Placeholder Content Image

How long does back pain last? And how can learning about pain increase the chance of recovery?

<p><em><a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>.</p> <p>Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>.</p> <p>If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups:</p> <ul> <li>acute – those with back pain that started less than six weeks ago</li> <li>subacute – where it started between six and 12 weeks ago</li> <li>chronic – where it started between three months and one year ago.</li> </ul> <p>We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.</p> <p>Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.</p> <h2>More pain doesn’t mean a more serious injury</h2> <p>Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease.</p> <p>There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.</p> <p>Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.</p> <p>The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.</p> <p>The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.</p> <h2>Reduce your chance of lasting pain</h2> <p>Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:</p> <ul> <li> <p>understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain</p> </li> <li> <p>reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.</p> </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> <p>Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.</p> <p>These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover.</p> <p>But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.</p> <p>When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>.</p> <p>Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community.</p> <p>But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, Post-doctoral Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>.</em></p>

Body

Placeholder Content Image

How to get rid of sciatica pain: solutions from back experts

<p><strong>The scoop on sciatica pain</strong></p> <p>Fun fact: The sciatic nerve is the largest nerve in the human body. It runs from the lower back down each side of your body, along the back of the hips, butt cheeks, and knees, down the back of the calf, and into the foot. It provides both sensory and motor nerve function to the legs and feet.</p> <p>Not-so-fun fact: Sometimes this nerve can get compressed in the spine at one of the roots – where it branches off the spinal cord – and cause pain that radiates down the length of the nerve. This is a dreaded condition known as sciatica. It is estimated that between 10 and 40 percent of people will experience sciatica in their lifetime.</p> <p>“Sciatica is the body telling you the sciatic nerve is unhappy,” says E. Quinn Regan, MD, an orthopaedic surgeon. “When the nerve is compressed at the root, it becomes inflamed, causing symptoms,” Dr Regan says. These symptoms can range from mild to debilitating.</p> <p>While sciatica can often resolve on its own, easing symptoms and feeling better usually requires some attention and careful behaviour modifications. Rarely, you may need more medical intervention to recover fully.</p> <p>Here’s everything you need to know about sciatica, including symptoms, how it’s diagnosed, how it’s treated, and what you can do to prevent it from recurring.</p> <p><strong>Symptoms of sciatica</strong></p> <p>Sciatica is quite literally a pain in the butt. The telltale symptom of sciatica is pain that radiates along the nerve, usually on the outside of the butt cheek and down the back of the leg. It usually only happens on one side of the body at a time. Sciatica doesn’t necessarily cause lower back pain, though it can.</p> <p>Dr Regan says that people with sciatica describe the pain as electric, burning, or stabbing, and in more severe cases, it can also be associated with numbness or weakness in the leg. If sciatica causes significant muscle weakness, to the point of losing function, and/or the pain is so bad you can’t function, it’s time to get immediate help, Dr Regan says.</p> <p>Another symptom that warrants a trip to the ER and immediate medical intervention: bowel or bladder incontinence. “That means there’s a massive compression, and the pressure is so severe it’s harming the nerves that go to the bowel and bladder,” says orthopaedic surgeon Dr Brian A. Cole. This is rare, but when it happens, it’s imperative to decompress the nerve immediately, he says.</p> <p><strong>The main causes of sciatica</strong></p> <p>The most common cause of sciatica is a herniated or slipped disc. A herniated or slipped disc happens when pressure forces one of the discs that cushion each vertebra in the spine to move out of place or rupture. Usually it’s caused when you lift something heavy and hurt your back, or after repetitive bending or twisting of the lower back from a sport or a physically demanding job.</p> <p>Sciatica also can be caused by:</p> <ul> <li>a bone spur (osteophyte), which can form as a result of osteoarthritis</li> <li>narrowing of the spinal canal (spinal stenosis), which happens with normal wear-and-tear of the spine and is more common in people over 60</li> <li>spondylolisthesis, a condition where one of your vertebrae slips out of place</li> <li>a lower back or pelvic muscle spasm or any sort of inflammation that presses on the nerve root</li> </ul> <p>Some people are born with back problems that lead to spinal stenosis at an earlier age. Other potential, yet rare, causes of sciatic nerve compression include tumours and abscesses.</p> <p><strong>Could it be piriformis syndrome?</strong></p> <p>Something known as piriformis syndrome can also cause sciatica-like symptoms, though it is not considered true sciatica. The piriformis is a muscle that runs along the outside of the hip and butt and plays an important role in hip extension and leg rotation.</p> <p>Piriformis syndrome is an overuse injury that’s common in runners, who repetitively strain this muscle, leading to inflammation and irritation. Because the muscle is so close to the sciatic nerve, piriformis syndrome can compress the nerve and cause a similar tingling, radiating pain as sciatica. The difference is that this pain is not caused by compression at the nerve root, but rather, irritation or pressure at some point along the length of the nerve.</p> <p><strong>Sciatica risk factors </strong></p> <p>Anyone can end up with a herniated disc and ultimately sciatica, but some people are more at risk than others. The biggest risk factor is age. “The discs begin to age at about age 30, and when this happens they can develop defects,” Dr Regan says. These defects slowly increase the risk of a disc slipping or rupturing.</p> <p>Men are three times more likely than women to have a herniated disc, Dr Regan says. Being overweight or obese also increases your chance of injuring a disc. A physically demanding job, regular strenuous exercise, osteoarthritis in the spine, and a history of back injury can also increase your risk. Sitting all day doesn’t help either, Dr Cole says. “You put more stress on your back biomechanically sitting than anything else you do.”</p> <p>Certain muscle weaknesses and imbalances can also make you more prone to disc injury and, consequently, sciatica. “People with weak core muscles and instability around the spine might be more prone to this since the muscles need to stabilise the joints of the vertebrae in which the nerves exit,” says Theresa Marko, an orthopaedic physical therapist.</p> <p><strong>How sciatica is diagnosed</strong></p> <p>If your symptoms suggest sciatica, your doctor will do a physical exam to check your strength, reflexes and sensation. A test called a straight leg raise can also test for sciatica, Dr Regan says. How it’s done: Patients lie face up on the floor, legs extended, and the clinician slowly lifts one leg up. At a certain point, it may trigger sciatica symptoms. (The test can also be done sitting down.)</p> <p>Depending on how severe the pain is and how long you’ve had symptoms, doctors may also do some scans (MRI or CT) on your spine to figure out what’s causing the sciatica and how many nerve roots are impacted.</p> <p>Scans can also confirm there isn’t something else mimicking the symptoms of sciatica. Muscle spasms, abscesses, hematomas (a collection of blood outside a blood vessel), tumours and Potts disease (spinal tuberculosis) can all cause similar symptoms.</p> <p><strong>Managing mild to moderate sciatica </strong></p> <p>Resting, avoiding anything that strains your back, icing the area that hurts, and taking nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen, are the first-line treatment options for sciatica, Dr Regan says. If you have a physically demanding job that requires you to lift heavy things, taking some time off, if at all possible, will help.</p> <p>While it’s important to avoid activities that might make things worse, you do want to keep moving, says Marko. “Research now advises against bed rest. You want to move without overdoing it.”</p> <p>A physical therapist can help you figure out what movements are safe and beneficial to do. For example, certain motions – squatting, performing a deadlift, or doing anything that involves bending forward at the waist – can be really aggravating. Light spine and hamstring stretching, low-impact activities like biking and swimming, and core work can help. “In general, we need the nerve to calm down a bit and to strengthen the muscles of your spine, pelvis and hips,” Marko says.</p> <p>“Within a week to 10 days, about 80 percent of patients with mild to moderate sciatica are going to be doing much better,” Dr Regan says. Within four to six weeks, you should be able to return to your regular activities – with the caveat that you’ll need to be careful about straining your back to avoid triggering sciatica again.</p> <p><strong>Treating severe sciatica</strong></p> <p>If you’re trying the treatment options for mild to moderate sciatica and your symptoms worsen or just don’t get better, you may need a higher level of treatment.</p> <p>If OTC pain relievers aren’t cutting it, your doctor may prescribe a muscle relaxant like cyclobenzaprine (Flexeril).</p> <p>An epidural steroid injection near the nerve root can reduce inflammation and provide a huge relief for some people with sciatica. The results are varied, and some people may need more than one injection to really feel relief.</p> <p>Surgery is usually a last resort, only considered once all of the conservative and minimally invasive options have been exhausted. Dr Regan notes that a small percentage of people with sciatica end up needing surgery – these are usually patients who have severe enough sciatica that their primary care doctors have referred them to spinal specialists. And only about a third of patients who see spinal specialists may end up having surgery, he says.</p> <p>Surgeries to relieve disc compression are typically quick and done on an outpatient basis, according to Dr Cole.</p> <p><strong>Preventing sciatica in the future</strong></p> <p>“Once you have a back issue, you have a higher chance of having a back issue in the future,” Dr Regan says. Which means that your first bout of sciatica isn’t likely to be your last. It’s important to adopt a healthy lifestyle to reduce the risk of sciatica striking again.</p> <p>Building core strength is key. “Think of your midsection as a box, and you need to target all sides,” Marko says. “By this, I mean abdominals, obliques, diaphragm, pelvic floor, glutes and lateral hip muscles.” These muscles all support the spine, so the stronger they are, the better the spine can handle whatever is thrown its way.</p> <p>If there’s an activity you enjoy that aggravates your back, ditch it for an alternative. For example, running can trigger back pain and sciatica in some people, Dr Regan says. If you’re prone to it, try a new form of cardio that’s gentler on your back, like swimming, biking, or using the elliptical. Even just logging fewer kilometres per week can help reduce your risk.</p> <p>Dr Regan also recommends making sure you learn how to weight train properly. Lifting with the best form possible, learning your limits, and reducing weight when you need to will help keep your back safe from disc injuries.</p> <p>Making small changes to your daily life and workouts can help keep your back healthy and minimise the time you have to waste dealing with sciatica in the future.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.com.au/backtips-advice/how-to-get-rid-of-sciatica-pain-solutions-from-back-experts" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Body

