Free2move Physiotherapy

Category: Featured Article

  • Habits and Choice

    Habits and Choice

    Habits and Choice

    In our classes we explore the way in which our habits influence our freedom of choice. We all have habits, some of them that are very useful. Consider the way we can drive a car or clean our teeth without making much conscious effort.

    Other habits are not very useful or even harmful such as constantly hunching the shoulders or poor posture at the computer. Holding the breath is a habit we often consider to be bad, however even our ‘bad habits’ have uses. It’s useful to hold your breath for example when you are diving underwater.  In Feldenkrais we are not trying to get rid of our habits, but simply to become aware of them, so that in any one moment we have freedom of choice.

    Moshe Feldenkrais often said that unless you have at least 3 options you have no real choice. Is having 2 options real choice? Imagine if someone told you that for the rest of your life you have 2 choices – you can wear any colour of clothing you like as long as it’s black or white. Would you have real freedom of choice? What about all the shades of grey in between? and all the colours of the rainbow?

    In every Feldenkrais lesson, group or individual, we present you with a variety of different and often novel movement options. These unique and different movement combinations awaken our sense of curiosity, facilitating learning. This begins the process of freeing ourselves from habitual ways of moving, thinking and feeling that may be limiting us. It’s as if each Feldenkrais lesson adds new colours to your movement palette, giving you true freedom of choice.

    Spinal Mobility – Alison’s Classes in Fourth Term 2016

    Neck and back pain are one of the most common health problems affecting people in our community today. They often cause us to restrict our movement to protect ourselves. While this may help in the short term, long-term it may result in chronic, persistent or recurrent pain. According to award winning author Norman Doidge, the patterns of self-protection may themselves become the primary source of pain and disability.

    In our classes we learn how to free ourselves from these restrictive patterns. There are pain-free ways of softening, turning and bending our spines. We will also be investigating how our breath, the use of your eyes and tension held at our jaws and hands can influence the mobility of the spine. Improving the efficiency of our movement patterns helps us to find a more fluid, comfortable and even graceful style of movement. Our aim is to improve our ability to bend and twist the neck and back, so we can relieve our own pain and tension.

  • Flexible Chest and Spine

    Flexible Chest and Spine

    A Flexible Chest and Spine – The Hidden Key to Freeing the Neck and Back

    The Hidden Key to Freeing the Neck, Back and Shoulders

    Most people don’t consider their chest and spine as playing a large role in feeling comfortable and at ease through the neck, shoulders and back. The first instinct when dealing with neck and shoulder pain is to spend time working on localised ‘knots’ and muscle tension. However this could be addressing the symptoms, whilst ignoring the underlying cause.

    The thoracic spine, and the rib cage serve as the support structure for the entire upper body. Finding comfortable alignment and releasing through the chest and spine allows the rest of the body to relax. In turn, when there is stiffness through the chest and spine, the neck, back and shoulders work overtime to try and correct this, leading to muscle tension, ‘knots’ and pain.

    The ‘knots’ are not actually a ball of tangled fibres as you might imagine, they are trigger points. Trigger points are highly sensitive points in the muscles and connective tissue, which can refer pain to other places. In Feldenkrais we don’t massage or manipulate the ‘knots’. Instead we address underlying causes – stress, poor posture and inefficient use of the muscles.

    How Feldenkrais Can Help

    Feldenkrais uses a process known as ‘sensory-motor learning.’ Students are guided to closely attend to how they are moving, reducing unnecessary and wasted effort. The Feldenkrais Method accesses our brain’s own neuroplasticity, allowing us to revise and replace movement habits which may no longer be serving us.

    READ MORE about how Feldenkrais actually works.

    BOOK A CLASS or REQUEST AN INDIVIDUAL APPOINTMENT

    Our Mental Map of the Thorax

    We begin the process of re-educating our posture and muscle use by improving  our self-image.

