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I had a lovely evening at the London Symphony Orchestra Christmas concert as a guest of one of their First Violins. Generously, she got tickets for myself and my colleague, Dr Craig Sheridan, after we helped her recover from frozen shoulder and tenosynovitis, using joint injections, exercise and manual therapy. First Violins' shoulders go through a lot over the course of a career! She also left a glowing review on Doctify; "The service is excellent, from the booking staff who are endlessly accomodating, to the practitioners. I have felt utterly confident in Craig's diagnoses and Tom is almost a magician. I feel so much better after he has manipulated me." [*****] Christmas Swing George Gershwin Overture: Girl Crazy Nikolai Kapustin Piano Concerto No 4 Leonard Bernstein Prelude, Fugue and Riffs Interval Pyotr Ilyich Tchaikovsky , Duke Ellington & Billy Strayhorn arr Jeff Tyzik The Nutcracker – Suite Pyotr Ilyich Tchaikovsky Selections from ‘The Nutcracker’ Leroy Anderson Sleigh Ride Sir Antonio Pappano conductor Frank Dupree piano Sérgio Pires clarinet Obi Jenne drum kit London Symphony Orchestra I love being part of a multidisciplinary team. We can all do our bit to help, and focus on what we're best at. There's probably a complex analogy with the different parts of an orchestra, but I'll spare you... #osteopathy #osteopath #notjustsportsmedicine #puresportsmedicine #shoulder #shoulderinjury #frozenshoulder #tenosynovitis #manualtherapy #exercise #rehab #jointinjection #violin #violinist #lso

Fact: lower back pain can be scary, particularly if it’s persistent or recurrent, but it’s rarely dangerous. People often tell horror stories about lower back pain, but however bad it seems at the time, you're very likely to recover fully, generally within a few weeks. A small percentage of problems may take months rather than weeks to resolve, but there are things that can help manage symptoms in the meantime. Lower back pain is very common, commonly recurs, and can temporarily keep you from your usual activities. It's best to stay active, though, as much as the pain allows. People who do so do better than those who avoid activities altogether. In recent years, researchers have turned attention to the effects of common beliefs about back pain, and how those beliefs affect people’s experience of back pain, how people go about dealing with it, and their recovery from it. There are a number of common myths about back pain, which we all have easy access to. This can lead to anxiety and poor coping strategies, and so make your experience of low back pain worse. Addressing some of these myths is a big part of helping people to have confidence that they will get better, and enabling them to take an active role in managing their own recovery. If you have back pain that isn't getting better on its own, it can be helpful to talk to a professional. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #sportsmedicine

It has often been thought that "wear and tear" with aging will inevitably lead to more lower back pain in old age. In fact, although different problems may affect older and younger people, older people do not suffer from more back pain overall. However, if you have this belief, it may become a self-fulfilling prophecy, as it often goes hand in hand with a belief that exercise causes wear and tear. But it has been shown that exercise helps reduce the incidence of lower back pain, as well as other joint pain, at all ages. For example, people who run regularly are less likely to have osteoarthritis in their hips and knees than people who don't. Fact: although it's a common belief that we're more prone to lower back pain as we get older, this isn't the case. Different problems may affect older and younger people, but older people don't suffer more back pain overall. For those who do, the right approach (including plenty of exercise) can help at any age. If you have back pain that isn't getting better on its own, it can be helpful to talk to a professional. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #sportsmedicine

Persistent back pain is rarely associated with serious tissue damage. The majority of back pain has no major injury associated with it, and imaging doesn't help with identifying a cause. Most of this may be explained by muscle strains or spasms, stress to other structures around the joints, such as the capsule and ligaments, or various other factors. If you do have an injury, tissues heal within three months. Pain beyond this point usually means there are other contributing factors such as stress, tension, fatigue, inactivity or unaccustomed activity which make the back sensitive to movement and loading. People sometimes fear that exercise will cause further damage, but in fact exercise is very helpful for lower back pain, so finding ways to overcome this sensitivity to movement and loading is important. Injuries heal, and we're not so fragile as we might think. We do better for movement, and worse for avoiding it. If you've had an extended period of pain, your nervous system responds to this by laying down new pathways that can prolong your experience of pain beyond the point where tissues have healed. Your nervous system has simply got used to firing off in a certain way, and this is the reason for your ongoing pain. Stress, anxiety and fear associated with back pain can contribute to this, and can be made worse by things like your social situation, how the back pain affects your work and life, and also by your thoughts and beliefs about low back pain. There are usually plenty of people ready to tell scare stories! All this can affect how you respond - what you do and don't do - and sometimes some of these decisions can be unhelpful in resolving your pain. This can be addressed, often in large part by simple education about back pain, and support in developing positive coping strategies. Exercise, stress management techniques, sometimes counselling, and generally taking a proactive approach can all be helpful. When low back pain doesn’t go away, it’s natural to start to wonder why, but sometimes the way we make sense of back pain can lead to anxiety and poor coping strategies which lead to worse experiences of pain. Addressing some of the myths around lower back pain can help people start to have confidence they can get better, and provide motivation to take control of managing their own recovery. Fact: persistent lower back pain is rarely a sign of serious damage, and can be helped with an approach that takes into account a broader range of factors. If you have back pain that isn't getting better on its own, it can be helpful to talk to a professional. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #sportsmedicine #chronicpain #persistentbackpain

