Entries by Tobias Hall

Pain As A Language

Pain As A Language

Pain As A Language

Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display.  

But symptoms can be incredibly hard to live with. In fact, the symptoms of mental and physical health challenges are among the pillars of the worst human suffering. Life can throw a lot at us. But only the very worst of it is a match for the incredible suffering caused by our bodily symptoms. 

It’s easy to overlook the fact that it’s mostly symptoms that we suffer from, as opposed to the diseases themselves.

The suffering of extreme thirst is primarily due to the body pushing us to find water, as opposed to the dehydration itself. 

The pain we associate with broken bones comes from nerve impulses, signalling the fact that it’s no longer safe to bear weight. The break itself isn’t intrinsically painful.

When there’s malaria in the body, we don’t feel the parasite itself. We feel the discomfort of the body’s reactions to the invasion and its attempts to fight it off. 

The discomfort of vomiting is caused by the violent but essential act of toxins being expelled. It’s the body’s mechanism that causes the extreme discomfort.

When we have a weak core, pain is the spine’s attempts to tell us it isn’t being supported properly. Having a weak core isn’t a painful event in itself.

Experientially, it’s symptoms that cause much of the suffering we associate with our health issues. So it is understandable that we tend to get caught up in approaching them as if they are a  problem in and of themselves. 

Our symptoms are either specific messages from the body about problems it faces. Or the unavoidable consequences of trying to deal with those problems.

Yet, at a less emotional level, we all know that symptoms like pain are the body’s way of communicating with us about ‘stuff going wrong’. 

As inhabitants of bodies, we are at the steering wheels of the most complex vehicles in the known universe. Yet, there is only a certain amount of control we have over the vehicle. Most of us can scratch our noses at will. But it’s not so easy to suppress tumours, synthesise proteins and fight viruses at will. Those are all jobs only the body knows how to perform.

So, we live in this body where we have some level of control. But there are a great many other areas where only the body has control, and other areas still where there’s an overlap between what the body can do and what we need to do to support it. In this overlapping realm, our bodies communicate to us very intentionally with symptoms. Being hungry is a good example of this. The body knows how to nourish itself, but only we can do the eating part. So, it signals us with hunger. Burn healing and prevention are similar. The body can heal cells after a burn, but only we can remove our hands from the hot stove. So, it signals us with pain. These collaborations between us and our bodies are only made possible by the language of symptoms.

The pain of a hot stove is the body highlighting the part we must play in preventing and resolving burns. While chronic pain is the body trying to communicate many far more subtle needs like a need for more movement, muscle strengthening, scar tissue to be broken up, chronic inflammation to be cleared from tissues, meniscus repair, stress management, or even a need for old emotional traumas to be processed therapeutically.

So, while pain is an unbelievably difficult symptom to navigate, it remains part of the ‘symptom language’  the body speaks when it needs us to take action. Remembering this in the background of all the inevitable days of suffering is one of the keys to finding freedom from pain in the long term. Because if we are only focused on ridding ourselves of the symptom, we are unlikely to give enough energy to resolving its underlying causes.

pain medication

However, there is another common perspective on chronic pain as a symptom. Orthodox Western medicine approaches chronic pain as a mistake that the body is making. An over-activation of pain and inflammation pathways for ‘no good reason’. A ‘body language’ gone wrong.

This approach presumes an absence of underlying dysfunction behind chronic pain and that chronic pain is a problem all of its own. A red dashboard light flashed, but there was no problem with the vehicle’s mechanics.

This is the core belief that justifies the long-term use of methods that ‘kill pain’. In the same way that we kill bacteria with antibiotics. Except we rarely take antibiotics long-term.

However, there is another common perspective on chronic pain as a symptom. Orthodox Western medicine approaches chronic pain as a mistake that the body is making. An over-activation of pain and inflammation pathways for ‘no good reason’. A ‘body language’ gone wrong.

This approach presumes an absence of underlying dysfunction behind chronic pain and that chronic pain is a problem all of its own. A red dashboard light flashed, but there was no problem with the vehicle’s mechanics.

This is the core belief that justifies the long-term use of methods that ‘kill pain’. In the same way that we kill bacteria with antibiotics. Except we rarely take antibiotics long-term.

There may (or may not) be some validity to this theory of chronic pain as a ‘mistake’. A symptom gone wrong. It’s certainly up for debate. But two things are for certain.

Firstly, ‘chronic pain is a mistake’  is an unproven theory, as opposed to a scientific fact. It is entirely possible that chronic pains are valuable feedback about all sorts of persistent mechanical and environmental issues.

Secondly, this theory has monumentally failed to ignite healing of the global epidemic of chronic pain that has been ballooning for the past half a century. And in many instances, it has made things significantly worse. 

What if it is not pain that goes wrong? What if it is us? What if chronic pain is just as instructive and caring as the acute pain of touching a hot stove? It is entirely possible that every single pain is a message that needs to be heard. What if some pains mean ‘too stressful’, ‘too weak‘, ‘not enough movement’ or even  ‘let it go and forgive so and so’? Depending on your experience with health and wellness, these may seem like improbabilities, but they are at least worth considering.

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Pain As A Language

Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display. 


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John is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all,  Let alone the type of running required to play competitive soccer against younger men.


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Free

Free

Free

We long to bepain-free. Because physical pain is somehow the exact opposite of physical freedom, it places terrible limitations on the variety, quality, and vibrancy of the life we are able to lead.

Living with chronic pain can feel like being ‘trapped‘. Not by bars or restraints but by invisible, internal knots and blockages. Knots and blockages that can seldom be seen, felt, or fully understood by others. 

Chronic pain sufferers tend to look like everyone else from the other side of the room. But when you really take the time to hear their stories and listen to what their lives are like, a very different picture emerges. 

On the day of writing this, I spent two nearly identical hours with two different ladies, who are both less than 35 years of age. Both appear perfectly healthy and cheerful when you first shake their hands and engage them in some small talk. Yet in both cases, the description of their day-to-day quality of life is very distressing to hear. 

Severed and strained relationships, clinical depression, faltering career paths, loss of confidence, inability to exercise, weight gain, broken sleep, severely constricted social lives, and substantial fear and uncertainty about pain. Factors that all too often lead to very real and very understandable mental health struggles. 

All of which is just normal for people with chronic pain, and depressingly normal for both of these ladies (both of whom have been like this for years, despite strenuous attempts to find a solution), And they are far, far, far from alone in their struggles. There are millions of people like them. Mostly suffering in virtual silence. 

For the worst sufferers, chronic pain becomes something like a biological prison. It constrains the full expression of our life force. 

Limitation‘,  ‘restriction’, ‘imprisonment’, ‘constraint’ ‘entrapment’ are all symbolic feelings we have about pain. And as feelings, they speak to the type of suffering pain triggers at the deepest levels of our psyche. Pain triggers some of our deepest, rawest, most ancient forms of suffering, like loss of freedom and loss of connection.

All of our physical connections and physical freedoms are underpinned by the ability to move without inhibition. 

All pain hurts physically, but persistent pains hurt us even more because of their impact on our basic physical freedoms, many of which spill over into another pillar of happiness—the ability to connect with others. Therefore,  chronic pain is limiting, but it can also be isolating.

Choose any topic that’s ever held your attention in any way, shape or form. It will almost certainly boil down to connection or freedom, or both! Connection & freedom are 2 of our most fundamental human instincts. Probably because for social hunter-gatherers, freedom to move and connection tend to equate to survival. Being physically trapped and/or separated from the tribe is not good. 

All our instincts for accomplishment, achievement, qualifications, career, excellence, financial success, creativity, travel, sport, health, fitness, well-being, conflict and survival represent freedom in one form or another. 

The exhilaration of reaching the goal, making the sale, passing the test, building the masterpiece, winning the race, overcoming the challenge, getting the promotion and receiving the bonus: owe their feel-good factor to a glorious inner sense of freedom. Freedom drives so much of what we do. 

And then there is a connection with others. 

Many of life’s deepest cravings are, at their core, cravings for connection. All the love, acceptance, approval, appreciation, praise, support, sharing, rewarding, caring, cooperation, charity, service, giving, community, pets, family, friends, and kids all represent connection in one form or another. 

When we give and receive, when we care, when we share time and socialise, when we serve, when we collaborate, and when we love, it all boils down to expressing our instinct to connect. It’s an impulse that’s deeply encoded into our social DNA.

Like our desires, our deepest fears often lay bare our most powerful instincts. Hence,  isolation and physical restraint are among our most fundamental human fears. And combining the two is, for most of us, a totally horrifying prospect.

Free - Solitary confinement

Being isolated and alone means no connection. Being trapped, enclosed or restrained means no freedom. Thus combining them makes for one of the worst experiences imaginable. This is why human societies have concluded that prison is such a logical punishment. And it is also why solitary confinement is widely considered the very worst form of human torture.

In a study published by the American Public Health Association, they concluded that acts of self-harm were strongly associated with the assignment of inmates to solitary confinement. Inmates punished by solitary confinement were approximately 6.9 times as likely to commit acts of self-harm, even after controlling the length of jail stay, mental illness, and ethnicity.

No matter how bad prison community life gets (which is often indescribably bad), solitary is almost always far worse. Most humans will beg to be allowed back to the threat of rape and violence in the general prison population, even after very short periods of solitary. And countless humans have chosen to take their own life rather than face extended solitary because they were deprived of their instincts to express freedom and connection.

It would be a mistake to think this is straying off the pain topic. We are deep in the truth about stubborn pain. Because chronic pain touches exactly the same human rawness that solitary confinement does, it just goes about it in a very different way. 

Imprisonment creates external constraint and disconnection, while pain creates internal constraint and disconnection.

Deep within the human psyche, persistent pain is like imprisonment; it limits our physical freedom – but instead of bars, there is a loss of mobility and deep shards of pain. And instead of physical isolation, pain is an invisible veil that disconnects and alienates us from those around us. Others can’t see it or feel it, and many cannot understand it. It also prevents us from full participation in life – which, for many, makes life feel lonely.

Being isolated and alone means no connection. Being trapped, enclosed or restrained means no freedom. Thus combining them makes for one of the worst experiences imaginable. This is why human societies have concluded that prison is such a logical punishment. And it is also why solitary confinement is widely considered the very worst form of human torture.

In a study published by the American Public Health Association, they concluded that acts of self-harm were strongly associated with the assignment of inmates to solitary confinement. Inmates punished by solitary confinement were approximately 6.9 times as likely to commit acts of self-harm, even after controlling the length of jail stay, mental illness, and ethnicity.

No matter how bad prison community life gets (which is often indescribably bad), solitary is almost always far worse. Most humans will beg to be allowed back to the threat of rape and violence in the general prison population, even after very short periods of solitary. And countless humans have chosen to take their own life rather than face extended solitary because they were deprived of their instincts to express freedom and connection.

It would be a mistake to think this is straying off the pain topic. We are deep in the truth about stubborn pain. Because chronic pain touches exactly the same human rawness that solitary confinement does, it just goes about it in a very different way. 

Imprisonment creates external constraint and disconnection, while pain creates internal constraint and disconnection.

Deep within the human psyche, persistent pain is like imprisonment; it limits our physical freedom – but instead of bars, there is a loss of mobility and deep shards of pain. And instead of physical isolation, pain is an invisible veil that disconnects and alienates us from those around us. Others can’t see it or feel it, and many cannot understand it. It also prevents us from full participation in life – which, for many, makes life feel lonely.

If your pain isn’t severe, these truths may only apply to you in a small way, like being unable to play golf with your friends (Sunday morning limitation & isolation). But for people with the worst pain, the loss of freedom and disconnection can be very severe and extremely isolating. And the worse our pain gets, the more like imprisonment or even solitary confinement it becomes. 

The sweetest freedoms are the simplest ones, and they are also the ones pain threatens most. 

Being able to cuddle someone without it feeling like there are pieces of sharp metal between you. Being able to rise from a chair easily. Being able to fall into a deep comfortable sleep when we’re tired. Feeling physically good enough to enjoy the company of others. Standing and walking comfortably. Being able to exercise comfortably. Being able to pick up a child. Playing with a child. Being able to concentrate at work without pain. Making love to someone we have chosen to spend our life with. These are the sweetest freedoms that make 99% of a happy life if we let them. And they reveal themselves so clearly to those with the most pain.

At its most fundamental level, pain is a loss of these freedoms. Therefore, we wish to be set free from our pain. In the same way, an inmate is set free at the end of their sentence.

Being pain-free is being free from constraint-free from disconnection and isolation –  free from frustration-free from stiffness – free from physical limitations – free from uncertainty – free from sleeplessness –  free from embarrassment – free from feeling trapped by a body that isn’t comfortably expressing the most normal and basic functions.

And the flip side of all this rawness is how good it feels to be free of our pain. How much happier we are when we are able to re-comment and re-mobilise.There is no sweeter feeling than the ‘release’ and ‘relief’ of getting better. No matter what kind of health challenges we face.

I’ve never told anyone this in person for some reason, but I can clearly remember the exact moment I knew I was cancer free.