    When Moshe Feldenkrais talked about the self-image he was not referring to self-worth or self-concept. What he meant was the sensory map of the entire body that each of us carry in our brain. Our self-image is not totally accurate and is constantly open to change. Neuroplasticity allows us to continually refine and update our mental maps

    Our mental map of the thoracic spine and ribs is often particularly vague. For one thing the back of our ribs are out of sight and therefore often out of mind. Secondly, it’s usually the hardest part of the body to reach with the hands. (Think about trying to apply sunscreen in between the shoulder blades!) Thirdly, the sensory nerve endings are spaced far apart in this area compared with say the hands and lips. As a result our ability to feel the difference between 2 different points is poorer in this area.

    Improving Awareness of the Chest and Thoracic Spine

    The thoracic spine is not only the longest section of the spine, it is also normally the stiffest. The reason for this is the attachment of the ribs cage. The ribs serve the function of protecting the vital organs within the thoracic cavity, including the heart and lungs. Although the ribs are made of bone, they are more flexible than we might imagine. They have moveable joints at the back, where they articulate with the spine. They also have bendable cartilage attachment to the sternum (breast bone) at the front. The lowest 2 ribs are even more flexible, because they don’t attach at the front but ‘float’ freely at one end. For this reason they are called ‘floating ribs’.

    If the thorax is used like an immobile block more strain is shifted onto the relatively mobile neck and lower back vertebrae. Without the protection of the ribs, these sections of the spine are prone to injuries such as cervical or lumbar disc herniations. Learning to better mobilise the chest also helps with the co-ordination of the arms and legs for walking, running and sports and a huge variety of other activities.

    The Chest, Ribs and Diaphragm in Breathing

    Holding on to unnecessary tension in the chest and abdomen increases the effort required to breath. At times tension is so great that the breath is held completely. At other times breath is not held but it is restricted. This can occur at the end of the breath in or the breath out or somewhere in between. Sacrificing breath markedly impairs our ability to function efficiently and drains energy.

    Breath holding and tension around the chest and diaphragm are a common response to physical, mental or emotional stress. Under stress the sympathetic nervous system takes over, resulting in the ‘Fight, Flight or Freeze’ reaction. In our current world we are constantly called upon to achieve, produce results and keep up with a myriad of small and large tasks. This includes keeping up communications through social media and the internet.

    Many people use television or social media platforms to relax when they finish work, however the content often keeps the mind revving in high gear. We are losing the art of unwinding and allowing our parasympathetic nervous system take over. The parasympathetic nervous system allows us to ‘rest, digest and repair’. For better sleep and more daytime energy, we need to know how to wind down before we go to bed.

    A Mobile Mind and a Comfortable Body

    By improving the accuracy of our mental maps as well as the mobility of the chest and ribs we can enhance all of the above functions. We reduce strain on the neck, shoulders and lower back by sharing the work load more evenly. We enhance our ability to easily and comfortably bend and twist the spine in all directions by listening to which sections of the spine are overworking and which could participate more fully. We can connect our limbs to our central axis so that we may use large muscles to provide the power, while smaller ones are reserved for accuracy

    Breathing can become simpler, lighter and more spacious, as we learn to use more of ourselves. The mind naturally becomes calmer and our sleep deeper and more refreshing. As we re-discover the pleasure of letting go of excessive effort, our parasympathetic nervous system naturally takes over. Some people even fall asleep during Feldenkrais class – and this is perfectly ok (but we’ll wake you up if you start to snore loudly!)

    Enrol in a Feldenkrais Class Now

  • 5 Ways to Counteract Sitting at Work

    5 Ways to Counteract Sitting at Work

    back pain - young woman in office with laptop

    Five Ways to Counteract Sitting at Work

    1. Micro-breaks

    Eye breaks – every 20 minutes spend 20 seconds focusing your eyes on something 20 feet away from you (the 20 – 20 – 20 exercise). You should also blink the eyes a few times to lubricate them.

    woman sitting on an office chair with her hands interleaved over her head stretching

    Deep breathing with an overhead stretch (sitting or standing). Interlace the fingers. Take a deep breath in as you raise your hands overhead and turn the palms towards the ceiling, looking upwards slightly. Repeat 3 times.

    2. Walking breaks

    Once every 30 to 60 minutes move away from your desk and walk briskly around the office. These short periods of activity that are simply part of your daily routine are known as ‘incidental exercise’. They are useful for preventing stagnation of the circulation. They help to raise your metabolic rate. There are many apps available to help remind you to get out of your chair.