Placeholder Content Image

Take the pain out of toothache with these 11 home remedies

<p><strong>Toothache remedy: clove oil</strong></p> <p>Cloves are a traditional remedy for numbing nerves; the primary chemical compound of this spice is eugenol, a natural anaesthetic. Research has shown that, used topically, clove oil can be as effective against tooth pain as benzocaine.</p> <p>Put two drops of clove oil on a cotton ball and place it against the tooth itself until the pain recedes. In a pinch, use a bit of powdered clove or place a whole clove on the tooth. Chew the whole clove a little to release its oil and keep it in place up to half an hour or until the pain subsides.</p> <p><strong>Toothache remedy: cayenne paste</strong></p> <p>The main chemical component of cayenne – capsaicin – has been found to alter some of the mechanisms involved in pain. Mix powdered cayenne with enough water to make a paste.</p> <p>Roll a small ball of cotton into enough paste to saturate it, then place it on your tooth while avoiding your gums and tongue. Leave it until the pain fades – or as long as you can stand it (the concoction is likely to burn).</p> <p><strong>Toothache remedy: swish some salt water</strong></p> <p>A teaspoon of salt dissolved in a cup of boiling water makes an effective mouthwash, which will clean away irritating debris and help reduce swelling. Swish it around for about 30 seconds before spitting it out.</p> <p>Saltwater cleanses the area around the tooth and draws out some of the fluid that causes swelling, according to Professor Thomas Salinas. Repeat this treatment as often as needed. “A hot rinse can also help consolidate the infection until you get to your dentist,” says Dr Salinas.</p> <p><strong>Toothache remedy: soothe with tea</strong></p> <p>Peppermint tea has a nice flavour and some medicinal powers as well. Put 1 teaspoon dried peppermint leaves in 1 cup boiling water and steep for 20 minutes. After the tea cools, swish it around in your mouth, then spit it out or swallow.</p> <p>Also, the astringent tannins in strong black tea may help quell pain by reducing swelling. For this folk remedy place a warm, wet tea bag against the affected tooth for temporary relief. “The fluoride in tea can help kill bacteria, which is especially helpful after a tooth extraction,” says Salinas.</p> <p><strong>Toothache remedy: rinse with hydrogen peroxide</strong></p> <p>To help kill bacteria and relieve some discomfort, swish with a mouthful of 3 per cent hydrogen peroxide solution diluted with water. This can provide temporary relief if a toothache is accompanied by fever and a foul taste in the mouth (both are signs of infection), but like other toothache remedies, it’s only a stopgap measure until you see your dentist and get the source of infection cleared up.</p> <p>A hydrogen peroxide solution is only for rinsing. Spit it out, then rinse several times with plain water.</p> <p><strong>Toothache remedy: ice it</strong></p> <p>Place a small ice cube in a plastic bag, wrap a thin cloth around the bag, and apply it to the aching tooth for about 15 minutes to numb the nerves. Alternatively, that ice pack can go on your cheek, over the painful tooth. Also, according to folklore, if you massage your hand with an ice cube, you can help relieve a toothache.</p> <p>When nerves in your fingers send ‘cold’ signals to your brain, they may distract from the pain in your tooth. Just wrap up an ice cube in a thin cloth and massage it in the fleshy area between your thumb and forefinger.</p> <p><strong>Toothache remedy: wash it with myrrh</strong></p> <p>You can also rinse with a tincture of myrrh. “Myrrh definitely has an effect on infected tissue and can sometimes also interfere with the pain generated by tooth infection,” says Salinas.</p> <p>Simmer 1 teaspoon of powdered myrrh in 2 cups water for 30 minutes. Strain and let cool. Rinse with 1 teaspoon of the solution in a half-cup water several times a day.</p> <p><strong>Toothache remedy: distract with vinegar and brown paper</strong></p> <p>Another country cure calls for soaking a small piece of brown paper (from a grocery or lunch bag) in vinegar, sprinkling one side with black pepper, and holding this to the cheek. The warm sensation on your cheek may distract you from your tooth pain. </p> <p>This technique is an example of the Gate Control theory of pain. By using a distracting stimulus, the ‘gates’ to the pain receptors in your brain close and you don’t feel the original pain as powerfully.</p> <p><strong>Toothache remedy: brush with the right tools</strong></p> <p>“Sensitive toothpaste is very helpful for people with significant gum recession,” says Salinas. When gums shrink, the dentin beneath your teeth’s enamel surface is exposed, and this material is particularly sensitive. </p> <p>Look for pastes that contain sodium fluoride, potassium nitrate or strontium nitrate – ingredients which have been shown to reduce sensitivity, according to Salinas. Switch to the softest-bristled brush you can find to help preserve gum tissue and prevent further shrinking.</p> <p><strong>Toothache remedy: cover a crack with gum</strong></p> <p>If you’ve broken a tooth or have lost a filling, you can relieve some pain by covering the exposed area with softened chewing gum. This might work with a loose filling, too, to hold it in place until you can get to the dentist. </p> <p>To avoid further discomfort, avoid chewing anything with that tooth until you can have it repaired. Just make sure you use sugarless gum, since sugar may actually exacerbate the pain (not to mention that it can cause cavities).</p> <p><strong>Toothache remedy: apply pressure</strong></p> <p>Try an acupressure technique to stop tooth pain fast. With your thumb, press the point on the back of your other hand where the base of your thumb and your index finger meet. </p> <p>Apply pressure for about two minutes. “This works in several ways,” says Salinas. “The pressure can help prevent pain signals from being sent as well as help express some of the fluid that causes swelling.”</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/11-home-remedies-for-a-toothache?pages=1" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Body

Placeholder Content Image

What is cognitive functional therapy? How can it reduce low back pain and get you moving?

<p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p>If you haven’t had lower back pain, it’s likely you know someone who has. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/22231424/">around 40% of adults</a> in any year, ranging from adolescents to those in later life. While most people recover, <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">around 20%</a> go on to develop chronic low back pain (lasting more than three months).</p> <p>There is a <a href="https://bjsm.bmj.com/content/54/12/698">common view</a> that chronic low back pain is caused by permanent tissue damage including “wear and tear”, disc degeneration, disc bulges and arthritis of the spine. This “damage” is often described as resulting from injury and loading of the spine (such as bending and lifting), ageing, poor posture and weak “core” muscles.</p> <p>We’re often told to “protect” our back by sitting tall, bracing the core, keeping a straight back when bending and lifting, and avoiding movement and activities that are painful. Health practitioners often <a href="https://theconversation.com/having-good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it-183732">promote and reinforce these messages</a>.</p> <p>But this is <a href="https://bjsm.bmj.com/content/54/12/698">not based on evidence</a>. An emerging treatment known as <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">cognitive functional therapy</a> aims to help patients undo some of these unhelpful and restrictive practices, and learn to trust and move their body again.</p> <h2>People are often given the wrong advice</h2> <p>People with chronic back pain are often referred for imaging scans to detect things like disc degeneration, disc bulges and arthritis.</p> <p>But these findings are very common in people <em>without</em> low back pain and research shows they <a href="https://pubmed.ncbi.nlm.nih.gov/24276945/">don’t accurately predict</a> a person’s current or future experience of pain.</p> <p>Once serious causes of back pain have been ruled out (such as cancer, infection, fracture and nerve compression), there is <a href="https://pubmed.ncbi.nlm.nih.gov/27745712/">little evidence</a> scan findings help guide or improve the care for people with chronic low back pain.</p> <p>In fact, scanning people and telling them they have arthritis and disc degeneration can <a href="https://pubmed.ncbi.nlm.nih.gov/33748882/">frighten them</a>, resulting in them avoiding activity, worsening their pain and distress.</p> <p>It can also lead to potentially harmful treatments such as <a href="https://pubmed.ncbi.nlm.nih.gov/27213267/">opioid</a> pain medications, and invasive treatments such as spine <a href="https://pubmed.ncbi.nlm.nih.gov/19127161/">injections</a>, spine <a href="https://pubmed.ncbi.nlm.nih.gov/12709856/">surgery</a> and battery-powered electrical stimulation of spinal nerves.</p> <h2>So how should low back pain be treated?</h2> <p>A complex range of factors <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">typically contribute</a> to a person developing chronic low back pain. This includes over-protecting the back by avoiding movement and activity, the belief that pain is related to damage, and negative emotions such as pain-related fear and anxiety.</p> <p>Addressing these factors in an individualised way is <a href="https://pubmed.ncbi.nlm.nih.gov/29573871/">now considered</a> best practice.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/15936976/">Best practice care</a> also needs to be person-centred. People suffering from chronic low back pain want to be heard and validated. They <a href="https://pubmed.ncbi.nlm.nih.gov/35384928/">want</a> to understand why they have pain in simple language.</p> <p>They want care that considers their preferences and gives a safe and affordable pathway to pain relief, restoring function and getting back to their usual physical, social and work-related activities.</p> <p>An example of this type of care is cognitive functional therapy.</p> <h2>What is cognitive functional therapy?</h2> <p><a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">Cognitive functional therapy</a> is about putting the person in the drivers’ seat of their back care, while the clinician takes the time to guide them to develop the skills needed to do this. It’s led by physiotherapists and can be used once serious causes of back pain have been ruled out.</p> <p>The therapy helps the person understand the unique contributing factors related to their condition, and that pain is usually not an accurate sign of damage. It guides patients to relearn how to move and build confidence in their back, without over-protecting it.</p> <p>It also addresses other factors such as sleep, relaxation, work restrictions and engaging in physical activity based on the <a href="https://www.restorebackpain.com/patient-journey">person’s preferences</a>.</p> <p>Cognitive functional therapy usually involves longer physiotherapy sessions than usual (60 minutes initially and 30-45 minute follow-ups) with up to seven to eight sessions over three months and booster sessions when required.</p> <h2>What’s the evidence for this type of therapy?</h2> <p>Our recent clinical trial of cognitive functional therapy, published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext">The Lancet</a>, included 492 people with chronic low back pain. The participants had pain for an average of four years and had tried many other treatments.</p> <p>We first trained 18 physiotherapists to competently deliver cognitive functional therapy across Perth and Sydney over six months. We compared the therapy to the patient’s “usual care”.</p> <p>We found large and sustained improvements in function and reductions in pain intensity levels for people who underwent the therapy, compared with those receiving usual care.</p> <p>The effects remained at 12 months, which is unusual in low back pain trials. The effects of most recommended interventions such as exercise or psychological therapies are <a href="https://pubmed.ncbi.nlm.nih.gov/34580864/">modest in size</a> and tend to be of <a href="https://pubmed.ncbi.nlm.nih.gov/32794606/">short duration</a>.</p> <p>People who underwent cognitive functional therapy were also more confident, less fearful and had a more positive mindset about their back pain at 12 months. They also liked it, with 80% of participants satisfied or highly satisfied with the treatment, compared with 19% in the usual care group.</p> <p>The treatment was as safe as usual care and was also cost-effective. It saved more than A$5,000 per person over a year, largely due to increased participation at work.</p> <h2>What does this mean for you?</h2> <p>This trial shows there are safe, relatively cheap and effective treatments options for people living with chronic pain, even if you’ve tried other treatments without success.</p> <p><a href="https://www.restorebackpain.com/cft-clinicians">Access to clinicians</a> trained in cognitive functional therapy is currently limited but will expand as training is scaled up.</p> <p>The costs depend on how many sessions you have. Our studies show some people improve a lot within two to three sessions, but most people had seven to eight sessions, which would cost around A$1,000 (aside from any Medicare or private health insurance rebates). <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, Professor of Musculoskeletal Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, Research Fellow in physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, Adjunct Associate Professor of Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">original article</a>.</em></p>

Body

Placeholder Content Image

If anxiety is in my brain, why is my heart pounding? A psychiatrist explains the neuroscience and physiology of fear

