All posts by Andrew Rowe

Does too much exercise cause back pain?

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Sometimes you wonder about scientists. Do they want their research to be understood? Or do they want to cloak it in mystery? One study, published quite a number of years ago (2009), sounds like the title of the latest instructions from a piece of drainage kit from Plumbers World: ‘Physical activity and low back pain: a U-shaped relation’ [1], The authors are assuming that the readers are not about to unblock their sink, but are actually epidemiologists with an enthusiasm for descriptions of graphs.What our Dutch researcher friends are attempting to get across is that if you look at a graph of the incidence of low back pain after physical activity you will see that it is U-shaped. According to their study of 3364 subjects, people who exercise minimally have a higher incidence of back pain, but so do people who engage in more strenuous exercise. Those doing moderate levels of exercise have the lowest levels of back pain.

Your spouse understands this intuitively when he says: ‘In a bit love, my back is playing up’ when you ask him for the third time to put the bins out. He thinks that he is engaging in strenuous exercise, whereas in reality he does almost no exercise. So, it’s little wonder that he gets back pain.

Our spouses all believe that their thinking is correct. But is it? A recent paper [2] suggests otherwise. These researchers, from Portsmouth University, studied 5802 people over 50yrs old, and found that the only level of exercise that reduced the incidence of musculo-skeletal pain was a high level of exercise.

So, it seems that you would be justified in informing your poor spouse that if, in addition to taking the bins out, perhaps he could also cut the grass and trim the hedge? He might get a bit less back pain!

Furthermore, the same recent study found that being overweight increased the risk of suffering from musculo-skeletal pain, as did poverty, and being female. There are plenty of societal issues for us to address.

I’m just off to put the bins out……..

btw…. these studies are all looking at groups of patients and seeing what is best ‘in general’. You cannot simply apply group statistics to an individual. There are, of course, individuals for whom doing high levels of exercise will cause more problems. So, get some individual advice if you are thinking about launching into a new physical exercise regime!

  1. Heneweer, H., L. Vanhees, and H.S. Picavet, Physical activity and low back pain: a U-shaped relation? Pain, 2009. 143(1-2): p. 21-5.

2. Niederstrasser, N.G. and N. Attridge, Associations between pain and physical activity among older adults. PLoS One, 2022. 17(1): p. e0263356.

Can you run faster with these?

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I’ve never been a very fast runner. My Parkrun speed is only 6.2 mph. Mostly I run for the mood ‘high’ that running gives me. I reckon that Jill, the family guinea pig, can run faster than me (size related). Guinea pigs can run at speeds of up to 8 mph! How come they can go so fast? Looking at some of the tech in running shoes might help us to understand why. There was a great article in the British Journal of Sports Medicine about this. Lets look at the Nike ‘Vaporfly’, which is claimed to help us run up to 6% faster! This is due to three design changes:

Firstly a carbon-fibre plate that shifts the point of lift-off forwards, increasing the upwards and forwards forces of lift-off, much like the long foot of a guinea-pig!

Secondly: more springy foam in the sole, returning 32% more energy, a bit like the elastic tendons in a guinea-pigs leg.

Thirdly: a thicker sole, increasing stride length and improving efficiency.

If my legs were longer, maybe I would be able to run faster? If Jills were too, perhaps she also could. Now that would be scary! My own running shoes are made by Saucony. They are currently extremely muddy, having just come back from a run to Culham, and back, via a very muddy riverbank!

#runningshoes, #nikevaporfly, #runningfaster, #teeter-tottereffect, #parkrun, #chiropractor, #abingdonchiropractor, #abingdonchiropracticclinic, #chiropractornearme, #chiropractorabingdon

A 45-yr old lady with mid-back pain

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A few weeks ago I did a cycle ride from Bath to Bristol. I cycled down to Didcot and took my folding bike on the train to Bath to meet up with Alex, (the older son). While I was waiting for him outside Bath station I popped into the bike shop there (it’s brilliant, btw) and bought a mini-pump, just in case we had a puncture. 

The mini-pump got me thinking about the first patient that I ever saw, while I was a student chiropractor down at the AECC college in Bournemouth in the mid 1980s. This lady was in her mid forties and had back pain, in between her shoulder blades. She was a smoker and did enjoy a glass of wine…. I thought that she had a problem with her thoracic spine, but with the benefit of hindsight, she probably didn’t. Mid-back pain is often caused by reflux of the acidic stomach contents up the oesophagus, and by stomach ulcers. The acid in the stomach is produced by parietal cells that ‘pump’ acid into the stomach to help with food digestion. This is why the mini-pump made me think of this patient!

These days there are some pretty effective medications called ‘proton-pump inhibitors’, that reduce the amount of acid in the stomach. A common one that you may have heard of is Omeprazole.  They are very safe, and they are effective in the treatment of the symptoms of acid reflux and stomach ulcers. However, like all medications, they have some downsides. Long-term use increases the risk of osteoporosis and fracture risk. They can also increase our risk of cardio-vascular events.

So what can we do, aside from taking these medications to minimise stomach acidity symptoms? Avoid anti-inflammatory medications  if you have reflux symptoms, because they may aggravate the issue. There was an article in the BMJ last year that made the following suggestions: 

  1. Avoid foods that precipitate reflux: coffee, alcohol, chocolate and fatty food.
  2. Avoid foods that irritate the stomach: citrus, carbonated drinks and spicy foods
  3. Avoid eating late, eating large portions, and avoid smoking. Lose weight

When chiropractors see patients with gastric and reflux issues we will often find tenderness in the mid-thoracic region as well as in the neck (more commonly the right side of the neck, I think). Interestingly the neck is the origin of the phrenic nerve, which both sends information to the diaphragm as well as receiving information from it . The diaphragm helps to prevent gastric reflux. It would be nice if treatment to the neck would help the phrenic nerve to control diaphragmatic function normally, resolving reflux problems, but sadly, this is not the case.

I do wonder, sometimes, whether we can improve the ability of the diaphragm to prevent reflux  by increasing our diaphragm tone through singing. I never did ask my patient back then to sing in the shower. Perhaps it would have helped her? Proton-pump inhibitor medications weren’t available back in 1985, but I think she probably would have benefitted from some lifestyle modifications!

Alex and I did make it to Bristol. It’s only about 14 miles. You ride through Staple Hill Tunnel which is slightly eerie, but dramatic. Someone was playing their trombone when we cycled through. We didn’t have any punctures, so the mini-pump didn’t get used on this trip. But it’s good to be prepared!

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