    You may simply get up, walk to another room and drink a glass of water or use the bathroom. It doesn’t necessarily mean that you stop working either. The break could be used, for example, to discuss something with a colleague or use the photocopier. Walking or jogging on the spot can provide an additional boost for your circulation. A short but brisk walk during the lunch break is another possibility.

    3. Walking meetings and walking phone calls

    Standing or walking during meetings helps increase activity level and lifts metabolic rate. If you use a mobile phone at work, make sure you have earphones with an inbuilt microphone. This way you can remain mobile while talking with colleagues or clients.

    4. Walk to work

    If you live too far from work to walk there, try parking your car further away and walking for the last 10 or 20 minutes. Taking public transport usually involves walking to and from the train or bus, which could be an improvement on taking your car. Research shows that we need an absolute minimum of 150 minutes a week of cardio-vascular exercise. This can be made up of any blocks of exercise that are at least 10 minutes long.

    5. Active computer work stations and fit desks

    Active work stations and fitdesks are a fantastic way to increase activity levels during the working day. Treadmill work stations allow you walk while you work. Cubii is an under desk elliptical that you can use while you work, without your knees hitting the desk. It has bluetooth connectivity so you can keep track of how far you have pedaled on your phone. Here is an interesting article that compares cycling desks with treadmill desks. The treadmill desks are more expensive but don’t interfere as much with productivity and the ability to work on a computer.

    Stretches you can do at your desk

    Stretches at work are helpful for reducing muscular tension and feelings of stiffness.

    The following stretches can be done without leaving the vicinity of your desk. They target the most common places people feel tension after being at a computer.

    READ OUR DISCLAIMER Please seek medical advice before commencing exercises, if you have a painful or medical condition.


    woman sitting in office chair wisting round to the left looking behind

    Spine twist – Sitting in your chair, twist around to one side and look behind you, hold for a few seconds and repeat to the other side. This exercise helps stretch the shoulders, lengthen the back and fills the lungs with air, expanding the chest.


    woman sitting on an office chair bending forward and touching her ankles

    Forward bend – Sitting in your chair, slide your arms down your legs and let you head hang forwards, hold for 2 or 3 breaths in and out, then return to sitting. This gently stretches the lower back if it has been arching or compressed. It may help to help relieve lower back tension.


    woman tanding near office chair with hands interleaved behind her back doing a pectoral stretch

    Pectoral stretch – Stand up, interlace the hands behind your back and raise the arms slightly towards the ceiling. The pectoral muscles at the front of the shoulders often become tight while using a keyboard. This exercise helps to lengthen them.


    woman standing up from chair and doing a back bend exercise

    Back bend standing – Stand up, tighten the buttock muscles, use the hands to support the lower back and gently lean backwards, while looking upwards. Repeat several times without holding. This helps to counteracted a rounded lower back that can occur from slouching.


    woman sitting on office chair with her hands out in front doing the stop sign stretch

    Stop sign stretch – Stretch one arm out in front of you with your elbow straight and your palm facing forwards, as in a policeman’s stop sign. Use the other hand to gently stretch the fingers back. Hold for a few seconds then repeat on the other side. This forearm stretch helps prevent Golfer’s Elbow (pain on the inside of the elbow).


    woman sitting in office chair with arms out front doing a forearm stretch

    Forearm stretch – Make a soft fist with one hand and extend it out in front of you, elbow straight. Turn the thumb side of the hand slightly towards the floor. Use the other hand to gently bend the wrist downwards. Do not do this stretch if you feel strain in the wrist. You may feel a stretch in the forearm if the extensor muscles which attach to the outside of the elbow are tight. Tight wrist extensors can lead to Tennis Elbow.


    Also refer to our article “The Risks of Prolonged Sitting”

  • The Risks of Prolonged Sitting

    The Risks of Prolonged Sitting

    The Risks of Prolonged Sitting

    businesswoman stretching after prolonged sitting at her computer and doing breathing exercises
    A business woman stretching at her computer

    Prolonged sitting at a computer endangers your health

    Do you feel stiff and sore after prolonged sitting at a computer for a few hours?