<p><em><a href="https://theconversation.com/profiles/arash-javanbakht-416594">Arash Javanbakht</a>, <a href="https://theconversation.com/institutions/wayne-state-university-989">Wayne State University</a></em></p> <p>Heart in your throat. Butterflies in your stomach. Bad gut feeling. These are all phrases many people use to describe fear and anxiety. You have likely felt anxiety inside your chest or stomach, and your brain usually doesn’t hurt when you’re scared. Many cultures tie cowardice and bravery more <a href="https://afosa.org/the-meaning-of-heart-qalb-in-quran/">to the heart</a> <a href="https://byustudies.byu.edu/article/bowels-of-mercy/">or the guts</a> than to the brain.</p> <p>But science has traditionally seen the brain as the birthplace and processing site of fear and anxiety. Then why and how do you feel these emotions in other parts of your body?</p> <p>I am a <a href="https://scholar.google.com/citations?user=UDytFmIAAAAJ&amp;hl=en">psychiatrist and neuroscientist</a> who researches and treats fear and anxiety. In my book “<a href="https://rowman.com/ISBN/9781538170380/Afraid-Understanding-the-Purpose-of-Fear-and-Harnessing-the-Power-of-Anxiety">Afraid,</a>” I explain how fear works in the brain and the body and what too much anxiety does to the body. Research confirms that while emotions do originate in your brain, it’s your body that carries out the orders.</p> <h2>Fear and the brain</h2> <p>While your brain evolved to save you from a falling rock or speeding predator, the anxieties of modern life are often a lot more abstract. Fifty-thousand years ago, being rejected by your tribe could mean death, but not doing a great job on a public speech at school or at work doesn’t have the same consequences. Your brain, however, <a href="https://doi.org/10.1006/nimg.2002.1179">might not know the difference</a>.</p> <p>There are a few key areas of the brain that are heavily involved in processing fear.</p> <p>When you perceive something as dangerous, whether it’s a gun pointed at you or a group of people looking unhappily at you, these sensory inputs are first relayed to <a href="https://doi.org/10.1038%2Fnpp.2009.121">the amygdala</a>. This small, almond-shaped area of the brain located near your ears detects salience, or the emotional relevance of a situation and how to react to it. When you see something, it determines whether you should eat it, attack it, run away from it or have sex with it.</p> <p><a href="https://theconversation.com/the-science-of-fright-why-we-love-to-be-scared-85885">Threat detection</a> is a vital part of this process, and it has to be fast. Early humans did not have much time to think when a lion was lunging toward them. They had to act quickly. For this reason, the amygdala evolved to bypass brain areas involved in logical thinking and can directly engage physical responses. For example, seeing an angry face on a computer screen can immediately trigger a <a href="https://doi.org/10.1006/nimg.2002.1179">detectable response from the amygdala</a> without the viewer even being aware of this reaction.</p> <figure><iframe src="https://www.youtube.com/embed/xoU9tw6Jgyw?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">In response to a looming threat, mammals often fight, flee or freeze.</span></figcaption></figure> <p><a href="https://doi.org/10.1038/npp.2009.83">The hippocampus</a> is near and tightly connected to the amygdala. It’s involved in memorizing what is safe and what is dangerous, especially in relation to the environment – it puts fear in context. For example, seeing an angry lion in the zoo and in the Sahara both trigger a fear response in the amygdala. But the hippocampus steps in and blocks this response when you’re at the zoo because you aren’t in danger.</p> <p>The <a href="https://doi.org/10.1176/appi.ajp.2016.16030353">prefrontal cortex</a>, located above your eyes, is mostly involved in the cognitive and social aspects of fear processing. For example, you might be scared of a snake until you read a sign that the snake is nonpoisonous or the owner tells you it’s their friendly pet.</p> <p>Although the prefrontal cortex is usually seen as the part of the brain that regulates emotions, it can also teach you fear based on your social environment. For example, you might feel neutral about a meeting with your boss but immediately feel nervous when a colleague tells you about rumors of layoffs. Many <a href="https://theconversation.com/trump-the-politics-of-fear-and-racism-how-our-brains-can-be-manipulated-to-tribalism-139811">prejudices like racism</a> are rooted in learning fear through tribalism.</p> <h2>Fear and the rest of the body</h2> <p>If your brain decides that a fear response is justified in a particular situation, it activates a <a href="https://doi.org/10.1093/med/9780190259440.003.0019">cascade of neuronal and hormonal pathways</a> to prepare you for immediate action. Some of the fight-or-flight response – like heightened attention and threat detection – takes place in the brain. But the body is where most of the action happens.</p> <p>Several pathways prepare different body systems for intense physical action. The <a href="https://doi.org/10.3389/fnins.2014.00043">motor cortex</a> of the brain sends rapid signals to your muscles to prepare them for quick and forceful movements. These include muscles in the chest and stomach that help protect vital organs in those areas. That might contribute to a feeling of tightness in your chest and stomach in stressful conditions.</p> <figure><iframe src="https://www.youtube.com/embed/0IDgBlCHVsA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Your sympathetic nervous system is involved in regulating stress.</span></figcaption></figure> <p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK542195/">sympathetic nervous system</a> is the gas pedal that speeds up the systems involved in fight or flight. Sympathetic neurons are spread throughout the body and are especially dense in places like the heart, lungs and intestines. These neurons trigger the adrenal gland to release hormones like adrenaline that travel through the blood to reach those organs and increase the rate at which they undergo the fear response.</p> <p>To assure sufficient blood supply to your muscles when they’re in high demand, signals from the sympathetic nervous system increase the rate your heart beats and the force with which it contracts. You feel both increased heart rate and contraction force in your chest, which is why you may connect the feeling of intense emotions to your heart.</p> <p>In your lungs, signals from the sympathetic nervous system dilate airways and often increase your breathing rate and depth. Sometimes this results in a feeling of <a href="https://theconversation.com/pain-and-anxiety-are-linked-to-breathing-in-mouse-brains-suggesting-a-potential-target-to-prevent-opioid-overdose-deaths-174187">shortness of breath</a>.</p> <p>As digestion is the last priority during a fight-or-flight situation, sympathetic activation slows down your gut and reduces blood flow to your stomach to save oxygen and nutrients for more vital organs like the heart and the brain. These changes to your gastrointestinal system can be perceived as the discomfort linked to fear and anxiety.</p> <h2>It all goes back to the brain</h2> <p>All bodily sensations, including those visceral feelings from your chest and stomach, are relayed back to the brain through the pathways <a href="https://www.ncbi.nlm.nih.gov/books/NBK555915/">via the spinal cord</a>. Your already anxious and highly alert brain then processes these signals at both conscious and unconscious levels.</p> <p><a href="https://doi.org/10.1176/appi.ajp.2016.16030353">The insula</a> is a part of the brain specifically involved in conscious awareness of your emotions, pain and bodily sensations. The <a href="https://doi.org/10.1038%2Fs41598-019-52776-4">prefrontal cortex</a> also engages in self-awareness, especially by labeling and naming these physical sensations, like feeling tightness or pain in your stomach, and attributing cognitive value to them, like “this is fine and will go away” or “this is terrible and I am dying.” These physical sensations can sometimes create a loop of increasing anxiety as they make the brain feel more scared of the situation because of the turmoil it senses in the body.</p> <p>Although the feelings of fear and anxiety start in your brain, you also feel them in your body because your brain alters your bodily functions. Emotions take place in both your body and your brain, but you become aware of their existence with your brain. As the rapper Eminem recounted in his song “Lose Yourself,” the reason his palms were sweaty, his knees weak and his arms heavy was because his brain was nervous.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210871/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/arash-javanbakht-416594"><em>Arash Javanbakht</em></a><em>, Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/wayne-state-university-989">Wayne State University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-anxiety-is-in-my-brain-why-is-my-heart-pounding-a-psychiatrist-explains-the-neuroscience-and-physiology-of-fear-210871">original article</a>.</em></p>

Body

Placeholder Content Image

“Invisible suffering”: Bella Hadid opens up about painful health battle

<p dir="ltr">Bella Hadid has shared a raw update to her fans, giving them further insight into her “painful” health battle with Lyme disease.</p> <p dir="ltr">On Sunday, the model took to Instagram to share a series of photos of her ongoing health battle, including photos of her medical records.</p> <p dir="ltr">“The little me that suffered would be so proud of grown me for not giving up on myself,” she began in the caption.</p> <p dir="ltr">She then thanked her mum, Yolanda Hadid, "for keeping all of my medical records, sticking by me, never leaving my side, protecting, supporting, but most of all, believing me through all of this”.</p> <p dir="ltr">She then continued to say that since contracting Lyme, her symptoms have gotten worse over time and it’s taken a toll on her in ways that are difficult for her to explain, but remained positive despite it.</p> <p dir="ltr">“To be that sad and sick with the most blessings/privilege/opportunity/love around me was quite possibly the most confusing thing ever,” she added before reassuring fans not to worry and that she is “okay”.</p> <p dir="ltr">The model also noted that despite her painful health battle, she “wouldn’t change anything for the world” and would go through it all again, as it has shaped who she is.</p> <p dir="ltr">“The universe works in the most painful and beautiful ways but I need to say that if you are struggling- it will get better,” she added.</p> <p dir="ltr">Bella also said that despite “almost 15 years of invisible suffering” she is grateful for the experience, and has so much “gratitude for and perspective on life” that has made her able to spread ”love from a full cup” and “truly” be herself.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Cvmz8ilAcxx/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Cvmz8ilAcxx/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Bella 🦋 (@bellahadid)</a></p> </div> </blockquote> <p dir="ltr">“I tried to pick the most positive pictures I could because as painful as this experience was, the outcome was the most enlightening experience of my life filled with new friends, new visions and a new brain,” she added before thanking everyone who has supported her throughout this journey.</p> <p dir="ltr">“I’ll be back when I’m ready, I miss you all so much, I love you all so much,” she concluded.</p> <p dir="ltr">The model shared a few photos of herself getting treatment with IVs sticking out of her arm.</p> <p dir="ltr">In a few other photos, the model can be seen resting on the couch as she gets a blood transfusion, with her loyal pup, “Petunia aka Beans,” never leaving her side.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Cvm1ImkA-89/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Cvm1ImkA-89/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Bella 🦋 (@bellahadid)</a></p> </div> </blockquote> <p dir="ltr">This is the model’s first health update after she revealed she was taking time off from modelling due to a flare-up in her Lyme disease.</p> <p dir="ltr"><em>Images: Instagram</em></p>

Caring

Placeholder Content Image

Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds

<p><em><a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-mclachlan-255312">Andrew McLachlan</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>Opioids are the one of the most prescribed pain-relief for people with low back and neck pain. In Australia, around <a href="https://link.springer.com/article/10.1007/s00586-017-5178-4">40% of people</a> with low back and neck pain who present to their GP and <a href="https://qualitysafety.bmj.com/content/28/10/826">70% of people</a> with low back pain who visit a hospital emergency department are prescribed opioids such as oxycodone.</p> <p>But our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext">new study</a>, published today in the Lancet medical journal, found opioids do not relieve “acute” low back or neck pain (lasting up to 12 weeks) and can result in worse pain.</p> <p>Prescribing opioids for low back and neck pain can also cause <a href="https://www.healthdirect.gov.au/taking-opioid-medicines-safely">harms</a> ranging from common side effects – such as nausea, constipation and dizziness – to <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/summary">misuse, dependency, poisoning and death</a>.</p> <p>Our findings show opioids should <em>not</em> be recommended for acute low back pain or neck pain. A change in prescribing for low back pain and neck pain is urgently needed in <a href="https://www.tga.gov.au/resources/publication/publications/addressing-prescription-opioid-use-and-misuse-australia">Australia</a> and <a href="https://www.thelancet.com/commissions/opioid-crisis">globally</a> to reduce opioid-related harms.</p> <h2>Comparing opioids to a placebo</h2> <p>In our trial, we randomly allocated 347 people with acute low back pain and neck pain to take either an opioid (oxycodone plus naloxone) or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/placebo-effect">placebo</a> (a tablet that looked the same but had no active ingredients).</p> <p>Oxycodone is an opioid pain medicine which can be given orally. <a href="https://www.nps.org.au/radar/articles/oxycodone-with-naloxone-controlled-release-tablets-targin-for-chronic-severe-pain">Naloxone</a>, an opioid-reversal drug, reduces the severity of constipation while not disrupting the pain relieving effects of oxycodone.</p> <p>Participants took the opioid or placebo for a maximum of six weeks.</p> <p>People in the both groups also received <a href="https://www.sciencedirect.com/science/article/pii/S1836955321000941">education and advice</a> from their treating doctor. This could be, for example, advice on returning to their normal activities and avoiding bed rest.</p> <p>We assessed their outcomes over a one-year period.</p> <h2>What did we find?</h2> <p>After six weeks of treatment, taking opioids did not result in better pain relief compared to the placebo.</p> <p>Nor were there benefits to other outcomes such as physical function, quality of life, recovery time or work absenteeism.</p> <p>More people in the group treated with opioids experienced nausea, constipation and dizziness than in the placebo group.</p> <p>Results at one year highlight the potential long-term harm of opioids even with short-term use. Compared to the placebo group, people in the opioid group experienced slightly worse pain, and reported a higher risk of <a href="https://academic.oup.com/painmedicine/article/20/1/113/4728236#129780622">opioid misuse</a> (problems with their thinking, mood or behaviour, or using opioids differently from how the medicines were prescribed).</p> <p>More people in the opioid group reported pain at one year: 66 people compared to 50 in the placebo group.</p> <h2>What will this mean for opioid prescribing?</h2> <p>In recent years, international low back pain guidelines have shifted the focus of treatment from drug to non-drug treatment due to <a href="https://www.thelancet.com/article/S0140-6736(18)30489-6/fulltext">evidence</a> of limited treatment benefits and concern of medication-related harm.</p> <p>For acute low back pain, <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">guidelines</a> recommend patient education and advice, and if required, anti-inflammatory pain medicines such as ibuprofen. Opioids are <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">recommended only</a> when other treatments haven’t worked or aren’t appropriate.</p> <p>Guidelines for <a href="https://pubmed.ncbi.nlm.nih.gov/33064878/">neck</a> pain similarly discourage the use of opioids.</p> <p>Our latest research clearly demonstrates the benefits of opioids do not outweigh possible harms in people with acute low back pain and neck pain.</p> <p>Instead of advising opioid use for these conditions in selected circumstances, opioids should be discouraged without qualification.</p> <h2>Change is possible</h2> <p>Complex problems such as opioid use need smart solutions, and another study we recently conducted provides convincing data opioid prescribing can be successfully reduced.</p> <p>The <a href="https://qualitysafety.bmj.com/content/30/10/825">study</a> involved four hospital emergency departments, 269 clinicians and 4,625 patients with low back pain. The intervention comprised of:</p> <ul> <li>clinician education about <a href="https://aci.health.nsw.gov.au/networks/musculoskeletal/resources/low-back-pain">evidence-based management</a> of low back pain</li> <li>patient education using posters and handouts to highlight the benefits and harms of opioids</li> <li>providing heat packs and anti-inflammatory pain medicines as alternative pain-management treatments</li> <li>fast-tracking referrals to outpatient clinics to avoid long waiting lists</li> <li>audits and feedback to clinicians on information about opioid prescribing rates.</li> </ul> <p>This intervention reduced opioid prescribing from <a href="https://qualitysafety.bmj.com/content/30/10/825">63% to 51% of low back pain presentations</a>. The <a href="https://emj.bmj.com/content/early/2023/04/02/emermed-2022-212874">reduction was sustained for 30 months</a>.</p> <p>Key to this successful approach is that we worked with clinicians to develop suitable pain-management treatments without opioids that were feasible in their setting.</p> <p>More work is needed to evaluate this and other interventions aimed at reducing opioid prescribing in other settings including GP clinics.</p> <p>A nuanced approach is often necessary to avoid causing <a href="https://theconversation.com/opioid-script-changes-mean-well-but-have-left-some-people-in-chronic-pain-156753">unintended consequences</a> in reducing opioid use.</p> <p>If people with low back pain or neck pain are using opioids, especially at higher doses over an extended period of time, it’s important they seek advice from their doctor or pharmacist before stopping these medicines to avoid <a href="https://www.healthdirect.gov.au/opioid-withdrawal-symptoms">unwanted effects when the medicines are abruptly stopped</a>.</p> <p>Our research provides compelling evidence opioids have a limited role in the management of acute low back and neck pain. The challenge is getting this new information to clinicians and the general public, and to implement this evidence into practice.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203244/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-mclachlan-255312">Andrew McLachlan</a>, Head of School and Dean of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, Postdoctoral Research Associate in Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/opioids-dont-relieve-acute-low-back-or-neck-pain-and-can-result-in-worse-pain-new-study-finds-203244">original article</a>.</em></p>

Body

Placeholder Content Image

Paracetamol versus ibuprofen – which works best and when?

