Many people are familiar with the term "bulging disc" in regards to lower back pain. It can feel like an intense, sharp, stabbing sensation that can often travel down your leg through your hips and bum, sometimes as far as your feet.
This is a common diagnosis when you start to develop back pain. You get a scan which shows changes in the disc, and the pain matches the effected nerve area. It can be a scary diagnosis.
But you may be surprised to know that a lot of people who don't have pain have also been found to have changes in their discs. I find this study to be really encouraging, because it shows that people who have significant changes to their disc structure can still live a painfree life. It suggests that the disc changes may have already been there for some time before any painful symptoms even began, and gives hope that even if the structure doesn't change, that the pain can change.
Lets have a look at this interesting literature review, particularly in regards to the findings around disc degeneration, disc bulges and disc protrusions.
This is a literature review of 33 separate studies that investigated the imaging of spinal degeneration in painfree people ranging from their 20's to their 80's. It was published in the American Journal of Neuroradiology in 2014.
In total, the review takes into account MRI and CT scan imaging on 3110 individuals with no painful symptoms.
As you would likely predict, the number of findings increased with the participants age group, showing age-related degeneration occurs even in people who aren't experiencing pain.
Lets have a look at the imaging results for the disc degeneration, bulge and protrusion categories:
Disc degeneration - changes to the disc and surrounding vertebrae that result in loss of cushioning and support, may include signs of osteoarthritis at the joint.
Disc degeneration in painfree participants was identified in:
Disc bulge - changes that alter the shape of the disc and can make portions of it "bulge" out of place, which can apply pressure to nearby nerves.
Disc bulge in painfree participants was identified in:
Disc protrusion - changes to the annular membranes around the disc allows the disc nucleus to protrude and apply pressure to the nerves.
Disc protrusion in painfree participants was identified in:
What does this mean for your bulging disc?
It means that theres a good chance that your structural changes were already present before your back became painful. The area may be irritated or flared up right now, but these findings are a good indication that even if your scans don't change, your back pain still can settle down.
It means that a scan showing disc changes doesn't have to be a life sentence of pain.
Does this mean bulging discs DON'T cause pain, then?
Don't get me wrong, bulging discs can be painful, and for some people it can be severe. This study just helps to show us that theres more to back pain that what shows up on MRI or CT scans. Structural changes are just one layer in the complex onion that is back pain.
We can help!
There are lots of ways we can change your experience of back pain through massage and myotherapy techniques like dry needling, taping and support, strengthening the surrounding muscles with exercises that are appropriate for you, and supporting your understanding of how your back functions.
Book a time to come see us to talk about your back pain and creating a treatment plan to reduce it.
We're pleased to say that after weeks of being closed due to COVID19, we're very close to reopening! We're sure you're as excited as Emily and I both are to get back into our treatment room for the myotherapy and remedial massage therapy treatments you've been missing!
We've been given the OK to reopen 4 days a week by our medical professional landlords, Dr Wajib Dib the GP we share our clinic with at Together Medical, and Amer Dib the pharmacist who owns and runs Knoxfield Pharmacy downstairs from us. They've been happy with the policies and procedures we've put in place for sanitisation and screening, and are welcoming us back from the start of June.
Needless to say, due to COVID19 we’ve needed to optimise the cleanliness of our space and put in place procedures to maintain social distancing outside of your treatment.
These are the changes we’ve made to ensure your health and safety during your appointment:
What else is new?
We've broken up Myotherapy and Remedial Massage into 2 categories. We hope this will make it easier for you to know what type of treatment you want to book.
If you have an injury to be assessed, a chronic condition needing expert maintenance, or want more advanced treatment techniques like dry needling, cupping, mobilisation, taping, or a tailored exercise plan, you can book a Myotherapy appointment.
We've also removed the need to book an Initial or a Return session for Myotherapy treatments, you can now just choose the appointment length you need.
This means if you would prefer "just a massage" to address your aches and pains, you can book for a Remedial Massage and get what you're expecting - feel good, hands on massage! Perfect for muscle soreness and general preventative care!
Appointment Length and Fees
From June 1st, we'll be offering the following appointment types:
Myotherapy - 30 mins ($79), 50 mins ($99), 80 mins ($134)
Remedial Massage - 30 mins ($70), 60 mins ($100), 90 mins ($130)
Ready to book in? Pick a time from our online booking page for when we return in June!
Anyone with long term pain will likely relate with this statement my sister recently made about her chronic back pain and exercise:
"Yeah, the pain flare ups seem to be less frequent with exercise. But also feels hard to convince myself to exercise, because if I stretch too far it hurts real bad, too??"
This situation is so common with people I see every day in the clinic. The pain has been there for a long time, but thinking on times that they've been most physically active, that tends to be the times that the pain has been its least intense, frequent and invasive.
So if we know that staying active can change the intensity, frequency and overall impact pain has on our lives, why is it so hard to convince ourselves to do the exercises? Its an internal fight that a lot of people have with themselves.
In practitioner language we call it Fear-Avoidance Behaviours, which basically means not doing the beneficial thing because of the fear of causing pain even if you know long term the beneficial thing reduces the pain intensity and/or frequency. It’s one of the biggest struggles for people with chronic pain.
I think a lot of the solution to it is finding a really enjoyable activity. In my sisters situation, she started taking MMA classes last year. A weird choice for someone who is already in pain, right? But even though shes learning some serious fighting moves and coming away with some proper bruises, her long term back pain has been more under control than it had been in ages.