    Along with poor posture, sitting at a computer can contribute to Occupational Overuse Injuries. These were previously called Repetitive Strain Injuries or RSI. Neck and shoulder pain, carpal tunnel syndrome and lower back pain are common in people who sit too much. Screen brightness and constant focal length can also cause eye strain. Many businesses now offer ergonomic work station assessments to help reduce these workplace injuries.

    How many hours do you sit each day?

    Try this calculation.

    1. Consider your morning routine on a average work day. How many hours are you sitting before you arrive at work? Include time spent sitting during breakfast, mobile phone or computer use, watching television and traveling to work by car, bus or train.
    2. Estimate the number of hours you sit at work each day. Include your lunch break.
    3. Finally consider the time you spend sitting between leaving work and going to bed. This includes sitting while you travel home, use your computer, mobile or TV. It might also include sitting while you read, eat or just relax.
    4. Add the 3 numbers together. You may be surprised at the total number of hours you are sitting on the average work day.

    Research reveals serious health risks of prolonged sitting

    Stiffness, pain and tension may not be the most serious risks faced by people in sedentary occupations. There is now scientific evidence that prolonged sitting is even more harmful.

    An Australian government site warns that sitting for more than 11 hours per day can increase the risk of death within the next 3 years by 40 percent. Regular prolonged sitting is related to a higher incidence of diabetes, heart disease, obesity, fatty liver disease and some forms of cancer. The risks may also be present for those who exercise regularly before or after work.

    Another large study at was done at Columbia University. This research involved almost 8,000 participants. Those who sat for at least 13 hours a day combined with multiple sedentary bouts of 60 to 90 minutes had nearly twice the risk of dying within 4 years.

    This highlights the need to get up from your chair at least once an hour.

    Metabolic syndrome

    The main problem with sitting is that it is sedentary. You may be in one position for several hours, with little muscular activity. This results in stagnation of the circulation, pooling of blood in the legs. During periods of inactivity there if often shallow breathing or breath holding.

    Your body is always burning energy. Even during sleep the body requires energy in order to carry out processes such as digestion and tissue repair. The metabolic rate is the number of kilojoules (calories) the the body burns per hour. When you sit for long periods the metabolic rate is low.

    A reduced metabolic rate means that relatively fewer calories per hour are being used by the body. A possible outcome is Metabolic Syndrome. This condition involves a collection of signs and symptoms:

    • increased blood pressure
    • high cholesterol
    • elevated blood sugar levels
    • weight gain (especially around the abdomen).

    Getting up regularly for a short brisk walk can help raise the metabolic rate. Research shows following vigorous exercise that the metabolic rate remains higher for up to 24 hours afterwards.

    Mental health problems and prolonged sitting

    A further problem with prolonged sitting is its effect on mental health. Research is now starting to show that it is related to higher levels of depression and anxiety. It is also known that regular exercise can be an effective treatment for mild to moderate depression.

    Read about how the Feldenkrais Method can help mental health.

    How to counteract prolonged sitting

    The best way to counteract these problems is to break up your sitting with frequent short periods of activity. This so called ‘incidental exercise’ can help to counteract the health risks of sitting.

    Breaks from sitting in front of a screen are vital for the musculo-skeletal, cardio vascular and respiratory systems as well as for weight management and mental health. The question is, how can these be incorporated into a busy schedule?

    Active work stations and active offices – way of the future

    Some offices are now creating activity centres or outdoor exercise areas. These are places where staff can participate in short periods of vigorous exercise, for example one to two minutes of cycling on a stationary bike or walking on a treadmill.

    Sit stand desks are becoming common. Although there is more muscle use in standing, it is still relatively sedentary and can cause pooling of blood in the legs.

    As a result, active work stations are currently being developed. These including cycling computer work stations and treadmill computer work stations. In the future perhaps we will all have the option of being more active, even while working on a computer for much of the day.

    5 Ways to Counteract Sitting at Work

     

  • Improving Posture

    Improving Posture

    three diagrams of a man sitting on a chair, the first 2 are bad posture the last is goog posture

    Improving Posture

    Have you ever tried to improve your posture? How well did that work for you? If you are not satisfied with the results, consider attending Feldenkrais classes. The Feldenkrais Method can help you achieve comfortable and effortless posture through ingenious and mindful movement exercises.