<p><em><a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>In most cases, pain and fever relief is as simple as a trip to your local supermarket for some paracetamol or ibuprofen.</p> <p>While both are effective at reducing pain, they work in different ways. So deciding which one you should choose is dependent on the type of pain you are experiencing. Sometimes it might be appropriate to take a medication that contains both drugs.</p> <p>In Australia, <a href="https://www.tga.gov.au/paracetamol-practitioner-fact-sheet#:%7E:text=It%20is%20available%20in%20many,Panamax%2C%20Chemist%20Own%20and%20Dymadon.">paracetamol</a> is branded as Panadol, Herron Paracetamol, Panamax, Chemist Own or Dymadon, plus there are generic chemist brands. Nurofen is the common brand name for <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&amp;t=&amp;q=ibuprofen">ibuprofen</a>, which is also sold under generic brand names.</p> <p>So how do you know which one to choose and when?</p> <h2>Different blocking actions</h2> <p>While ibuprofen and paracetamol can be taken for similar reasons (pain relief) each works in a slightly different way.</p> <p>Ibuprofen is a <a href="https://www.healthdirect.gov.au/anti-inflammatory-medicines">non-steroidal anti-inflammatory drug</a>, which means it acts by blocking the enzymes that produce a group of chemicals called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081099/">prostaglandins</a>. These chemicals are important for normal body functions such as relaxing blood vessels, preventing blood clotting, secreting protective mucus in the gut and helping the uterus contract. They are also involved in inflammation, pain and fever.</p> <p>It is still not completely understood how paracetamol works. Like ibuprofen, it is thought to act by blocking the enzymes that produce prostaglandins, although through a different mechanism to ibuprofen. There is also good evidence paracetamol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590544/">interacts</a> with the brain’s <a href="https://www.healthline.com/health/endocannabinoid-system">endocannabinoid system</a> and the “<a href="https://www.physio-pedia.com/Pain_Descending_Pathways">descending pain pathway</a>”, which inhibits the perception of pain.</p> <h2>Is one drug better than the other?</h2> <p>Because they each provide pain relief in different ways, paracetamol can be better at treating some types of pain, while ibuprofen is better at treating other types. But be wary of packaging that claims a medication is useful for targeting pain associated with a specific condition as these claims are <a href="https://www.abc.net.au/news/2017-08-03/nurofen-offers-3.5-million-compensation-to-customers/8770910">not true</a>.</p> <p>Because it reduces inflammation, the <a href="https://www.tg.org.au/">Australian Therapeutic Guidelines</a> state ibuprofen is the better choice for pain associated with osteo- and rheumatoid arthritis, period pain, some types of headache, and for pain that comes from having an operation. Paracetamol does not reduce inflammation but it is a better choice when fever is associated with the pain, like when you have a cold or flu.</p> <p>The Australian government recommends either paracetamol or ibuprofen if you have <a href="https://www.healthdirect.gov.au/covid-19/treating-symptoms-at-home">pain associated with COVID</a>.</p> <h2>What about taking both or ‘piggybacking’ them at intervals?</h2> <p>We can sometimes get better relief when we take both types of medicine at the same time, since each targets a different cause or pathway of the pain. If one pathway does not completely control the pain then it can be useful to target the other one. The effects of each drug <a href="https://www.frontiersin.org/articles/10.3389/fphar.2017.00158/full">can add</a> together for a bigger effect.</p> <p>Combination products that contain both paracetamol and ibuprofen in a single tablet include <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&amp;id=CP-2022-CMI-02442-1&amp;d=20230620172310101">Nuromol</a> and <a href="https://maxigesic.com.au/wp-content/uploads/2021/05/cmi-approved.pdf">Maxigesic</a>.</p> <p>Using a combination product means you can take fewer tablets. However, the doses in these combined products are sometimes less than the maximum recommended dose, meaning they might not work as well when compared with taking the tablets individually.</p> <p>Other times, you can get the best effect by alternating doses of ibuprofen and paracetamol. This keeps the levels of the medication in the body more constant and helps to provide more steady pain relief. This may be particularly useful when treating <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Pain_relief_for_children_-_Paracetamol_and_Ibuprofen/#:%7E:text=So%20that%20your%20child%27s%20pain,too%20much%20of%20either%20medicine.">pain</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009572.pub2/full?highlightAbstract=therapy%7Cfor%7Cibuprofen%7Calternating%7Cchildren%7Creview%7Cfour%7Ctherapi%7Caltern%7Ccombin%7Cfebril%7Ccombined%7Cparacetamol%7Cfebrile%7Cchild">fever</a> in children. To do this, one drug is given, then a dose of the other drug is given a few hours later, with you continuing to alternate between the two throughout the day.</p> <p>If you are alternating between different pain medicines, make sure you leave <a href="https://www.nhs.uk/medicines/paracetamol-for-children/taking-paracetamol-for-children-with-other-medicines-and-herbal-supplements/#:%7E:text=If%20you%27ve%20given%20your%20child%20paracetamol%20and%20they%27re,1%20medicine%20at%20a%20time">time (at least one hour)</a> between the dosing of each product to get more effective and consistent relief. Only give the recommended dose of each medicine as outlined on the pack. And do not administer more than the maximum recommended number of doses for each medicine per day.</p> <h2>How do the side effects compare?</h2> <p>Side effects from either drug are rare and generally mild.</p> <p><a href="https://www.tga.gov.au/sites/default/files/otc-template-pi-ibuprofen.rtf">Ibuprofen</a> does have a <a href="https://www.webmd.com/rheumatoid-arthritis/features/anti-inflammatory-drugs-rheumatoid-arthritis">reputation</a> for causing stomach problems. These can manifest as nausea, indigestion, bleeding in the stomach, and diarrhoea. For this reason, people with a history of bleeding or ulcers in the gut should not take ibuprofen. Ibuprofen is also known to sometimes cause headaches, dizziness, and higher blood pressure.</p> <p>Because ibuprofen thins the blood, it should also not be taken by people who are taking other medicines to thin the blood; like aspirin, warfarin, and clopidogrel. Ibuprofen should also be <a href="https://www.tga.gov.au/sites/default/files/otc-template-pi-ibuprofen.rtf">avoided</a> by pregnant women and people with asthma. In these cases, paracetamol is the better choice.</p> <p>However, you need to be careful when using these medicines to make sure you don’t use more than is recommended. This is particularly important for <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50296">paracetamol</a>.</p> <p>Paracetamol at the recommended doses is not toxic but too much can lead to liver failure.</p> <p>Because paracetamol is found in lots of different products, it can be hard to keep track of exactly how much paracetamol you have taken and this increases the risk of taking too much.</p> <h2>Both work, both need to be used safely</h2> <p>Paracetamol and ibuprofen are effective medications for the relief of both pain and fever; however, care must be taken to use them safely.</p> <p>Always read the label so you know exactly what products you are using and how much. Only take the recommended dose, and if you need to, write down the time you take each dose. Your pharmacist or doctor can also advise on the best medicine for your pain and fever and how to use the selected medicine safely.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207921/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, Associate Professor of Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/paracetamol-versus-ibuprofen-which-works-best-and-when-207921">original article</a>.</em></p>

Body

Placeholder Content Image

6 ways to combat headaches without painkillers

<p><em>Marissa Sandler is the CEO and co-founder of Careseekers. Previously a social justice lawyer and researcher for over 15 years, Marissa is passionate about helping people live with dignity and finding innovative solutions to problems.</em></p> <p>According to Headache Australia 5 million Australians suffer from headaches. Although most of us reach over for the painkillers whenever a headache strikes there are ways to combat headaches that don’t involve any medication at all.</p> <p>Headaches are rarely a one-off event and that is why although it is helpful to explore the different non-medicinal cures at the same time you need to look at prevention. If you don’t address the reasons you get headaches, no sooner have you got rid of one headache, you will be on the path to another one.</p> <p><strong>If a headache does strike here are some things you can try to cure it:</strong></p> <ol> <li>Have a rest in a cool, dark room</li> <li>Alternating hot and cold therapies – place an ice pack on your head or have a warm bath or switch from one to the other</li> <li>Take a walk in the fresh air</li> <li>Get a massage</li> <li>Peppermint oil on your temples, foreheads and wrists will alleviate tension headaches</li> <li>Acupuncture has been known to help the most vicious of migraines</li> </ol> <p>Headache Australia has lots of tips to minimise the number of headaches you experience. Their advice is based on understanding when headaches strike, knowing what causes them and then making lifestyle changes to reduce the causes.</p> <p><strong>Understand when headaches strike</strong></p> <p>Keep a headache diary – on the days you experience a headache make sure you note down what you ate, what exercise you did (if any) what was going on emotionally for you (was it a stressful day?) how much alcohol you consumed etc.</p> <p><strong>Know what causes them</strong></p> <p>By identifying precipitating factors that cause headaches – this includes the amount of sleep, environmental factors like amount of light and noise you are exposed to, diet, physical exertion</p> <p><strong>And then… make lifestyle changes</strong></p> <p>If lots of sugar causes headaches you will need to cut the sugar, if its alcohol you may look at cutting down the number of drinks you have in a week.</p> <p>If stress causes tension headaches you will need to reduce the stress in your life, this is obviously easier said than done but when it comes to stress you can only control your reaction. Take yourself out of situations you know cause you additional stress or distance yourself from people that cause you undue stress.</p> <p>Alternatively plan for stressful periods, if you know you have a stressful week at work try and make other aspects of your life not stressful or make sure you make time to go for a walk or eat healthy food.</p> <p>This all cannot happen if you don’t take responsibility for your headaches, understanding headaches are something that happens within you and not to you may empower you to take control of your headaches and make changes to reduce their occurrence and severity.</p> <p><em>Images: Getty</em></p>

Body

Placeholder Content Image

Why does my back get so sore when I’m sick? The connection between immunity and pain

