S E29: Ep 29 – The Art of Living Without Pain: Highlights from Season 1

Hello and welcome to the Paint Free Living Podcast and my name is Bob Allen and I am your host.

This is the first episode of the Paint Free Living Podcast and I just want to give you a taster of what you can expect in future episodes.

I will be having a couple of co hosts as well who will be asking me questions as if they were they were you.

So well done and thank you for finding the Pain Free Living podcast.

The fact that you found it means that you may be in pain.

Or there's something in the title that resonated with you and that is a good thing because if you are in pain, you want to avoid pain.

You've had pain in the past and you don't want it coming back, then you're in the right place.

That's what really this podcast is all about.

It's about giving you ideas about why you may be in pain, what may be causing the pain, and what you can do about it.

Some of the topics I've covered in the past include things like the myth of low back pain.

That was quite a popular one.

Now, if you Google low back pain, then it's going to come up potentially with hundreds of millions of options about what low back pain is, together with 5, 7, 10 exercises, 10 for you to do that will help get rid of your back pain.

Now, what it doesn't mention is that there's probably around 25 to 30 different causes of back pain.

Actually, there's more than that, but that's kind of a conservative number.

And if you do the wrong exercises that may cause you more pain, won't cause you any.

It won't be anything major, but it's just to say that there are no five ideal exercises that will get rid of your back pain because there's so many different causes of it.

So what I cover are things like does going to the gym cause back pain?

Actually know as long as you know what you're doing, you've been shown how to do the exercises, going to the gym, absolutely perfect.

And there's other things that we cover as well.

Sciatica, for example.

Sciatica is a general term that means irritation of the sciatic nerve.

It doesn't give you any clues as to what's causing the sciatica, but and won't necessarily help you to resolve the problem.

So I go into sciatica a little bit, some of the causes of sciatica and what you can do about it.

If I was to offer you a pill that would reduce your risk of heart problems, reduce your risk of cancer, reduce the risk of developing dementia, it would improve the strength of your bones, it would improve your mood, improve your sleep and a whole host of other beneficial things.

If I could put that in a pill and if I could offer you that pill, would you take it?

If that pill doesn't actually exist, but if it did, I can guarantee there'd be a queue a mile long just to get it.

Unfortunately, there is no pill, but what you have got is you have got exercise.

I know you've heard it before, I know you've heard about how beneficial doing exercise is, but you may not have heard it in quite the way that I'm going to put it across to you today.

Fitness industry doesn't help itself because the fitness industry promotes itself based on the Love island six pack, buns of steel, bulging biceps, all of Those things that 99% of the population don't really care about.

When you've got a fitness industry that promotes that image of exercise, and when you've got the World Health Organization asking you to spend a significant amount of your time doing exercise, it's no wonder that a lot of people, particularly in this day and age with stress, the world is switched on 24, 7.

We never have time to think for ourselves, never mind actually fit in.

You know, half an hour's exercise five times a week, plus resistance and all those other things.

So I think that they're looking at it in the wrong way.

I think that my, my approach is that movement is medicine.

If you're reluctant to exercise because of the, the amount of time it takes to spend doing it, think of it the other way.

Movement is medicine.

The more you move, the less you have to come and see somebody like myself, unless I have to go and see egp, because there are all those benefits.

And start off small.

That's the first thing.

Start off small.

So if you can only allocate five minutes a day, then five minutes a day is a start.

It's five minutes more than you were doing before.

What conditions do osteopaths treat?

I would love to say we treat everything.

The reality is we treat mainly muscle and joint issues.

The type of issue depends on the type of osteopath you go and see.

So for me, I treat a range of muscle and joint stuff.

Low back pain, neck pain, headaches, sprained ankles, quite a broad range of issues.

Once you graduate, you tend to specialise more.

I tend to work more with people with complex medical issues.

So it's the kind of thing where they may have been to see three or four medical healthcare professionals.

And because they work in their own silos, nobody's actually worked out what's going on.

So coming to see somebody like myself, I will look at a full case history, I will take down all of the information and then I'll put piece together what I think is going on from that.

And obviously I'll talk to the person that comes in to see me and I would kind of go through my thought process and I'll say, this is what I'm going to treat.

Let's see how it goes.

