Medicine

Food- more than just fuel. 

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What we eat has a huge effect on how we perform. 

Not just in the balance of macronutrients (carbohydrate, protein, fat) but in the way each food affects us. 

We all know about food allergies, apparently increasingly common, where the person has a massive and rapid negative reaction to a specific item but there are some other ways what we eat influences our performance. 

One of the most important is the potential inflammatory response from consuming items that our body reacts to. This is known as a non IgE mediated reaction and are more commonly treated as food intolerances.  Because of the delayed onset, between 4 and 48 hours after ingestion, they are difficult to isolate. This also makes the effect harder to observe using standard clinical blood tests.

However, this background reaction can significantly effect not only every day life but athletic performance as well, due to the generalised inflammation it can cause. 

The most common reactive agents are: 

  • Dairy
  • Grain
  • Seafood
  • Nuts
  • Soya
  • Egg
  • Nightshades (tomato,aubergine,peppers etc)
  • Alcohol 

If you suspect that this is something you are dealing with, the safest way to detect these reactions is to follow a medically supervised exclusion diet under an experienced doctor so that they can help guide you towards avoiding the substances in question. 

Pain is not normal

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Pain is the body telling you something is wrong. It is driven, as with most things, by only a few factors – Degeneration, disease processes or dysfunction. However, as we age, we tend to normalise it, put it down to getting older, one of those things or to be expected. We are even told this by medical professionals, which reinforces the myth.

Aging happens, it is better than the alternative. Some of the processes of aging are unavoidable but many are not. By attempting to eliminate those triggers we can control, through correction of function and awareness of degeneration, then the pain left is triggered by either a disease process or changes which have already occurred. With the miracles of modern medicine and the bodies inherent desire to heal itself, even the majority of these can be improved with time, patience and external intervention.

Prevention is always better than a cure and the necessary activities to prevent degeneration are all things that we know. Eat a nutritious, well balanced diet, maintain a sensible weight, exercise regularly and moderately including resistance work. Dysfunction can be reduced or prevented by considering the way we use our bodies and becoming aware of our senses more. We are sensory creatures and yet spend so little time in our bodies that we recognise only those signals that are big enough to break through to our conscious awareness.

You do not need to live with pain unless there is a known and unavoidable reason for its presence. Even then, osteopathy and allopathic medicine can both help, together with self driven changes to give you back control. With a good working diagnosis and a plan, the future can look far brighter.

5 points to being pain free:

1) Get a diagnosis of why you have pain. If you don’t understand why, you can’t change the triggers
2) Start a treatment plan that you are actively involved with
3) Get your life patterns in order. Change diet, exercise or other factors that can influence the pain
4) Engage with the pain and take control, mentally and physically
5) Practice mental and physical activities within a pain free framework every day

The Camford Clinic
http://www.the-camford-clinic.co.uk
01420 544408

Anatomy is not everything

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Anatomy is important.

Anatomy describes how one bit connects to another and what it’s called. It lays out the typical positions of the components of the body and, with physiology, tells us how it all works.

But anatomy does not say how you move. One could not look at a supine body and say with any certainty whether they had back pain, felt stiff in the mornings or found running difficult. Dissection and a pathological examination indicate areas where the soft tissues and skeleton have changed over time, but since almost 50% of the adult population have dysfunctional spinal discs, yet not all of them present with neurological symptoms, this would be only indicative that there might be a problem not a definite diagnosis. Even then, that does not describe where they would potentially experience that pain or how it would present clinically.

All of that must be discovered through the case history and observation. Observation in all senses, including what they’re not saying or doing, how they feel, how they respond to palpation and so forth. And, as we exist within a dynamic world, at least part of that assessment has to take place with the person moving in their normal position. It is impossible to see why a shoulder is hurting if it is not normally used lying down. A knee may only twinge when the patient walks down stairs and so on. Active and passive examination needs to be considered, and not rote.

Learning to observe, to see rather than just look is a vital skill that we need to learn over time, it is a root from which other elements grow. Without effective observation feeding the diagnostic sieve, we cannot know which tool in our set to apply most effectively.

Artists learn to observe by doing. They try to see the whole, consider how it fits together, the interlocking parts. Relaxed, open, non judgemental. As practitioners, our process flow often inhibits this gentle scanning. We have probably talked to the person, taken the case history, formulated ideas, theories, considered current models of diagnosis. And through that filter attempt to see the problem in front of us. But what if we turned it around? Asked what that person experiences, why they’re with you today and then, non-judgementally asked them to move? Once we’ve observed them, then you can start the therapeutic journey.

