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The Healing Process after Injury: Part 1

As you can probably imagine, we at the West 12 Health Centre have nothing better to do with our time than read, research and post content for those of you reading this (Kidding! Ok, maybe not totally). This post is going to address healing – the healing of injuries, more specifically musculoskeletal injuries eg muscles, ligaments and tendons. 

Before we begin though, we must stress that the timelines given for the healing of the tissues are rough guidelines that most people will fall into. Healing is a huge topic and is dependent on many, many factors that will vary from one person to the next. Generally, the fitter and healthier one is both MENTALLY and physically, the faster and more potential one has to recover. 

Generally, when visiting a manual therapist (chiropractor, massage therapist, osteopath, physiotherapist etc), patients will find that there is an almost instant relieving of pain and better function after the treatment. Miraculous cures are generally the exception and not the rule with most conditions following a natural process of recovery. Healing after injury usually follows three stages:

  1. Inflammation
  2. Repair
  3. Remodelling

All tissues (muscles, ligaments, bones etc) go through this healing process after injury. Times can vary depending on which tissue is injured. Generally, tissues that have an ample blood supply, such as muscles, tend to heal faster than tissues that do not have such a great blood supply, such as tendons and ligaments. Hence why we get those nagging tennis elbow injuries that never seem to go away, or achilles tendon problems that seem to last forever. 

Inflammation

As you know, after injury there is always that initial period where everything around the area seems really sore and sensitive to touch. This is when the inflammation process has begun and is coincidentally the time in which we take anti-inflammatory medications. Usually the process peaks 48-72 hours after injury, which is why pain often gets worse before it gets better

Inflammation is actually the bodies way of setting up the healing process. It makes the injured area very sensitive as it doesn’t want that area to be further damaged and what better way to do that then make the area so sensitive and sore that one doesn’t want to move it? During this time the area becomes really warm, especially the skin and you will generally notice swelling. The extra heat and swelling is partly due to the damaged cells and tissues but also due to the increase in blood flow to the injured area as the inflammatory process takes place. Blood carries everything needed to patch up the wound – platelets that clog up the area and stop the bleeding (scabs when skin is torn) as well as white blood cells which prevent and fight of potential infections entering the body. Any debris and damaged cells are carried away by the blood. Hence why tissues with an ample blood supply heal faster than tissues that do not. 

The inflammatory process is a vital one that sets up the body for further healing. It is also a time when we feel most sore and sensitive, hence the use of anti-inflammatories. Some argue that we shouldn’t take them, however the pain can often inhibit us from our daily activities and that is when they can be useful.

There can also be confusion over putting ice or using a warm water bottle during this time – ice is the preferred of the two as the cold makes the skin cooler, makes the blood vessels coming to the area smaller and reduces the inflammation and pain in the area. Hot water bottles do the opposite, although they feel nice when on.

Key points:

  • Peaks at around 72 hours after injury and by 2 weeks is significantly less
  • Pain often gets worse initially before getting better
  • Vital process for the setting up of healing and preventing of infection
  • Ice the area during this phase, do not use a hot water bottle

Repair

Thankfully our bodies decide to begin the repair process soon after the inflammation begins. As the inflammation peaks around 48-72 hours after injury, the real repair work begins as soon as the body has blocked and patched up the injury and peaks around 2 to 3 weeks later. From there it begins to taper off slowly but continues on for many months after the injury.

Louis Gifford, the physiotherapist and author, has written a great passage on this in this last set of books where he makes the point that although in the early stages after injury when we are really sore it is okay to take it easy, what really is important is that we are designed to heal WHILE WE ARE MOVING. He gives an example of a cut, where we don’t really pay attention to it and continue with our lives, not minding if it bleeds a little here and there. However, when we have back pain or other joint pain we stop completely, thinking that we are doing more damage to ourselves when in fact it is just the natural course of healing that it aches here and there. As time goes on the pain begins to die down and we can move more and more with less pain. His books Aches and Pains are a great read for all and something we would recommend.

