biopsychosocial

Is that a knot in my muscle?

Knots.jpg

54 year old Barbara has pain extending across the top of the shoulders, frequently extending into the neck. Is it a muscle? Is it a trapped nerve? Or is there something more complex going on?  Why didn’t it hurt six months ago?

Surely, the muscles are tight?

They may actually be a bit wound up actually, especially with a little bit of stress in your life.  Most of us have experienced a rush of adrenaline in the work place, at home or even crossing the road.  Adrenaline is great; it prepares your body to get moving by increasing your heart rate and your breathing so you can send more oxygen to your muscles.  The free-floating adrenaline also binds to your muscle spindles, increasing the resting tension so your muscles can burst into action. 

Most of the time though, we’re left not bursting into action but taking a deep breath and getting on with not moving.

But is all that tension going to make a knot?

One study specifically found there is no clear evidence of a strong relationship between increased electrical activity of muscles and the development of musculoskeletal disorders (2).  Keep in mind this was one study, and the definition of a musculoskeletal disorder might not include Barbara and her sore muscles across the top of her shoulders.

I can definitely feel a knot in there.

There is zero consensus about what that hard lump in the muscle actually is and ‘knot’ seems like a fairly innocuous word to all those other than knitters and sailors.  And just like knots in the real world, most are amenable to unwinding given the right intervention.

Bio (Body) Psycho (Brain) Social (Environment/Interaction) 

Like many things in the body and pain, the pathophysiological mechanisms remain unclear. We are always more than the sum of our parts and if we look at the risk factors above, you need to find out whether Barbara has stress in the workplace, disappointment in her job, her relationship, whether she has a cold, whether her dog just died and she’s stopped walking, whether her children left her with five grandchildren on the weekend? And then what is her ability to control any or all of these aspects of her professional and personal life?  

See the problem?  This is why a medical history is important, why Osteopaths ask a lot of questions, why we need to spend more than seven minutes with you to grasp how to help you out of pain.  We need to find out what’s tipped you from not even noticing that you’re a bit tight, to not being able to tolerate your shoulder discomfort a moment longer.  

Hopefully, it’s as simple as softening off the muscles, turning a computer to a better angle, taking some micro breaks in the workplace and heading out for a daily walk.

Let’s get back to Barbara...

Step One:

take a slow deep breath

drop your shoulders

release the tension

Step Two: 

get up from your desk occasionally

wave your arms around or run them quickly on the spot for ten seconds

smile at your colleagues and let them know you’re not crazy

Step Three:

Find some daily exercise that you love

Step Four:

Advise your children you can no longer care for all five grandchildren at once for an entire weekend.

References:

Ratey, John J.,Hagerman, Eric. (2008) Spark :the revolutionary new science of exercise and the brain. New York : Little, Brown,

 

Westad C, Westgaard RH, De Luca CJ.   J Physiol. 2003 Oct 15;552(Pt 2):645-56. Motor unit recruitment and derecruitment induced by brief increase in contraction amplitude of the human trapezius muscle.

What is Osteopathy?

The word Osteopathy, along with the concept, was developed well over a hundred years ago. "Osteo" is clearly a derivation relating to "bone", but an Osteopath is much more than just treating bones.  I'm pretty sure if it was developed now, a whole team of branding and marketing specialists might come up with a better name.  It does have a fair bit to do with bones (as part of the overall musculo-skeletal system), but I don’t think there are many Osteopaths still out there who think we can use joint manipulation to cure serious disease.  So whilst many theories have been culled from the original concept, the manual side of Osteopathy has evolved to help people with pain and provide professional advice in their recovery from injury or surgery. 

A foundational principle, or perhaps the philosophy of Osteopathy, remains sound.  Historically, Osteopaths were trained to treat the body, mind and spirit.  In today’s speak, Osteopaths are trained to take a bio-psycho-social approach.  Bio (body) pscyhological (mind) social (spirit) is at the very foundation of how Osteopaths think.

BIOLOGY (BODY)

We work with the body because we are manual therapists.  This means we use our hands, our eyes and our brain to assess your body and use a broad range of hands-on techniques and movement therapies in order to modulate your pain and help you move better.  Modulate in this context means to modify, hopefully in a positive direction, with the result being, you have less pain and movement is easier.

PSYCHOLOGICAL (MIND)

But where would we be without your brain, or ours for that matter.  Our brain works with your brain. This doesn't mean we’re psychologists but it does mean we’re good listeners and we recognise the person standing in our room has a brain, a mind, a long history of lived experience; possibly trauma, happiness, an education.  We work together with your brain, in countless ways, listening, discussing, educating and providing advice.  We might challenge your default or resting postures, and significantly, we will educate you about pain and this might challenge the way you think about your pain.

SOCIAL (SPIRIT)

Osteopaths have historically also worked with your ‘spirit’.  This is the part that can make people feel we’re a bit ‘out there’, a bit ‘crystal healing’, a bit ‘woo’.  Once again, this aspect has an historical context. Osteopathy was developed when Science and Medicine didn't have answers for many horrible afflictions.  Using leeches and ‘bleeding’ people was common practice. 

Like medicine and the manual and physical therapy realm, Osteopathy has benefited from great leaps of understandings in Science over the last 100 years and especially research into neuroscience in the last 20 years.  

Most people’s experience of pain improves when you are provided with nurturing environments, good education about pain and why it’s there, empowering explanations, and the knowledge of how to change their pain.  This isn't pandering to the concept of a ‘spirit’ but it does recognise that people are complex creatures and appreciate being treated as humans.

TODAY

Many practitioners, whether medical or manual, still practice within a biomedical model in which they tend to treat just the anatomical aspects of a problem.  “Here take some ibuprofen”, “You need to see me forever every four weeks to be truly healthy”, “Let’s strengthen your core to really solve the problem”, “Stand up straight”.  They often ignore the other human aspects that might be contributing to the problem, including the most important part that runs every single aspect of our mind and body, our brain. 

And we don’t forget the basics either.  We are very qualified to rehabilitate post-surgical or post-injury movement dilemmas. That's our bread and butter.

At Fairfield Osteopathic Clinic, our Osteopaths meet with you for up to an hour the first time you come in, in order to grasp the whole picture. 

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