It was 2010, and I was living in an idyllic but very small blue boat shed that I was renting from a friend in Pauahatanui, NZ. It was early morning, and I was stirring from a very deep sleep. It was one of those mornings when half woke, I was not sure where I was.

My eyes were adjusting to the room, trying to figure out where I had woken up. Then I suddenly realised what was different, and it wasn’t the location. I’d slept through a whole night without waking drenched in pain or sweat. I’d had a deep, full, restful sleep for the first time in 3 years. And I knew exactly what that meant. I could feel with absolute certainty there was no cancer in my body. 

We talk about ‘floods’ of emotion for a reason. The healing we have craved over the years can feel like a dam bursting when it finally comes, and that’s exactly what that moment was like for me. I’m re-feeling some of the emotional relief as I type this more than ten years on. I am still relieved. I still feel set free from that sickness and the physical suffering that came with it.

Finally, feeling better after sickness or pain is one of the best feelings in the world. It’s a release that stands in absolute contrast to the feelings of limitation and disconnection. Most of us feel a piece of that euphoria even after a short bout of food poisoning, let alone when we have struggled with pain or sickness for years at a time.

A month later, my doctors told me officially that after three years of biopsies, every alternative therapy under the sun, chemotherapy, radiotherapy, more chemotherapy and bone marrow transplants, my cancer had finally relented. It felt like a formality because I already knew I was better. 

If you are genuinely 100% done with your pain, and you put a ¼  of the energy into it that I put into healing my cancer – you’ll probably love where you end up. The freedom and reconnection of a pain-free life are almost certainly a possibility for you.

You’ll get to take a breath. Life will feel so sweet, and you’ll feel so happy and grateful just to be alive. The effort was all so worth it. Calm seas and a gentle breeze. Freedom.

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Better Injury Care

Better Injury Care

Better Injury Care

John (that’s not his real name) is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all,  Let alone the type of running required to play competitive soccer against younger men. John’s left leg is riddled with arthritis.

John’s arthritic left leg is an anomaly because the whole rest of his body is extremely strong, mobile and healthy for its age.

To understand a left leg like Johns, you have to view it in its context. John’s whole body is exceptionally mobile and healthy for his age, he has the look of a lifelong athlete and all-around strongman because that’s what he is. No part of him is 30 years old any more. But he has no signs of stiffness or weakness anywhere in his arms, spine, or right leg. His overall mobility is excellent for his age, hence in part, the long soccer career. 

John’s left leg is another story. It has advanced osteoarthritis in every major joint. His knee, hip and ankle are all severely arthritic. They stand in complete contrast to the rest of his body which is not even mildly arthritic, let alone suffering from advanced cartilage loss. He has had four separate arthroscopic surgeries at different times. All on joints in his left leg.

It’s all a bit surprising until you look closer – firstly, at John’s gait pattern and, secondly, his health history. Once you have understood those, the left leg makes perfect sense.

Computerised gait analysis measures the distribution of weight in each foot during walking and running in great detail. It then compares the left with the right to establish whether there is a gait insufficiency or asymmetry compared with the normal population. Essentially, it’s a dynamic postural analysis of the lower limb.  

Gait analysis of John’s left leg reveals a catastrophic degree of pronation (arch collapse) with every step. While John’s healthy leg only exhibits the slightest amount of pronation (the amount he was born with). The pronation reveals that his gluteal muscles have wasted away to nothing on his arthritic side. His knee, ankle and hip all collapse inwards with every step – Millions of times yearly on the same side as all the arthritis.

Based on all this, John’s case starts to look like the healthcare equivalent of a murder mystery with no suspects until you go back far enough. 

It’s all a bit surprising until you look closer – firstly, at John’s gait pattern and, secondly, his health history. Once you have understood those, the left leg makes perfect sense.

Computerised gait analysis measures the distribution of weight in each foot during walking and running in great detail. It then compares the left with the right to establish whether there is a gait insufficiency or asymmetry compared with the normal population. Essentially, it’s a dynamic postural analysis of the lower limb.  

Gait analysis of John’s left leg reveals a catastrophic degree of pronation (arch collapse) with every step. While John’s healthy leg only exhibits the slightest amount of pronation (the amount he was born with). The pronation reveals that his gluteal muscles have wasted away to nothing on his arthritic side. His knee, ankle and hip all collapse inwards with every step – Millions of times yearly on the same side as all the arthritis.

Based on all this, John’s case starts to look like the healthcare equivalent of a murder mystery with no suspects until you go back far enough. 

When John was 16 years old, the full weight of an adolescent rugby scrum collapsed onto his left ankle. The resulting sprain was so bad that he was on crutches for five months. He confesses that his ankle never felt the same again. He also recalls that he sustained two further bad sprains during his late teens and early 20s. Mystery solved.  

The joint trauma, scar tissue and muscle wasting left in the wake of the ankle sprain left John with a severely unstable foot and ankle. And if you have an unstable ankle, you have an unstable leg, foundations being what they are. The chronic instability caused chronic wear and tear, not only in the ankle but also in the knee and hip. Yet it was more than three decades before John started to really feel the longer-term impact his ankle injury would have on the hip and knee.

As for John playing masters football on such a severely compromised leg, that was easily attributable to a combination of innate athleticism and sheer belligerence. Despite this, once he had seen the results of his gait analysis and finally understood why his left leg was so compromised, he played the last two matches of the season. Finally, he retired—instead, choosing to pursue general exercises and rehab to prevent further unnecessary joint degeneration. He had never connected the ankle sprains with the arthritis he had in that leg, nor had any of his previous healthcare providers.

Despite the common and somewhat irrefutable nature of case studies like John’s ankle, there is still some scholarly debate over the true prevalence of joint degeneration after injury; because the current data is far from conclusive. Yet there is so much data, clinically, statistically and anecdotally, there is a consensus about there at least being some level of correlation. And arthritis aside, there is certainly no doubt about the high prevalence of further pain and injuries after ankle sprains and the like.

A study published in the Journal of Athletic Training in 2019 highlighted what countless clinicians have known for a long time. Up to 70% of people who sustain an acute ankle sprain develop some level of residual physical disability in that leg. This study highlights the devastating potential of ankle sprains; and also the fact that we struggle to effectively rehab even the most straightforward musculoskeletal injuries.

We need to do a better job of injury care if we are going to conquer the pandemic of chronic pain we live in at this point in history. Unrehabilitated injuries and complex injuries contribute significantly to the pain burden. Walking must always come before running, individually and collectively. So, if we can’t get to grips with the humble ankle sprain, what chance do we have of conquering back pain, complex PTSD-associated pains and an opioid epidemic?

Improved injury management is as much a mindset as it is a set of rehab approaches. 

If we adopt a mindset where we assume that all but the most extreme injury events have something to reveal about the integrity of our musculoskeletal chains, we have made a giant step towards better care of injuries, complex injuries and complex pain.

If we adopt a mindset where we assume that the injuries seen on scans and x-rays are just the tip of the injury iceberg; and that other more subtle but significant soft tissue injuries play out ‘under the medical radar’. A world of injury and pain healing approaches opens up to us.

If we adopt a mindset where we are willing to give our painful and ‘injury-prone’ body parts the kind of long-term attention we give our teeth, we will have made another quantum leap towards preventing long-term pain and disability.

Once we have made this small handful of shifts in our belief structure around injuries and rehabilitation, we become open to proper use of the full injury and pain rehabilitation toolkit, in which the techniques and approaches are often surprisingly straightforward. Just like flossing your teeth daily and seeing a hygienist twice a year is straightforward.

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Own Your Pain

own your pain

Own Your Pain

Steve (that’s not his real name) was a fixer, the kind of person you really trust to get the job done. He was a resourceful and intelligent business coach with 20 years of experience pulling small business owners out of deep stressful-filled holes they mostly dug for themselves. He had the appearance of someone who had failed to take the necessary time to care for themselves over a long period of time. Despite having a naturally healthy and athletic disposition, the combination of occupational stress, minimal sleep, and a poor diet was making his 43 years look like an unhealthy 53. At the centre of all this was Steve’s bad back pain, which had contributed to his loss of physical well-being. And Steve mostly blamed his back for his poor physical state.

Taking a deeper dive into Steve’s pain and his attempts to resolve it revealed two common themes. The first was that he had consulted unsuccessfully with around 20 different clinicians from all disciplines, including multiple doctors, multiple surgeons, multiple physiotherapists, multiple chiropractors, and a list of many others. The second common theme was that Steve had done absolutely nothing to try and fix himself, no stretching, no pilates, no yoga, no stress management, no core exercises, no research, no cardio, and no weight loss.  

Steve had taken almost no responsibility for working on his own pain. This observation is offered without judgement; Steve’s choices weren’t based on laziness. His choices were, in fact, more rooted in a lack of education. He genuinely didn’t realize that his pain was caused to a large extent by his lifestyle, stress, and his general physical condition; if he had, he may have acted very differently. 

Steve believed his pain was among the types of medical conditions that require ‘a medical procedure’ to be performed. He genuinely thought that his back pain was like a tooth cavity that just needed the right dentist to do the right filling, and it would be permanently fixed. He didn’t realize that the bulk of the issue he was facing was far more like being unfit or having a poor diet. Thus being a life challenge that requires an unavoidable and sizable dollop of personal responsibility.

Happily, once Steve realized this truth, he was able to gradually merge better self-care with treatments that helped reduce his pain meaningfully. After a few months, he was able to gain some real momentum. This ultimately led to the resolution of his pain. After many many years of suffering.

Steve’s case is a slightly unusual one because most pain sufferers these days do take a certain amount of responsibility for their pain, in the form of exercises and tools intended to reduce their pain over time. In truth, though, most pain sufferers sit somewhere on a ‘responsibility spectrum’, inhabited at one end by those who take no responsibility and at the other by those who take too much responsibility and won’t ask for help. 

I have met literally thousands of pain sufferers and had the opportunity to have substantial conversations with them about their pain. As you might expect, there are many repeating patterns, especially among those who have suffered the most and for the longest. One such pattern is the Steve pattern, where the patient sees it as the job of healthcare providers to fix the pain. In particularly bad cases, this logic extends to those patients who start to blame their ‘doctors’ for their pain. It is no coincidence that this type of ‘blame psychology’ and the feelings of powerlessness that go with it are well-documented as significant contributing factors in many of the worst poor pain and disability outcomes.

From an early age, we are somewhat conditioned to think of our physical complaints as the job of a doctor to fix, and of course, there are times when this is true. Personally, I believe we are responsible for our own well-being. But of course, I don’t, for example, extend that to a small child who needs treatment for leukaemia, which is definitely a job for an oncologist, not a toddler. It also isn’t our job to put pins and plates in our own broken bones. you need an orthopedic surgeon for that.

Not all health issues are the same in nature, and not all of the chapters within the history of each health issue are the same. If we use tooth decay as an example, it is quite clear that it is the dentist’s job to perform the filling. But whose job is it to prevent tooth decay from happening in the first place? If you have a tumour in your lung, it is your medical team’s job to see if they can resolve it for you, but is it the consultant’s job to stop you from smoking? No, that’s your job!

So understanding that we probably have a certain amount of work to do ourselves if we want permanent resolution of our pain is a big step. But there are two other ingredients that must be added before we are able to graduate to taking full responsibility. The right tools and understandings.

The completely opposite type of pain sufferer (from Steve)  are those who work relentlessly at fixing themselves and refuse to seek any professional help. This type of approach tends to be driven partly by fundamentally positive personality traits  (like confidence, independence and tenacity) but also by disillusionment with past treatments that have not worked. Consulting with multiple practitioners and not getting anywhere can easily create the impression that help will never come, leaving the patient entirely self-managing and self-Googling their own chronic pain. 

Sadly taking too much responsibility can be as fruitless as taking no responsibility, no matter how admirable it is. Dealing with chronic pain is, on many levels, the responsibility of the individual suffering from the pain. Yet without the correct guidance, much of the effort can be wasted on ineffective or inappropriate tools that won’t get the job done.

To be able to take the right amount of responsibility for our pain, we need to be armed with the right tools. To get the right amount of help with our pain, we need practitioners who are also armed with the right tools and insights. It is our responsibility to care for our own pain and our own body. But taking personal responsibility doesn’t mean you have to figure it ALL out for yourself.

The best health outcomes tend to come when there is a healthy shared responsibility for resolving the complaint and its causes between ourselves and practitioners whom we trust. Part of their job is to perform the ‘pain-relieving procedures‘ that help us return to normal function, but it is also their job to help guide us towards which aspects of our physical well-being WE need to work on and then we fully commit to running that gauntlet on our own 2 feet.

Chronic pain needs more than ‘a procedure’ in almost every instance. Even after full joint replacement surgery, a significant percentage of patients continue to suffer from pain in the same area, and countless more continue to suffer from stubborn pain elsewhere in their bodies. This clearly demonstrates that even our most radical pain solutions seldom land like magic bullets. 