    The changes become integrated into your every-day life. Soon you will find yourself sitting, standing and moving in ways that you never imagined could be so easy or comfortable.

    Body Scan Exercise in Sitting

    Sit on a firm chair with your feet flat on the floor. Come forward in the chair a bit so you are not using the back rest. Sit normally and close your eyes for a few moments. Notice your posture. Stay there for a minute or two just observing yourself. Then open your eyes again.

    When you observed your posture, what is the first thing that came into your awareness? What parts of the body did you sense? Perhaps you thought about whether you were sitting or standing up straight? You might have become aware or your head, neck and back. Perhaps you sensed your spine and checked its alignment. Maybe you tried to correct yourself. These are things many of us were taught to do growing up.

    Consider that parts of your body that may not have been included in your awareness. Your hands and feet? Your chest and rib cage? Was your abdomen free to move with the breath? How long could you sustain this posture comfortably

    3 minutes to Better Posture

    Now try this short exercise with Ruthy Alon. Then go back to the sitting body scan above and feel the difference.

    About Ruthy Alon

    Ruthy is an international Feldenkrais trainer who studied and taught with Moshe Feldenkrais for over 20 years. It is hard to believe that in this video she is 85 years old. Ruthy is still teaching, a huge inspiration for those of us interested in healthy ageing.

    4 Reasons why trying harder to sit or stand up straight doesn’t work

    1. When we try to straighten the spine we often increase effort in the muscles of the back without releasing the flexor muscles in the front of the body. The result is one muscle group working against another. This causes spinal compression.

    2. Some of us work so hard in our back muscles to maintain good posture that we end up bowed backwards, thinking that we are actually straight. This ‘military’ style of posture can lead us to be stiff and stuck in our movements. People who do this are usually unaware of it.

    3. A common frustration in trying to improve posture is that the changes only work while you are consciously paying attention. As soon as you stop doing that, you slip back into old habits.

    4. Yet another problem with this method is that the effort to straighten can result in restriction of the breathing.

    4 Ways that Feldenkrais helps improve posture

    1. Focusing on dynamic, not static posture

    Moshe Feldenkrais described good posture as ‘the ability to move equally easily in all directions’. This is dynamic posture. By contrast, static posture may involve trying to hold yourself still when you are sitting or standing. This may cause breath holding. It’s also literally impossible be completely still. We actually maintain our balance in upright positions by using subtle swaying movements.

    2. Reducing effort

    As you learn where to let go of unnecessary effort, you will discover how to find more efficient support from your muscles and bones. Learning to move easily in and out of a particular position is just as important as maintaining good alignment.

    3. Learning first while lying down

    To learn a new way of supporting the body against gravity Moshe Feldenkrais first taught a variety of movement lessons lying down. The reason is that lying down makes it easier to reduce muscular effort. This helps you sense what you are doing more clearly so you can make small adjustments towards greater efficiency. It means you are less likely to fall into inefficient habitual patterns and postures.

    4. Expanding the self-image

    In the Feldenkrais Method you will learn to bring your attention to each part of the body that is involved in an action. You will learn how even seemingly unrelated parts of the body such as your hands, feet, eyes, ribs and hip joints can influence your posture. The more parts of your body that can be included in your self-image, the more clearly you will know what you are doing. In the words of Moshe Feldenkrais ‘When you know what you’re doing you can do what you want’.

    “When you know what you’re doing you can do what you want” – Moshe Feldenkrais.

  • Relieve Lower Back and Hip Pain with Feldenkrais

    Relieve Lower Back and Hip Pain with Feldenkrais

    Group doing back and hip Feldenkrais exercises in fitness center

    Relieve Lower Back and Hip Pain with Feldenkrais

    Exercising with Lower Back or Hip Pain

    Lower back and hip pain can make it hard to exercise. The alternative – not exercising – can lead to increasing weakness and stiffness, with a tendency to gain weight.