Key Points:

  • Begins 2-3 days after injury and peaks at 2-3 weeks post injury
  • From 2-3 weeks post injury it slowly tapers off
  • Take it easy initially for a day or two
  • Most importantly – KEEP MOVING AS MUCH AS POSSIBLE even if it is sore
  • Most injuries will heal and pain will slowly decrease as we slowly regain our function

Remodelling

This brings us to the last stage in the healing process and is one that works in harmony with the repair phase as you will now see. The remodelling begins 1-2 weeks after injury just as the repair phase starts to ramp up but first a little information on the technicalities. Bear with us, it should be pretty simple to understand.

When we injure our muscles, tendons, ligaments etc as you now know inflammation begins as the first stage in our step to healing and does a great job by increasing blood to the area, removing damaged cells and other parts, while also providing protection from infections. These are just a few functions of a long list of inflammation’s jobs. The second phase – repair begins with what one might call it a bit of a shabby repair job, if one were a builder or plumber.

The body decides it needs to plug the injury as quickly as possible to prevent further injury, which is clearly a good thing, however the materials used are not very strong and they lead to the formation of scar tissues eventually. The fibres of the initial stop gap are not very strong or well organised, nor do they align or run in a similar direction to the rest of the tissue. The feeling we get is that of stiffness as a result as the scar is not particularly stretchy or strong. 

The best way to get stronger fibres to be laid down is to put progressive force or movement through the area consistently and as early as is safely possible into the repair process. The fibres then begin to gradually realign with the rest of the surrounding fibres along the lines of force being put through the area. To quote Louis Gifford,’Big point here is that this phase starts in the first 1-2 weeks and needs movement and physical stress to stimulate the shapening and neatening [of the fibres].’

A quick point to make here is that healing here is done by the formation of scars and continues for long after we stop feeling the pain and have returned to ‘normal’ activities. However, because of the scar formation, ultimately the injured area of the tissue does not return to the same strength as before injury. Although this does not mean that we cannot return to the pre-injury activites and train or compete at the same level as before the injury.

Key points:

  • Begins around 1-2 weeks post injury
  • Initial repair is like an emergency stop gap – stops further damage but not very strong or stretchy
  • Scar tissue forms and is not as strong as pre-injury tissue
  • Best way to strengthen area is to realign fibres of the scar by putting progressive and consistent force through muscle, ligament, tendon etc – DONE BY MOVING 
  • The important lesson – MOVE AS EARLY AS SAFELY POSSIBLE POST INJURY and SORENESS DOES NOT MEAN YOU ARE DAMAGING IT FURTHER. Start slow and light and progressively increase the load.

That is enough for this post, make sure to look out for part 2, which will focus more individually on the healing times and adaptation of muscles, ligaments and tendons. Keep moving and as always, if you have any suggestions, don’t hesitate to contact us. All the best.

West 12 Health Centre

 

Twitter: @West12Health

Facebook: http://www.facebook.com/west12healthcentre

 

 

 

 

 

 

 

 

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New Year’s Resolution Tips and Advice

We know you’re all probably well into your new year resolutions by now, or have totally given up on them, whether that is exercising more, changing your diet or attempting to change your behaviour in  general. So here at West 12 Health we have come up with a few tips and reminders to help you along with your endeavours.

Fad and Instant Weight Loss Diets

Does dieting really work? Well, we would all like to think so. The scale says you’re losing weight, but what is that weight actually made up of? 

No doubt you have seen the countless advertisements of diets mentioning ‘rapid’ or ‘instant’ weight loss. There is a huge market out there for slimming products, from shakes and snacks to gums and ketones. The problem is that they are not sustainable in the long term and are completely unrealistic. Let us explain why:

It is only physically possible to lose about 1 KILOGRAM OF FAT IN ONE WEEK – even when the body is severely starved because 1 kilogram of fat contains 1000 kcal a day for seven days under starvation conditions. So how is it possible then that when we step on the scales a week into our crash diet, we have lost significantly more? Well, although our intention is to only lose fat, fad diets that reduce our normal calorie intake too quickly in a short period of time end up with us losing water weight and lean muscle tissue too. The body is shocked by the reduction in calories and assumes that it is being starved – as a result it PRESERVES FAT  and BREAKS DOWN MUSCLE instead.