Stubborn pain is a highly complex issue, and the genuinely mature approach to it acknowledges this by not oversimplifying it. But instead, taking a broad and flexible approach. By tackling pain in a collaborative, holistic, and self-responsible way. 

Perhaps the best way to achieve this mindset is to stop asking, ‘Who can help me’ or ‘How do I fix myself’ and instead ask…  ‘Who can help me fix myself’.

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The Old Age Myth

Over time, a toxic belief can be as harmful to the body as a toxic chemical.

One of the most toxic and inaccurate beliefs nurtured by many pain sufferers is that their pain is caused by getting older. The old age myth may stem directly from the global family doctor’s office, where it is often advertised, but it’s hard to know for sure where it started.


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Why Is Sleep Necessary?

Why Is Sleep Necessary?

Why Is Sleep Necessary?

Sleep is vital, not only for survival but also for the best performance of both our minds and bodies.

While our bodies enter a state of rest during sleep, allowing for a reduction in blood pressure and body temperature, our brains remain engaged. Our brains use these moments of rest to perform essential tasks like memory formation, waste clearance, and enhancing learning abilities.

There seems to be a trend these days, for sleep to be considered something that can be skipped or reduced, with people pushing themselves to achieve and acting as if we  simply don’t require much sleep. This mentality and the long-term consequences of this approach may result in significant health issues in the long term.

What does a lack of sleep mean for our bodies?

Failing to get enough sleep, or to find quality sleep, can have profound effects on our physical, mental, and emotional well-being.

Immediate Impact:

You may find yourself feeling irritable, weak, or excessively tired, with your overall functionality diminished. Mood alterations can occur, throwing your emotional balance and mental focus off-kilter.

Also,  consistent lack of rest can weaken our immune responses, increasing our susceptibility to infections and diseases.

Medium-to-Long Term Effects:

The consequences can extend even further. A prolonged lack of sleep can result in metabolic changes, affecting blood sugar levels. As a result, you may encounter difficulties with weight control, as one expert points out, potentially leading to weight-related health problems.

People often find it challenging to shed weight under these circumstances, and the risk factors for conditions like diabetes increase. The long-term scenario paints a bleak picture, with higher risks for mental health disorders such as anxiety and depression, and even extending to increased risk of suicide.

How to Determine if You’re Getting Enough Sleep?

Research shows that a great many of us are not able to accurately assess whether we are getting enough sleep, including the author of this blog. It turns out we have strong tendency to over-estimate our state of restedness and claim that we are able to function on less sleep than the research indicates is optimal for good health.

At the core of this is the fact that if the current data is accurate virtually all of us need 7 or more hours per night, even if we feel like we can function well on less. Test subjects who have had less than 7 hours perform poorly on mental tests, physical tests and show biomarkers associated with stress. And they tend not to thrive in the longer term.

 

How to Achieve Good Quality Sleep: Understanding Your Body Clock

Getting quality sleep isn’t only about the number of hours you rest but about knowing your body’s rhythm and aligning your sleep schedule accordingly.

Begin with Self-Reflection

Determining the best time to sleep requires some introspection and possibly a little experimentation. We are all a little different from one another in this respect.

  • Experiment on Your Schedule: If uncertain, try this experiment during a vacation when you’re not bound by work or study. Follow your natural sleep rhythm, going to bed when you feel sleepy and waking up without an alarm. Repeat this pattern for several days to weeks to understand your natural sleep pattern. You can also use smart watch functionality to help with this process

Recognize Your Sleep Type

According to sleep experts, people’s sleep patterns fall into two main categories:

  • Average Clockers: These individuals usually feel sleepy around 10 pm or 11 pm and wake up six to eight hours later.
  • Owls: These people don’t feel sleepy until between 1am and 3am, with their natural waking time falling between 10 am and 12 pm.
Figuring out whch type you are at the present stage of your life and rolling with it can be an excellent step towards getting better sleep in the long term. 

Simply focusing on getting eight hours of sleep without considering your natural body clock can lead to problems. If you force yourself to go to bed at 10 pm, but you’re an “owl,” you might find yourself awake and anxious until 2 am.

 

Why Am I Waking Up in the Middle of the Night?

If you’re finding yourself waking up during the night and don’t have any significant sleep disorders or health concerns, the explanation might be a restless mind. Yet, a brief interruption in sleep is common and usually not a cause for alarm.

Difficulty falling asleep or waking up in the middle of the night is often linked to over-thinking. Many people tend to worry about things like exams, projects, requirements, and essays, leading to sleep disturbances. If you find yourself in a pattern of waking at night it is worth taking a closer look at what might be causing some chronic stress or over-stimulation with a views to resolving it.

If your mind tends to wander and worry, engaging in calming and relaxing activities can be the solution. Here are some strategies to try:

  • Avoid Work and Study Before Bed: Give yourself a break from work or study a few hours before bedtime.
  • Try Relaxing Activities: Yoga, tai chi, meditation, or reading non-academic books can soothe your mind. Listening to music or playing an instrument can also create a calming atmosphere.

 

Is Napping During the Day Okay?

Napping during the day can have varying effects on different individuals. While some find naps to be a regular and beneficial part of their routine, others may experience negative impacts. Here’s a closer look at when napping might be appropriate and what to consider before taking that daytime snooze.

The Benefits and Drawbacks of Napping

  • For Sleep-Deprived Individuals: If you are not getting enough sleep at night, a nap can be an effective way to catch up on rest.
  • Timing Matters: However, napping can be problematic if the timing is not right. Naps taken too close to bedtime may lead to a decrease in night-time sleep quality.
  • Potential Negative Effects: For some, napping may even have an adverse effect, making them feel worse after waking up.

Assessing the Need to Nap

If you find yourself consistently feeling the need to nap during the day it’s worth examining what might be driving that desire. Ask yourself:

  • What’s Behind the Urge to Nap?: Are you sleep-deprived? Engaging in excessive partying, gaming, or studying?
  • Listen to Your Body: Understanding the underlying reasons for your need to nap requires paying close attention to what your body is telling you.

Napping during the day is neither universally good nor bad. It varies from person to person and depends on the individual’s specific situation and needs. By considering your unique circumstances and paying attention to your body, you can make an informed decision about whether napping is right for you.

Tips for Achieving the Best Night’s Sleep

Sleeping well is vital for overall well-being, and incorporating some simple practices into your routine can make a significant difference. Below are tips to help you enjoy a restful night:

1. Disconnect from Electronic Devices

Why? The bright blue light from laptops, smartphones, and video games can interrupt the release of melatonin, a neurohormone that induces sleepiness.

Turn off laptops, smartphones, and video games one to two hours before bedtime. 

2. Create a Night-Time Ritual

Why? We are creatures of habit and routine. Associating a particular routine with relaxation can be powerful in priming your mind for sleep.

Develop a calming bedtime routine that could include:

  • Sipping herbal tea.
  • Engaging in some relaxing self care.
  • Reading a book.
  • Practising gentle yoga or meditation.
  1. Consider Your Biological Clock

Why? Exposure to bright light in the morning helps adjust your body clock, making it easier to feel sleepy at night.

What to Do? If possible, expose yourself to natural light, such as sunlight, for 30 minutes after waking up. This exposure helps regulate your body clock and stimulates melatonin secretion at night

Special lamps that provide the right kind of light are also available as alternatives.

4. Optimize Your Sleeping Environment

  • Since body temperatures drop during sleep, most people find a cooler room more conducive to drifting off.

By integrating these strategies, you can create a supportive environment for sleep and enjoy the benefits of a restorative rest night after night. Happy sleeping!

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Healthy, strong tissues are highly resilient to damage; if they weren’t, there would be no such thing as contact sports. So true injuries are, without exception, memorable physical events. If you experience a ‘sudden pain’ in your spine picking up a box of tissues, it is worth questioning how healthy your spine is; and whether it really qualifies as a true injury at all.


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The Connection Between Chronic Pain & Adverse Life Events

The basis of musculoskeletal pain is biomechanical. Yet, emotional trauma is the single most influential factor in determining the severity of chronic pain a population of patients will suffer. However, many chronic pain sufferers do not identify as having any significant trauma. Some because they legitimately don’t. Many others because they do, but were just not aware.


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The Biology Of Trauma

The set of physical and mental conditions we refer to as trauma are caused by a failure to process our natural responses to stress. Adverse life events cause traumatisation via the mechanisms of our ancient biology. 


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Respect All Of Science

Respect All Of Science

Respect All Of Science

Few things in life deserve more respect and appreciation than science. Science has made our lives so much easier, warmer, drier and safer that it is hard to fathom.

Medical science has made a particularly large contribution to the quality of life we are blessed to lead now. Only 250  years ago, a child born in a Western country had less than a 20% chance of making it into their early teens. Taking out funeral insurance for your child as soon as they were born was common practice. Now only a handful of generations later, the loss of a child is more like a lightning strike than the everyday occurrence it was only a handful of ages ago. Thanks to innovations that all stem from medical science.

Closer to 500 years ago, King Henry VIII was infamously one of the worst husbands in all recorded history. But uxoricide wasn’t his only interest in life; he was also very interested in medical science.

Henry founded the Royal College of Physicians in 1518 and amalgamated ‘The Barbers Company of London and the ‘Fellowship of Surgeons’ to form the Company of Barber-Surgeons in 1540. His administration passed seven acts of parliament aimed at regulating medical practitioners that would endure for 300 years after his death. Henry presided over major improvements in public health, installing public water supplies and sewers and implementing segregation and disinfection processes during epidemics. 

Henry’s interest in medicine may have arisen (as it often does) from his own substantial health struggles. In his early life, Henry was an unusually fit, healthy, strong, and robust young man, an athletic 6ft and 15 stone of muscle. Then, in his late 30s, he injured his foot badly playing tennis (most likely a bad sprain) and sometime later had an ulcer (probably caused by a mixture of stress and injury) in the same leg. Both of which resolved but foreshadowed the unimaginable physical suffering that would ultimately end his life.

In 1536 at 44 years of age, Henry suffered a catastrophic injury when he fell from his horse during a jousting match—sustaining what was almost certainly a severe brain injury and fracturing at least one leg bone. Following the injury, Henry exhibited signs of what we now know as CTE (chronic traumatic encephalopathy), which more than likely contributed very significantly to the fragmentation of his mental health. Then in the months following, he once again suffered from ulceration of the tissues in his leg, which this time was not destined to resolve.

Over time the ulcerations in Henry’s leg became giant deep pus-filled fistulae. For treatment, these frequently required red hot pokers to be inserted into them, such were the medical procedures of the day. Which, even in an age of anaesthesia, would have been a hellish cycle of pain most of us can’t imagine. The repeated cauterising of the wounds helped temporarily reduce individual ulcerations but was ultimately ineffective at halting the progression of the physical processes playing out in Henry’s leg tissues.

The day-to-day existence of a person whose legs are being eaten alive by bacteria is about as bad as it gets medically. It undoubtedly contributed to Henry’s ever-increasing proclivity for boiling people alive when they inconvenienced him later in life.

It is highly likely that Henry had DVT (deep vein thrombosis), where blood clots form in the blood vessels of the leg. Similarly, the presence of Type 2 diabetes is retrospectively a virtual certainty. The majority of DVT and diabetic ulcers are known to be bacterial ‘culture positive’, which means that even in modern times, the ulcers that form as a result of these vascular blockages often develop colonies of virulent bacteria. 

By 1543 Henry was 51 years old and weighed around 30 stone. The vile stench of his leg ulcers could be detected from 3 rooms away. He was literally decomposing whilst refusing to rest whatsoever and continuing to fully function as Britain’s monarch. Then in 1547, after a decade of agonising decomposition and violent rage, Henry finally succumbed to the organisms that had been slowly consuming his tissues for all that time. The end would have shown up as a raging fever as the infection managed to take over his internal organs.

So, just a handful of generations ago, the wealthiest man on the planet died one of the most horrifying deaths imaginable. And if you suffer from the same health issues now, it is highly likely you would be fixed up within a month of antibiotics and anticoagulants, followed by some judicious longer-term dietary adjustments. None of which was available to Henry, who, despite having unlimited resources, had to watch helplessly as his body was slowly consumed by a large payload of (somewhat karmic) bacteria. He didn’t even have any pain relief to cover the countless days on which hot pokers were inserted into his leg ulcers.

Thanks to medical science, even the poorest among us now live a more privileged existence than the king of everything did only a very short time ago. The vast majority of yesterday’s fatal diseases, accidents and infections have been reduced to today’s mild inconveniences. 

Today we get to complain about the negative impact antibiotics have on our guts and waiting times at emergency departments. Yesterday those were luxuries that even kings and queens could only dream of. Modern medical science is a technological marvel.

Yet, despite its success in treating diseases, medical science has many failures. And one of those is its failure to make any meaningful impression on the pandemic of chronic pain we live amidst. In that instance, it has proven to be as ineffectual as Henry VIII’s physicians were in their attempts to prevent his legs from being consumed.