<p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/mark-hutchinson-105409">Mark Hutchinson</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p>Have you ever wondered why your back aches when you’re down with the flu or a cold? Or COVID?</p> <p>This discomfort, common during many illnesses, is not just a random symptom. It’s a result of complex interactions between your immune system and your brain called the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314453/">neuroimmune synapse</a>”.</p> <p>A fascinating and yet-to-be-understood consequence of this conversation between the immune and brain systems during sickness is that it is particularly noticeable in the <a href="https://academic.oup.com/brain/article/145/3/1098/6370954">lower back</a>. This is thought to be one of the body’s most sensitive regions to neuroimmune threats.</p> <h2>Immunology basics</h2> <p>Our immune system is a double-edged sword. Yes, it fights off infections for us – but it also makes us acutely aware of the job it is doing.</p> <p>When our body detects an infection, our immune system releases molecules including signalling proteins called <a href="https://www.researchgate.net/publication/227831648_The_functions_of_cytokines_and_their_uses_in_toxicology">cytokines</a>. These proteins coordinate our immune system to fight off the infection and talk to our brain and spinal cord to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740752/#:%7E:text=Production%20of%20proinflammatory%20cytokines%20induces,to%20depression%20in%20vulnerable%20individuals.">change our behaviour</a> and physiology.</p> <p>This can result in symptoms like fatigue, loss of appetite, fever and increased sensitivity to pain. Classically, we think of this as a beneficial behavioural change to help us conserve energy to fight off the infection. It’s why we often feel the need to rest and withdraw from our usual activities when we’re sick – and also why we are grumpier than usual.</p> <h2>Invisibly small changes</h2> <p>Part of this self-protective response is a change in how we perceive threats, including sensory stimuli.</p> <p>When we are sick, touch can become painful and muscles can ache. Many changes in behaviour and sensory systems are <a href="https://doi.org/10.1159/000521476">believed</a> to have origins at the nanoscale. When molecular changes occur in part of the brain linked to cognition or mood, we think and feel differently. If these neuroimmune synapse changes happen in the sensory processing regions of the brain and spinal cord, we feel more pain.</p> <p>Such sensory changes, known as <a href="https://www.iasp-pain.org/resources/fact-sheets/allodynia-and-hyperalgesia-in-neuropathic-pain/#:%7E:text=Allodynia%20is%20pain%20due%20to,stimulus%20that%20normally%20provokes%20pain.">allodynia and hyperalgesia</a>, can lead to heightened pain sensitivity, even in areas not directly affected by the infection – <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889159114001731?via%3Dihub">such as the lower back</a>.</p> <h2>Immune memories</h2> <p>This immune response happens with a range of bacterial infections and viruses like COVID or the flu. In fact, the sick feeling we sometimes get after a vaccination is the good work our immune system is doing to contribute to <a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">a protective immune memory</a>.</p> <p>Some of that immune-cellular conversation also alerts our brains that we are sick, or makes us think we are.</p> <p>After some viral infections, the sick feeling persists longer than the virus. We are seeing a long-term response to COVID in some people, termed <a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">long COVID</a>.</p> <p>Women, who generally have a <a href="https://www.nature.com/articles/nri.2016.90">stronger immune response</a> than men, may be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937378/">experience pain symptoms</a>. Their heightened immune response (while beneficial in resisting infections) also predisposes women to a higher risk of inflammatory conditions like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980266/">autoimmune diseases</a>.</p> <h2>When to worry and what to do</h2> <p>If the pain is severe, persistent, or accompanied by other concerning symptoms, seek medical attention. Mild to moderate pain is a common symptom during illness and we often notice this in the lower back. The good news is it usually subsides as the infection clears and the sickness resolves.</p> <p>While treating the underlying infection is crucial, there are also ways to dial down sickness-induced neuroimmune pain.</p> <p>Maintaining a diverse microbiome (the collection of microorganisms living in and on your body) by <a href="https://pubmed.ncbi.nlm.nih.gov/31704402/">eating well and getting outside</a> can help. Getting quality sleep, staying hydrated and minimising inflammation <a href="https://karger.com/bbe/article/97/3-4/197/821576/Sickness-and-the-Social-Brain-How-the-Immune">helps too</a>.</p> <p>Amazingly, there is <a href="https://pubmed.ncbi.nlm.nih.gov/34404209/">research</a> suggesting your grandmother’s traditional chicken broth recipe decreases the immune signals at the neuroimmune synapse.</p> <p>Scientists are also <a href="https://pubmed.ncbi.nlm.nih.gov/24799686/">showing</a> mindfulness meditation, cold water therapy and controlled breathing can drive profound cellular and molecular changes to help activate bodily systems like the autonomic nervous system and alter the immune response. These practices might not only help manage pain but also add an anti-inflammatory component to the immune response, reducing the severity and duration of sickness.</p> <p>Heat treatment (with a pack or hot water bottle) might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401625/">provide some relief</a> due to increased circulation. Over-the-counter pain relief maybe also be helpful but seek advice if you are taking other medications.</p> <h2>All in the mind?</h2> <p>Is this all mind over matter? A little of yes and a lot of no.</p> <p>The little of yes comes from <a href="https://pubmed.ncbi.nlm.nih.gov/26194270/">research</a> supporting the idea that if you expect your breathing, meditation and cold bath therapy to work, it may well make a difference at the cellular and molecular level.</p> <p>But by understanding the mechanisms of back pain during illness and by using some simple strategies, there is hope to manage this pain effectively. Always remember to seek medical help if your symptoms are severe or persist longer than expected. Your health and comfort are paramount.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207222/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/mark-hutchinson-105409">Mark Hutchinson</a>, Professor, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-does-my-back-get-so-sore-when-im-sick-the-connection-between-immunity-and-pain-207222">original article</a>.</em></p>

Caring

Placeholder Content Image

This common condition could be the cause of your heel pain

<p>When it comes to our feet, heel pain is one of the most common complaints. According to a 2017 report by podiatry groups My Foot Dr and Balance Podiatry, almost half of people wake up with heel and foot pain at least once a week.</p> <p>If you’re one of them, you’re probably wondering why you’re in so much pain. You might think it’s bruising, but the most common cause of chronic heel pain is actually a condition known as plantar fasciitis.</p> <p>Characterised by a sharp pain that feels like a pencil poking your heels, plantar fasciitis occurs when the fibrous tissue of the foot has been over-stretched, causing inflammation and pain.</p> <p>“Too many cases of heel pain are passed off as bruising or wrongly attributed to heel spurs or Achilles tendonitis,” Sydney-based podiatrist Dr Brenden Brown, founder of A Step Ahead Foot + Ankle Care, explains. “Addressing heel pain really does start with getting the right diagnosis.</p> <p>“Many people suffering from heel pain ignore their condition – hoping rest and time will cure it. Every day I see patients who have put up with their heel pain for months, years even. Unfortunately the ‘zero action approach’ will just prolong the pain.”</p> <p>So, how is plantar fasciitis treated? Well, there’s a number of treatment methods.</p> <p>First, avoid the temptation to go barefoot. “Walking around without shoes puts additional strain on the plantar fascia (the fibrous ligament that runs along the bottom of the foot, from the heel bone to the toes) – particularly first thing in the morning, when the muscles and tissues are tight.”</p> <p>The same goes for thongs, fashionable footwear and other unsupportive shoes, which may only make the issue worse. Instead, Dr Brown recommends “a shoe with a firm shell and a small amount of structured cushioning”. Additionally, the shoe should never bend in the middle.</p> <p>Next, you need to focus on strengthening rather than stretching, which may worsen your pain. “There’s an increasing body of evidence to support strengthening exercises and isometric holds,” Dr Brown says. “These are relatively easy to perform; they don’t require fancy equipment but they help strengthen the plantar.”</p> <p style="text-align: center;"><iframe src="https://www.youtube.com/embed/D8ApCyO9gGc" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <p>Ultimately, if you’re experiencing any type of foot pain, it’s essential to seek help.</p> <p>“Choose a practitioner who understands heel pain and is open to new approaches,” Dr Brown recommends. “Ask the right questions to find out whether they’re experienced in dealing with this particular type of foot pain. You can ask: Is this something you treat often? How many patients do you see a day with heel pain? What’s your success rate?”</p> <p><em>Images: Getty</em></p>

Body

Placeholder Content Image

Turning down the volume of pain – how to retrain your brain when you get sensitised

<p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p>For every feeling we experience, there is a lot of complex biology going on underneath our skin.</p> <p>Pain involves our whole body. When faced with possible threats, the feeling of pain develops in a split second and can help us to “detect and protect”. But over time, our nerve cells can become over-sensitised. This means they can react more strongly and easily to something that normally wouldn’t hurt or would hurt less. This is called “<a href="https://sitn.hms.harvard.edu/flash/2022/sensitization-why-everything-might-hurt/#:%7E:text=When%20neurons%20responsible%20for%20sensing,subset%20of%20chronic%20pain%20patients.">sensitisation</a>”.</p> <p>Sensitisation can affect anyone, but some people may be more prone to it than others due to possible <a href="https://doi.org/10.1111/jabr.12137">genetic factors, environmental factors or previous experiences</a>. Sensitisation can contribute to chronic pain conditions like fibromyalgia, irritable bowel syndrome, migraine or low back pain.</p> <p>But it might be possible to retrain our brains to manage or even reduce pain.</p> <h2>‘Danger!’</h2> <p>Our body senses possible threats via nerve endings called <a href="https://www.sciencedirect.com/topics/neuroscience/nociceptor">nociceptors</a>. We can think of these like a microphones transmitting the word “danger” through wires (nerves and the spinal cord) up to a speaker (the brain). If you sprain your ankle, a range of tiny chemical reactions start there.</p> <p>When sensitisation happens in a sore body part, it’s like more microphones join in over a period of weeks or months. Now the messages can be transmitted up the wire more efficiently. The volume of the danger message gets turned way up.</p> <p>Then, in the spinal cord, chemical reactions and the number of receptors there also adapt to this new demand. The more messages coming up, the more reactions triggered and the louder the messages sent on to the brain.</p> <p>And sensitisation doesn’t always stop there. The brain can also crank the volume up by making use of more wires in the spinal cord that reach the speaker. This is one of the proposed mechanisms of central sensitisation. As time ticks on, a sensitised nervous system will create more and more feelings of pain, seemingly regardless of the amount of bodily damage at the initial site of pain.</p> <p>When we are sensitised, we may experience pain that is out of proportion to the actual damage (<a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/hyperalgesia">hyperalgesia</a>), pain that spreads to other areas of the body (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327510/">referred pain</a>), pain that lasts a long time (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573040/">chronic or persistent pain</a>), or pain triggered by harmless things like touch, pressure or temperature (<a href="https://www.ncbi.nlm.nih.gov/books/NBK537129/#:%7E:text=Allodynia%20is%20defined%20as%20%22pain,produce%20sensation%2C%20causing%20pain.">allodynia</a>).</p> <p>Because pain is a biopsychosocial experience (biological and psychological and social), we may also feel other symptoms like fatigue, mood changes, sleep problems or difficulty concentrating.</p> <h2>Neuroplasticity</h2> <p>Around the clock, our bodies and brain are constantly changing and adapting. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557811/">Neuroplasticity</a> is when the brain changes in response to experiences, good or bad.</p> <p>Pain science research suggests we may be able to <a href="https://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain">retrain</a> ourselves to improve wellbeing and take advantage of neuroplasticity. There are some promising approaches that target the mechanisms behind sensitisation and aim to reverse them.</p> <p>One example is <a href="https://pubmed.ncbi.nlm.nih.gov/21306870/">graded motor imagery</a>. This technique uses mental and physical exercises like identifying left and right limbs, imagery and <a href="https://www.physio-pedia.com/Mirror_Therapy">mirror box therapy</a>. It has been <a href="https://www.tandfonline.com/doi/full/10.1080/24740527.2023.2188899">tested</a> for conditions like <a href="https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome">complex regional pain syndrome</a> (a condition that causes severe pain and swelling in a limb after an injury or surgery) and in <a href="https://www.ncbi.nlm.nih.gov/books/NBK448188/#:%7E:text=Phantom%20limb%20pain%20is%20the,underlying%20pathophysiology%20remains%20poorly%20understood.">phantom limb pain</a> after amputation. Very gradual exposure to increasing stimuli may be behind these positive effects on a sensitised nervous system. While results are promising, more research is needed to confirm its benefits and better understand how it works. The same possible mechanisms of graded exposure underpin some recently developed <a href="https://mhealth.jmir.org/2019/2/e13080/">apps</a> for sufferers.</p> <p>Exercise can also retrain the nervous system. Regular physical activity can <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.01317.2012">decrease the sensitivity</a> of our nervous system by changing processes at a cellular level, seemingly re-calibrating danger message transmission. Importantly, exercise doesn’t have to be high intensity or involve going to the gym. Low-impact activities such as walking, swimming, or yoga can be effective in reducing nervous system sensitivity, possibly by providing new evidence of perceived <a href="https://doi.org/10.1097/j.pain.0000000000002244">safety</a>.</p> <p>Researchers are exploring whether learning about the science of pain and changing the way we think about it may foster self-management skills, like pacing activities and graded exposure to things that have been painful in the past. Understanding how pain is felt and why we feel it <a href="https://doi.org/10.1111/1756-185X.14293">can help</a> improve function, reduce fear and lower anxiety.</p> <figure><iframe src="https://www.youtube.com/embed/eakyDiXX6Uc?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>But don’t go it alone</h2> <p>If you have chronic or severe pain that interferes with your daily life, you should consult a health professional like a doctor and/or a pain specialist who can diagnose your condition and prescribe appropriate active treatments.</p> <p>In Australia, a range of <a href="https://aci.health.nsw.gov.au/__data/assets/pdf_file/0003/212772/ACI-chronic-pain-services.pdf">multidisciplinary pain clinics</a> offer physical therapies like exercise, psychological therapies like mindfulness and cognitive behavioural therapy. Experts can also help you make lifestyle changes to improve <a href="https://painhealth.csse.uwa.edu.au/pain-module/sleep-and-pain/">sleep</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584994/">diet</a> to manage and reduce pain. A multi-pronged approach makes the most sense given the complexity of the underlying biology.</p> <p>Education could help develop <a href="https://www.sciencedirect.com/science/article/abs/pii/S0738399121006467">pain literacy and healthy habits</a> to prevent sensitisation, even from a young age. Resources, such as children’s books, videos, and board games, are being developed and tested to improve <a href="https://doi.org/10.1016/j.jpain.2022.07.008">consumer and community understanding</a>.</p> <p>Pain is not a feeling anyone should have to suffer in silence or endure alone. <!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/202850/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a><br /></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/turning-down-the-volume-of-pain-how-to-retrain-your-brain-when-you-get-sensitised-202850">original article</a>.</em></p>

Caring

Placeholder Content Image

Do aches and pains get worse in the cold?

