Welcome to some of our favourite topics to discuss with people when they come to the clinic. They might sound like familiar topics and there is a reason for that.
Sometimes it might take years for good, current and evidence based information to become accepted. Thankfully there is a sense of change and acceptance when referring to some of this info.
Firstly, it’s important to realise that all of this information might go against the general trend. But that is generally where we make progress. Something about you can’t make a delicious omelette and not break any eggs, right?
Secondly, due to the fact that some of this information might come as a surprise, we don’t blame you for questioning it. Questioning is good!
Thirdly, most of this isn’t even new information!
The problem is that old and fusty information keeps being recycled and recycled and recycled. I’m sure the individuals recycling the old and outdated (and in some ways dangerous) information have their reasons but here we think there isn’t really an excuse especially with access to so much information at our fingertips!
*I’m certainly not sitting here with a glittering halo on my head. I can remember giving some of this exact information to patients in the past. The difference is we’re now on (and have been for a long time now) a mission to change thoughts, feelings, beliefs and behaviours through education. Myth busting is a place to start*
What’s wrong with old and outdated information? The problem is this information can lead to altered beliefs and behaviours. Beliefs and behaviours influence how we live our lives.
One prime example being “I was told I shouldn’t bend my back when I lift something from the floor because it might damage my back”. At its most extreme, this is often interpreted as “if I move my back, I will be causing damage to it”.
Let us tell you, you absolutely do not have to keep your back straight when you bend down to pick something up from the floor. Recent research has not only found that to be untrue but some new research goes on to prove that potentially having a rounded back might even be preferable!
Lastly, this is a blog post. This isn’t medical advice and doesn’t take your past medical issues into concern. This is the exploration into better information. We hope you enjoy perusing and please feel free to contact us with any questions.
So here are a few of our favourites.
1. Lifting with a flexed spine is dangerous
We need to add a bit more information for this one. This one is a really common myth as mentioned above. Within healthcare we are still forced to attend “Manual Handling” training and unfortunately this outdated information exists within that too.
Lifting with a flexed spine is believed to increase the amount of force placed on the spinal discs increasing the risk of injury. The issue is most of the research used to back up this notion was performed on dead animal and human spines. Meaning you can’t transfer that data across to a living, breathing, moving individual.
Some studies have also found that having more of a back bend during a lift can actually reduce the force exerted on the discs! (Please refer to @adammeakins on his Instagram for more information on this – he did a great series on this at the beginning of this year (Jan 2021)).
We encourage you to take a look at some of the worlds strongest athletes lifting some extremely heavy items off the floor (deadlifting). Below is a link to Eddie Hall’s world record of 500kg – his back definitely does not remain straight.
https://www.youtube.com/watch?v=U4AQlamvFzs (deadlift at 2:13).
So feel free to move, twist, bend and load the back. The back (and the body in general) is built to do this.
2. The dreaded “P” word – posture. The cause of all of your pain!
To our fellow therapists, PTs, chiros, osteos and everyone working with people in pain out there, try this exercise. Think about the following from the last 7 days:
- The number of times you’ve heard the word posture from a client
- The number of times that you’ve heard the word posture linked to a cause of pain
- The number of times you’ve caught yourself thinking about your own posture
- The number of times you’ve caught yourself looking at someone standing or sitting “incorrectly”
- The number of posts you’ve read on Instagram or Facebook with content about posture
We just did the same and it was a lot. Too much? Quite possibly. So no wonder there is still conflicting information out there if we’re still doing this too.
So where did this obsession with posture originate and how does it stand up to today’s discussion around pain and myths?
Without falling too deep into the history of “posture” there appears to be roots from the military, finishing schools and societal demands, social class comparisons, world war propaganda and the health and fitness world such as Pilates (even a brief look is really interesting).
It is easy to see where this obsession has originated, deep routed in history and society. But what we term as “good” and “bad” posture is the myth. “Bad” posture causing our pain is another myth.
Take away the fact that even we as Physiotherapists can’t decide what “good” or “ideal” posture even is (https://pubmed.ncbi.nlm.nih.gov/22608170/), the scientific evidence does NOT support the theory that posture can lead to pain.
There is no ideal, perfect position for everyone to adopt. Instead we recommend finding a position of comfort for YOU. If you start to experience discomfort as a result of that, move to a new position. And so on. If you notice a trend, try to break that trend.
Posture does not cause your pain. Your pain might be exacerbated in various positions, but it is very unlikely they are the cause of your pain.