When it comes to healthcare, the word ‘science‘ is commonly misappropriated and misrepresented. Increasingly the term science is used to mean ‘ isolated, tested and statistically proven by large volumes of recorded experimental data’. The type of science we use to discern the effectiveness of drugs. Which is a part of some sciences but categorically not what science is. 

There are whole branches of science that are purely theoretical and not based on experimentation, like theoretical physics. The mechanisms proposed in scientific concepts that we accept wholeheartedly, like natural selection (evolution) and the big bang, are theories.

Science is not ‘experimental data’; it is something much broader and deeper than that. Amongst other things, science includes sound methodologies, theories and working hypotheses. All of which are valid.

The scientific process is something far broader and more nuanced than ‘data’.

Modern medicine has heavily inferred that it’s best to limit one’s pain treatment options to those that are ‘scientifically proven’ by data. Yet, in the real world, this approach rarely leads to the best possible long-term outcomes for chronic pain sufferers. 

The best results in pain management come from a willingness to take the current evidence and build on it with a sound working hypothesis, like many other sciences do, and put these hypotheses into action. Both with proven tools and other tools that have yet to be properly ‘researched’; but nonetheless have a strong anecdotal track record. Then apply all of the above aggressively in an attempt to get the patient out of pain now. Not in some distant and improbable future where we have enough data to act effectually.

Sadly, pain management is a speciality plagued by a severe lack of high-quality ‘scientific  data’ regarding the effectiveness of treatments. Relative to the scale of the problem, at least. This is in no small part due to the extreme difficulty of generating high-quality data for pain treatments. For study design and economic reasons, it is infinitely harder to generate high-quality data on a new osteopathic treatment than it is a new non-steroidal anti-inflammatory. And sadly, drug therapies don’t resolve pain; they simply mask it.

You would be mistaken if you assume that this lack of quality research only applies to allied health treatments like chiropractic, acupuncture and osteopathy. 

Consider the following statement published in the British Medical Journal. Based on a 2021 meta-analysis of a large number of randomised control trials on the effectiveness of elective orthopaedic surgeries.

‘No strong, high-quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives.’.

The data analysed revealed that 8 out of 10 orthopaedic surgical procedures either had no evidence to support their effectiveness or had evidence that specifically pointed to a lack of effectiveness. Relative to the far safer alternatives, like acupuncture, shockwave therapy, LLLT, osteopathy and exercise prescription.

For complete clarity, the pre-eminent British Medical Journal is telling us that there is a severe lack of high-quality scientific evidence to support the use of 8/10 of the most common orthopaedic surgeries. 

The funding pool behind surgical research outstrips every other pain management profession by an exponential margin. Yet, despite this vast research budget, orthopaedic surgery for pain still seriously lacks quality supporting data.

Sadly this data on surgery, or lack thereof, accurately reflects the broader state of pain management research in the 21st century. 

Yet, a lack of data does not necessarily imply a lack of effectiveness. 

A ‘lack of evidence’ often just means that no one has got around to generating any quality data. With pain treatments, one tends to find a few scraps of data but no rigorous study on a large enough group of patients to have gained any certainty.

More often than not, this leaves the scientifically minded patient and practitioner alike being forced to choose between no treatment and ‘unproven’ treatment. But luckily, a strong case can be made for trying out many ‘unproven’ pain treatments. 

Reflecting on non-healthcare disciplines sometimes helps pain patients develop some comfort with the idea of ‘valid but unproven science‘. Which, in truth, applies to the vast majority of life’s competencies.

Brazilian Jiu-Jitsu (BJJ)

Over the past 20 years, Brazilian Jiu-Jitsu (BJJ) has moved from complete obscurity to becoming one of the world’s most popular martial arts. BJJ is a reiteration of Japanese Jiu-jitsu, modified into a shockingly effective system of grappling, chokes and submissions. 

The primary feather in the cap of BJJ is that it was once tested in open competition against many other martial art forms and came out on top of the heap. Thus ending countless testosterone-laced debates about which is the most effective martial art. BJJ also has a proven track record for enabling smaller men to beat much larger men in martial arts contests—a major feat and one that has been performed repeatedly with the BJJ system.

For those of us who have no experience in the grappling arts, being on the ground with the wrong amateur BJJ practitioner has great potential to be a life-altering unpleasant experience. 

On being instructed to avoid getting choked or having any of our joints snapped, we make a few instinctive attempts at self-preservation. Then, depending marginally on our level of physical strength, within a handful of moments (or possibly just one), we would find ourselves in serious trouble. 

An instinctive movement of our neck, arm or leg that felt like the right thing to do. Leading on to a sudden realisation that something important, like an elbow, was about to snap out of its socket. Other exciting possibilities include blacking out due to a lack of blood in our brain faster than we dreamed was a physical possibility or having our ankle joint snapped. Luckily for us, though,  most BJJ practitioners are very wholesome types who wouldn’t dream of fully executing the move. So the whole thing could be put down to a near-death experience for the elbow.

Over the past 20 years, Brazilian Jiu-Jitsu (BJJ) has moved from complete obscurity to becoming one of the world’s most popular martial arts. BJJ is a reiteration of Japanese Jiu-jitsu, modified into a shockingly effective system of grappling, chokes and submissions. 

The primary feather in the cap of BJJ is that it was once tested in open competition against many other martial art forms and came out on top of the heap. Thus ending countless testosterone-laced debates about which is the most effective martial art. BJJ also has a proven track record for enabling smaller men to beat much larger men in martial arts contests—a major feat and one that has been performed repeatedly with the BJJ system.

For those of us who have no experience in the grappling arts, being on the ground with the wrong amateur BJJ practitioner has great potential to be a life-altering unpleasant experience. 

On being instructed to avoid getting choked or having any of our joints snapped, we make a few instinctive attempts at self-preservation. Then, depending marginally on our level of physical strength, within a handful of moments (or possibly just one), we would find ourselves in serious trouble. 

An instinctive movement of our neck, arm or leg that felt like the right thing to do. Leading on to a sudden realisation that something important, like an elbow, was about to snap out of its socket. Other exciting possibilities include blacking out due to a lack of blood in our brain faster than we dreamed was a physical possibility or having our ankle joint snapped. Luckily for us, though,  most BJJ practitioners are very wholesome types who wouldn’t dream of fully executing the move. So the whole thing could be put down to a near-death experience for the elbow.

Now, if we take that same novice BJJ practitioner who went easy on us and put her against a fully-fledged black belt, her experience could easily be over faster than ours was. She would almost certainly lose 100/100 matches against her teacher. Then having conducted that experiment, if we take that black belt and put them against a BJJ world champion, once again, we would see someone being submitted very fast every single time. 

You could go to any number of clubs all over the world; and find a gravely consistent disparity in ability between yourself and the novice, between the novice and the black belt, and between the black belt and the champion. Which incidentally is a lot like repeatable scientific data.

BJJ is an effective, practical and repeatable system based on sound scientific principles. If you doubt this, all you need to do is go to your local club and tell them; they will help you to understand better. 

Now that you understand BJJ a bit, there is something else important to understand. ‘There is zero scientific data to support BJJ’s effectiveness. It is ‘scientifically’ completely unproven. 

There are no research articles published on BJJ’s effectiveness at breaking elbows. There are no literature reviews on how consistently black belts choke out blue belts. There are no in-depth peer-reviewed technical papers on the best way to secure an arm bar. And there are no randomised blind controlled studies on the probability of getting choked unconscious by a club black belt after you tell them in front of the class that BJJ is an unscientific system.

BJJ’s effectiveness is ‘purely anecdotal’ in scientific terms. And yet, this utter lack of data has no bearing whatsoever on the stark, visceral and predictable reality of grappling with its practitioners. BJJ is a verifiable and repeatable science.

But if  BJJ practitioners limited themselves to the parts of their art form that were scientifically proven by medical standards, they would all just have to sit on mats looking at each other – Paralysed by the need for statistical proof. But they don’t worry about that; they just get on with it – extremely well. 

It is possible, of course, that BJJ isn’t the best all-around martial art. In fact, rolling around on the floor isn’t always the safest form of combat when it comes to self-defence in the real world. The point is that it is a verifiably effective science that has been developed without the need for ‘scientific proof’.

What if successful management of chronic pain is the same? An area where competence is possible despite the lack of quality research data. Do you choose to steer clear of it due to this lack of high-quality evidence? Or do you dive in? 

Regardless of what your answer is, pain management is not a martial art. There is an unseen subtlety and complexity to effective pain management. One that is admittedly lacking relative to the art of choking one’s neighbour unconscious in white pyjamas.  

Pain resolution is a nuanced well-being issue. The underlying goal of which is achieving a good state of health, given that a healthy body and mind naturally tends to be a pain-free body and mind. So in the data drought, the pain sufferer finds themselves in, it’s worth wondering whether we have any collective track record for gathering valid health and well-being knowledge; outside the medical science realm. And happily, we most certainly do.

The old Norse word for cod liver oil is ‘lysis’, which means light. Which we can safely assume was a name born out of reverence. Light has special significance to cultures that spend a large part of their yearly cycle in relative darkness.

Over 1000 years ago, the Vikings had come fully to terms with the unmatched benefits of Omega 3 fatty acids. Ten centuries before we even knew Omega 3’s existed, Norse cultures prized fish liver oil to such an extent that they referred to it as ‘the gold of the ocean’. They were not the only culture to uncover this class of ‘medicines’. 

The oil of marine species’ livers has a long history of medicinal use. In ancient Greece, Hippocrates himself (the so-called “Father of Medicine”) prescribed dolphin liver oil to treat skin problems.

The Vikings most commonly extracted cod liver oil by laying birch tree branches over a kettle of water and placing fresh fish livers on them. The water was brought to a boil, and as the steam rose, the oil from the liver dripped into the water and was skimmed off. They also had methods for producing fresh raw cod liver oil.

The Vikings primarily consumed cod liver oil during winter when the days were shorter and lacked sunlight. This was both convenient and poetic, given that they referred to it as ‘less’ light. Vitamin D is a key constituent in cod liver oil and a key benefit of sunlight. They may well have been aware that the benefits of light and oil were comparable. Living in the open air in an intensely seasonal environment offers many subtle insights that would be lost on us.

The old Norse word for cod liver oil is ‘lysis’, which means light. Which we can safely assume was a name born out of reverence. Light has special significance to cultures that spend a large part of their yearly cycle in relative darkness.

Over 1000 years ago, the Vikings had come fully to terms with the unmatched benefits of Omega 3 fatty acids. Ten centuries before we even knew Omega 3’s existed, Norse cultures prized fish liver oil to such an extent that they referred to it as ‘the gold of the ocean’. They were not the only culture to uncover this class of ‘medicines’. 

The oil of marine species’ livers has a long history of medicinal use. In ancient Greece, Hippocrates himself (the so-called “Father of Medicine”) prescribed dolphin liver oil to treat skin problems.

The Vikings most commonly extracted cod liver oil by laying birch tree branches over a kettle of water and placing fresh fish livers on them. The water was brought to a boil, and as the steam rose, the oil from the liver dripped into the water and was skimmed off. They also had methods for producing fresh raw cod liver oil.

The Vikings primarily consumed cod liver oil during winter when the days were shorter and lacked sunlight. This was both convenient and poetic, given that they referred to it as ‘less’ light. Vitamin D is a key constituent in cod liver oil and a key benefit of sunlight. They may well have been aware that the benefits of light and oil were comparable. Living in the open air in an intensely seasonal environment offers many subtle insights that would be lost on us.

Ultimately, cod liver oil was prized by the Vikings because they knew its ability to prevent sickness and disease. So they rubbed it on their bodies and routinely consumed whole fresh livers dipped in liver oil.

Cod liver oil has remained a widespread folk remedy in Northern European fishing communities over the centuries. And we can safely assume they were not consuming it because of its flavour profile. 

As early as 1782, English physicians began studying cod liver oil and prescribing it for rheumatism. In 1822, cod liver oil was officially recognised by the medical profession for its curative powers. Yet no one understood why or how it worked. By the mid-18th century, it was widely observed that cod liver oil was highly effective in the treatment of rickets, rheumatism, skin wounds, chronic pain, gout and some forms of tuberculosis.

Cod liver oil is approximately 20% omega-3 fatty acids. Though similar in fatty acid composition to other fish oils, cod liver oil has higher concentrations of vitamins A and D. According to the United States Department of Agriculture, a tablespoon of cod liver oil contains 4,080 μg of retinol (vitamin A) and 34 μg (1360 IU) of vitamin D.

In the modern era, the use of Omega 3’s, a dietary supplement, is supported by a mountain of scientific data. They are one of the very few nutritional supplements whose value there is no disagreement upon. The benefits are extremely broad and well-documented across brain and mental health, cardiovascular health, eye health, liver health, respiratory health and bone health. It would be easy to make a case for Omega 3 fatty acids being the king of ‘nutraceuticals’.

So The Vikings and many others before and since managed to identify that there was medicinal magic held within fish livers. And not only that, they accurately discerned that it was the oils in the cod liver that had special significance and possibly even that it contained a key benefit that matched the benefits of sunlight. When all is said and done, they discovered what may be the world’s most important nutritional supplement 1000 years before medical science was even conceptualised.

