Dr Attam Singh of the London Pain Clinic discusses how we can overcome musculoskeletal pain
We tend to think of joint pain as something that just affects elderly patients, but you can get early onset arthritis as a result of trauma, sport or repetitive injuries. There are also juvenile and genetic causes of joint pain – such as psoriatic arthritis, which affects people with psoriasis; or sceptic arthritis, which is due to an infection.
Pain is experienced through three main categories. First, after trauma to tissues or when organ pain receptors transfer chemicals and impulses to the central nervous system, and the central nervous system transfers them to our brain. The other route is a trauma to the nervous system itself, which includes the nerves, the central spinal cord and the brain. The final category is when the nervous system is not working appropriately, so the brain perceives normal impulses as being painful.
We all share these common processes, but the level of impulses felt and the amount of chemicals released vary hugely, so the severity of pain experienced is different from person to person. On top of that, there are huge social, environmental, and genetic influences, as well as the impact of the way you were brought up.
Lower back pain is the biggest cause of disability across all age groups, and it’s estimated that eight in every 10 people will experience back pain at some point. That’s because the back is consistently and continuously in use; it doesn’t rest. Even when you’re sitting, relaxing, there will be some degree of tension in your back. The only time it rests is when you’re asleep, but even then it may be in a twisted position with your back muscles out of sync. Even within the NHS, we’ve only recently realised how important back care is for longevity. Ten or 15 years ago it was an afterthought and we’re seeing the consequences of that now.
The effects of work
The job you do has a major impact. If you’re a manual worker who does a lot of heavy lifting, that repetitive heavy work increases risk. On the other hand, being too sedentary can also be problematic. The musculoskeletal system is made up of the skeleton – so bones and joints, which can be worn down by repetitive movement – and the muscles around the skeletal system, which are there to try to protect it. By being sedentary, you may preserve your skeletal system to a degree, but if your muscles aren’t being used they’ll atrophy and you’ll get muscular issues that could cause pain, restriction in movement and a decrease in mobility. A simple way of looking at it is that lack of movement damages muscles, while excessive movement can lead to significant skeletal changes. Both too much and too little movement can cause joint pain, so you have to get that balance.
Why our weight matters
Studies clearly show that reducing weight reduces the risk of musculoskeletal disorders, particularly osteoarthritis in the hips and knees. There are causes of joint pain you can’t do anything about, like rheumatoid arthritis or psoriatic arthritis, which you’re born with, but you can influence your weight.
You can mitigate much of the effect of a sedentary lifestyle with a relatively small amount of activity. Even walking is beneficial.
For it to count, there has to be some degree of heart rate change, some degree of stress on the body, but that means different things to everybody. That aerobic conditioning increases blood flow and provides nutrients to the parts of the body that need it.
Because our professional lives are more sedentary now, many health-conscious people try to overcome that through extreme exercise – I see so many more people doing triathlons and marathons. I would never dissuade people from exercising, but too much of anything is bad, so take precautions. I tell my patients to start by simply incorporating exercise into their normal lives as much as possible.
Using your own body weight as resistance can improve joint stability. Websites like backpain.com and NHS Live Well have exercises to try. You can do arm exercises for shoulder problems while you’re sitting at your desk, or neck exercises while watching a movie, or you can lift your legs and hold them for 20 seconds while lying in bed to strengthen your lower back muscles – it’s as simple as that.
Diet-wise, vitamin D, calcium and fish oils are crucial. You need to avoid inflammatory foods, so that means high sugar content foods, additives and processed meats. Cod liver oil is beneficial to joints but also good for your heart and digestion, and we regularly check vitamin D levels in clinic because a lack of it can cause joint pain.
I find that no matter what we do, if problems to do with work/life balance aren’t sorted, we can’t treat pain effectively. Stress perpetuates pain, and pain perpetuates stress, so you can’t look at one without the other. Self-management techniques or CBT can help, but I always recommend relaxation, meditation and mindfulness.
Often patients come to see me and say, ‘This is my problem, what can you do for me?’ I think it’s really important that people know what they can do for themselves. You really can take ownership of the situation, and vastly improve it.
Dr Attam Singh is a consultant specialising in musculoskeletal and neuropathic pain at the London Pain Clinic. He regularly speaks at international conferences, and has organised medical outreach centres in rural India.
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