3. What does running do to your brain? “When you are under stress, metabolic processes in your liver convert the amino acid tryptophan into a molecule with the mumble-inducing name of knyurenine. Some of that knyurenine finds its way into your brain, where its accumulation has been strongly associated with stress-induced depression, anxiety disorders and schizophrenia. When you exercise, the levels of an enzyme called kynurenine aminotransferase build up in your muscles. This enzyme breaks down knyurenine into the related molecule kynurenic acid, which, importantly, cannot enter the brain. In this way, exercising your skeletal muscles by running clears from your bloodstream a substance that can cause mental health problems. It is important to note that, for technical and ethical reasons, some of the details of this mechanism have been proven only in laboratory animals.”
It is no secret that pregnancy, labour and parenthood put a huge strain on you and your body.
From general tiredness to aching backs and limbs and even debilitating conditions such as pubic symphysis dysfunction, there are a myriad of potential problems facing mums and mums to be.
One of the most common complaints is low back pain, which is experienced by up to 80% of expectant mothers, and may be accompanied by pelvic, groin and leg pain. It may also persist for several months after giving birth – the very time you could do without it!
By understanding the common causes of back pain, you can find ways to prevent and reduce it.
One major factor is the weight and size of your baby. At up to 6kg, this places extra strain on the joints of your lumbar spine and pelvis, and on the muscles of your back and tummy.
There is a natural arch in your low back which is designed to act as a shock absorber. You can see it if you look at someone side on. Carrying the weight of a baby causes this arch to become exaggerated, which may reduce its shock absorbing ability and lead to pinching of the small joints in your spine. This is turn makes it harder for your back muscles to keep you upright. They may go in to spasm, resulting in tiredness, aching and stiffness in your low back.
During pregnancy your abdominal muscles become stretched. They may also separate (this is called diastasis recti). This means your abdominal muscles can’t contract to support your low back quite as easily as pre-pregnancy. This can further increase the pressure going through your low back.
Your pelvis also takes a lot of the strain of carrying a baby. It begins to tilt forward, further increasing the curve in your low back. Pressure is placed upon the three joints in the pelvis; the pubic symphysis at the front, and two sacro-iliac joints at the back. The pubic symphysis may widen by up to 9mm.
This may cause the pelvic bones to move slightly out of their normal positions, which in turn causes you to feel pain in your low back and legs. To make matters worse, the baby sometimes come to rest on a bundle of nerves in the abdomen, which can cause shooting pains and numbness in the leg.
Our joints are usually supported by ligaments, which bind bone to bone. During pregnancy these ligaments become a looser than normal thanks to a hormone called relaxin. While this is necessary for childbirth, it has the unfortunate side effect of reducing the stability of your joints and thus aggravating the problems discussed above.
Thankfully, there are many simple but effective techniques for managing back pain.
Prevention is better than cure.
If you are generally active and healthy, have good muscle tone and core strength and don’t usually suffer from back pain you are more likely to have a pain free pregnancy.
Take care of your posture.
Try to stand and sit up right rather than slouching. Avoid crossing your legs. Use a small cushion to support the small of your back when sitting down. This helps reduce the pressure to your low back and pelvis.
Support your back and your bump.
Try to sleep on your side, with your knees bent up and a cushion under your tummy. You can also try placing a pillow or folded towel between your knees. When you are standing, ‘tuck in’ your bottom to flatten the curve in your low back. If you are suffering from back pain, a support belt may help.
If back pain has set in and the above steps aren’t shifting it, get professional help. Speak to your GP and midwife as there may be other causes of back pain such as urinary tract infection. Consider having ‘hands on’ treatment such as osteopathy. Ring 020 8520 5268 to book an appointment or free 15 minute chat with me.
There’s nothing like a good night’s sleep. That feeling of waking up pleasantly rested, not too hot and not too cold, supported by a comfy pillow and mattress is just bliss. So it is pretty annoying when an uncomfortable pillow stops you sleeping.
Choosing a pillow is very personal. Your best bet is to try lots of different ones before deciding which is your favourite. Luckily there are a few guidelines to narrow down the options.