The problem here is then that we are not even close to accomplishing our goal – to lose just fat while maintaining muscle. We are instead breaking down the MOST ENERGY DEMANDING unit in the body – muscle. The complete opposite of what we want. As the body continues to think that it is starving, it breaks down the muscle tissue before the fat, as fat provides more energy, resulting in a lower metabolism and slow down of the fat burning. You may also feel very tired during this time due to the rapid reduction in calories and may be craving for certain foods. When the diet comes to and end, normally there is a rebound binge and the weight quickly returns to what it was, usually more than when the diet started. These are the yo-yo dieters and we recommend that you try your utmost to avoid ‘miraculous’ diets, potions and any other cures.

We suggest a long term behavioural change approach to losing weight. A slower, more progressive approach that involves changing the diet over a longer period of time to avoid cravings along with a progressive exercise regime. 

Weight Maintenance?

We will provide an interesting summary of information of the great achievement that weight loss maintenance actually is using a brilliant manual produced by the Weight Management Centre as a main source, along with other complementary sources. A section on weight loss and weight maintenance in this manual provided much food for thought and we thought we would try to break it down for you here.

Weight maintenance may seem like a bit of a strange suggestion but it could be described as being of more importance than weight loss. If we cannot maintain our weight once we have lost it, whats the point in beginning with the weight loss at all? Results of surveys indicate that only ≈20% of people in the general population are successful at long-term weight loss maintenance. Evidently it is a difficult task but a sizeable amount of people do achieve it every year.

What about the emotional impact of having lost it, only to regain it, rather than maintaining what we have? Failed weight loss/dieting often leads to greater total body fat than before the attempted weight loss due to the drop in self esteem at failing to reach and maintain targets and then a return to old pre-weight loss habits.

There are various reasons why weight that is lost is regained:

Plateuing – We can’t lose weight forever. If the weight loss slows and we don’t achieve a target weight we have set, those feelings of failure damage our self esteem and belief that we can lose weight at all. The failure is closely related to body self-image, confidence etc and may affect future attempts to change behaviour. It is important to recognise that there are many other targets we can strive for other than weight loss which would then help with the acceptance of maintaining weight and improving our health, such as increasing active periods, exercise times or changing dietary habits.  These are all realistic, achievable goals.

Weight Loss Maintenance is not acknowledged – Not achieving weight loss goals often has a knock on effect mentally that stops them from acknowledging any losses in weight or any other gains/goals they may have achieved, as maintenance is not even a consideration at this point and any attempt at losing weight is done away with.

According to the Weight Management Centre, weight maintenance is the key to success and that developing and practicing weight management skills (distinct to weight loss skills) is crucial. This can be helped by setting more realistic goals when losing weight initially and learning to accept things that can and cannot be changed. Once the weight loss phase is complete, we must accept stabilising our weight rather than continuing weight loss.

Goal Setting – Psychologically, maintaining our weight is more difficult for three reasons:

  • maintaining is not losing, so others are less encouraging
  • losing weight is a much more short term, time limited goal, compared to maintaining weight
  • weight maintenance may involve accepting our weight and body shape that was previously regarded as unacceptable

Therefore, we must remember to CELEBRATE and SUPPORT WEIGHT LOSS MAINTENANCE, just as much, if not more than weight loss. It is difficult to achieve in today’s society where there can be a lot of pressure to look a certain way.

Once we have learned how to maintain weight after losing it and understand that they are separate challenges, it is easier to then attempt further weight loss again in the future.