<p><em><strong>Andrew Lavender, Lecturer, School of Physiotherapy and Exercise Science, Curtin University, asks if joint and muscle aches get worse in the cold.</strong></em></p> <p>The winter chill is often associated with an increase in aches and pains for many older people, particularly in the joints, but also in the muscles. Some <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Strusberg+I+Mendelberg" target="_blank" rel="noopener">recent studies</a></strong></span> have shown an increase in general aches and pain in older men and women, and in particular a correlation between joint pain and weather conditions in patients with <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/27633622" target="_blank" rel="noopener">rheumatoid arthritis</a></strong></span> or <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/26329341" target="_blank" rel="noopener">osteoarthritis</a></strong></span>.</p> <p>For those without these conditions, any experience of pain with cold or wet weather may be related to changes in physical activity and diet.</p> <p><strong>How does the cold affect our muscles and joints?</strong></p> <p>In investigating a link between weather and joint pain, <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/11838853" target="_blank" rel="noopener">studies have examined</a></strong></span> temperature, barometric pressure, precipitation, humidity and sunshine for their links to pain. The results are somewhat inconclusive because they vary greatly. This is largely because pain is subjective and it’s difficult to isolate a particular cause.</p> <p>Other factors like exercise, mood and diet also have an influence on pain perception. <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/19714599" target="_blank" rel="noopener">Some research focused on the idea</a></strong></span> that atmospheric pressure may have the greatest effect. This is because there are gasses and fluids within joints, and if atmospheric pressure reduces, these gasses and fluids might expand, putting pressure on surrounding nerves causing pain. But this has not been shown clearly.</p> <p>A <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Savage+rheumatoid+arthritis+pain+2015" target="_blank" rel="noopener">recent study found</a></strong></span> the combination of temperature, sunlight exposure and humidity correlates with joint pain in patients with rheumatoid arthritis. But the authors were quick to point out the variability in pain perception and other factors, like exercise and diet, means a clear link still can’t be drawn with confidence.</p> <p><strong>How we can prevent aches in winter</strong></p> <p>There are some things that can help reduce pain during the colder months.</p> <p><strong>Exercise:</strong> joint pain is <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/28355375" target="_blank" rel="noopener">often associated with excess weight</a></strong></span>, so a weight-loss exercise program will help to take the pressure off the joints. Exercise also helps to improve metabolism and blood flow through muscles and joints, which can reduce inflammation, stiffness and pain.</p> <p>Many people tend to be more active in the warmer months when the weather is pleasant and it’s comfortable to be outside. It’s important to continue exercise into winter as a reduction in physical activity in winter for more than two weeks <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Colliander+detraining" target="_blank" rel="noopener">results in loss of muscle strength</a></strong></span> and mass as well as reduced bone density. Being inactive for long periods can lead to a gain in fat mass and overall body weight which puts <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/28142365" target="_blank" rel="noopener">excess pressure on joints that can lead to injury</a></strong></span>.</p> <p>Movements that include large muscles of the legs, arms and torso such as squats, sit-ups and push-ups can be done in a fairly small space, and so are ideal inside during winter. Resistance exercise of this type is important for muscle and bone strength. Like muscles, bones adapt to the stimulus of repeated load bearing making them stronger and less prone to injury. This is <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Beavers+Martin+CHnge+bone+mineral+density+2017" target="_blank" rel="noopener">particularly important</a></strong></span> for older individuals.</p> <p>This doesn’t mean you need to go to a gym and lift heavy weights, although you may consider joining a gym for individual or group exercise sessions. You can get enough stimulation for maintenance of muscle and bone strength through daily tasks and home workouts.</p> <p><strong>Vitamin D:</strong> exercising regularly can help to reduce symptoms in the long term, and getting outdoors for longer periods more often provides <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/27258303" target="_blank" rel="noopener">vitamin D for healthier bones and joints</a></strong></span>.</p> <p>When daylight hours are limited, vitamin D supplements are a good way to continue to get the benefits of this vitamin, which has an important role in bone mineralisation, muscle function and nerve growth. Studies have found daily supplementation with vitamin D <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/22592290" target="_blank" rel="noopener">reduces the risk of bone fracture</a></strong></span> and improves muscle strength for older people.</p> <p>It’s recommended adults get at least 200 to 600 international units (IU) of Vitamin D daily if they’re getting some exposure to sunlight most days. It’s not easy to get vitamin D through diet, but in a country like Australia, where sunlight is available even in winter, this presents less of a problem than for people living in regions that have limited sunlight in winter.</p> <p>The best foods for vitamin D include fatty fish like sardines, mackerel and herring, milk, margarine and vitamin D-fortified soy drinks. But it’s important to remember dietary sources alone are not sufficient to provide enough vitamin D. Sunlight is an important source and supplementation should be considered for those who have limited exposure to the sun in winter.</p> <p><strong>Glucosamine and chondroitin:</strong> glucosamine and chondroitin sulphate help to provide nourishment to cartilage to improve joint function. They make movement of the joint smoother by <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/26881338" target="_blank" rel="noopener">reducing the friction produced</a></strong></span> between the articulating surfaces of the bones. Crustaceans provide a good source of glucosamine, while chondroitin sulphate can be obtained from cartilage of animal bones. Supplementation of these is <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/26881338" target="_blank" rel="noopener">prescribed for patients</a></strong></span> with osteoarthritis to help restore cartilage.</p> <p><strong>Heat therapy:</strong> heat therapy can help greatly when you do have pain. Warm baths or showers, particularly in the morning <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/27403866" target="_blank" rel="noopener">can make a big difference</a></strong></span> to the level of pain and stiffness. Warming the body increases elasticity of the tissue and improves blood flow making movement easier. It also activates neural pathways that <span style="text-decoration: underline;"><strong><a href="http://www.tandfonline.com/doi/full/10.1080/00325481.2015.992719" target="_blank" rel="noopener">reduce the brain’s perception of pain</a></strong></span>.</p> <p><em>Written by Andrew Lavender. Republished with permission of <a href="http://theconversation.com/" target="_blank" rel="noopener"><strong><span>The Conversation</span></strong></a>.</em><img src="https://counter.theconversation.com/content/81260/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation" width="1" height="1" /></p> <p><em>Images: Getty</em></p>

Body

Placeholder Content Image

“It pains me”: Tennis star shares sad news

<p dir="ltr">Emma Raducanu has revealed that she will have to miss the French Open, Wimbledon and the US Open, as she undergoes three “minor” surgeries on both of her hands and left ankle.</p> <p dir="ltr">The twenty-year-old posted the update to Instagram on Wednesday, revealing that she has kept the severity of her injuries private for some time.</p> <p dir="ltr">Raducanu shared a snap from her hospital bed with a cast on her right hand, after undergoing the first of her three planned procedures.</p> <p dir="ltr">“It is safe to say the last 10 months have been difficult as I dealt with a recurring injury on a bone of both hands,” she wrote in the handwritten statement.</p> <p dir="ltr">“I tried my best to manage the pain and play through it most of this year and end of last year by reducing practice load dramatically, missing weeks of training as well as cutting last season short to try heal it, unfortunately it’s not enough.”</p> <p dir="ltr">“I’m disappointed to share that I will be out for the next few months and while I am at it will have another minor procedure that is due on my ankle.</p> <p dir="ltr">“It pains me that I will miss the summer events and I tried to downplay the issues so I thank all my fans who continued to support me when you did not know the facts.”</p> <p dir="ltr">“Looking forward to seeing you all back out there,” she ended the note with a hand drawn heart.</p> <p dir="ltr">The 2021 US Open champion has been struggling with a string of injuries as she tried to adjust to the demands of being a professional tennis player.</p> <p dir="ltr">Her most recent hand injury forced her to withdraw from the Billie Jean King Cup finals at the end of the last year. At the beginning of this year, she rolled her ankle mid-match in a tournament in Auckland.</p> <p dir="ltr">Raducanu is set to have the operation on her left hand this month after getting surgery for her left ankle in the coming weeks.</p> <p dir="ltr">She hopes to train on the tennis court again by the end of the summer, but her team has refused to predict an exact return date.</p> <p dir="ltr">Many fans and fellow tennis players have commented their support and well wishes for the star.</p> <p dir="ltr">“Rest up, Emma, and come back stronger 💜💚,” commented the official Wimbledon Instagram account.</p> <p dir="ltr">“Speedy recovery ❤️,” wrote Ukrainian tennis player, Marta Kostyuk.</p> <p dir="ltr">“Surgery is never nice, always a little scary, well done,” commented one person.</p> <p dir="ltr">“Get well soon Emma and you have many fans around the world supporting you and having your back,” wrote another.</p> <p dir="ltr">“Get well soon Emma!, we will be waiting for you when the moment is right, wishing you the best,” commented a third.</p> <p dir="ltr"><em>Image: Instagram</em></p>

News

Placeholder Content Image

Woman’s painful shoulder leads to shock diagnosis

<p dir="ltr">In December 2022, a normal day in the office turned into a nightmare for 24-year-old Kadi Watson.</p> <p dir="ltr">The customer service rep stretched out her hand to feel her shoulder - the same shoulder she'd been experiencing pain with a day prior. </p> <p dir="ltr">Speaking to<em> 7Life</em>, the 24-year-old revealed, “It felt kind of like when you do a workout and then days later you get the muscle soreness.”</p> <p dir="ltr">“I hadn’t done anything to warrant having that soreness.” </p> <p dir="ltr">She said she was feeling between her neck and her right shoulder when she discovered a lump. </p> <p dir="ltr">“OK, that’s a bit unusual,” she recalled. </p> <p dir="ltr">For the next two days, she monitored the lump, but it didn’t go away.</p> <p dir="ltr">So, she booked a doctor’s appointment and her GP reassured her there shouldn’t be “much need to worry”.</p> <p dir="ltr">However, to rule out anything malicious, the GP booked her in for an ultrasound of the lump and an X-ray. </p> <p dir="ltr">A week later, as Watson was set for her ultrasound, the technician contacted a radiologist and requested that Watson also undergo a CT scan. </p> <p dir="ltr">The scan showed “heaps of lumps” around her chest and heart.</p> <p dir="ltr">“That’s when they said, ‘This is more serious than just a lump growing on your neck’,” she revealed.</p> <p dir="ltr">She underwent surgery to remove the lumps and admitted she had come to terms with the possibility she could have cancer. </p> <p dir="ltr">When she learned the results, Watson was diagnosed with Hodgkin Lymphoma - a rare type of blood cancer.</p> <p dir="ltr">“I was expecting a phone call, I knew it wasn’t going to be face to face,” she said, adding that by that point she was exhausted from going to appointments every day and waiting around for calls.</p> <p dir="ltr">“Obviously, a call would have been better, but I got the text message instead,” she explained.</p> <p dir="ltr">“I feel like I was a bit more mentally prepared when I got those results because by that time it had been three or four weeks with, ‘This is what you could have’ and me mentally preparing for that answer.”</p> <p dir="ltr">Watson said her diagnosis put her life into perspective. </p> <p dir="ltr">“I thought by 24 I would have done a bit more than just do the old routine kind of thing,” she said.</p> <p dir="ltr">“I felt like I should have done more with my life than just sat here and worked.</p> <p dir="ltr">“You spend so much time working - and not enough time living.”</p> <p dir="ltr">She has also connected with people on their own journeys throughout 2023 so far.</p> <p dir="ltr">“I get probably five messages a day of people telling me how much this has helped them and what they can look out for,” she admitted.</p> <p dir="ltr">“It’s not really the most common cancer out there and I didn’t know about it until I got diagnosed with it.</p> <p dir="ltr">“So I’m glad to spread a bit more awareness.</p> <p dir="ltr">“I’m very, very excited for the day where I can say ‘I’m in remission’.”</p> <p dir="ltr"><em>Image credit: Instagram</em></p>