We clearly have the ability to perform sophisticated problem-solving in the wellness arena. Without modern medical science. By means of empirical and experiential real-world problem solving, and ultimately, science. 

The only conceivable argument against this type of learning being a valid part of how we select healthcare interventions is our inherent fallibility. Yet there are few more well-documented examples of a fallible system than the very one that claims, above all others, to be supported by medical science—the pharmaceutical industry.

In the past decade alone, big pharma has paid out in excess of 20 billion USD in damages and criminal fines due to the wholesale carnage caused by drugs that were deemed ‘proven’ therapies by the data-based standards of Western medical science. The real story behind these numbers is not a financial one but one of heartbreaking human suffering on a grand scale. Caused by complete failures on the part of medical science itself. 

All forms of science carry some level of fallibility. From those we develop purely through real-world experience to those that are validated by substantial investment in the generation of ‘medical proof’.

It is possible, and perhaps perfectly reasonable, to hire your pain management team on the same basis you hire a lawyer, martial arts coach, singing coach, piano teacher, carpenter, or even a barrister. On the basis of education, experience and a sound working hypothesis about the cause of your pain. Rather than on the basis of rigorously designed, large-scale, double-blinded, randomised control trials published in peer-reviewed journals, which seldom exist in any case. 

There are times when it is safer to keep the entire scientific process locked away from the public through the entire arch of its development. Successful development of bioweapons would be an excellent example of this. And many drug therapies need to be treated with similar caution. 

There are, however, also times when it is far safer to unleash the scientific process on the general public at the ‘working hypothesis’ stage. An exploding global pandemic that shortens millions of lives and ruins the quality of countless others could be an example of this – certainly when the safety profile of the relevant procedures is beyond a reasonable doubt – as it is with the likes of acupuncture, fascial release, meditation, core exercises and spinal mobilisation.

And when all is said and done, the entire topic of science is only one part of healthcare. 

Healing disciplines are not science; they are based on science. In the real world, all healing disciplines are, to varying degrees, art forms based on scientific principles. Pain management is a safe and effective art form based on scientific principles.

Those of us who are suffering with chronic pain have a golden opportunity. To dive into effective pain management on the basis that it is an ‘unproven’ but valid art form underpinned by scientific principles. Like Brazilian Jiu Jitsu, or the extraction of oil from fish livers using wisdom, birch and steam.

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Getting To Grips With Pain Triggers

Many pain sufferers struggle to discern between what really causes their pain and what simply triggers their underlying pain issues.

Triggers are always external forces and events, like bad sleep and awkward lifts. Whereas causes can be environmental, but are often internal challenges, like having a weak core, for example.

The true causes of pain are always a very big and important deal. Pain triggers, on the other hand, are very helpful to know but often trivial in the grand scheme. 


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For most of human healthcare, we assumed that our symptoms were the problem. 

We have moved past that now to a large extent. For example: we know that the virus is the problem, not the green snot. Mucus is just a byproduct of healthy immune function.

Prior to the microscope, we naturally assumed the redness and swelling of an infection was ‘the problem’. But since microscopes, we know our swelling is the body’s vital inflammatory response and the actual problem was an invasion of hostile microbes. Through this deepening of scientific understanding, we’ve moved past ‘symptom blaming’. Somewhat. Because we still very much do it with pain.


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Cupping – Drawing & Eliminating Inflammation

Cupping - Drawing & Eliminating Inflammation

Cupping - Drawing & Eliminating Inflammation

After using intensive cupping therapy to support remedial care of chronic pain patients for nearly 20 years, I feel an incredible weight of responsibility. To help people understand this often overlooked but vital tool in the box of remedial pain management techniques. 

Cupping is not strange or niche; it has been used inter-culturally for thousands of years to great effect and continues to be used by elite athletes (and elite clinicians) to this day. Cupping does not cause bruising or release toxins; it draws inflammation away from painful areas

Only a small percentage of cups applied to patients leave discolouration. If you put a cup on healthy tissue, it just leaves a pink circle which vanishes in 20 minutes. Cups that leave a mark have drawn inflammation away from painful and/or injured tissue.

We live in an age where sophisticated pharmaceuticals and surgeries have transformed the world profoundly. So it’s easy for us to overlook how powerful some of life’s ‘low tech’ basics can be, especially when it comes to health. 

Consider the fortifying power of simple cardiovascular exercise. No pill, medical device or surgical procedure will ever supersede or replace the value and potency of that. Consider the simple logic of digging a small splinter out of a child’s finger, as we have done for thousands of years, another health-related activity where biomedical advances are not warranted. Cupping sits in this empirical realm, where the basics of health (like strong blood flow) are irrefutable and irreplaceable.

In healthcare, there may be as much forgotten knowledge as there is new knowledge. As we learn sophisticated and undeniably wondrous new means of healing, vital basics sometimes get left behind. And sometimes, the discarded knowledge is shockingly basic.

What could be more basic than hygiene in a healthcare setting? Yet ‘recently’, we totally forgot about it, for well over 1000 years.

The father of modern medicine, Hippocrates, was passionate about sterile healthcare practices 2500 years ago. The Egyptians used copper to effectively sterilise wounds. Greek infantry often fought naked because they realised that getting fabric into wounds caused infection. Aristotle advised Alexander The Great to have his soldiers boil drinking water to sterilise it. In 200 AD, Galen boiled his surgical equipment before performing surgery on gladiators.

Then the modern wing of Western medicine came along and totally lost sight of this achingly basic knowledge for something like 1500 years. And didn’t rediscover the concept of asepsis (surgical sterilisation) until the late 1800s. 

Up to the mid-1800s, a knife used to perform autopsies on diseased corpses could routinely be used moments later to perform a caesarian section; without being so much as wiped. And for the record, the doctors and surgeons who engaged in these practices were just as self-assured about their level of science as our doctors are today.

Nearly 1500 years with no surgical hygiene, long after its value was discovered and used to significant effect. That is how capable we are of losing sight of healthcare basics. And this long tradition of forgetfulness is very much alive and well today.

Thousands of years came and went during which our species understood that mechanical pressure could be used to draw chronic inflammation away from painful tissues, to great healing effect. Cupping was a big part of this, but there have been other methods too – like leeches.

leech therapy

Your friends, family and colleagues may raise their eyebrows at the notion of leeches as valuable healthcare. But in so doing, they embody the collective amnesia we have around the vital topic of relieving congestion and inflammation. 

The medical use of leeches was fully re-established in 2004 when the U.S. Food and Drug Administration approved the use of leeches for localised venous congestion after microsurgery and skin grafts. The effectiveness of leeches is based on their ability to draw congested blood from injured tissue, not unlike the mechanism behind the use of cupping for pain and injuries. And leeches may be an even more sophisticated technology than cupping.

 Leech saliva contains hirudin, an anticoagulant and anti-platelet agent that prevents blood clots and eliminates blood congestion in damaged tissue. Other chemicals in leech saliva keep the blood flowing in the damaged area, even after the leech is detached, allowing time for new veins to expand and consolidate blood flow. Leech treatment is also painless (a claim that cupping cannot make). Leeches implant a naturally occurring anaesthetic that numbs the injured area. 

Along with cupping, we had totally disregarded leeches as medicine and no doubt continue to under-utilise them to this day. But like leeches, cupping is making a solid comeback – for good reason. Cupping is an indispensable part of the tool kit needed to manage chronic pain. 

Your friends, family and colleagues may raise their eyebrows at the notion of leeches as valuable healthcare. But in so doing, they embody the collective amnesia we have around the vital topic of relieving congestion and inflammation in the body. 

The medical use of leeches was fully re-established in 2004 when the U.S. Food and Drug Administration approved the use of leeches for localised venous congestion after microsurgery and skin grafts. The effectiveness of leeches is based on their ability to draw congested blood from injured tissue, not unlike the mechanism behind the use of cupping for pain and injuries. And leeches may be an even more sophisticated technology than cupping.

 Leech saliva contains hirudin, an anticoagulant and anti-platelet agent that prevents blood clots and eliminates blood congestion in damaged tissue. Other chemicals in leech saliva keep the blood flowing in the damaged area, even after the leech is detached, allowing time for new veins to expand and consolidate blood flow. Leech treatment is also painless (a claim that cupping cannot consistently make). Leeches implant a naturally occurring anaesthetic that numbs the injured area. 

Along with cupping, we had totally disregarded leeches as medicine and no doubt continue to under-utilise them to this day. But like leeches, cupping is making a solid comeback – for good reason. Cupping is an indispensable part of the tool kit needed to manage chronic pain. 

Geoff was 76 years old. And more physically fit than many 35-year-olds. And he was putting his physical fitness to good use – single-handedly sailing a 30ft yacht around the coast of New Zealand. Literally single-handedly because he only had one working arm. The other arm was completely incapacitated by an apparent frozen shoulder. He had carried on like that for three years.

The shoulder had started off as quite a mild pain. At that time, Geoff justified not getting it treated by explaining that it wasn’t too bad. Then when the shoulder got worse, he conceded briefly that he should seek some help. Later, when the shoulder had not responded to medication, Geoff justified not seeking treatment by explaining that the shoulder was untreatable, or in his words, ‘old and completely f***ed’. All of which had left him living with a substantial amount of pain and physical limitation.

In the background to all this, Geoff had worked incredibly hard his whole life and created a very large and successful plumbing firm. Then, within months of his retirement to carry out his dream of a life on the high seas, his shoulder started hurting. And it was now seriously jeopardising his retirement dream.

 But rather than continue to seek answers, Geoff decided the shoulder meant his time had nearly run out. So he was squeezing every bit out of what he had left, which meant pushing himself extremely hard physically. And the shoulder was not appreciating it.

Toughness is an admirable trait, and Geoff had it in bucketloads. Yet, when healthy toughness is repurposed, ignoring the body’s endless cries for help (in the form of pain) can become harmful. Geoff had been using his innate toughness to ignore pain and, in so doing, had created a serious disability. 

Geoff’s shoulder was so ‘frozen’ he couldn’t lift his hand above waist height. Anyone who has had a frozen shoulder will let you know this means the use of the arm is essentially lost. Yet, Geoff was still managing to sail the open ocean for 9/10 weeks in the year. 

It was Geoff’s first mate (wife) who marched the reluctant and brow-beaten Geoff into my office. As wives of the walking wounded often do. 

Geoff had basically resigned himself to his fate. But his wife was still eager to seek solutions to the one-armed sailor problem. As well as hating to see Geoff suffer, she increasingly had to perform tasks on board a ship that she didn’t feel safe doing, which added to her sense that something needed to be done.

On examination, Geoff’s shoulder very much appeared to be classically ‘frozen’. In frozen shoulder, the fibrous capsule of the ball & socket joint becomes thickened. This causes severe loss of movement. And often severe pain. Most other shoulder problems leave the patient with far better function than a frozen shoulder. A frozen shoulder is a disability.

Frozen shoulder is not easy to treat. It usually takes months of regular focused shockwave therapy sessions, joint mobilisation, acupuncture, stress management and lifestyle changes. Progress tends to be meaningful but so gradual that it feels like trench warfare.

The little bit of shoulder movement Geoff did have came from shrugging his shoulder blade up because his shoulder joint itself was utterly immobile. This made the arm essentially useless. Clearly, it was just sheer grit and the support of his non-sailor wife making the improbable feat of sailing a large boat possible.

Despite appearing mostly like every other frozen shoulder, there were several curious aspects to Geoff’s presentation. 

Geoff was a man, and most frozen shoulders affected the ladies. Geoff’s symptoms had come on far more slowly than most frozen shoulders. There were far more tender points around Geoff’s deltoid muscle than in a normal frozen shoulder. And Geoff hadn’t been acutely stressed in the lead-up to his shoulder pain, which is a feature of nearly all frozen shoulders.

With the benefit of hindsight, these facts should have cast serious doubt over whether Geoff’s shoulder was frozen. But at the time, I felt confident it must be a frozen shoulder because of the sheer lack of movement. I was seriously wrong, however. Geoff’s shoulder might have been stiff, but it was far from frozen. Without my knowing, it was inflamed beyond belief.

When it came to treatment, I had a very small window of opportunity. Geoff would be available for three consecutive days before sailing north to Auckland for two weeks. Then two weeks later, he would be available for a full week of treatment. 

The first three days of treatment went without incident. Geoff received daily radial shockwave treatments, joint mobilisation and some dry needling. The combined impact of which was typical of a true frozen shoulder. He reported a 20% improvement in movement, which slowly dissipated once he stopped getting treatment and resumed sailing north.

However, on day 2 of Geoff’s second treatment window, something happened that I will never forget.

Geoff’s response to shockwave therapy was proving a little less impactful than I had hoped. So I decided to use some mechanical vacuum cups on those unusually tender areas over his deltoid muscle. With regular frozen shoulders, cups often help increase blood flow around the joint capsule and reduce pain. For a small percentage of frozen shoulders, they can make a big difference.