The importance in the planning of weight loss and maintenance then is a key aspect for those of us smashing away at the treadmills in January, desperate to change our bodies. Here is a quick list of tips:

  1. Set appropriate goals – weight loss is not forever, so when it begins to slow down, remember that the body is adapting and so you must adapt by maintaining your weight to avoid putting back on what you have lost.
  2. Good nutrition is key – Speak to an expert (dietician/nutritionist) before embarking on your journey as often following quick and instant weight loss diets found in magazines, papers and on the internet are impossible to stick to long term. You may also be doing yourself more harm than good by losing lean muscle mass. Too much of any macroingredient in the diet is not good, so beware of diets that have a huge amount of PROTEINS, CARBOHYRDATES OR FATS. The aim is a healthy balance between all three. 
  3. Physical activity is a must – The benefits of exercise go far beyond the physical and can change out psychological state too, making us feel better about ourselves. It is an important predictor of weight loss maintenance along with the healthy eating.
  4. Don’t be obsessed with the numbers on the scale – Remember that it is only possible to lose roughly 1 kilo of FAT per week and that is what we are aiming for, not loss of muscle tissue and an excessive amount of water. Muscle weighs more than fat so getting a more detailed composition of our body is more accurate an assessment.
  5. Don’t listen to the crowd – Know that everyone is on their own journey to get to their desired weight. It takes time for your body to change. Remember that weight loss maintenance is just as important, if not more than weight loss – as it is whether we maintain our weight that will determine whether the attempt at losing it was a success or futile activity. Studies illustrate that the single best predictor of risk of regain was how long participants had successfully maintained their weight loss. Individuals who had kept their weight off for 2 years or more had markedly increased odds of continuing to maintain their weight over the following year. So remember this is long term, for life and not for the short term – 2 YEARS, THE MAGIC NUMBER.

WEIGHT LOSS MAINTENANCE then is something to be encouraged and celebrated. The health benefits of losing weight and keeping it off are well documented. All that is left to say is good luck, we hope this helped to provide a different insight into your goals for the new year. All the best.

West 12 Health Centre

 

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Hi there folks, we hope you had a good Christmas here at the West 12 Health Centre and would like to wish you a Happy New Year. To continue with our previous post we think it would only be fair to explain some of the theories behind the inevitable weight gain we all experience this time of year in particular.

64% of adults in the UK are overweight or obese (BMI >25 and >30 respectively), interestingly though people may fail to recognise their own weight gain over time as well as their weight problems (Ziebland et al, 1996). This is surprising as the physical and psychological risks of excessive weight gain are well documented. It has also been recognized that such risks to health occur with any level of weight gain. Increases of less than five kilograms have been found to be associated with increased disease load, even for those within a healthy BMI range (18.5-25)(Lim, et al., 2008; WHO, 2000).

The easy explanation for weight gain is having too much energy intake from food and not enough burning off of this energy via exercise and physical activity, we all know that. We also know that it must be more complex than that otherwise it wouldn’t be such an issue! For the purposes of this article we will concentrate on early biological factors and briefly, environmental factors that contribute to weight gain.

It is important to begin by stating that a fluctuating body weight is normal for most adults throughout their lives. Even those who appear to maintain a stable weight  fluctuate above and below their ‘preferred’ weight. Just like any other system, when there is a change that disturbs one’s weight, the body has mechanisms that attempt to restore our weight to a set value. Clear examples of this are seen in those who have starved or recovered from food shortages post-war (Keys et al, 1950) and in pregnant women, who return to their initial weight post-partum (Garrow, 1974).

One theory that follows this train of thought is the set point theory. It states that each of us has a preferred weight that is genetically programmed in our bodies and is a weight that we would prefer to maintain under normal circumstances. This theory works well with muscle tissue, as after famine or stopping of bodybuilding, lean muscle mass returns to its initial levels. Fat mass however, is less well behaved as it acts as a buffer to store energy for times it may be needed. In order to understand why it is important to understand how our fat develops from an early age to adulthood.

Firstly, we are all built differently genetically and we all inherit different body types and shapes. What we know is that the number of fat cells is a major determinant for the fat mass of adults. The number of fat cells stays constant in adulthood in lean AND obese individuals and is set during childhood and adolescence (Spalding et al, 2008) and this begins with what we inherit.

The likelihood of children being overweight or obese when one or both of their parents is obese is significantly higher. A child with one obese parent has a 50 percent chance of being obese. When both parents are obese, their children have an 80 percent chance of obesity. How much of that is genetic and how much of that is due to our environment is still under discussion (24-77%) (Wardle et al, 2008). A key reason is that overweight/obese parents are more likely to raise their children in an obesogenic (fattening) environment.