For side sleepers try a larger, fairly firm pillow. You want to be able to lay on your side with your neck fairly straight, so it’s not leaning down towards your mattress or up towards the ceiling. The broader your shoulders, the larger the pillow.
For back sleepers a flatter pillow is better. Your head should feel supported but the pillow shouldn’t lift your head up very much. Ideally your neck remains quite straight.
If you are a larger build go for a firmer pillow. Your head and neck may be heavier so need more support.
If you are a lighter build a softer pillow will probably be ok.
If you suspect your pillow is too soft try putting folded towel underneath it to make it firmer. Sleep on it for a few nights and see if you like it.
You may also like to consider the pillow’s contents; is it hypoallergenic, is it washable?
I often find that supple, healthy necks are feel comfortable in many situations, and stiff neck joints and muscles cause discomfort even with very good pillows.
If you’re having difficulty finding a comfy pillow you may have some irritated muscles or joints in your neck or upper back. It would probably be worth seeing an osteopath or similar therapist who can help improve your flexibility.
There are lots of treatment options for sciatica. Different combinations will work for different people but any treatment needs to be informed by an accurate diagnosis.
Treatment basically involves reducing pain and improving your strength and flexibility.
I use lumbar spine mobilisations to improve flexibility, reduce muscle guarding, improve circulation and reduce local inflammation. Some people believe these techniques help reduce the size of a disc bulge.
I use different variations of these techniques, usually starting with gentler versions and moving up to more forceful techniques as the pain reduces.
I also work on local muscles in the low back, glutes, hamstrings and hip flexors. This aims encourages flexibility, reduce pain arising from muscle guarding, retrains your nervous system to activate muscles and reduces sensitivity. Usually these are massage style techniques but I also use stretches and modified stretches such as Muscle Energy Techniques (METs).
With most sciatica sufferers I will also work on their mid back and shoulders as I find this is useful for short term relief.
Most important of all is exercise! I give all of my patients simple stretches to do each day. I also give simple exercises to strengthen and reactivate the core muscles.
It’s important to stay active with gentle walking and as many normal daily activities as you can tolerate. It is not a good idea to rest for long periods as this allows your muscles to stiffen. It’s also quite boring and isolating and leads you to dwell on pain.
Many of my sciatica patients use painkillers to help manage their symptoms. I can’t give specific advice on painkillers but they are usually fine to use alongside osteopathy and exercise. It is best to speak to your chemist for advice on over the counter medication or your GP for prescription medication. Many of my sciatica patients use ice packs to help manage pain.
If conservative treatment doesn’t help you may wish to consider other treatment options. Injections into the facet joints are commonly offered and can give some pain relief. If your sciatica symptoms are caused by a disc herniation you may be offered an operation to reduce the size of the disc bulge.
Most cases of sciatica resolve with time and non-invasive treatment such as those described above.
If you think you have sciatica please give me a call on 020 8520 5268 to find out how I can help.
I’m often asked what the best sleeping position is, and the best answer is whichever position feels most comfortable.
Having said that there are some advantages and disadvantages to each position.
On your Back
Many people with neck pain seem to find it more comfortable to sleep on their back. It’s best to sleep with a fairly flat pillow so your neck is held in a nice neutral position.
Some people find resting on their back with their legs straight can irritate the low back. Those people might find it more comfortable with a pillow under their knees or with their knees bent.
On your Side
Sleeping on your side with your legs slightly bent is a good choice for most people. It usually places your spine in a neutral, supported position which is pretty comfortable. It’s best to choose a pillow which supports your head and doesn’t causes your neck to tilt sideways.
If you have low back pain you could also place a cushion between your knees to support your low back.
On your Front
Sleeping on your front can place strain on your neck as you have to turn your head to the side. However, if you feel comfortable on your front just go for it! A flat pillow is best here. You might also like to put a small pillow under your tummy as this can be more comfortable for your low back.
July has been another lovely month. I had to spend a couple of days resting with a virus but apart from that it has been great!
Our BBQ at the start of the month was a real success with perfect weather and lots of our favourite people. Our experimental Limoncello Spritz cocktails proved very popular and all the food got eaten. There wasn’t even much tidying to do the next day!
My husband ‘treated’ me to an evening at Lords for Middlesex vs Surrey. I’m not really that bothered by cricket but it was an enjoyable evening.