Once the deltoid muscle cups were on, I left Geoff and his wife to their good-natured bickering and went to tend to another patient. Unaware that the two previous decades of using cups to treat pain had left me totally unprepared for what I would find when I returned.

On returning to the room, Geoff was smiling broadly, but his wife, on the other hand, looked quite pale and shaken. The 3 cups on Geoff’s shoulder were full to the brim with Geoff’s skin which had expanded and turned so black that you would think it was frostbitten. Somewhat shocked, I carefully removed the cups immediately. 

Where each cup had been, there was a golf ball-sized swelling. Each golf ball was dark blue, almost black. I was very concerned that I was seeing a once-in-a-lifetime serious negative side effect to cupping. Geoff, on the other hand, had already deduced it was a good thing. And he was grinning ear to ear. 

After the cups had been off for a moment, still smiling as if in a state of bliss, Geoff gently rotated the shoulder a couple of times as if to check something. Then he promptly lifted the shoulder right up to his ear as if it had never hurt a day in its life. His wife’s jaw dropped. And so did mine.

In the following days, Geoff’s wife experienced a good deal of embarrassment on multiple occasions because Geoff kept stopping on busy streets to shadow boxes with his reflection in shop windows. 

The emotional impact of that week was like witnessing a person’s sight suddenly return after three years of unexplained partial blindness. To say Geoff was happy would be a huge understatement. In fact, it wasn’t apparent how unhappy he had been about his shoulder until one saw how jubilant he was about its miraculous recovery.

Naturally, I was happy too and somewhat amazed. Moments like this force me to re-evaluate my perception of how the body works.

Geoff’s said that during the 10 minutes the cups were on, it literally felt like all the pain and stiffness was being pulled out of him, which is why he was smiling so broadly when I returned. In the weeks following the cupping session, Geoff’s entire upper arm turned bright yellow, like you might see after a very serious injury. 

It appears that Geoff had a severe build-up of congested inflammation in his deltoid muscle. Perhaps equivalent to the swelling found in a severely sprained ankle. And no meaningful use of the shoulder joint. Then once that swelling was drawn to the surface, his body could finally disperse the inflammation. This theory is supported by the fact that when we repeated the procedure two months later, his shoulder (which had continued a 95% improvement) only generated a very mild bluish reaction to the cups, which passed within 24 hours. And the remaining 5% of his symptoms resolved with that session.

There is a question of how Geoff’s deltoid got so congested. Most likely overuse. But perhaps the biggest mystery is that the muscle had not appeared at all swollen; it was just tender to touch.

We understand very well that our bodies are subject to inflammation. Cases like Geoffs heavily insinuate that there are aspects of inflammation we currently have little understanding of. Although by way of circumstantial evidence,  MRI scans often do reveal ‘fluid build-ups’ in chronically painful tissues. Especially in Geoff’s age group.

It is worth noting that the really unusual thing about Geoff’s case wasn’t so much the results. Done properly, cupping frequently attains similar levels of success over time. The unusual things were the speed of recovery and the visual intensity of the reaction. 

Josh’s shoulder cupping story also has ties to life at sea. And the dangers of pushing through too much pain. It also reveals a great deal about how some pains get stored in the body, particularly after serious injuries.

Josh’s area of expertise is the use of concrete in strengthening office buildings. It’s incredibly harsh physical work done by some of life’s unsung heroes. Un-strengthened buildings in countries like Haiti and Turkey have crushed thousands of people in recent years. And those of us who are lucky enough to live in countries where this is not tolerated owe a great debt to men like Josh.

In his former professional life, Josh didn’t learn anything about reinforced steel and concrete. But he did learn about the physical resilience needed to do the work he does now. 

At 17 years of age, Josh signed up to work on a trawler—fishing for Patagonian Tooth Fish in the depths of the arctic ocean. Working on a trawler on the southern ocean involves a level of physical toughness most of us are barely aware exists -let alone have personal experience of. It also involves working alongside some very tough characters.

On the second day of his very first jolly fishing trip, Josh was on deck and got hit by a wave, which knocked him completely unconscious. As he fell, already unconscious, the tip of his right shoulder hit the metal deck very hard. 

When Josh had recovered from the blow to the head, it became apparent that the shoulder was badly injured. All he could do with the arm was hold it at his side as if it was in a sling. He felt searing pain in the bone with any movement of the shoulder, and the whole arm felt incredibly weak. Less than ideal for working on a fishing trawler in ferocious seas.

Under normal working conditions, this injury meant a trip to the hospital and probable weeks of sick leave. But hunting Tooth Fish in the depth of a freezing maelstrom is not a normal working condition. And the work culture is very different to most work cultures, thankfully for the rest of us.

Josh’s injury put him in a very awkward position. He basically had three options. The first was to stop working. This would mean three weeks of being treated with all the warmth a police informant would receive from a boat full of career criminals. The second option was requesting an airlift at great cost to his employer, which would have been provided, along with harsh criticism, shaming and permanent dismissal. The third option was to keep working. Josh took option three.

To cut a long story short, Josh spent three weeks sorting fish and performing the role of a general ‘dog’s body’ with one arm. During which, he lost count of how many times the point of his shoulder bounced off metal walls; as he was thrown around in rough conditions. His workmates renamed him ‘Squeak’ after the unusual noise he would make every time the point of his shoulder hit something hard. But he pushed through the whole ordeal. Making it to the end of the trip without missing a single shift.

Once back at port Josh went to the hospital. X Rays confirmed that he had cracked the end of his acromion process (the hard pointy bone on top of the shoulder). There was no procedure to repair it. 

Afterwards, his workmates learned he had worked through a broken bone, which secured their respect. They even stopped calling him Squeak. But he had paid a heavy price.

As a result of re-traumatising the fracture so many times, it didn’t heal properly. 

So Josh ended up on a disability benefit for 15 months before he was able to work again.

Josh’s shoulder also never fully recovered. Twenty years later, he still found it would ache for days if he pushed himself on a concrete job. He also permanently lost the ability to sleep on the injured side.

But I didn’t know about any of this the first time Josh came to me about his shoulder. We had never spoken about it. He would come to me periodically with acute episodes of lower back pain. Which I would help settle down so he could return to work. Usually far faster than I recommended. 

On the day of Josh’s memorable cupping session, he called me to ask if I could take a look at his shoulder. And I could hear from his voice on the phone that it wasn’t good. Then when he showed up, it was apparent he couldn’t move the arm – due to pain around his AC (acromioclavicular) joint on top of his shoulder.

The AC joint is a little fibrous joint on top of the shoulder. An inch away from where Josh’s fracture had occurred. It is susceptible to sprains and dislocations. Very heavy lifts can dislocate the AC joint, and sports tackles have a track record for doing the same. But Josh had done none of the above that week. Thus it appeared to be a mystery AC sprain.

Josh was in a terrible state. He was very pale and sweating from the pain. He is durable, obviously, so I was concerned. It even occurred to me that he might have an infection, but there were no other signs of that. I tried some gentle mobilisation of his AC joint, but it was too painful. So, fatefully, I thought I would try a vacuum cup to draw some of the inflammation to the surface.

The rest of that session was exactly like Geoff’s cupping session. When I returned, there was a golf ball-sized black swelling right over the top of Josh’s shoulder. Right next to where I would later learn he’d been injured all those years before. He, too, experienced a complete resolution of his symptoms on the spot. The movement of the arm returned instantly. His colour returned. And he was back to his normal manly self in less than 20 minutes. The relief, as they say, was palpable.

Then after the session, Josh found he could sleep on that side for the first time in 20 years. His old injury appeared to have spontaneously healed itself. Like Geoff, he, too, had a large yellow bruise-like stain down his arm after the session.

It had been so long since the fishing incident that Josh barely recalled it was the cause of his niggly shoulder. It wasn’t until the shock and mystery of how much inflammation had been released, and seeing how confused I was, that it occurred to him that there may be a connection. That is when he recounted the trawler fishing story.

Josh’s shoulder had been harbouring an unhealed AC joint sprain (adjacent to the original fracture) for 20 years. Over time the joint and surrounding tissue had become deeply congested with chronic inflammation. Then, for whatever reason, on that particular week, Josh’s nervous system decided to activate his pain pathway, bringing the old issue into very sharp focus.

Cases like Geoff and Josh (and countless others) teach us that there are times when the body starts its healing processes but simply can’t finish them without assistance. And that this is a major cause of chronic pain in our society.

This ‘unhealing’ tends to happen most often in areas of repetitive use, like shoulders. So presumably, it is a repetitive strain that leads healing to pause, sometimes for decades. It happens a lot after bad injuries, it happens a lot after surgeries, it happens a lot in people who push their bodies to extremes, and it is very easy to treat with cupping.

We are accustomed to the idea of ‘anti-inflammatories’, which use chemicals to ‘neutralise’ inflammation in painful tissues. Cupping is the same but different.

It uses mechanical pressure to draw inflammation away from painful tissues so the body can disperse it. 

Cupping inflamed tissue is as logical as using mechanical pressure to remove a splinter from a child’s finger.

Using mechanical pressure to remove splinters from fingers is basic common sense. And so well established that there’s clearly no need for a triple-blinded randomised control trial to assess if it is valid. Cupping is a lot like that. It is so safe, so logical, so effective, and so well established that it should not need to be supported by any scientific evidence. But it is.

If you type ‘cupping therapy for pain‘ into Google Scholar, it comes up with over 44 thousand results. I cannot claim to have read all 44 thousand papers. But I have read many, and all the ones related to ‘effectiveness’ concluded basically the same thing. 

‘This trial showed good results, but the sample size and study design weren’t good enough to offer scientific certainty’… more high-quality research is warranted.’

There are tens of thousands of small studies on cupping, yet still no large-scale studies with bulletproof design.

It’s hugely expensive and difficult to execute studies that meet the criteria for ‘high-quality evidence’, especially with therapies of this nature. To generate this type of research, big pharma money, government money, or funding from an extremely large private entity is usually required. 

Pain therapy research is not an even playing field. The treatments that promise big profits in the long term attract funding. As do treatments that fit comfortably with the present-day paradigm. Cupping ticks neither box and is thus evidentially hobbled by a lack of the highest-quality research data.

Meanwhile, thousands of positive research findings (and tens of millions of anecdotal reports) indicate cupping is an important pain management tool. So you can be confident that cupping for pain is a case of ‘no smoke without fire’. Especially when that smoke keeps persistently rising for thousands of years.

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The Family Doctor Myth

There is nothing wrong whatsoever with seeking pharmaceutical pain relief to tide you over until real healing of your chronic pain starts to take effect. But in most instances, seeking real answers to chronic pain from your family doctor is a highly questionable endeavour. Doctors are trained and equipped to treat medical issues. And there can be grat value in drawing a distinction between medical issues and fundamentally non-medical issues. Value for us individually but also value for an overloaded healthcare system.

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At what point do sickness,  weakness, tightness, and soreness become medical issues? 

These are not easy questions to answer necessarily in some cases, and yet in other cases, they are extremely easy to answer. Like those above. 

There is no question that if the struggles faced by our musculoskeletal system become severe enough that they can become medical issues. Major injuries and auto-immune disorders qualify. Yet, perhaps surprisingly, chronic pain seldom qualifies. Despite the severe impact it can have on our lives.

I meet people on a daily basis who have been back and forth to their family doctor for years, asking for help with their pain. They are often quite frustrated with the way their issues have been handled.

The list of solutions explored tends to follow the same basic patterns. Pain killers, non-steroidal anti-inflammatories, blood tests, x-rays, surgical specialist referrals, steroid injections and, sadly, on occasion, opioid medications, which have been conclusively shown to be far more lethal than chronic pain itself. All of which approach pain as if it was a disease rather than a fundamentally healthy form of biofeedback.

There was a study carried out in the U.S. which highlights the absurdity of having a family doctor manage ongoing pain

In an attempt to loosely measure how well we manage pain in the elderly, a group of researchers measured the duration of pain consults in doctors’ offices. 

Many elderly patients consult their doctor about multiple issues at the same time, so it was a little tricky to design the study. Getting specific about the duration of pain

 consults meant it was necessary to start a timer the moment a patient mentioned pain and stop the timer again once that part of the conversation concluded. They did this across hundreds of doctor visits. 

The average duration of a pain consult for an elderly patient at their doctor’s was less than 3 minutes, which is close to constituting a complete dismissal of a very serious health issue.

To put that in context. In my clinic, we often spill over the 60-minute mark in initial pain consults with older patients. And trust me, I am every bit as time-poor as any of those doctors.

The time spent on specific issues reveals a great deal about practitioners. It’s a direct flow from the amount of honest training, thought and focus we have placed on that topic. If you asked me or your dentist for some advice about diabetes, this would be apparent. That would be a very short conversation, mostly about who you should actually be talking to.

Now, I’m not claiming any insight into what your doctor has or has not done for you. Nor am I seeking to diminish the good work family physicians do. 

