View from a Physiotherapist’s desk…

It’s a cold day in February, we are in the midst of lockdown #3 and the 2021 Spring bulbs are pushing their way up through the wet soil. These monthly articles are a mixture of specific Physiotherapy advice, research findings and general health and well-being information. Last month it was common wrist problems and at the back end of 2020, overviews of recovering from injuries and important stretches.

They are diverse in subject because modern Physiotherapy involves a holistic – ‘overall’ – view of our health; long gone are the days when we simply rubbed a sore muscle and left it at that. So thinking holistically this month, we’re looking at the view from my desk – from left to right the contents of the five bits of paper pinned above it and why I think they’re relevant enough to be there. (The snowy view above is recent and local but is definitely not the actual view from my desk.)

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1. ‘Physical activity benefits for adults and older adults’

Is it just me or is this a really bland and boring title? Most of us know that exercise is good for us. In this age of information we have heard that ‘activity improves sleep’ and ‘manages stress’ and ‘reduces our risk of getting a nasty disease’ many many times, in many different ways.

Physiotherapist’s are frontline in getting people moving, be this to rehab an injury or in a more general sense. So the reason I have this slightly annoying piece of paper pinned up is because it is so important. Because beyond the worries, tasks and preoccupations of the right here right now, looking after our bodies and by association our minds, is really important. If we want a better, happier and more fulfilling life it’s important. It actually is that important.

But how can we better link the dry and dusty science to our lived-in experience? The answer to this is most likely a little different for each of us but it can be based on trust and experience.

The Trust bit…

Evidence-based medicine is not perfect but it’s hard to argue with the enormous library of researched, reviewed and critiqued evidence that says what this piece of paper says. I don’t want to suffer the debilitating effects of dementia or diabetes somewhere down the line. The heightened stress and tiredness that life and lack of sleep can bring are not things that I want running my life. My quality of life is worse when my back seizes up because I’ve sat around too much. So – to keep suffering, or trust the evidence? My method, with a long-term view, is to cheerfully/gently coax myself to/give self a stern talking to and go for a run or sweat through a fifteen minute online workout. Some people walk the hills, others ride bikes, do Pilates or kettlebell workouts, dance, climb rocks, chase grandchildren, and more.

The Experience bit…

Over time the benefits of this trust form a reliable bank of memories. Getting moving becomes a habit, you gain experience and the benefits become believable, even if a degree of self-discipline is still required! Getting your heart rate up requires effort, yes, but frankly the problems associated with not getting active are grim. The hard evidenced truth is that boosting your activity is – for you – worth it.

2. Dermatomes and what they mean for you

I have these colourful people pinned up because frankly I can’t always precisely remember the details shown. And this slightly techy-looking image of the front and back of a lined and shaded human body is relevant to you because it helps explain a little about how our nerves work and why they can be covert problem causers.

Explanation:

Any two of the black lines drawn on the body demark the skin (dermatome) area served by the nerves that originate at that level in your spine. As an example, let’s look at ‘L4’, where ‘L’ = ‘lumbar’ i.e. lower back and ‘4’ = level 4 of 5 in the lower back (enlarged in the pic).

The area served by L4 nerves covers across your lower back, across your bottom, down the sides of your hips, to the front of both thighs and knees and into the inside of your calves and feet. When the nerves at L4 are ‘talking’, a feeling or lack of – tingling, pain, warmth, numbness, cold, ache and others – can be experienced anywhere in this area. This helps explain why a sensation in your calf or foot or thigh or hip or bottom can be – by no mean always but can be – caused by a problem your back. The lines are approximate guides; there is considerable overlap at most of them and we will each show individual variation too.

The takeaway points?

We are complicated beings with no body part existing in isolation. The source of pain isn’t always where we feel that pain (though detailed assessment is necessary to establish if this is the case). And we are all unique: my back/neck/rib/leg pain is not the same as yours. So while Physiotherapists see common conditions and repeating patterns, everyone needs to be looked at with fresh eyes and treated accordingly.

3. Pain Explained

I’ve covered the epic topic of ‘Pain’ a couple of times. It’s complicated but this third piece of A4 helps keep the salient points clear in my head. I’ve condensed the points to explain pain and demonstrate what we know, whilst humbly bearing in mind that there’s an awful lot for us still to find out.

Any and every experience of pain is completely normal, very personal and always real. Pain is but one of the many protective outputs that your body is capable of – thoughts, emotions and immune responses are amongst the many others.

Though it may not feel like it, we humans don’t have specific sensors for pain. Instead we have danger sensors. Your brain will generate pain if it interprets the incoming ‘danger’ information as pain. Any pain experienced works on a sliding scale: the more danger your brain perceives, the more pain you are likely to feel. This pain needs context and can be influenced by many things, including what you see, smells, sounds, memories, beliefs, people, situations and more. Related to this, it’s relevant to remember that pain and actual physical damage rarely relate – you can have one without the other.

Our nerves and our whole nervous system is bioplastic, meaning that it can change. This is a point of huge relevance and optimism to many, if not most of us. As a result our personal experience of pain can be dialed up and down – it changes – over time, as our essentially malleable brain changes. Knowledge of this and of how pain works is power and a form of therapy. Knowing that we all suffer with pain in different ways and to different degrees at different times can help demystify pain and make it easier to deal with. With understanding comes a reduction in fear.

And when you understand you are better placed to plan, treat, cope with and reduce pain. Taking this active stance aids recovery, be the pain a metaphorical thorn in your side, a cut finger, a broken leg, the diffuse pain of a long-term health condition, or a broken – and fixable – heart.

4 & 5. Connection to others

The last two pieces of paper are as much about Physiotherapy and the world we live in as they are obviously personal to me. At any time, and particularly in trying times, we all need to feel connected in some way to others. Mental health problems will likely at some point touch us all and I regularly see clients whose physical problems are to a greater or lesser degree a reflection of what is going on in their head.

Positive visual reminders can help keep us tapped into a sense of no one – not even you – being an island. My son drew the big yellow sunshine some years ago. He wrote the ‘Z’ of his name backwards when he was still in the early stages of learning to write. The card suggesting that cake is on a par with a good bout of exercise (but is it?!) makes me smile and reminds me of the connection that I have with the friend who gave it to me.

Lockdowns don’t last forever and nor do we. What view can we all take to better enjoy our days and connect with others? Circling back to that first piece of A4, getting outdoors, with or without company, and getting active is one way. Connecting with others in whatever way you can is important. A slab of cake? Pretty satisfying, especially enjoyable after a good stint in the outdoors and even better when shared.