Step away from the anatomy, the collection of organs, muscles, nerves, fascia and bones that sits in front of you and look.

5 tips for better sleep tonight.

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We all feel better after a good nights sleep but how often do you wake up wishing for more, and not refreshed and ready to go? The lack of sleep is sometimes considered a chronic health issue, due to its links with lots of other modern problems including diabetes, depression, and stress.

Up until open hundred years ago, our daily lives were regulated by the sun. Candles and lamps were expensive and comparatively ineffective, so we worked when the sun shone and rested when it set. Although our bodies expect this, it is no longer the case, thanks to the electric light and modern 24 hour entertainments giving us far too many reasons not to go to bed.

This means that we are saturated with blue light. From the backlights of our televisions and mobile devices to the harsh illumination of an LED or low energy bulb, blue is far more visually and cortically stimulating than older bulbs, triggering the brain into thinking it’s still daytime and interrupting melatonin production, a vital hormone that helps us sleep better.

So we often self medicate with alcohol. That drink that helps us calm down, feel relaxed and far too often doze off in front of the tv actually stimulates us a few hours later, as the sugars in it are metabolised and converted into fuel, which the body doesn’t actually need, leading to a restless night.

The result of which is the need for a stimulant in the morning to kick-start our day and another later to get us through the evening. But time these wrongly and yet another restless night will follow, repeating the pattern. It’s far better to suffer an afternoon of feeling sluggish but allow your adrenal glands to unwind and therefore help you sleep better than it is to take yet more energy drink.

But this stress is a chronic problem for many of us, where our bodies are constantly in a state of fight, flight or freeze, trapped in a biological cycle of not knowing how to respond to a situation it cannot control. We are flooded with cortisol, elevating blood pressure, blood glucose and adrenaline and when we finally collapse, exhausted into bed, we sleep tense, grinding our teeth, stiffening our muscles and waking once again feeling just as tired as when we pulled the covers up.

Similarly, we know exercise is good for us, but too much too late at night can have a stimulating effect, pumping up our blood supply and kicking the adrenaline levels back into action, just when we’d prefer to be unwinding. If you need to stay awake for long periods of time, simple whole body exercises have been shown to help, so why do it if you want to rest?

How to solve this modern health crisis? Research has shown that there are a few simple things we can do to make massive improvements in our sleep, which most of us did for our children yet forget to do for ourselves as we get older.

1) Turn off that screen. No blue lights, LEDs or TVs for at least an hour before bed. Instead read, bath, any activity you enjoy that allows you time to relax and unwind. Gradually turn the lights down, creating your own sunset effect and losing the blue.

2) Have a fixed routine. The body is controlled by circadian rhythms, patterns when it knows and expects events to happen. Experimentation and research has shown that melatonin is typically released between 9pm and 2am, so turning in at 10.30 would maximise your exposure to its beneficial effects. Also, getting up at the same time every day also helps stabilise the routine, improving productivity and effectiveness during the working day.

3) Sleep in the dark. Light is stimulating, be it a control LED on a clock radio or the dull glow of a tv on standby. Tape over them or even better, remove as many electrical items as you can from the bedroom. Think like a caveman, invest in blackout curtains or a really good eye mask.

4) Avoid eating or drinking anything stronger than water or herbal teas for a couple of hours before you sleep. You don’t need the energy in them, they are stimulating and you need to give your body time to digest and sort itself out. In terms of anything properly stimulating i.e. coffee or energy drinks, they have a long metabolic half-life, so at least 8 hours is a good window. In reality, this often means none after 2-3pm for many people.

5) If you are plagued with restless thoughts at night, get up, write them down and reset the pattern. If, in the morning, there is something that you know you can action, get it done and make steps to sorting it out. If there are more troubling issues surfacing regularly, go and see a professional for assistance. Whatever the problem, you are not the only person in the world with that issue.

Restful nights and busy days.

3 dietary changes that could save you

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Clinically, we all ask the endocrine questions during our case history taking. Are you sleeping ok? Do you feel tired all the time? Have you noticed any untoward changes in your hair, your skin, your weight? Are you feeling much more thirsty? Are you feeling too hot, too cold? These cover many different symptoms and pathologies and if any of them don’t add up, we know to refer to other medical professionals for further investigation and treatment.

But what of those subclinical ones, changes that are sitting in the background, induced by life patterns. Borderline type 2 diabetic, adrenal fatigue, chronic overtraining. Is there any advice we can safely give that could help that person and make sure they don’t fall over the edge and need medical intervention?