Secondly, there are key moments in our childhood where the number and size of our fat cells are determined:

  1. Ages 0-2 years – A growing child has a huge increase in the number of cells at this age, therefore being overfed or being overweight here increases the number of cells dramatically. This clearly depends on genetics, birth weight, how the mother fed during pregnancy and how much/what the baby is fed etc. Breast fed babies grow at a slower rate than formula fed and this may contribute to weight in later life (Ziegler, 2006). If the mother has conditions during pregnancy, then these may increase the babies likelihood of being overweight. Early life is CRITICAL for healthy development.
  2. 5-7 yearsAdipose Rebound – This is the age where  a child’s body fat reaches its lowest point, along with the body mass index (BMI), before it increases. An early rebound (before the age of 5) is associated with an increased risk of overweight and has shown that adult obesity occurs more frequently in children who have early adipose rebound (Rolland-Cachera et al 2006)
  3. Age 9 -13 years (puberty-adolescence) – Going into puberty is the time when there is more emphasis on an increase in the size of the fat cells that we already have in the body. Too great an increase in the size of these fat cells leads to resistance to insulin. Insulin resistance may be linked to increased cardiovascular risks as well as diabetes. If children reach this age overweight, they have a much higher likelihood of being an overweight or obese adult. Interestingly, girls may be at particular risk for adult obesity if their disease is present or develops during adolescence, and that adolescent-onset obesity in females may herald a lifelong problem (Dietz, 1994). Boys more than girls, appear to deposit fat around the belly (read our first post for more info) and lose fat peripherally as they mature. Increased belly fat in obese adults predicts heart disease, hypertension (high blood pressure), and hyperlipidemia (high level of fat in the blood). These effects contribute to glucose intolerance and type 2 diabetes.

It is clear to see childhood is very important for the development of weight gain in adults. The environment (including diet) in which children are raised is just as important, if not more important than the genetics we gain from our parents. A large responsibility therefore rests on the parents, who of course are feeding their children but cannot be held solely responsible. Schools and government etc must also attempt to educate parents and society in general about the importance of good nutrition throughout childhood (and life in general) as it clearly impacts adulthood and therefore society as a whole in the future. Overweight and obesity is costing the UK nearly £50 billion a year when taking into account all the problems related with being overweight or obese…£50 billion…

Back to the subject, children raised in an environment where they are exposed to being overweight or obese is known as an obesogenic environment. It is defined as “an environment that promotes gaining weight and one that is not conducive to weight loss” within the home or workplace (Swinburn et al, 1999). This environment leads to a vicious cycle in children/adolescents who gain excessive weight because they have:

  1. Low physical activity level
  2. Insulin resistance
  3. More fat cells produced
  4. Hormone problems causing increased hunger
  5. Lower self-esteem
  6. Poorer sleep – disrupting appetite further and increasing fatigue
  7. Socioeconomic disadvantage – reduced social and economic opportunities, increased discrimination in workplace, health care etc

It is easy to see how this can become a constant vicious cycle that is very hard to break out of and is one that often continues through to adulthood. It is a complex issue that is misunderstood, with public response often being ‘stop being so lazy’ or ‘exercise more and go on a diet,’ when the truth is that it is not as simple as that for many of us. For more, have a read of this great article on the subject:

http://www.latimes.com/science/sciencenow/la-sci-sn-eat-less-more-obesity-20150212-story.html

Some suggest that the environment is now overriding genetics. This is seen especially when these ethnic groups (African and South Asian) enter western society and show high increases in their BMI due to the high fat, sugar and dense food combined with lower levels of physical activity. South Asians have a lower healthy BMI and waist circumference size due to their ethnicity.

Now to throw a spanner in the works – Epigenetics. I realise this is probably a term most people haven’t come across so we will try to make the explanation more understandable without all the scientific jargon.

Not until quite recently was it thought that everyone’s DNA was hardwired.That we all got a mix of genes of some sort from our parents and that nothing we ever do in our lifetime will alter our DNA and that it would be passed on unchanged to our children. However, with epigenetics, we now know that just having a gene for something (like obesity) doesn’t mean that it will be expressed.