In fact, with the majority of lower back pain, imaging shows no specific identifiable cause. A lot of back pain may be caused by muscular spasm, muscle strains, and mild sprains to ligaments, which won't show up on imaging. However, it is generally not necessary to definitively identify a specific tissue or structure. What's more important is to establish the bigger picture. This includes considering you as an individual and how the pain is affecting you, looking at your lifestyle and occupation and addressing factors that may predispose you to back pain, or may be helping to maintain it. Factors such as stress, tiredness, inactivity or unaccustomed activity may make your back sensitive to movement and loading. The other side of the picture when it comes to imaging is that we now know (through doing a lot of imaging) that people with no back pain often will have specific findings like disc bulges. This tells us that disc bulges and other changes to the spine don't always cause back pain, and are a normal finding from our 30s onward. However, imaging reports that mention what are actually normal findings can often be a source of anxiety that may in fact worsen your experience of back pain. If it's not likely to change the treatment or management of your back pain, there's little reason to do imaging, and it may have a negative effect. Imaging is only really indicated in the very small percentage of cases where other approaches, such as surgery, need to be considered. A thorough case history and clinical examination, along with monitoring your response to treatment where appropriate, will ensure you get the right care for you. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #sportsmedicine #mri

With persistent back pain, it’s very common for your spine and surrounding muscles to become very sensitive to touch and movement.The pain that you feel during daily activities and movement is due to this sensitivity. There can be a fear that pain means serious damage, or the danger of causing further damage, but this isn’t the case. One way to think about this is to look at pain as a warning system. If you hold your hand over a candle flame, you feel pain before you get burnt. The sensitisation associated  with persistent pain means that your warning system is triggered much earlier, further from harm. It’s normal to feel some pain when you start to exercise and move more, and it’s safe to do so. In fact, it brings lots of benefits - for your lower back pain as well as your general health and well-being. Movement and exercise are very effective in treating back pain. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain   #chronicpain

Although they may be painful when we have lower back pain, activities like sitting, standing and bending do not cause back pain. A variety of postures, movements and activities are good for your back. The best way to look after it  is to keep moving - regularly change your posture, get up and move about throughout the day, and get plenty of exercise! #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #sportsmedicine

A weak core does not cause lower back pain. Back pain is a bit more complex and multi-factorial than that, and is influenced by things like poor sleep, stress, anxiety, low mood, inactivity or unaccustomed activity. Plenty of people who come to see me with back pain have perfectly good core strength, and most are holding some kind of excess tension or muscle spasm in core muscles, often as a kind of “bracing” against potentially painful movement. This excess muscle tension can be very painful in itself, and generally needs to be relaxed for things to improve. There has undoubtedly been a bit too much of a focus on “one size fits all” prescription of core strengthening exercises for low back pain, a lot of the time when it’s not really needed. This doesn’t mean core strength isn’t worth working on. Sometimes when I examine people standing, just a little gentle prodding around their low back will be enough to unbalance them a bit. This is kind of the definition of not enough core strength (the ability to stabilise your trunk while doing things like moving your arms and legs, carrying a load or reacting when you take a knock or something unexpected happens to throw you off balance). Rather than being tense and rigid, we need the ability to relax in order to respond and stabilise ourselves. We tend to think of core strength as a specific set or type of exercises, often quite static, like planks, but we first develop core strength as babies, through simple actions like looking up, reaching, turning over, sitting up, crawling, eventually walking. The ability to stabilise ourselves while moving is clearly useful to us, so it’s worth thinking of dynamic exercises such as dead bugs or 4-point activation. It’s also worth recognising that we’re working our core in a variety of movements and more general exercise. Swimming, for example, is great exercise for our core. I used to get thrown around a lot doing martial arts, which was super-intense dynamic core exercise  just trying not to collapse in a heap. Failing to do 5-minute planks is not a cause of back pain, but a variety of movement, exercise and activity that you enjoy is great for a healthy back. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #sportsmedicine

Backs do not wear out with everyday bending and lifting. In the same way that exercise in the gym can make your muscles stronger and healthier, or yoga can make you more flexible, movement and loading can make your back healthier, stronger and more flexible. People do sometimes run into problems if they launch themselves into bouts of unaccustomed activity or exercise without allowing themselves to get used to it first, but activities such as bending, twisting, running and lifting are safe as long as you start slowly, build up gradually and keep it up regularly. It can also be helpful to think of preparing your body for a variety of demands. A balance of strength, power, endurance and flexibility through a variety of exercise is beneficial for most of us, rather than too much of one thing. We all do well for keeping active and exercising often. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #bending #lifting #sportsmedicine

Flare-ups can be painful and scary, but they usually don’t mean more damage has been done. They can be triggered by lack of sleep, stress and tension, anxiety, low mood, inactivity or sudden bursts of unaccustomed activity. Keeping these things under control can help to avoid flare-ups. Sometimes the fear of making things worse can keep you from being active, but this in itself can cause ongoing problems. The more inactive you are, the more deconditioned you become, and you end up in a worse position than before. If you have a flare-up, rather than treating it like an injury and avoiding doing anything, try to stay calm and keep moving as far as you’re able. Back pain tends to improve faster when you stay active. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain #sportsmedicine

Lower back pain is common, and although it can be very painful, for most back pain the causes are minor. It will get better in time, with or without treatment. Only a very small percentage of people with more serious causes of lower back pain may require surgery. Spinal injections and surgery also bring their own risks and side effects, so aren’t worth considering unless there’s a real need. For most, simple self-management advice can be helpful, such as keeping active and finding ways to minimise aggravating factors, as can a specific exercise plan and appropriate general exercise. Other approaches, such as manual therapy, can help alongside this. For persistent back pain, spinal injections, surgery and strong drugs like opioids usually aren’t a cure, and long term use of opioids has significant risks. What is helpful is to find low risk ways for you to manage and control your pain. #painrelief   #backpainrelief   #pain   #physicaltherapy   #lowbackpain   #spine   #sciatica   #osteopathy   #osteo   #jointpain   #lowerbackpain   #painmanagement   #mobility   #LowerBackPainMyths   #backpain