3. Your body is out of alignment
What is alignment? What is normal? Who decided how and what we should model ourselves on?
Firstly, similar to posture, there is no agreed “normal” or “ideal” alignment. So if we can’t decide on what is “normal” how do we define abnormal??
Secondly, attributing an individual’s pain from a purely mechanical stance is incredibly reductionist. Research has proven that diagnoses based solely around biomechanical problems have been greatly exaggerated.
As human beings we aren’t machines or vehicles that can be fixed by a tweak here or a crack there. Take away the fact that manual therapy and manipulations will only ever give you short term relief, people are a mix of physiology, neurology, biochemistry, psychology and much more. We exist with thoughts, feelings, emotions, fears and pain.
Symmetrical very rarely exists in real life, even in its most minor presentation.
Leg length discrepancy on average can range between 1-3 cm. Some people sit with a flexed thoracic spine. Some have more anterior pelvic tilt than others in standing. This is the beauty of being human. We are all different. And the best bit? We can all exist with these “abnormalities” with absolutely NO problem whatsoever.
For more info on this particular topic, click on this link. This chap summarises it nicely and in much greater detail. https://www.painscience.com/articles/structuralism.php
4. Quick Fixes
Our society has become accustomed to instant results. In most areas of life. Thank you Amazon Prime!
We have the internet at our fingertips. We can (usually) travel to the opposite side of the Earth in 24 hours door to door. We can search for and watch countless fitness and health related videos. We can contact anyone around the world and instantly have a response.
As amazing and incredible as all of this is, it’s altering our perception of what is achievable when it comes to our bodies. We’re expecting the same instant results when it comes to rehab and pain.
Although our health and fitness information is accessible with a few taps of our fingers, it fails to inform us of a cold hard truth – our bodies still require time. The narrative of “do this to fix this” or “the best exercise for …” is far too simplistic and designed to be that way to be applicable to a mass market.
Now of course there are exceptions to this. Some perceived issues can be sorted with a simple shoe insert or use of patella taping. We can achieve short term relief from manual therapy as stated above.
But in general time is your most valuable commodity. In general the body will do its thing, healing itself and we’re there to guide you through this. Sure, it can be a frustrating and long process but you can’t rush it.
On average, you can expect an injury to take 6-12 weeks to sort itself out. However some examples of the longer term rehab time-frames can include:
- Tendon rehab 3-6 months
- ACL reconstruction rehab 9-12 months+
So take your time. Enjoy the process along with the result.
5. You are your scan
Finally for this mini series of myth busters we present to you the myth of imaging.
The context surrounding this myth is important. So, for the purpose of this point, we should clarify. This represents the potential misinformation historically surrounding delivery of results from ultrasound scans, x-rays or MRI.
Every so often (more than we’d like) a patient will come through the clinic after receiving imaging and experience similar fear, anxiety and worry to the discussion earlier in this post.
This can be partly explained due to the context and delivery of information delivered post-scan. Often a scan is followed by a complete lack of information delivered so patients are left worrying about something that sounds quite serious or turning to Dr. Google.
For example a clinician might write “degenerative disc disease” on a report and leave it at that. That sounds scary!
Degenerative disc disease. Degenerative in itself is concerning. Using the word disease is even worse! But it is not a disease. This is the completely normal process of ageing within our body. Discs change as we age.
As we age, so does our body. I like the description of “in the same way our hair starts to turn grey on the outside, our bodies naturally age on the inside too”.
- It’s normal
- It’s natural
- It’s inevitable
- It’s not linked to an increase in pain
Of course, there are benefits to imaging. There’s absolutely no doubt in that. There are occasions, in light of possible serious pathology, where we need to scan!
However, evidence tells us that we can no longer rely on imaging alone to diagnose or locate a source of someone’s pain.
For the purpose of this post, we’ll skip over the fact that pain is incredibly complex and look at the facts. Have a look at the image below. This shows the number of changes that can occur in the body, seemingly dangerous or damaging changes, respective of age. The main point is that these changes exist in completely asymptomatic individuals.
Changes on an MRI scan do NOT correlate with pain.
So there are a few of the most common myths we discuss with patients and other healthcare professionals. To summarise:
- You can lift with a flexed back
- You can sit and stand in any way you like
- You are not out of alignment
- The body takes time sometimes
- Your scan results do not equal reality
Please feel free to get in touch with any questions or queries.
Until next time, stay safe!