Cushing syndrome describes the signs and symptoms produced due to prolonged and excessive cortisol exposure (from overstimulation of the adrenal glands due to pituitary gland issues).

These include [1,2]:

  • Centralised (around the torso) weight gain
  • Fat pads on the back of the neck and clavicle,
  • Thinning of the skin
  • Bone loss
  • Glucose insensitivity
  • Memory changes and concentration issues

Some of these symptoms may look remarkably like the effect of prolonged stress on many people who will be presenting to us as patients.

Another cause of adrenal fatigue is over training in athletes. To them, if some is good, then more is better. The flaw in this logic is that, past a certain point, more becomes destructive, with the body no longer able to deal with the training load, leading the athlete to slow down, more tired and more prone to injury and illness. So they push harder, train longer and eventually run the risk of systemic collapse. The hormonal response in this depends on the sex and makeup of the person in question but in all cases, there may be evidence of adrenal fatigue, insulin resistance and muscle metabolisation [3]

Type II diabetes, or late onset occurs when the body becomes resistant to insulin and is often caused by obesity. Typical symptoms include increased thirst, increased frequency of urination and increased hunger. The effects of diabetes in any form are multi factorial, leading to potential peripheral neuropathy, damage to the eye sight, systemic organ failure and increased healing times in the skin. This is most commonly treated through a combination of diet, exercise and medication if necessary.

The commonality between these conditions is the recommendations offered for recovery and healing. If a patient is suffering from Cushing Syndrome  they are advised to take a low carbohydrate, low calorie, high potassium diet [2]. In diabetes, the patient is told to lose weight, change their dietary patterns and reduce their carbohydrate intake significantly. In a recovering athlete, they need to reduce the stress on the body, look at their dietary patterns and ensure they have sufficient protein in their diet to allow full muscle and immune system recovery. Magnesium is also recommended as it has been shown to lower cortisol, help improve mood swings, improve glucose sensitivity and help manage blood pressure [4]. Omega 3 oils have been indicated as beneficial in helping deal with the mental effects of cortisol and as such, can help with cognitive processes in all the above cases.

The message, time and again, is that a lower carbohydrate diet is beneficial. There is little evidence we need carbohydrate to the extent that we need proteins and fat. It is a highly efficient source of fuel but one that needs to be used rapidly, otherwise it is metabolised into fat in the liver. With athletes, it is important that they receive sufficient energy to support their performance and healing but some believe that this should be achieved by increasing their fat intake. Quite how much carbohydrate is still in discussion but the consensus appears to be drifting to less than 100g for sedentary people (strict advocates would suggest lower). For athletes it is harder to factor, since they are burning so much more but they might consider fueling around training sessions and health status with fat as the dominant energy source.

Take home tactics?

  1. Magnesium supplementation (250mg per day)
  2. Significantly less carbohydrate
  3. Omega 3 oils

Simple and with reduced adrenal stimulation, very successful.

References

1: http://en.wikipedia.org/wiki/Cushing’s_syndrome

2: Pathophysiology Made Easy, Lippincott, Williams and Wilkins 2006

3: http://en.wikipedia.org/wiki/Overtraining

4: G. Paolisso, A. Scheen, F. D’Onofrio, P. Lefèbvre (1990), ‘Magnesium and glucose homeostasis’, in Diabetologia, 33: 511-514

5 easy ways to stop back pain

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Over 70% of adults will suffer from back pain at some point and this number is rising every year. We all use our backs every day without thinking about it until they hurt.

Whether its from acute discs to muscle spasms, trapped nerves to torn ligaments, there are lots of ways for them to go and some easy ones to prevent it, without resorting to pills and surgery. Techniques doctors don’t always have time to tell you but save you time, money and worry.