    Even if you have already tried other forms of exercise without success, Feldenkrais is different. The focus during the movement classes is on learning to sense your body movements more clearly. Increasing your awareness of your movement habits is the key. That’s why Moshe Feldenkrais called the classes ‘Awareness Through Movement’

    ‘When you know what you’re doing you can do what you want’ Moshe Feldenkrais

    How Feldenkrais Helps

    By reducing effort and shifting your attention to the quality and smoothness of the movement, you discover new ways to move with comfort and ease. As you learn to let go of tight muscles, range of movement in your lower back and hips improves. You compare different movement options and discover what works best for your unique body. Better coordination and control of your muscles brings a sense of effortless power.

    Help break the cycle of pain and tension in your lower back and hips by enrolling in our regular Feldenkrais Classes in North Perth. All classes are run by a qualified Feldenkrais Physiotherapist.

    READ MORE about Feldenkrais Classes.

  • Tight Hamstrings or Short Hamstrings: Why are they a problem?

    Tight Hamstrings or Short Hamstrings: Why are they a problem?

    A woman trying to touch her toes suffering from tight hamstrings

    Tight Hamstrings or Short Hamstrings: Why are they a problem?

    Many people have short hamstrings, the main muscle group in the back of the thigh which bend the knee and extend the hip. Shortened hamstrings are more common in men. Spending a lot of time sitting may be a contributing factor. Another factor is sitting with your pelvis tilted back and knees bent. This posture results in a loss of the lumbar lordosis, the natural arch of the lower back. It not only places strain on the joints, discs and muscles of your lower back but it also puts the hamstrings in a shortened position.

    LENGTHEN YOUR HAMSTRINGS EASILY by trying this Free Feldenkrais Lesson.

    Shortened hamstrings make it more difficult to bend and lift things safely, because they limit the forward tilt of the pelvis. Some people believe they have short hamstrings because these muscles feel tight, however tightness is a sensation, not an actual limitation in mobility. It is possible to over-stretch the hamstrings, which can result in reduced pelvic stability, so if in doubt get advice from your health professional.

    The Straight Leg Raise test is a quick test that can be performed by your Physiotherapist to determine whether your hamstrings are a functional length. Most people need 80 to 100 degrees of hip flexion, which allows you to sit on the floor with legs long and still keep your back fairly straight. If your hamstrings are tight but not short, you may be better to massage on a long foam roller rather than stretching them.

    The Feldenkrais Method offers many creative ways to lengthen the hamstrings without straining the lower back. This gentle method helps you reduce excess tension in the muscles without the need for passive stretching.

  • Recovering from a Lumbar Disc Injury

    Recovering from a Lumbar Disc Injury

    Recovering from a Lumbar Disc Injury

    A disc bulge or prolapse can occur in the neck, lower or middle back. The lowest lumbar discs (L4/5 and L5/S1) take the most weight and often form a ‘hinge point’ for movement of the trunk. By far the majority of lumbar disc injuries occur at these two levels.

    Basic Anatomy and Pathology

    To understand a disc bulge or herniation first requires a basic understanding of the anatomy. The spine consists of a series of 24 vertebrae, plus the sacrum and tail bone at the base of the spine. Each inter-vertebral discs sits between a pair of vertebrae, acting as a shock absorber and allowing the spine to bend. Each disc is a mini-hydraulic system, with tough, concentric fibrous layers on the outside (the annulus fibrosus) and soft mobile material in the centre (the nucleus pulposis).

    A disc bulge occurs when a weakness in the outer wall (the annulus fibrosis) allows the disc to change shape. The material on the inside (the nucleus pulposis) bulges outwards deforming the outer wall, which may put pressure on sensitive surrounding structures including the nerve roots. This is a common and less severe form of disc injury.

    A disc herniation (also called a disc prolapse) occurs when pressure on the disc causes the softer nucleus material to crack the outer wall of the disc and leak out.

    Most commonly the material bulges towards the back of the body, either centrally or to one side, where it may put pressure on sensitive structures such as ligaments and spinal nerves. Local swelling and inflammation may increase this pressure. Irritation of the nerve roots in the lower back may cause sciatica – pain anywhere along the course of the sciatic nerve, which passes through the buttock, down the back of the thigh, where it divides in two branches which go down the lower leg to the foot. (Not all leg pain associated with lower back problems are caused by sciatica however.)