Body

Placeholder Content Image

Simple yoga moves that help with hand and wrist pain

<p><em><strong>Tracy Adshead is a yoga teacher specialising in yoga for seniors. She is passionate about bringing healing and healthy ageing to the community.</strong></em></p> <p>As we age, tendonitis is one of the most common problems associated with the hands and wrists. If you are experiencing pain or having difficulty bending one or more of your fingers normally then you may have a tendon inflammation or irritation. The condition is usually short-lived but because many of our daily activities involve repetitive movements such as knitting, texting or typing, joints can easily become aggravated.</p> <p>Yoga helps us to engage in our daily activities in a less stressful way. We can address the cause of the injury by slowing down and observing our habitual movements, then think about how we can do things differently.</p> <ol> <li>Stop whatever activity triggered the inflammation.</li> <li>After swelling has subsided, rest the hand(s) for 4 – 6 days.</li> </ol> <p>Yoga is best used for helping with the healing process at this point when a very slow range of motion can be performed. Be careful not to stretch the muscles so much that you trigger any pain. This practice should be used to supplement conventional therapy, not replace it:</p> <p><strong>1. Lift up the injured hand in front of you</strong>, if possible straighten out all the fingers, finger-tips pointing towards the ceiling. If the fingers are not able to straighten then just move them to a comfortable position.</p> <p>With a slow count of five, little by little, draw the thumb in towards the palm – it may not touch the palm and that’s fine. Next the index finger for the same count. Repeat for each of the fingers.</p> <p>Open up the hand slowly.</p> <p>Now reverse it, small finger moves first towards the palm for the count of four, then all the rest of the fingers follow, thumb comes last. Open up the hand and repeat once more.</p> <p><strong>2. Spread all of your fingers out like a starfish.</strong> With a slow count of 10, begin to fold all your fingers down, closing the hand down into a fist or as close to. Then slowly, all the way open again spreading the fingers out like a starfish. Repeat five to seven times.</p> <p>When this practice becomes comfortable move into a really active hand movement by speeding up.</p> <p><strong>3. Bring the palms together into “namaste” or “prayer” position in front of the chest.</strong> Press the fingers and palms together as you gently lift up your elbows and stretch your wrists.</p> <p>Inhale, lift the elbows up for the count of three. Exhale, lower the elbows for the count of six. Repeat five times.</p> <p>Consult your doctor before starting any new forms of exercise.</p> <p><em>Images: Getty</em></p>

Body

Placeholder Content Image

Golfers guide to lower back pain

<p><em><strong>Dr Richard Parkinson is a highly trained neurosurgeon who has performed ground breaking and complex surgery on some of Australia's elite sportspeople and recognised as a leading expert in sports injuries.</strong></em></p> <p>Golf is a great sport for general fitness, including muscular endurance and cardiovascular wellbeing. However, it’s time we talked about golf back pain, which is a fairly common affliction, exacerbated by the more advanced age of the average amateur golfer. Fortunately, the pros of getting out there on the green outweigh the cons.</p> <p>Lower back pain in golfers is common, as are a range of other injuries to areas including the neck, shoulders, elbows, head and eyes. Interestingly enough, injuries to the knees are pretty rare. Golf back pain and neck pain are usually related to bending or twisting injury and both are, in turn, often related to current swinging of the club. Golf is, unfortunately, a fairly asymmetric sport.</p> <p><strong>The price of the swing</strong></p> <p>The problem is that the swinging action causing the pain is unavoidable in golf. You can't hold your back completely still while you swing. Having said that, though, it's not a tremendously high impact sport by any reach of the imagination, and the exercise you get from being outdoors and getting some gentle exercise is very beneficial.</p> <p>So for people who are a bit older, golf remains an excellent way to get some exercise and have some fun. Equally, however, that twisting can increase the problem with lower back pain and really the only thing you can do is, if you're hurting, work on your short game and minimise your swing. Other solutions might be to work on your putt and to try to improve your score by avoiding the big screen with the three wood. Most people can do a short swing with an iron and get three quarters of the way.</p> <p><strong>The core of the problem</strong></p> <p>When I discover lower back pain in golfers, I usually tell them to go and see a physio and get some work done on their core. In the meantime, they can still work on their short game while they gradually find their way back to full strength with the assistance of a physio. Core strength is the key to avoiding golf back pain. Golfers need to learn how to turn their core on—to engage it, in other words—when they swing, and to start approaching their game in a physiological way with a bit of knowledge about how their body works.</p> <p>There are a lot of golfers out there, and it is, generally speaking, a low-risk game for injuries—but what if you have an established back problem or disc herniation, what should you do about your golf? After I perform disc surgery, I usually tell patients to have three months off golf, because the twisting can predispose you to golf back pain.</p> <p><strong>Your first step</strong></p> <p>If you do have an injury, it's always worthwhile giving it some physiotherapy and, as a Sydney neurosurgeon, I can definitely refer my patients to a physio with an interest in golfing injuries.</p> <p>There are physios out there that specialise in asymmetric sports; then there are those that specialise in over-arm sports − and there are those physios that specialise in bending and twisting type sports.</p> <p><em>Images: Getty</em></p>

Body

Placeholder Content Image

6 stretches for lower back pain

<h2>Lower back pain 101</h2> <p>Low back pain is a beast. And not just because it can make you feel like your body is rebelling against you. Back pain can is a symptom of a problem. To treat the symptom – with things like stretches for lower back pain – you have to know what the problem is.</p> <p>This becomes complicated because the cause of low back pain is sometimes hard to pin down. Sometimes it’s obvious. You pick up a heavy box without thinking about proper lifting form and – bam! – you pull a muscle and end up with an acute bout of pain. But other times, the problem is more insidious and unclear.</p> <p>Maybe after years of inactivity, you’ve felt pain starting to creep in, possibly due to changes in muscle balance, decreases in strength, and general inflammation. Maybe you injured yourself years ago and, over time, a minor injury exacerbated it into something more serious.</p> <h2>Here’s why stretching could help lower back pain</h2> <p>That doesn’t mean you have to live with the pain. Movement (you know, exercise) is one of the best ways to prevent, limit, and address back pain.</p> <p>“Most of us aren’t moving in the variety of ways our bodies are built for, and habitual postures and sedentary living create excessive muscular tension, which leads to discomfort,” says Lara Heimann, a licensed physical therapist and yoga instructor. “Our bodies signal to us ‘please move!’ But we often ignore the signals and instead adapt to not listening. Over time, we lose some of the innate brain signallings that would otherwise keep us healthy and mobile.”</p> <p>The answer, then, is to move more. You need a well-rounded exercise program that includes back pain exercises, as well as cardiovascular and muscle-strengthening exercises. Incorporating flexibility and stretching exercises can also help you attain and maintain the range of motion you need to help keep pain at bay.</p> <p>“Taking time to stretch helps decrease stiffness, reduces pain and discomfort, and reprograms our brains to send signals when we need to get up and stretch,” Heimann says.</p> <p>Regular stretching can also facilitate better circulation, allowing for more efficient transportation of oxygen and nutrient-rich blood throughout the body, says Heimann.</p> <p>But most importantly, Heimann stresses that stretching is a preservation tool for movement, helping prevent tightness and tension that can set the stage for injuries. “Regular stretching helps to preserve joint health,” Heimann says. “The joint can move freely and efficiently in all directions with decreased stress placed on its structures.”</p> <h2>Word of caution</h2> <p>Back pain has so many causes and some are more serious than others. If your back pain persists for more than a few days, or if it’s severe or causes weakness or tingling in your extremities, make an appointment to see your doctor. Also, avoid any stretch or exercise that causes sharp or shooting pain. Not all types of stretches or exercises are appropriate for every person or every injury. This is why extended self-treatment isn’t advised. To address an issue effectively, you need to know exactly what the issue is.</p> <h2>Warm up</h2> <p>You know how you feel a little more tight first thing in the morning or after sitting still for a few hours? While stretching is a good way to “wake up” your muscles and joints after remaining stationary, you’ll feel better all-around if you’ve gotten your blood pumping a little bit first. And you’ll likely move more smoothly and comfortably through a full range of motion as you stretch.</p> <p>This is because circulating blood delivers oxygen and nutrients to your working muscles, helps warm them up, and prepares them for whatever movements you’re about to ask of them.</p> <p>Walking briskly or marching in place for a few minutes before you dive in is a good way to help prep your body for your stretching routine. For each of the exercises below, an exercise mat is recommended.</p> <h2>Cat-Cow</h2> <p>For those with back pain, cat-cow – an exercise that is popular in yoga – is a good, active stretch that takes the spine through flexion and extension. According to Heimann, it can help improve posture. Plus, it’s one of the best stretches to do for morning back pain relief.</p> <h3>How to do Cat-Cow</h3> <p>Start on your hands and knees on the floor in a “tabletop” position (back flat, knees under your hips, palms under your shoulders). In a controlled action, press your tailbone up and slowly extend your spine by allowing your abdomen to release toward the floor as you press your chest and shoulders up. You should create a U-shaped curve in your back as you look up toward the ceiling. Think about moving each vertebra separately in a wave-like fashion as you create the extension.</p> <p>Hold for a second, then reverse the action. This time, release your head and neck toward the floor as you flex your spine, ultimately tucking your tailbone under to create a rainbow-like arc with your spine.</p> <p>The first position is “cat,” and the second position is “cow.” As you move into cat, inhale; as you move into cow, exhale. Continue alternating between the two positions for a total of 30 to 60 seconds to help release tension in the back.</p> <h2>Prone Press-up</h2> <p>The Prone Press-up is sometimes called the cobra pose in yoga. But it’s also an essential part of the McKenzie Method that physical therapists and other clinicians often use to help address back pain. While people with low back pain might assume that back flexion (stretches like forward bends to touch the toes) should be used to help loosen up tight hamstrings, hips, and low back, the research actually suggests otherwise. Many people with low back pain are better served by doing back extension exercises, like the prone press-up.</p> <p>“Through clinical observation and research, we have seen that moving into the direction of lumbar spine extension can make a tremendous difference in many people with low back pain,” says chiropractor Jordan Duncan.</p> <p>“One reason for the great benefit of moving into spinal extension is likely due to the fact that as a society we spend the bulk of our time in flexion and very little time in extension,” he says. “Therefore, in the majority of people, spinal extension allows us to undo the effects of a great deal of time spent in flexion.”</p> <h3>How to do Prone Press-up</h3> <p>Lie on your stomach with your palms flat on the mat at your shoulders, as if you were going to do a pushup. Keeping your legs and hips on the floor, press through your palms and lift your chest from the mat, aiming to fully extend your elbows as you try to achieve full extension through your spine. Hold for one or two seconds, then slowly reverse the movement and lower your chest back to the floor.</p> <p>Continue repeating the exercise in a controlled fashion for 30 to 60 seconds. If you can’t reach full extension without pain or irritation, move to the range of motion you can comfortably achieve. As an alternative, press up to a partial extension balanced on your elbows.</p> <h2>Standing Backbend</h2> <p>If the Prone Press-up is simply not doable, the Standing Backbend is another option for achieving back extension. This can be particularly helpful if you experience localised pain while sitting, says physical therapist Sara Mikulsky. “When we spend long hours sitting, our core muscles can weaken and our hip flexors can tighten,” she says. “This then puts abnormal strain on the spine and its structure, which can lead to pain.”</p> <h3>How to do Standing Backbend</h3> <p>Stand tall with your feet roughly hip-distance apart and your knees very slightly bent. Place your hands on the back of your hips. Engage your core and gently lean back. Don’t overdo it, but do allow your shoulders to open and your chest to lift up toward the ceiling. Hold for a few seconds, then carefully return to the starting position. Repeat for 30 to 60 seconds.</p> <h2>Kneeling Hip Flexor</h2> <p>The Standing Backbend can help stretch the hip flexors while also releasing tension in the lumbar spine. You can also specifically target your hip flexors to help loosen them up with a Kneeling Hip Flexor.</p> <h3>How to do Kneeling Hip Flexor</h3> <p>Start on your knees, your hips extended and your torso tall. Place your right foot on the floor in front of you, with your right knee bent at a 90-degree angle (as if you’re about to propose). Place your hands on your hips and shift your weight forward without leaning your torso forward as you press and more fully extend your left hip flexor.</p> <p>You should feel the stretch at the front of your left hip. Hold for a second, release the stretch, then repeat. Continue for 30 to 60 seconds, then switch legs.</p> <h2>Supine Figure 4 Stretch</h2> <p>If you tend to have pain that travels down your leg, the best stretches might differ. Mikulsky points out that this form of pain may be caused by a nerve or disc injury that requires further medical attention. However, stretches – like the Supine Figure 4 stretch – that target a deep muscle in your buttocks called the piriformis, might provide some lower back pain relief (although they’re unlikely to fix the underlying problem).</p> <h3>How to do Supine Figure 4 Stretch</h3> <p>Lie on your back with your knees bent and your feet flat on the floor. Lift your right foot from the floor and place your ankle across your left thigh. Allow your right knee to open outward, creating a “4” shape with your legs. You should feel a stretch through the outside of your hip.</p> <p>Holding this position, reach your hands behind your left thigh and use your hands to guide your left knee closer to your chest. Lift your left foot from the floor to deepen the stretch through your right buttock and hip. Hold for a few seconds, then release your left foot to the floor. Repeat for 30 to 60 seconds before switching sides.</p> <h2>Knee to Chest</h2> <p>If you tend to have back pain while standing, Mikulsky says this might a joint issue or arthritis. If this is the case, a back extension might actually place more stress on your spine, leading to pain. (This is the tricky part about back issues – the stretches that are most appropriate for one issue might be the least appropriate for another.) If you find that standing or attempting back extension stretches – like the Standing Backbend or the Prone Press-up – cause more irritation or pain, try the Knee to Chest exercise.</p> <h3>How to do Knee to Chest</h3> <p>Lie on your back with your legs bent and feet on the floor. Place your hands on the back of each thigh and use your hands to guide your knees toward your chest. Place your hands on your shins and gently pull your knees even closer. You should feel the stretch across your lower back. Hold for 30 seconds to a minute, then repeat two or three times.</p> <p><em>Images: Getty</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/fitness/6-stretches-for-lower-back-pain" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