The allotment has been suffering a little in the heat but we’ve been getting a good harvest of courgettes, potatoes, beetroot, chard and onions. I need to plant a few more crops to fill in the gaps but it’s just been too hot!
This weekend we are away at Indietracks festival. I am volunteering for the first time and looking forward to wearing my high vis jacket! I am also praying for a sunny, dry festival as the last few years have been quite wet.
Knots in muscle are also known as myofascial trigger points (MFTPs), trigger points and tender points. Their name, cause and identification can be contentious but they are a very common phenomenon and frequently contribute to muscular pain.
Knots usually have these characteristics:
Feel lumpy,hard or gristly in a taut band of muscle.
May be sore or tender to touch.
On pressing a knot it may cause pain to radiate outwards or produce pain in another location.
Knots can appear in groups with a primary trigger point surrounded by secondary points.
They may align with acupuncture points.
Skin over a trigger point may be slightly warmer than the surrounding area.
Trigger Points in levator scapulae. Taken from The Concise Book of Trigger Points by Simeon Niel-Asher
Trigger points are usually described as a hypersensitive group of muscle fibres. They may develop following stress or strain to muscle e.g. overuse, sustained poor posture, emotional stress. It seems likely that poor diet contributes to the formation of trigger points.
There are lots of treatment options for knots. Their efficacy varies from person to person and also depends on the location and severity of the knot. Usually it’s best to use a combination of techniques. It’s difficult to get rid of knots entirely but you can definitely minimise them and reduce pain levels.
stretching. including muscle energy techniques (METs)
It is possible to treat trigger points at home but you should see a qualified therapist or your GP to confirm the diagnosis. There are more serious conditions which can appear similar to trigger points but require medical treatment.
Intervertebral discs sit between the bones in your spine (vertebrae) and act as shock absorbers. They also contribute to the flexibility of your spine.
Spinal Anatomy taken from Functional Anatomy of the Spine Middleditch & Oliver
Discs sit in the anterior (front) part of your spine so you can’t feel them through your skin. When you touch your spine you are feeling the Spinous Processes, which are the pointy bits of each vertebra shown on the picture above.
There are a few components of the disc which are useful to understand. At the top and bottom of each disc is the vertebral end plate, which grows into the adjacent bone and helps provide nutrition to the disc.
Anatomy of intervertebral discs taken from Functional Anatomy of the Spine by Middleditch & Oliver
If you take a horizontal slice through a disc you can see outer rings. This is called the annulus fibrosus. The centre of the disc is made of a thick gel called the nucleus pulposus. This structure allows your discs to stretch and move.
The outer part of your discs are supported by several of your spinal ligaments, which join bone to bone and also grow into the annulus fibrosus.
What’s a slipped disc?
Your discs don’t actually slip anywhere, they are held firmly in your spine so they cannot come out of place. They can become injured, irritated or change shape which may lead to pain. Interestingly MRI studies have shown that many people have disc ‘injuries’ with no pain or stiffness!
We think that several different things can happen to your discs.
Firstly the outer annulus can become torn. This may lead to inflammation and then to pain and muscle guarding.
Secondly the disc may change shape and bulge outwards. This can happen anywhere around the edge of the disc but is most common towards the back and side. A disc bulge can be very small or more substantial. They can also change depending on your position.
If a disc bulge is close to a nerve root it may irritate the nerve or squeeze it. This can cause pain, pins and needles or numbness along the path of the nerve. A famous example of this is sciatica.
Disc injuries are very common. Most people make a full recovery with conservative care such as exercise, stretching and manual therapy (including osteopathy).
If you are not enjoying your favourite things as much as you used to, new research suggests a way to break through the boredom: Try the same old things in new ways. Researchers found that people found new enjoyment in popcorn, videos — even water — when they consumed them in unconventional ways.
It includes our wedding anniversary and my birthday, which are made even better by a nice holiday. We spent 9 days in Italy enjoying the sights of Pompeii and the taste of pizza and Aperol Spritz. We had 2 lovely AirBnBs (Naples, Ischia). You can get £25 off you first stay with my link: www.airbnb.co.uk/c/soliver8