I just picked a few. I think it demonstrates that physical activity and exercise have an effect on us on a number of different levels, from the heart to the head to pain as well.

  • Do it
  • Do it
  • Do it
  • Do it