Health, Nutrition, Uncategorized, Wellness

3 Things people in pain want us to know

Taken from a great article on the pain revolution website.

3 things people in pain want us to know

” Jo’s words:

Please hear us,
The most important part of any therapeutic interaction is feeling heard. Too many people have answers for us before they even know us or our pain. We have seen the face you make when we want to tell you our stories, and the way that you want to cut us off because there’s limited time in the clinic. Remember that feeling like we’re an active participant in decision making, and that we have likes, dislikes and preferences, even in the face of pain is critical to us getting better. Listening is a skill – and one that we need to practice, not just in the clinic, but in our everyday interactions with people.

Know you can’t FIX us
Please don’t say you know exactly what’s wrong with us and can fix us. We’ve been to so many people who’ve made such claims, and none of them could. Tell us pain is complex and that we’ll figure out the way forward TOGETHER, as equal partners. When we’re in pain, we really want to believe you, that you do have all the answers, because life gets really big and heavy when everything hurts. Disappointment hurts too. Stick with the science, help us to understand the complexity, and make sense of our stories, and we’ll all do much better in recovering from persisting pain.

Please be a Human
Pain is a human experience. As much as you can, treat me as a friend. You don’t need to “be” my friend, but compassion is sadly lacking in pain care. Pain is hard, for both the person in pain and the person trying to treat them. If we can recognize the humanity in one another we’ll all be better off, on both sides of the equation.”

Full link below:

http://www.painrevolution.org/our-blog/3-things-people-in-pain-want-us-to-know

A huge thank you to Joletta Belton, who writes at http://www.mycuppajo.com for her expert input in to this post. Jo received her expert qualifications in pain through her own experience and recovery from persisting pain (although she did return to University to study it too!). She is changing the world of people in pain with the Endless Possibilites Initiative.

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Health, Nutrition, Uncategorized, Wellness

What is the difference between an Osteopath, a Chiropractor and a Physiotherapist?

The differences between osteopaths, chiropractors and physiotherapists can be difficult to differentiate between as they all seem to treat similar areas of the body and are drug free manual therapies. In this article we will attempt to make the professions a little clearer, citing their similarities and differences to help make the right choice.

When investigating the claims of the three professions it can be difficult to choose between the three as they claim to have similar systems of care. Below is a table comparing their philosophies.

Osteopathy Chiropractors Physiotherapy
The body has the natural ability to maintain itself and, by helping this process, an osteopath can promote restoration of normal function. The principle of osteopathy is that the well-being of an individual relies on the way that bones, muscles, ligaments, connective tissue and internal structures work with each other.An osteopath will take the time to understand their patient, and their unique combination of symptoms, medical history and lifestyle. This helps to make an accurate diagnosis of the causes of the pain or lack of function (rather than just addressing the site of the condition), and from that, to formulate a treatment plan that will achieve the best outcome.

They may also provide advice on posture and exercise to aid recovery, promote health and prevent symptoms recurring.

Osteopaths frequently work alongside other health professionals, such as GPs, nurses and midwives as well as alternative medical practitioners. Osteopathy works well to complement other medical interventions including surgery and prescribed medication.

(Institute of Osteopathy, GOsC)

Chiropractors are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system (bones, joints, and muscles), as well as the effects these disorders can have on the nervous system and general health. They have a specialist interest in neck and back pain, but when they assess patients, they take their entire physical, emotional and social well-being into account.Chiropractors use a range of techniques to reduce pain, improve function and increase mobility, including hands-on manipulation of the spine. As well as manual treatment, chiropractors are able to offer a package of care which includes advice on self-help, therapeutic exercises and lifestyle changes.

Chiropractic treatment mainly involves safe, often gentle, specific spinal manipulation to free joints in the spine or other areas of the body that are not moving properly. Apart from manipulation, chiropractors may use a variety of techniques including ice, heat, ultrasound, exercise and acupuncture as well as advice about posture and lifestyle.

(British Chiropractic Association)

Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice.

They maintain health for people of all ages, helping patients to manage pain and prevent disease.

The profession helps to encourage development and facilitate recovery, enabling people to stay in work while helping them to remain independent for as long as possible.

Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and well-being, which includes the patient’s general lifestyle.

At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment.

(The Chartered Society of Osteopathy)

Essentially, they are all non-invasive, drug-free, manual techniques, which aim to improve physical health and well-being.

In the UK, physiotherapy is most integrated within the NHS and consequently better known. There is no charge to visit physiotherapists on the NHS with referral via the GP but waiting lists can be long. Physiotherapists work both on the NHS and in private practice. Osteopathy is not as widely available on the NHS and the majority of osteopaths and chiropractors work in private practice, where no referral is needed.

What we believe to be essential here, regardless of profession is that your healthcare professional of choice operates of the best available evidence to treat your condition. A recent article on comparison between the three professions had Dr Andrew Leaver, Senior Lecturer in Physiotherapy at the University of Sydney pointing out that evidence-based practice is “not a black and white proposition”. It is important to understand that there is not enough robust evidence available for every condition.

Whether you see a physiotherapist, chiropractor or osteopath, Dr Leaver says the most important thing is that you find a practitioner who “operates under an evidence-based paradigm”.

“So physiotherapy is not a treatment — it’s the person who provides the treatment. And similarly, chiropractic is not a treatment — it’s the person who provides the treatment.”

What you want to avoid, he says, is somebody who makes false promises of a cure and takes too much credit for natural recovery. Correcting “misaligments” for example do not fit with the later scientific understanding of pain.

“You don’t want to be seeing somebody who is holding out a false promise of a cure with lots of interventional treatment — so somebody who does lots of things to you, rather than teaches you to do things for yourself.”

“You want to see someone who empowers you look after your own body, and to look after yourself, who teaches you good strategies for dealing with day-to-day pain,” Dr Leaver said.

The article featuring Dr. Leaver’s views can be found below:

http://www.abc.net.au/news/health/2017-03-16/physiotherapy-chiropractic-osteopathy-whats-the-difference/8360154

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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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