I am merely seeking to highlight the undeniable truth of this matter; the average family doctor’s education does not encompass the rehabilitation of chronic pain: any more than it does the management of tooth decay. It’s just not their field of expertise.

The fact that so many of us still rattle on year after year, Endlessly consulting doctors who know next to nothing about rehabilitation, biomechanics or pain management, is just another symptom of a society that struggles with pain. 

Cut your family doctor some slack; they do a hard job. If you are peeing blood one day, they might save your life. But if you have knee pain, consider leaving them in peace. 

Our problems become medical once they are so bad that the body cannot heal itself any more, like a badly broken bone or an infection that exceeds the immune system’s capacity. Less than .001% of chronic pains qualify. The body has the ability to resolve chronic pains in the same way that it has the ability to resolve obesity or a general lack of fitness.

Work with professionals who are actually trained to diagnose, treat, and rehabilitate pain. Just make sure they are primary healthcare providers. You might have something serious going on, so they need to be fully qualified! If you do it this way, with the right people, everyone wins, but mostly you.

But of course, there is nothing wrong whatsoever with seeking pharmaceutical pain relief to tide you over until some real healing takes effect.

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The happy news about chronic pain is that it’s virtually always treatable with tools and methods that already exist. The ‘cures’ for chronic pain are not out in the future of pain science; they are right here in your lifetime.

After 25 years of managing pain, when I receive emails from people who claim to have ‘tried everything’ for their chronic pain, I feel genuinely excited for them. Because I know that if they have truly had enough, they are almost guaranteed to get better – given some time and effort.

As I have slowly realised just how manageable most chronic pain really is, I increasingly found myself feeling a bit sad and angry. And I still do sometimes feel like that about it. Not angry at anyone in particular. Just angry that there are millions of people suffering so unnecessarily. There is something extra frustrating about the thought of suffering that is unnecessary and easily avoided.

But so many people struggle to resolve their chronic pain. You could be forgiven for assuming it is nearly impossible to treat. Yet, armed with the right tools and methods, the vast majority of chronic pains are very treatable. But there are challenges to overcome. The contextual challenge is that quality pain management is not always easy to access. The personal challenge, on the other hand, is mostly just mindset. Then, once the healthcare and the mindset are right, healing the body is often found to be the least challenging piece.

There is a surprising truth about pain sufferers that many find a little hard to swallow. It’s easier to predict the likelihood of recovery by looking into their eyes than by looking at their scans. Because wanting to be pain-free is a lot like wanting to lose weight or get fit. One of life’s challenging but achievable physical goals. Yet, only once we are fully committed to change.

When I was 8 years old, my father took me birthday shopping for my grandmother. It was her 65th, and he was a doting son. So he wanted us to get her something special, and he wanted me to choose the gift. So we went shopping in London.

We went to Liberty’s in Knightsbridge, and I remember being amazed by all the colourful fabrics. We looked at all sorts of bags, clothes and accessories. My grandmother loved scarves. Liberty’s is definitely the place to buy a good scarf. But in the end, I chose a hip flask, the kind you put whisky in. It was wrapped in luxurious floral fabric and had leather details. My logic was that it looked just as lovely as all the other things but was way more practical. Because I knew my nanna liked whisky.

I didn’t learn this until years later, but that hip flask would cure my grandmother of her alcoholism in a flash.

On the morning of her birthday, my nanna opened her special gift over breakfast. But it didn’t generate the intended feelings of appreciation and love; in fact not even close. Years later, she would tell me how she felt when she realised what it was. She felt like her own shame and self-hatred could swallow her up. These feelings were so intense that they changed the course of her life.

Unbeknownst to me, my nanna had been drinking very heavily for 40 years. Since the trauma of her first husband (my grandfather) vanishing without a trace. He had said he was going to buy some cigarettes one evening and simply never reappeared. This had left her suddenly alone with three children, no support, and almost no money. The shock and grief of this had driven her into the depths of addiction. All of which needed to be reconciled with her uninterrupted efforts to be the perfect mum.

She’d been a high-functioning, heavy drinking and deeply ashamed closet alcoholic for four decades. Still, she held herself together through sheer East London grit, mostly for the sake of her children, who she adored. She managed to hide the extent of the issue but not the fact that she drank. Hence, her grandson knew she liked to drink whisky.

My 8- year old self didn’t even know what an alcoholic was. I just knew that my nanna liked to drink whisky sometimes. But for my nanna, who’d been hiding a severe addiction for 40 years, that hip flask held deep symbolism.

She concluded from the nature of the gift that I saw her as an alcoholic. And was so overwhelmed by the wave of feeling this generated that she gave up alcohol immediately; after 40 years of extremely heavy drinking. She just couldn’t bear the pain of it.

That hip flask was something like a bolt of lightning through my grandmother’s nervous system. One that jolted her out of years of severe addiction. It was also the catalyst for her quitting smoking 12 months after she stopped drinking. That was a big deal, too, as she had smoked 20 per day since she started working as a typist in her late teens.

It’s doubtful that the hip flask increased the pain my nanna had inside of her. It’s more likely that it just ‘cracked open’ the pain that was already there. I honestly believe she hadn’t fully felt the depth of her own suffering until she opened that gift. Having ‘pushed it all down inside‘ for decades – and numbed it with alcohol, of course.

She had suppressed her suffering so successfully that it had been somewhat tolerable. But once she felt the full depth of her suffering, she was instantly done with it. Chronic pain is often very much like this. When we are done, we are done. But generally, that takes some kind of rock bottom to be hit.

In order to cope with pain of all kinds, many of us learn to ‘push it into the background‘ or ‘disassociate’ from it. This makes it a lot easier to live with. But it can also create layers of apathy about resolving it.

We all have a unique fingerprint when it comes to how much pain we will accept, both emotionally and physically. With chronic conditions like pain, addiction, depression, and obesity, there tend to be long periods where we suffer; but are not fully resolved to get better. Yet thankfully, most of us have a threshold where we shift into ‘no matter what it takes’ mode.

People who truly heal from chronic pain all have one thing in common. They are like my grandmother after she received the hip flask. A day, month or year came when, for whatever reason, they were willing to do whatever it took to get better. 

The mystery is in how widely we differ in our willingness to endure chronic pain. Some people only need one week of bad back pain to decide they will do whatever it takes to make sure it never happens again. Others experience a great deal of apathy about their pain, even after years of terrible suffering. It is quite a mystery. But core beliefs most probably play a big part.

Admittedly, however, many pain sufferers are forced to maintain a state of determination for years at a time before they find solutions. Nonetheless, it is that determination that all the real success stories have in common. Every part of them wanted to get better. ‘No matter what it took’

Conversely, those who are fed up but haven’t quite reached the ‘I am definitely done with this’ or ‘by any means necessary’ stage don’t heal anything as reliably. These people tend to have doubts, fears and other priorities that are simply ‘making more internal noise’ than their desire to get better.

Most of us know that outcomes in education, sport, weight loss, fitness and even dental health are significantly determined by mindset. Yet we seldom think of pain rehab in quite the same way. Maybe because we are taught to believe chronic pain is essentially a non-communicable disease that doctors either treat or fail to treat.

A note of caution to those who go to the other extreme. 

The role that hard work and mindset play in the rehabilitation of chronic pain can be misinterpreted. It doesn’t imply you need to meditate for 2 hours a day, live on kale and do 25 hours of yoga per week. For a percentage of pain sufferers, the ‘extreme self-care’ pathway can be a trap all of its own. One that often goes with a tendency to try and ‘fix it’ without professional help, which is seldom advisable. Extreme ownership is excellent, but best under guidance from a professional who has experience with many similar cases.

The ‘hard work’ of pain rehab is made up of highly specific activities. Like seeing the right practitioners regularly. Being willing to fail a few times at finding the right practitioner. Sticking with the right practitioner even if there are a few challenges. Making lifestyle changes. The long-term persistence with highly specific exercises and self-care. None of which is particularly extreme or time-consuming. It just requires sustained effort, sustained trust, and some targeted methods. 

So, wonderful news! Chronic pain is seldom outside your control. Getting pain-free is like getting fit, so once you’ve truly ‘had enough’, your pain tends to become very treatable. You just need to check in with yourself and make sure that every part of you is determined to get better, with no room for ‘buts’. 

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Shockwaves, Pain Treatment & Hormetic Stress

Shockwaves, Healing & Hormetic Stress

Shockwaves, Pain Treatment & Hormetic Stress

Using hormetic (healthy) stress to heal painful tissues is a crucial element of pain management.. Even for pains that are predominantly nervous system based (like PTSD-associated pain), there is great value in healing and strengthening painful tissues.

Hormetic stress‘ is a term few have heard of. Yet it’s a cornerstone of health, of our lives, and the entire natural world. Hormetic stress is also a significant key to getting out of chronic pain. 

Hormetic stress is an invisible by-product of healthy life processes, and it’s everywhere. If life were a chocolate cake, Hormetic stress might be the baking powder. An invisible flavourless ingredient that nonetheless holds everything together. Without this, the entire recipe becomes an unappealing stodgy mass.

In nature, the benefits of hormetic stress show up under a wildly diverse and broad set of circumstances. Its benefits support individual cells, organs and muscles but extend to shaping entire species and even the environments they live in.

Excessive stress of almost any kind can destroy life very quickly. Zero stress tends to cause a slow death and failure to thrive. But, with the right amount of stress, life is fortified and can truly thrive. This healthy stress is hormetic stress.

If you set up a warm, damp environment in a petri dish, bacteria love it. Then, if you add a sugar solution, they can continue to survive. But there’s another ingredient that you can add that will cause them to truly thrive—a microdose of arsenic. 

Bacteria left with the perfect conditions for life are consistently outperformed by bacteria with the perfect conditions for life – plus a little bit of poison. Knowledge of this fact reveals a great deal about life, health and successful pain management.

Bacteria with too much arsenic die. Bacteria with no arsenic just survive. Bacteria with a microdose of arsenic become a roaring success. The right amount of poison in their environment acts as a hormetic stressor. A manageable dose of stress forces adaptation and makes them stronger. In this way, infinite versions of hormetic stress benefit all of nature, from single-cell organisms to entire ecosystems.

Giant Sequoia trees

Giant Sequoia trees bear the largest scars on any life form on earth- Scars left by fire. Sequoias are utterly besieged by seasonal fires in a way that is almost impossible to believe could be helpful to them in any way – Until you look closer.

Sequoia once occupied the entire Northern Hemisphere. Yet only three species have survived ‘recent’ ice ages. The Giant Sequoia is one of the three. And their home range is now limited to 77 small tree communities in a 260-mile strip of the Western Sierra Nevada mountains.

Compared to Giant Sequoia, human biology is ant-like. They are living, breathing apartment blocks with three-foot thick skin. The largest being 100 ft in circumference at the base and 26 stories tall. Body masses that exceed that of 15 blue whales (or 300 elephants) are common. Single trees can live 3-4 times longer than the most successful human cultures, over 3000 years. But these are not the big numbers.

The Giant Sequoia’s direct bloodline is around 150 million years old. That’s about as long as the entire mammalian family tree. And they may achieve a longer stay on the planet than all of the dynasties of dinosaurs combined. They are a single, seemingly immortal species that have outlived numerous biological epochs. And the secret to their success is mastery of hormetic stress.

Giant Sequoia trees bear the largest scars on any life form on earth- Scars left by fire. Sequoias are utterly besieged by seasonal fires in a way that is almost impossible to believe could be helpful to them in any way – Until you look closer.

Sequoia once occupied the entire Northern Hemisphere. Yet only three species have survived ‘recent’ ice ages. The Giant Sequoia is one of the three. And their home range is now limited to 77 small tree communities in a 260-mile strip of the Western Sierra Nevada mountains.

Compared to Giant Sequoia, human biology is ant-like. They are living, breathing apartment blocks with three-foot thick skin. The largest being 100 ft in circumference at the base and 26 stories tall. Body masses that exceed that of 15 blue whales (or 300 elephants) are common. Single trees can live 3-4 times longer than the most successful human cultures, over 3000 years. But these are not the big numbers.

The Giant Sequoia’s direct bloodline is around 150 million years old. That’s about as long as the entire mammalian family tree. And they may achieve a longer stay on the planet than all of the dynasties of dinosaurs combined. They are a single, seemingly immortal species that have outlived numerous biological epochs. And the secret to their success is mastery of hormetic stress.

The Sierra Mountains are prone to biblical forest fires. A bad forest fire can burn for up to 6 months at a time. And fire, being fire, has the capacity to decimate vast tracts of forest. The Castle Fire in 2020 destroyed 4 million acres of forest. Smaller tree species tend to get the worst of it. Yet when fires are bad enough, Sequoia groves can suffer catastrophic losses too. But giant sequoias are uniquely fire-tolerant. 

In the same way that antelope are highly adapted to the specific goal of not being eaten. Sequoias are highly adapted to the specific goal of not being burned alive. What a lioness is to an antelope, too much fire is to a Giant Sequoia. So a substantial portion of their biology is dedicated entirely to fire resistance. 