  1. Move regularly. Your back is often painful if you sit for too long. The muscles go weak, the ligaments holding the bones together stretch and pain is the end result. Instead, walk a bit more, sit a bit less and use those muscles. Exercise doesn’t have to be gyms and furious sweating, simple moves at home will do it.
  2. Lift Properly. Whether it is a bag of shopping, a suitcase out of the car or a small child, we often lift very heavy objects without thinking and without doing it properly. Even if you can only manage a few of these items, they will massively reduce the risk. There is a simple way to remember lifting:
    1. Stop: Stop and think about the lift. Is it too heavy, too bulky?
    2. Face: Move to face the object. Twisting, bending and using the spine is the fastest way to cause lots of damage quickly.
    3. Brace: Pull your tummy muscles in. They are orientated so that they help support the spine safely but we often neglect to use them.
    4. Legs: Bend your knees, back straight and lift by pushing your heels into the ground and driving through your bottom.
  3. Stretch. If we spend too long sitting down, all the muscles at the front of us shorten, all the muscles at the back lengthen and we develop imbalances that cause pain when we try and stand up. Simple stretches can make an enormous difference to how you stand and move.
  4. Lose weight. If you are overweight, every step you take creates excess load on all your joints, even the ones in the spine. Your back has to take more force in the wrong directions, increasing the risk of it hurting.
  5. See an Osteopath. If in doubt, see an expert. Preferably before it starts hurting and you need the emergency appointment. Osteopaths are able to see where it might go and help free you up, allowing you to enjoy life without worrying.

Try these before its too late and you’re laid up.

Pareto Principle

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Vilfredo Pareto, an Italian economist, observed that there in general, there is an 80/20 split to all things.

  • 80% of a businesses income will come from 20% of the customers
  • 80% of the commodities will be owned by 20% of the people
  • 80% of the work will take 20% of the time

Interestingly, this also seems to apply to the treatment of patients.

 

x = time, y = improvement

If we take the above plot (y = log x +2, where x = 0 to 10) we can see that, for a greater value of x, y takes proportionally longer to increase. A simplistic interpretation and a mathematician will be able to show that it never truly will be horizontal, (y will always change) but it can also be seen that the greatest increase in y happens very quickly (approximately within the first 20% of the graph).

We can therefore use this tool and curve as a multilayered example to discuss with our patients.

  • Intial improvement should be rapid, within the first few treatments. If it isn’t, are we as clinicians missing something important?
  • 80% of their improvement will take 20% of the treatment time
  • They will never reach 100% better. We are all carrying compensations from the moment we are born, there will always be niggles. Our job is also to educate the patient on when these are mild or serious.
  • Treatment is progressive and dynamic. As they pass the 80% improvement point (on the y axis) then they should be encouraged to take more responsibility for their improvement, through exercises, diet and behavioural changes.

The Pareto pricinple can also be applied to others areas of practice. We will get 20% of clients who are unusual presentations, 80% of problems will be resolved with 20% of our treatment techniques and so forth. It is that 20% that requires our focus and skill.

168 Hours

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There are 168 Hours in a week.

We sleep, on average, for 56 (8 hours a night)

We sit and work for 45 (9 hours a day, 5 days a week)

We sit and commute for 10 (1 hour each way, 5 days a week)

We sit eating, reading or watching TV for 21 (3 hours a day, 7 days a week)

That leaves 36 hours to do other things, mostly at the weekend.

That which we do the most of, we become.

An hours exercise or movement a day really doesn’t seem much to ask does it? And if you recieve treatment for half an hour a week and change nothing else, how can you expect it to work?

You can’t fix them all.

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Conversations with colleagues often produce unexpected results. One of these recently was, for me, the realisation that you can’t help everyone.

We graduate from college, ready to take on the world and  slowly the experience knocks the corners off us, we grow into our own style of practice and learn what works for us.

However, one of the hardest things to face up to is that not everyone will get better. There are, of course, the red flag patients who should be referred to medical care and those who need other forms of intervention. But in theory, the rest should be amenable to treatment, at least to some extent.

So to understand that you can’t do it all is a big leap. There will be some where  your personality clashes with theirs, those who come with high expectactions, hoping for a magic click that frees them of the chronic pain that they have had for the past 20 years, people who blame you when they don’t improve, in spite of not following your advice, patients where the problem is as much psychological as physical and many others.

The skill is in recognising this, accepting it and moving on in the most appropriate direction, whatever that may be.

For me, once I came to this conclusion, the pressure lifted and, as long as I felt I could stand by my clinical decisions, my practice improved.

The use of compression wear in recovery from injury

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Many people use compression wear for racing, training and recovery. However, I’ve been thinking about using for recovery from injury.

As of yet, I haven’t been able to design a suitable controlled trial but we have been trialing it in clinic with some athletes and other active clients.

We noted that it seems to help improve recovery time in people with both calf injuries and tendonopathies. It appears that the compression wear (in this case compressport calf guards) helps reduce buildup of oedema when worn overnight and support the muscle during everyday activity during the day.

We are going to continue trialing this and hopefully will have sufficient day to draw a more solid conclusion soon but i thought i’d put it out there for general consideration. We are also going to try the quad guards for hamstring and quad injuries if suitable clients present.