    Symptoms
    With a minor lumbar disc bulge or herniation, pain will be localised to the lower back, possibly radiating to the buttock or thigh at times. The pain is usually worsened by prolonged sitting, bending, or simply staying in any one position for too long. In more severe cases, pain may extend down the leg on one or both sides, or alternate sides, sometimes as far as the foot. The pain may be constant or may come and go.

    If the disc impinges on a nerve root, there maybe be neurological signs such as numbness, pins and needles or loss of power in parts of one or both legs. People with significant neurological symptoms may have to consider surgery, however surgery poses significant risks and in most cases it is worth trying less invasive approaches first.

    When to call a doctor

    Things to consider

    Please bear in mind two things. Some people have a disc bulge on MRI or CT scan but no pain at all. Also pain often comes from more than one structure. You could have an un-diagnosed problem in addition to the disc bulge, such as a jammed facet joint or sacro-iliac joint or soft tissue pain from muscles and ligaments, which cannot be imaged well with CT scanning. Inflammation, instability or minor mal-alignment may not show up on any scan. Just because a disc problem shows up on your scan does not prove that this is what is causing your pain.

    Can a disc heal?

    Now the important question about the disc. Can it heal? YES. A major prolapse or herniation may not heal by itself and surgery may be advisable in some cases, but potentially a bulge and small to moderate sized prolapses can be healed by the body’s own repair processes in time. How long? That depends on how severe and how unstable it is, your age and most importantly how much stress you put on it, which is the part you can control. It also depends on the state of your spinal and abdominal muscles, as weakness or imbalances in these may be part of what caused the problem in the first place.

    Disc bulge and herniationWith a disc bulge, the walls of the disc are still intact, and healing time is shorter, though in some cases it can still take months. With a disc herniation (prolapse) it can take many months or even years to resolve.

    Once you injure your disc, it will be unstable for a period of time (months or years for a severe prolapse). This means that the disc will bulge a lot more than usual when you are weight-bearing (eg standing, sitting, bending, lifting) and typically gets worse as the day goes on. An unstable disc is more likely in a young or middle aged person because as you get older the disc dehydrates and the nucleus becomes more rigid – stiffer but more stable. Young people may heal quicker after a disc injury due to tissue repair processes.

    How to recover in the shortest possible time

    Acute stage:  severe, disabling, constant pain

    • Rest. Rest. Rest some more. Get horizontal as frequently as you can during the day. Take time off work. Avoid sitting as much as possible and if you do sit never slouch on the couch. Lie down or stand leaning back against the wall if you are tired.
    • Avoid lifting anything over 2 – 5 kg and avoid any thing else that aggravates the pain.
    • Don’t stiffen against the pain. Try to keep moving and relax your muscles. If possible get up and walk around regularly but lie down again if pain starts to worsen.
    • Learn some gentle exercises that you can do at home to maintain your range of movement and activate the spinal support muscles. Get professional help from an experienced Physiotherapist for this.
    • See your doctor for a neurological examination and medication to assist with managing the pain. Too little pain medication may result in severe muscle spasm and create a vicious cycle of pain and tension. Too much analgesia and you may unknowingly move in a way that aggravates the problem.
    • Try other pain relieving measures such as a heat packs, cold packs or a TENS machine.
    • If you absolutely have to sit, try various back supports to improve your posture and spinal stability for example an individually moulded back brace can be fitted for you and worn a few hours a day to improve spinal stability and comfort while you are on your feet. A lumbar support cushion can often help when you have to sit.

    The single biggest factor in disc healing, in my opinion, is NOT STRESSING IT. You want to maintain your physical fitness, range of movement and strength to the best of your ability without aggravating the pain. Aggravation of the pain may mean that you have pushed the wall of the disc out further again, worsening the bulge.

    Importantly, no practitioner can ‘put a disc back in’ though some claim to. The temporary relief of pain associated with adjustment / manipulation may be due to the release of neuro-chemicals – your body’s own pain relieving substances. Massage and physio can relieve other aspects of the pain such as joint stiffness and muscle spasm, but this is also temporary. There is also a high risk of aggravating a disc injury with spinal adjustment, manipulation or even massage.

    Be very cautious with any exercises. You have to start with very minimal subtle exercises and progress vary carefully under professional guidance and listening to your own body.