Naturally, large enough fires can wipe out sequoia groves. Like too much arsenic poured on a bacterial culture. And even the most massive trees can succumb to fire. Larger trees need to burn for months for it to happen, but once several feet of bark armour is breached, the delicate heartwood can burn, and the tree will die. 

giant sequoias burn

But even when the protective bark is breached by fire, sequoia usually doesn’t die. Instead, they end up with giant scars that can be up to five stories in height. These giant black V-shaped scars serve as a stark reminder of how fragile all life is. And that even the immortal sequoia, who lives through the rise and fall of empires, has its own vulnerability and impermanence. It is also the scars that create the false visual impression that fire is the Giant Sequoia’s enemy.

Seeing the damage fire inflicts on these magnificent beings; it appears certain that fire is a destructive presence in their lives. But nothing could be further from the truth. Fire deeply nourishes, supports and even births sequoia trees. 

Sequoia requires vast resources to support its growth. Fire clears out smaller trees that might otherwise compete for the nutrients they desperately need to support their enormous mass. 

Sequoia needs granite-hard pine cones. So their seeds are safe from pests during the 20 long years their cones take to grow. Only fire can crack open the cones and birth the sequoia’s baby seeds. Flames fulfilling the role of midwife to the trees.

Giant Sequoia is a pioneer species. Once their seeds are free, rising hot air from fires gently lifts Sequoia seeds. It carries them to their own part of the forest, where they have a chance to establish themselves at a healthy distance from their giant parent.

Despite their parent’s size, sequoia seeds are the size of an oat flake and very fragile. If the seeds do not land on bare earth, they dry out and die. So fire lovingly clears debris from the forest floor, creating the perfect bare soil conditions for the seedling to sprout.

Young sequoia grow very slowly compared to smaller tree species. So when fire pre-clears the forest of smaller trees for the seed, it also removes competition that might otherwise choke the slow-growing baby tree and compete with it for light.

When Giant Sequoia seedlings sprout from the ground, their ‘first meal’ is the fertilising ash left behind by fire. Like a first drink of mother’s milk, fed directly to it by the process of fire.

Once adults, sequoias are strengthened and supported by the presence of fire also. Fire adaptations make sequoia taller, thicker, and more resistant to pests, rock falls and droughts. These attributes enabled them to ‘outrun’ all other tree species in their environment. Thus winning the race for light, water and nutrients.

In the right amounts, fire acts as a classic hormetic stressor to the biology of Sequoia trees. By harnessing and adapting to it, they have become some of the largest, longest-lived and broadly indestructible organisms on earth. The fire that appears as such an alarmingly destructive force to the sequoia is its very lifeblood.

But even when the protective bark is breached by fire, sequoia usually doesn’t die. Instead, they end up with giant scars that can be up to five stories in height. These giant black V-shaped scars serve as a stark reminder of how fragile all life is. And that even the immortal sequoia, who lives through the rise and fall of empires, has its own vulnerability and impermanence. It is also the scars that create the false visual impression that fire is the Giant Sequoia’s enemy.

Seeing the damage fire inflicts on these magnificent beings; it appears certain that fire is a destructive presence in their lives. But nothing could be further from the truth. Fire deeply nourishes, supports and even births sequoia trees. 

Sequoia requires vast resources to support its growth. Fire clears out smaller trees that might otherwise compete for the nutrients they desperately need to support their enormous mass. 

Sequoia needs granite-hard pine cones. So their seeds are safe from pests during the 20 long years their cones take to grow. Only fire can crack open the cones and birth the sequoia’s baby seeds. Flames fulfilling the role of midwife to the trees.

Giant Sequoia is a pioneer species. Once their seeds are free, rising hot air from fires gently lifts Sequoia seeds. It carries them to their own part of the forest, where they have a chance to establish themselves at a healthy distance from their giant parent.

Despite their parent’s size, sequoia seeds are the size of an oat flake and very fragile. If the seeds do not land on bare earth, they dry out and die. So fire lovingly clears debris from the forest floor, creating the perfect bare soil conditions for the seedling to sprout.

Young sequoia grow very slowly compared to smaller tree species. So when fire pre-clears the forest of smaller trees for the seed, it also removes competition that might otherwise choke the slow-growing baby tree and compete with it for light.

When Giant Sequoia seedlings sprout from the ground, their ‘first meal’ is the fertilising ash left behind by fire. Like a first drink of mother’s milk, fed directly to it by the process of fire.

Once adults, sequoias are strengthened and supported by the presence of fire also. Fire adaptations make sequoia taller, thicker, and more resistant to pests, rock falls and droughts. These attributes enabled them to ‘outrun’ all other tree species in their environment. Thus winning the race for light, water and nutrients.

In the right amounts, fire acts as a classic hormetic stressor to the biology of Sequoia trees. By harnessing and adapting to it, they have become some of the largest, longest-lived and broadly indestructible organisms on earth. The fire that appears as such an alarmingly destructive force to the sequoia is its very lifeblood.

It is deeply telling that such potent and successful life forms have an intense relationship with hormetic stress. It points to how essential hormetic stress is in enabling all life to thrive. It also points to how important it is that we understand hormetic stress’s role in maintaining our general health. And how vital it is to harness this wisdom when seeking to heal tissues that are stuck in the cycle of chronic pain. 

Hormetic stress supports life on every conceivable scale. From micro-organisms all the way up to entire mountain ranges. And everything in between, including the human body. There are countless ways that hormetic stress benefits the human body

Exercise is a hormetic stressor to humans. The most obvious hormetic stress mechanism in our human world is physical exercise. We all know the body needs the constant stress of movement to support healthy muscle and cardiovascular function.

Gravity is a hormetic stressor to humans. Without the stress of gravity, bone demineralises and wastes away. One year in space can leave a cosmonaut with over 20% of their bone mass wasted away to nothing. Without constant mechanical strain, bone stops regenerating itself effectively. 

Heat is a hormetic stressor to humans. Sauna research has shown that when we are exposed to heat, our body’s cells generate heat shock proteins. Heat shock proteins assist with cell repair, muscle repair, inflammation control, improved immunity, cardiovascular function and elimination of free radicals.

Cold is a hormetic stressor for humans. The stress of regular cold exposure has been shown to increase dopamine levels, promote greater well-being, reduce auto-immune inflammation, boost immunity to viruses and boost metabolism. 

Fasting is hormetic stress for humans. Calorie restriction imposes healthy stress on the human machine. Intermittent fasting can trigger a healthy switch from glucose metabolism to ketone metabolism, increase stress resistance, increase longevity, and decrease the incidence of diseases, including cancer and obesity.

Toxins are hormetic stressors for humans. Tannins found in tea are poisons. Yet, in controlled doses like a cup of tea, they are known to protect against cell damage, heart disease, cancer, invading microbes and toxic free radicals. In larger doses, though, tannins are very toxic to the body, like all forms of hormetic stress.

But the question is, how does this all apply in more specific terms to successful chronic pain management?

Hormetic stress can be harnessed and directed to resolve pain, to significant effect, in the overwhelming majority of cases. And the hormetic stressor most vital in healing chronic pains is not heat or cold of chemical stress; it is ‘mechanical stress’.

Mechanical stress can be used almost universally to stimulate the healing and strengthening processes required to resolve chronic pain. To some extent, this is common knowledge, as hopefully, we all understand the central role exercises play in resolving chronic pain. Yet another integral phase of hormetic healing is required (usually before exercise prescription). Where treatments that harness mechanical stress are necessary to trigger healing in painful tissues. If you have found that exercises increase your pain, this should be of some comfort.

There are many pain treatments that leverage hormetic stress to heal tissues and reduce pain. In fact, the overwhelming majority of effective pain relief tools involve the application of mechanical stress to tissues. One example, in particular, serves as an excellent window into how these treatments work.

Quite unexpectedly, it turns out that intense soundwaves can support tissue healing, the same way fire supports giant trees, by delivering a controlled dose of healthy stress that supercharges biological processes.

Extracorporeal Shockwave Therapy (ESWT) was originally developed in the late 20th Century for the treatment of kidney stones. Some brainiacs realised that intense soundwaves travelling through fluid created a shockwave. And that these shockwaves were strong enough to crack a piece of porcelain; but did not harm living tissue. Because tissue is mostly fluid and offers less resistance to the energy. These observations teased the potential for safe,  non-invasive breaking up of kidney stones using shockwaves.

After many years of research and development, ESWT was cleared for use on humans with kidney stones. Which is when something very curious started happening among the test subjects -In the form of unexpected side effects.

After the successful dissipation of their kidney stones, numerous patients felt to compelled to inform the researchers that stubborn pains they had suffered for years had spontaneously resolved. At first, this was understandably dismissed as either placebo or a coincidence. But then something far harder to ignore happened.

A patient with chronic hip pain found that it spontaneously resolved shortly after the treatment of her kidney stones. Which in itself was not unusual, except that the known cause of her hip pain was osteonecrosis (bone tissue death) of her femoral head (upper thigh bone). Then, when x-rays were taken, the bone had spontaneously healed itself. The tissue had mysteriously come back to life. An unheard-of and ‘medically impossible’ event had taken place in her tissues. 

Osteonecrosis of the femur happens when the head of the bone loses connection to its blood supply. This can happen as a knock-on effect of other health issues, including radiation treatment, various diseases, and trauma. And often also occurs for no apparent reason. Starved of its blood supply, the bone tissue literally rots away inside the body, causing inevitable pain and disability.

So the only reasonable explanation was that shockwave treatment had triggered the dying bone to re-establish its own blood supply. Naturally, this warranted significant further investigation.

Fast forward 40 or so years, and ESWT is a gold standard treatment for an incredibly wide range of musculoskeletal pains. Plantar fasciitis, heel spurs, tendinopathies, calcific tendinopathy, stress fractures, Achilles pain, tennis elbow, knee pain, and frozen shoulder are all firmly on the list. And many others, like back pain and neck pain, have yet to be studied in depth but, nonetheless, often respond well in real life. 

Shockwaves’ ability to heal bone and soft tissue means that it has potential application for treating pain almost anywhere in the body. In addition, it has become a standard treatment for erectile dysfunction. And its ability to trigger nerve regeneration has even led to it being studied for its potential use in treating spinal cord injuries, brain damage and Alzheimer’s.

Underlying all this lies a bewildering number of well-documented cell and tissue healing responses. Exactly the type seen when stem cells go to work. New blood vessel growth, new cartilage growth, protein synthesis and the release of various ‘growth factors’ are all well documented. 

All of which come directly from the application of mechanical stress to the cells and the spaces between the cells. The soundwaves create intense pressure, which creates mechanical stress in the tissue, which creates a hormetic response.

So ESWT is a classic hormetic stressor. It imposes healthy stress on tissues and stimulates a wide range of healing responses, which lead to a reduction in pain. Fundamentally acting just like controlled doses of fire do on groves of sequoia trees.

ESWT is very typical of the treatments that most reliably lift people out of chronic pain. Because most of them also apply mechanical stress to the tissue and elicit a hormetic stress response. 

Rehab exercises, deep tissue release, spinal manipulation, yoga, pilates, cupping, fascial release and acupuncture and trauma release exercises are other excellent examples of how home mechanical stress can be exerted in order to heal tissue.

For most pain sufferers, the secret to harnessing these hormetic stressors is to use multiple stressors in conjunction with each other. Combining ESWT with cupping, for example, dramatically improves its already excellent hit rate. In addition, it’s usually necessary to do things in the right order. 

The more passive treatments (i.e. the ones you just lie down on a treatment table and receive) should be used first to heal the tissues and reduce pain. Then, when the pain has reduced, less passive treatments like strength exercises should be used. This helps avoid bad reactions to exercise by ensuring the tissues are sufficiently healthy before strengthening starts. 

The best way to explore all the options is to find a clinic where they systematically mix and match treatments. Failing that, you can curate your own investigation into various hormetic stressors. By hiring a deep tissue therapist, a shockwave therapy practitioner, a chiropractor and an acupuncturist (just for example). In addition, always prescribing your own dose of hormetic stress by keeping your body moving regularly and in healthy ways (as much as you can without causing more pain). 

A strategy of this nature ensures that your painful tissues receive diverse forms of mechanical hormetic stress. The benefits of which should become apparent within weeks, or at least months. Once the treatment combination is right for your body, that is.

Beyond these pain specifics, it’s also well worth considering a more holistic embrace of hormetic stress. Sauna, cold plunges, cardiovascular exercise and fasting have all been of immeasurable benefit to people on healing journeys of all kinds.

Annoyingly, both in and out of pain management, hormetic stressors tend to be uncomfortable. Shockwave therapy isn’t always fun, running up hills isn’t fun, and cold plunges are generally even less popular. So it takes willpower to repeatedly throw one’s self into these fires. But ultimately, a life hollowed out by chronic pain is infinitely worse. So once they fully understand the value of hormetic stress, most pain sufferers find the choice between the two quite an easy one to make.

It’s a mystery why the body needs agitation to be fit .. to heal pain. But it so often does.

 

 

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