I explained it to her like this.
"You’re not there to slug away at a pointless activity that you don’t enjoy. You have fun, you learn, it’s interactive, the people are nice and supportive, it’s social, it’s not 100% competitive, you get to do it as a family activity with Matt and the kids. So it’s probably so much more appealing than going for a run or going to lift weights at a gym by yourself for an hour a few days a week."
And I think she got it!
"Absolutely! Ohh that all makes so much sense... it's so true though. Going to the regular gym or even working out at home is like... ugh. No thanks. But going to MMA is so easy?! Because it's just fun... I mean, it's actually a really complicated work out, and some of it SUCKS... but is somehow so damn fun?!"
While she's having all this fun kicking and punching, she'll definitely be using a lot of back muscles to coordinate and control the movements, and core muscles, hip stabilisers, all the areas that single exercise prescription focuses on. The difference is instead of doing separate specific exercises for each muscle group, it’s all just rolled into a sequence of movements and blows and dodges, mixed in with an instructor that makes her laugh and being able to spar with her partner. This is way more enjoyable for her than doing strict sets and reps of isolated exercises.
Some people love doing the specific exercises, and guess what, thats awesome too because if you love it and enjoy it, you're more likely to do it!
Lets talk neuroscience
We already know that almost any kind of exercise produces endorphins, which are these wonderful little brain chemicals (neurotransmitters) that are natural pain and stress relievers.
Endorphins act a little differently on the Peripheral Nervous System (all the nerves in your body that aren't part of your brain or spinal cord) and the Central Nervous System (the brain and spinal cord)
They work by binding to opioid receptors in the Peripheral Nervous System. Its like your own personal stash of codeine, and your body makes it in response to exercise! They also work by reducing the amount of inflammatory chemicals that the nerve produces.
In the Central Nervous System, endorphins also bind to the opioid receptors. Here their effect is to reduce another neurotransmitter called GABA. With GABA reduced, your brain is able to produce more dopamine - the pleasure neurotransmitter! Interestingly, these opioid receptors in the brain are most abundant in regions of the brain that control pain regulation.
So how is it more helpful to have a fun active hobby?
Researchers found that endorphin release varies depending on the intensity of the activity, suggesting that higher physical intensity leads to increased endorphins compared to more moderate activity.
But is the endorphin rush better from a fun activity vs an activity that you find boring or tedious?
I'm honestly not sure, but what I do believe with certainty is that most people are way more likely to actually DO the exercise if its something they find fun and enjoyable and actually have a desire to do it.
Realistically, it probably doesn't matter WHAT you do, more that you just DO IT!
Yesterday, Premier Dan Andrews announced an update regarding COVID-19, and extended the State of Emergency til May 31st.
Some positive changes and updates were announced.
From tomorrow onwards, people can start to visit their loved ones, and have up to 5 guests in their homes.
The testing results from over 140,000 tests in Victoria identified 30 new cases, which is about 0.018% of all the tested individuals.
The numbers of infections and hospitalisations here in Victoria are relievingly low, compared to other similar sized cities across the world.
However, the Premier has encouraged people that if they can work from home, they must continue to work from home. The 1.5m social distancing requirements are still in place. There are now 5 reasons allowable to leave your home - seeking medical care, going to work, doing essential shopping, exercising, and now to visit family or friends.
We will remain closed a little longer, but we feel like things are starting to shift and we hope to bring better news of reopening soon!
The May 50K officially started just a few days ago. That means my practice runs are wiped off the board, and we're starting the 50km target from May 1st til May 31st!
I've just logged another 4km run today, so I have about 42km to go for the rest of the month.
The May 50K is raising funds for research for Multiple Sclerosis. Its a condition that hits close to home for me because I work with patients who have MS. Its such a varying condition, some people have few flares and mostly manageable symptoms, where others have constant symptoms and complications.
The days are getting colder and wetter, so that doesn't exactly make it an enticing environment for running, but I'm finding that once I do actually get going, its quite good. I like the challenge, and I know I need the fitness.
The thing I enjoy most about the running is afterwards. I know I bang on about this to patients, but honestly, the endorphins that flow after exercise is pretty magical. The running itself can feel hard physically and mentally, but almost as soon as I stop I feel that nice shower of reward brain chemistry, and I feel like "perhaps I could do that again!"
As a team, the Myotherapists for MS are doing quite well. Mat Richardson from Tecoma Myotherapy has set himself a double goal of 100km for May. He's just a fantastic guy and brilliant therapist, who I am very lucky to have close by to throw ideas around with and lern from his many many years of industry experience. Rhianna Bridgett from The Wellness Nest in Docklands has set herself the goal of 50km walking. I'm a bit not-so-secretly a fan girl - she's one of my lecturers at Endeavour College for my Bachelor degree in Myotherapy, and one of the most amazingly hard working, genuine people I've been lucky enough to meet.
Some days the lockdown isolation is really getting to me, as I'm sure it is for most people. I'm so glad to have The May 50K to focus on right now, so I can still feel like I'm doing something to help patients with Multiple Sclerosis, even if its not providing actual treatment.
I'm very much looking forward to being able to reopen soon when the restrictions lift!
For now, follow my running efforts on our Facebook page, and if you can, we would love your support by donating to help us achieve our team goal of raising $1500 for MS Research this month!
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