    Sub-acute stage: moderate pain which comes and goes

    • Gradually get moving. Walking can be a helpful exercise for some people, others find it aggravating. Pace yourself. Listen to your body’s messages. Try walking in warm, waist-deep water, but remember anything can aggravate your symptoms if you over-do it.
    • Restrict sitting to short periods of time if it aggravates your pain and always use adequate lumbar support, such as a BodyBolster or contoured lumbar cushion,  especially when driving or sitting at a computer. (Free2Move sell both.)
    • Have a Physiotherapy assessment and get an individual exercise programme specific to your individual situation. Remember that the wrong exercises or exercising too soon can make you worse instead of better.
    •  Get your Physiotherapist to show you how to test the safety of any exercise. Learn which type of exercises relieve your pain – for example spine neutral or extension based exercises are usually best for lumbar disc pain.
    • Be careful but not overly cautious (or stiff) when bending and lifting. Don’t lift anything over 5 to 10 kg. Get your Physiotherapist to check your lifting and bending techniques.
    • Learn to let go of the muscle spasm (Feldenkrais classes are amazing for this – more effective than a massage and you can do it for yourself).
    • Improve postural awareness (Feldenkrais and Clinical Pilates)
    • If you aggravate things go back to the acute stage.
    • Have patience. A moderate disc bulge will take around 6 weeks to get better but only IF you do the right thing, but may never heal if you keep aggravating it.
    • See your doctor if symptoms don’t improve.

    What if it becomes chronic?

    A ‘chronic’ condition is one that persists over time without improving, usually more than 3 months. Once a condition becomes chronic it is harder to reverse, because the body adapts to it. Changes occur in the way your brain interprets pain messages. Muscle imbalances and compensation patterns often develop. These may have been part of the initial cause of the injury, or may have developed as part of your body’s response to the injury. Either way once this occurs the disc injury and / or the pain associated with it become the body’s ‘normal’ state and you have to find a way to break the cycle.

    Recent research shows that people who develop low back pain have difficulty activating the deep abdominal and pelvic muscles which are a part of the normal stabilising mechanisms of the lower back. The muscles may have become weak, difficult to activate, or there may be a delay in their activation, so that they are too slow to switch on. You may go to lift something for example and at the critical moment, if the muscles have not engaged to stabilise your lower back, the result is strain and further injury.

    Muscle spasm or tightness is also extremely common in people who have chronic lower back. Immediately after your injury, the muscle spasm actually helps to protect you, It restricts your movement and helps avoid further damage. Long term though, the muscle spasm becomes a source of considerable pain and inhibits normal movement. Here’s an analogy: If you break a leg and don’t get it set in plaster (or surgically fixed) the bone might not ever heal. But if you left the plaster on for the rest for the rest of your life, the plaster would become the problem, rather than the solution to your problem.

    Surgery may be less likely to be effective once pain becomes chronic, because surgery can help correct the structural problems but the defective way that the muscles are working can only be corrected by skillful muscle re-education. If you do end up having surgery it is absolutely essential to participate in a specific muscle and posture re-training programme that is customised to your particular strengths and weaknesses. It is very hard to work this out yourself, even if you are a therapist or movement teacher, because you will almost certainly have ‘blind spots’, things you are not aware of about your own habitual muscle use.

    Jodie and Feldenkrais 1

    The major tasks in recovering your normal muscle function and posture are:

    1. Correcting imbalances which occur when one muscle group becomes habitually tight and it’s opposing group switches off or becomes significantly weakened.
    2. Sensing ‘neutral’ postural alignment in order to correct your posture.
    3. Learning safe ways to move and do everyday things so that you won’t re-injure yourself, for example learn to improve the way you roll over, get up from lying or sitting, bend, reach and lift so that there is the least possible strain on your back.
    4. Read More about Chronic Pain

    Good luck and remember it will take time to recover. Make sure you get professional help so that you are sure you are on track, but also it’s critical that you learn to listen to your own body signals. For this I have not discovered anything better than the Feldenkrais Method.

    Free2Move Physiotherapists are now able to offer secure video linked online consultations using Telehealth technology.

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    Copyright Jodie Krantz February 2020