If it, if it does make a difference in one or two treatments, then we'll review and then say, okay, maybe it's not that we'll look at something else, but for me I'm quite general.

There are other osteopaths who specialise in treat in sports injuries.

Other osteopaths will specialize in treating children, et cetera, et cetera.

So it all depends on who you go and see.

How does osteopathy differ from chiropractic or physiotherapy?

As an osteopath I specialise in looking at all of the different systems.

So it's not just muscle and joint, it'll be whether you've had any gut issues, it'll be taking in the whole picture.

All three professions tend to look at the big picture, but we just train differently.

So as a physiotherapist you tend to be more specific to exercise rehabilitation.

So it tends to be people post surgery, post injury, and then bringing them back to health.

And chiropractic, they are taught because every muscle and joint in the body is connected to the nervous system.

They are trained more that if the spinal column and the nerves coming out of the spine and going back into the spine are in alignment and there's no compression and there are no issues and it's all moving well, then that brings you to optimal health.

So we're all trained in a different way, but once we get, once we throw the training wheels away and we get out in the real world, we then tend to specialize more in different areas.

Tend to do lots of post grad stuff on areas of interest to us.

So for me, I, I do a lot of work with older adults, I do a lot of work with people with a disability because those are areas of interest of mine.

Whereas like I said, others will look at doing cranial osteopathy or visceral or different branches of osteopathy.

Got you.

Okay, big question here.

Is osteopathy evidence Based.

That is a good question and the answer is yes and no.

So most physical therapies are actually quite difficult to do on an evidence based using an evidence based system.

So if you're talking about medium medication, then you know you'll have the 5 milligrams, 10 milligrams, whatever it is, of that medication and you'll give that to a group of people and then you'll see what the results are.

Big question here.

Is osteopathy evidence based?

That is a good question and the answer is yes and no.

So most physical therapies are actually quite different.

Difficult to do on an evidence based, using an evidence based system.

So if you're talking about medication, then you know you'll have the 5 milligrams, 10 milligrams, whatever it is, of that medication and you'll give that to a group of people and then you'll see what the results are.

You'll also have a, a control group where you give them a sugar pill or a placebo which looks, tastes like the actual medication.

And you'll see whether the effects that you get from your group that's had the meds is the same or how it differs from the group that haven't had the medication.

You can't really do that with the physical therapy.

So although there are, there are, there are studies out there that have tried to mimic certain techniques, in my view it's pretty unrealistic because if you're doing a physical therapy technique, say it's a mobilization of a shoulder joint, it means putting hands on and moving that shoulder.

Now you can't really pretend to put your hands on and move a shoulder.

You either do or you don't.

So you can't really have that control group or you do something that's kind of pretend, but because you're actually.

So that's the reason there's not a massive amount of an evidence base.

The other reason that it's not a massive evidence base is because research costs money.

Now if you are selling a drug, there are the potential behind the potential gains from coming up with a new drug and selling that are phenomenal, huge.

So this is why big pharmaceutical companies would much rather have something where they are going to have exclusive rights to it for however many years.

They are prepared to invest millions, if not tens or hundreds of millions in coming up with new drug because they know they can make a profit on that.

Yeah, if you're talking about a physical therapy, you know the returns are going to be nowhere near the same.

It's very difficult to patent something like a joint manipulation.

It's very difficult to patent something like a shoulder mobilization.

So the funding 10 is, is just not there.

So that's one reason why there's this much smaller evidence base.

Having said all of that, nice.

Who will approve or disapprove of things that are used by the nhs have said that osteopathy is a valid treatment approach for cases of low back pain, short term cases of low back pain.

So although the evidence base is small, it is there and there's more evidence coming along all the time.

So yes, it is evidence based to answer that question.

So I guess clients, if they're considering going to an osteopath, might be thinking how many sessions am I going to need?

And I would be thinking how long is a piece of string?

It depends.

For me the average is 3 to 5.

Treatments generally resolves most problems regardless of how long they've been there.

Sometimes where a person is where their job is quite demanding and they are constantly getting that muscle tension, those joint issues, then it can be more regular than that or it can be more, you know, there's one or two people I've been seeing for a few years because the problems they're getting because of the work they do are not going to resolve.

So it's, it tends to be ongoing, but that's a minority majority of people.