Body

Placeholder Content Image

"How did you live with this much pain?": Bindi Irwin hospitalised

<p dir="ltr"> Bindi Irwin has issued an emotional statement on social media after undergoing surgery for endometriosis.</p> <p dir="ltr">The beloved Australian conservationist has been battling with the condition for 10 years, and detailed in her post what it had been like to struggle with “insurmountable fatigue, pain &amp; nausea.”</p> <p dir="ltr">She confessed that she had spent a long time wondering whether or not she should share her story, but ultimately believed it to be her “responsibility” to share her story for others like her who haven’t been able to get the help they desperately need for their condition. </p> <p dir="ltr">“I’m aware of millions of women struggling with a similar story,” Bindi wrote, “there’s stigma around this awful disease. I’m sharing my story for anyone who reads this &amp; is quietly dealing with pain &amp; no answers. Let this be your validation that your pain is real &amp; you deserve help. Keep searching for answers.”</p> <p dir="ltr">According to the World Health Organisation, endometriosis - a chronic disease for which there is no known cure - affects approximately 10% of the world’s population of women, girls, and gender diverse individuals of a reproductive age (that’s roughly 190 million people). It is associated with severe pain during periods, bloating, nausea, fatigue, and even infertility. </p> <p dir="ltr">However, the symptoms can be so varied that healthcare professionals often struggle to diagnose the condition, and that many sufferers don’t know enough to put a name to it. Due to this, there are often large spans of time between first noticing symptoms, getting a formal diagnosis, and getting help. </p> <p dir="ltr">“These last 10yrs have included many tests, doctors visits, scans, etc.,” Bindi explained in her caption. “A doctor told me it was simply something you deal with as a woman &amp; I gave up entirely, trying to function through the pain.”</p> <p dir="ltr">“I decided to undergo surgery for endometriosis,” she continued, after noting that a friend had helped steer in the right direction. “Going in for surgery was scary but I knew I couldn’t live like I was. Every part of my life was getting torn apart because of the pain. </p> <p dir="ltr">“To cut a long story short, they found 37 lesions, some very deep &amp; difficult to remove, &amp; a chocolate cyst. @seckinmd’s [Bindi’s doctor] first words to me when I was in recovery were, ‘How did you live with this much pain?’”</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Cpf6o7YJ0xa/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Cpf6o7YJ0xa/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Bindi Irwin (@bindisueirwin)</a></p> </div> </blockquote> <p dir="ltr">Bindi, in true Irwin fashion, took the time to pay tribute to the support of her family and friends who had been on that journey with her for over a decade, and wrote of the “indescribable” relief at the “validation for years of pain”. </p> <p dir="ltr">“THANK YOU,” she gushed, “for encouraging me to find answers when I thought I’d never climb out. Thank you to the doctors &amp; nurses who believed my pain. I’m on the road to recovery &amp; the gratitude I feel is overwhelming. </p> <p dir="ltr">“To those questioning the cancelled plans, unanswered messages &amp; absence - I had been pouring every ounce of the energy I had left into our daughter &amp; family.</p> <p dir="ltr">“Things may look fine on the outside looking in through the window of someone’s life, however, that is not always the case. Please be gentle &amp; pause before asking me (or any woman) when we’ll be having more children. </p> <p dir="ltr">“After all that my body has gone through, I feel tremendously grateful that we have our gorgeous daughter. She feels like our family’s miracle.”</p> <p dir="ltr"><em>March is Endometriosis Awareness Month, for more information visit: </em></p> <p dir="ltr"><em><a href="https://www.endometriosisaustralia.org/">Endometriosis Australia</a></em></p> <p dir="ltr"><em><a href="https://nzendo.org.nz/2023-march-awareness-month/#:~:text=March%20is%20International%20Endometriosis%20Awareness,years%20before%20they%20are%20diagnosed.">Endometriosis New Zealand</a></em></p> <p dir="ltr"><em>Images: Instagram</em></p>

Caring

Placeholder Content Image

The pleasure and pain of cinephilia: what happened when I watched Groundhog Day every day for a year

<p>“What would you do if you were stuck in one place, and every day was exactly the same, and nothing that you did mattered?” </p> <p>So asks time-stranded weatherman Phil Connors, played by Bill Murray, as he begins to come to grips with his predicament in the 1993 comedy classic <em>Groundhog Day</em>. </p> <p>On February 2, while reporting on the annual Groundhog Festival in the quaint Pennsylvanian town of Punxsutawney, Phil becomes trapped in a time warp where he lives the same day over and over again.</p> <p>In 2021 I was wrestling with the same question. Living in lockdown, I was feeling frustration, ennui, and like forward progress had ground to a halt. The circumstances created an opportunity to subject myself to a very unusual challenge: to watch the same film once a day, every day, for a year. </p> <p>As a film scholar and cinephile, I wanted to find out how well a movie would sustain this kind of viewing and what a viewer might get out of the experience. <em>Groundhog Day</em> was the natural candidate. </p> <p>On a Monday morning in September of 2021, I sat down on my couch and hit play.</p> <h2>The act of watching</h2> <p>In the first month, my primary engagement was with the narrative. </p> <p>Like many previous viewers, I found myself asking how long Phil was trapped in the loop for (my own approximation is 30 years, which sits between the 10 years offered by director Harold Ramis and the 10,000 years in the original screenplay by Danny Rubin). </p> <p>I questioned the credibility of Rita (Andie MacDowell) falling in love with Phil having only known him for a day. I wondered how much of Murray’s performance was improvised (in Rubin’s words, <a href="https://www.reddit.com/r/IAmA/comments/qhkyh/comment/c3xp27e/">some “colouring”</a> but proportionally less than is assumed).</p> <p>Gradually, my familiarity with the narrative led me to shift focus. Rewatching became about exploration, as I sought to discover details the average viewer may have missed. </p> <p>I began to notice the re-occurrence of certain extras from scene to scene, building my own narrative around their identities. I realised the boy in a wheelchair in the background of the hospital scene is the same boy Phil will eventually save from breaking his leg every day. </p> <p>I consumed as much extra material on the film as possible. <a href="https://howtowritegroundhogday.com/">Rubin’s screenplay</a> and accompanying commentary, film critic Ryan Gilbey’s <a href="https://www.bloomsbury.com/us/groundhog-day-9781838716035/">detailed monograph</a> and Harold Ramis’s commentary were all illuminating. I realise in hindsight that I was following my natural inclination as a scholar, to try to understand something more fully by diving more deeply into it. </p> <p>And then I reached the doldrums. </p> <h2>Shifting perspectives</h2> <p>By the midway point, my viewing had shifted into a mode of cataloguing and memorisation. Phil Connors’ weather reports ran through my head unbidden, and I had built myself a mental map of Punxsutawney to the extent I felt like I could give directions to a visitor. I began to talk to the film as it played. </p> <p>Some days, the viewing felt like a curse.</p> <p>When Rita discovers Phil’s dilemma, she says: “Maybe it’s not a curse. Maybe it depends on how you look at it.” </p> <p>My own shift in perspective came into play in the final three months. I found myself returning to the exploratory mode of viewing, encouraged by sharing and discussing theories with others who liked the film but who weren’t nutty enough to watch it hundreds of times.</p> <p>New theories emerged. </p> <p>I decided the bartender at the Pennsylvanian Hotel is clearly aware of Phil’s predicament (make note of his knowing looks and how quickly he serves them their favourite drinks), and that one of the Punxsutawney townspeople is clearly having an affair, as he can be seen visiting the Groundhog Festival with his wife and the banquet with his mistress. </p> <p>I’m not the first to posit <a href="https://www.cbr.com/groundhog-day-movie-theory-ned-ryerson-devil/">alternative readings</a> of the film, but I understood in my final stretch of viewing that a film can transform with us, revealing new layers from viewing to viewing. </p> <h2>Films as friends</h2> <p>In recent years, many scholars have examined the practice of repeat viewing, particularly with the emergence of technologies that provide flexibility to view when and where we like. </p> <p>Film theorist Barbara Klinger <a href="https://www.ucpress.edu/book/9780520245860/beyond-the-multiplex">suggests</a> familiar movies have the capacity to become our “friends” and she introduced the term “karaoke cinema” to describe the joy of deep familiarity and quotability, arguing this experience provides the audience with an element of both comfort and mastery.</p> <p>My experience certainly affirms her claims. Watching <em>Groundhog Day</em> every day for a year provided me with a deeper appreciation for how a film may contain multitudes – particularly those we choose to willingly re-experience. </p> <p>The legacy of <em>Groundhog Day</em> can be seen in the recurring appeal of the time loop narrative in TV shows and films such as Palm Springs, Russian Doll and Happy Death Day. </p> <p>And, like every piece of worthwhile art, it can also sustain its own deep interrogation and reveal to the curious rewatcher its multifaceted layers and dimensions.</p> <p>On reaching the finish line I was elated and celebrated with a final viewing on the big screen. I have a feeling it will be some time before I revisit the film, but it’s comforting to know it will be there when I’m ready, an old friend who welcomes visitors.</p> <p><em>Image credits: Columbia Pictures</em></p> <p><em>This article originally appeared on <a href="https://theconversation.com/the-pleasure-and-pain-of-cinephilia-what-happened-when-i-watched-groundhog-day-every-day-for-a-year-198668" target="_blank" rel="noopener">The Conversation</a>. </em></p>

Movies