Epigenetics looks at how our environment and external influences can affect our gene activity WITHOUT changing our actual DNA. It suggests that our lifestyle choices and diet at ANY AGE can change how our genes are expressed and therefore change our observable characteristics like physical appearance, physiology, behaviour etc.

The most famous of these epigenetics studies is called Avon Longitudinal Study of Parents and Children, which has monitored 14,500 families since the early 1990s. The on going study has found that:

  • the lifespan of grandchildren seemed to be influenced by their paternal grandfathers’ access to food, particularly during the grandfather’s slow growth period – that is between the ages of 9 and 12 before they reached puberty. Children tended to live longer if their grandfather had endured food scarcity during this particular time of life.
  • Additionally, grandsons of grandmothers who smoked, even if their mothers didn’t, were bigger.
  • Meanwhile, that men who had started smoking before they were 11 had sons who were more likely to be obese by the time they were teenagers.

Therefore, the message is – whatever we do not only affects our lives but the health, behaviours etc of our future generations. The positive is that we can affect our gene expression and can change no matter what we inheritSo for all of you sitting there cursing your parents and your grandparents for certain traits, there is always hope and possibility to change, no matter your circumstances, especially weight gain…and there is no better time to start than now.

Well…that was a bit of a marathon, we know, we know…well done for getting this far, we hope you enjoyed our second post. Look out for another soon and have a great start to the New Year.

West 12 Health

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References

Dietz WH. (1994). Critical periods in childhood for the development of obesity. Am J Clin Nutr. . 59 (5), 955-959.

http://www.bbc.co.uk/news/health-25576400

http://www.bristol.ac.uk/alspac/news/2005/71.html

http://www.latimes.com/science/sciencenow/la-sci-sn-eat-less-more-obesity-20150212-story.html

http://www.theguardian.com/science/2014/sep/07/epigenetics-heredity-diabetes-obesity-increased-cancer-risk

Garrow, J. Energy balance and obesity in man. New York: American Elsevier, 1974.

Keys, A., Brožek, J., Henschel, A., Mickelsen, O., & Taylor, H. L., The Biology of Human Starvation (2 volumes), University of Minnesota Press, 1950.

Lim, S. S., Norman, R. J., Clifton, P. M., & Noakes, M. (2008). Losing weight through lifestyle modification: A focus on young women. In A. B. Turley & G. C. Hofmann (Eds.), Life style and health research progress (pp. 155-181). Hauppauge, NY: Nova Biomedical Books; US

Rolland-Cachera MF, Deheeger M, Maillot M, Bellisle F. (2006). Early adiposity rebound: causes and consequences for obesity in children and adults. Int J Obes (Lond). S11-7.

Spalding KL, Arner E, Westermark PO, Bernard S, Buchholz BA, Bergmann O, Blomqvist L, Hoffstedt J, Näslund E, Britton T, Concha H, Hassan M, Rydén M, Frisén J, Arner P. (2008). Dynamics of fat cell turnover in humans. Nature. 453 (7196), 783-787.

Swinburn B, Egger G, Raza F. (1999). Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity.Prev Med. 29 (6 Pt 1), 563-570.

Wardle J, Carnell S, Haworth CM, Plomin R. (2008). Evidence for a strong genetic influence on childhood adiposity despite the force of the obesogenic environment. Am J Clin Nutr. 87 (2), 398-404.

World Health Organization [WHO]. (2000). Obesity: preventing and managing the global epidemic. Geneva: World Health Organization

S Ziebland, M Thorogood, A Fuller, J Muir. (1996). Desire for the body normal: body image and discrepancies between self reported and measured height and weight in a British population. J Epidemiol Community Health. 50 (1), 105-106.

Ziegler EE. (2006). Growth of breast-fed and formula-fed infants.Nestle Nutr Workshop Ser Pediatr Program. 58 (51-9), 59-63.

Health, Nutrition, Uncategorized, Wellness

Ideas and Important Ages for Weight Gain

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