Three to five treatments is generally enough to resolve the issues and linked to that is.

And how often would you need to see them?

Yeah, again it depends on how acute they are.

So typically the first couple of treatments will be within a week or two and then the job is always to extend that time between treatments.

So the first couple of treatments might be within a, a couple of weeks and then extend it to three or four weeks and then the fourth or fifth treatment may be a month or six weeks away and then we get to that point where you're done, you don't need to come back because one of the things that I do is I give people exercises and things that I can do in terms of self care.

So my, my, my what my approach is always to do as few treatments as possible and to give them the tools they need to go away and actually look after themselves.

So Bob, tell us a bit more about hypermobility.

Okay, so we'll start off with what hypermobility is and it's what people call double jointed.

It's where people have different little party pieces.

And when I was training as an osteopath, one of my tutors said that, yeah, hypermobility is people being double jointed and they generally have really weird party pieces that they can do.

And he loved to tell a story of one guy who used to be able to get his fist it in his mouth.

And that was his party piece.

Except that one day he did it and his jaw locked and it meant going down to A and E. So if you're double jointed and if you have a little party piece.

Yeah, don't do that.

There's a good chance it could go wrong.

And if it goes wrong.

Yeah, it may well be a trip to A E for you as well.

Right.

So how do you then identify hypermobility?

Well, there's.

There's a test called the bait and scale, which is kind of like the gold standard for identifying whether people are hypermobile or not.

So looks at flexibility in certain joints.

And the more mobile certain joints are, the higher the score on the scale, as a couple of simple examples.

And some people can do it, some people can't.

So one example is, can you get your thumb to touch your forearm?

So wrist is flexed.

Can you get your thumb on your forearm?

Basically you're not far off.

I am quite mobile.

I'd probably be on the low end of the hypermobility spectrum.

So that's one measure, another.

So if I can do that with both arms, then that's two points.

So if I extend my arm out, so as you can see, it's kind of fairly straight.

Yeah, yeah.

If I was hypermobile, then there'd be more of a bend that way.

So elbows hyperextend.

If I could do that on both elbows, that's another two points.

If I can keep my legs straight, get my palms flat down on the floor, that's another point.

And then you look at the knees and there's a couple of other tests as well.

So the higher the score, the more you score on the Beighton scale.

If people score highly on the Beighton scale, then they may go on to do other tests.

Let's talk about helping to manage it then because I guess there's a range of things that you're able to do.

Yeah, yeah, there is.

I mean, one of the things that can happen with hypermobility is that lots of muscle and joint aches.

Now the muscle and joint aches are because the muscles are trying to do the job that the ligaments and tendons can't do.

So ligaments and tendons being loose means that, say again, let's go with the elbow ligaments and joints that are Loose in the elbow means that the elbow might hyperextend, which then puts more tension in the elbow joint.

Now, because the ligaments and tendons can't do it, you build up the strength in the muscles.

So one of the issues that can cause the muscle tension, the muscle pain, is the fact that the muscles are overworking.

They're constantly trying to stabilize a joint which is unstable.

So what I would do with someone in that situation, first thing to do would be to build the strength in the muscles.

We can't improve the strength or the stability in the ligaments and the tendons because they, you know, that's the genetic thing that we cannot control.

But what we can do is make the muscles stronger to, to be able to better support the ligaments and tendons.

So a strength program is a definite.

But there's a little caveat to that in that you can't go down the typical gym and go, okay, you've, you, you've had a hypermobility diagnosis.

You then want to get stronger.

You need to find somebody that understands what hypermobility is so they can then do a proper assessment and then build the strength and the muscles that need to be strengthened around the joint.

It's not immediately obvious.

So if you went to your typical gym and tried to do that yourself, you know, you might think, okay, I'll strengthen the bicep and tricep.

And that's going to sort out, actually, there's a lot of muscles around the elbow joint, not just the bicep and tricep.

You've got all the flexors and extensors in the forearm as well.

All of those come across the elbow joint.

So you need to work on everything.

And also, if you start too heavy or you've got poor technique, that's potentially going to make things worse rather than better.

So if you're going to start a physical program, which is what I'd recommend, find somebody who knows what hypermobility is first.

So that's a conversation you need to have, because if they don't understand what it is, they can potentially make things worse.