Happy brains

Powerful thoughts, powerful language, powerful body

Here is another little gem from my favourite physio and pain guru, David Butler.

The brain loves to change (have you heard of neural plasticity?) and in addition, the brain loves to swim in its 'soup' of neurotransmitters and hormones. The brain loves happy hormones the best to keep us and our central nervous system feeling optimum!

When it comes to language, the use of metaphor, rhyme and alliteration really sticks in the brain. Think 'coca cola', or 'lululemon' or those kids nursery rhymes (that are hard to shake from the brain despite all your trying).  Language and it's power can turn your brain soup either happy or sad and have a strong impact on your nervous system, the way you feel, the pain levels you are in and your overall well being.

So.... we are not going to dwell on our bad backs, tight traps or degenerating discs. We will instead be exercising, focussing and becoming stronger to feel good as gold and picture perfect for summer.  Let's dive in and heal our hips, mend our muscles and turn that soup to a happy medley of hormones!    

Modern medical advancement such as MRIs and other scans have really changed the landscape of medicine. We can more than ever get to 'see' inside the body. As costs come down and the numbers of scanning machines multiply, scans are done more than ever. This helps with diagnosis, but can also add to 'knowing too much.' Could we be over-scanning?

As we understand more and more about pain and the brain, health professionals are now realising that damage to the tissues does not directly correlate to the amount of pain we feel. Pain is a central process, meaning that it comes from the higher centers in the brain. Sure, inflammation is one part of the pain response, but not the whole. Our values about pain or exercise, our previous pain experiences, our mood, our brain chemistry, our immune system and our general fitness or conditioning all play a huge role in our pain responses.

So, when scans can see inside and show us issues with joint and tissue structure, such as 'wear and tear', bulging discs, muscle and tendon thickening or scarring, what does this really mean for that individual? Are these findings on scan actually the sole or part contributors to their pain? Are we getting a false representation of the individual and their tissues? Does a scan result make you jump to conclusions too quickly, such as the need for surgery which may not be really warranted? Do we panic at the findings and provoke fear and anxiety and even avoidance of activity in someone unnecessarily? Do we even contribute to their pain response by drawing too much attention to scan findings? Scary.

Studies are increasingly looking at this dilemma we have created through medical advancement. Above is a clear reflection of these recent studies, where populations were scanned and even those without symptoms of pain had scans showing significant findings. Take the lower back disc injury as a great example, where 37% of 20 year olds without lower back pain have 'bulges' in their discs, or where 20% of those over 40 are living pain free with knee cartilage or meniscal tears.  

Scanning certainly has it's place,  but the rush to the scanners that appears to becoming the new norm really needs to be thought about more cautiously.

Why does my period make my back and pelvis hurt?

To understand why the back or pelvic hurts during a period, we need to understand the menstrual cycle and the changing levels of hormones. The menstrual cycle is made of a few main phases.

• The first phase, which is menstruation, begins on the first day of your period. During menstruation hormones, oestrogen and progesterone, are relatively low.

• In the second phase, also known as the follicular phase, FSH (or follicle-stimulating hormone) is released, which causes immature eggs to develop. These follicles cause a lot of oestrogen to be produced, and the lining of the uterus thickens, for a possible egg to be embedded.
• The third phase in ovulation, and is when a mature egg is released from the ovary. It is triggered by an abrupt rise in LH (or luteinising hormone). At ovulation, the cervix moves higher and its opening widens. The release of the egg and the movement of the cervix is why some women experience cramps or aches at ovulation, and why some women experience ovulation spotting. After ovulation, the egg enters the fallopian tube and moves along the uterus.
• The fourth phase, also known as the luteal phase is when oestrogen production drops and progesterone increases. This further thickens the uterine lining to allow for a fertilized egg to embed. If fertilization doesn't occur, the egg breaks down, and progesterone levels drop, which disintegrates the uterine lining, in preparation for a period. This drop in progesterone is why some women experience mood swings, bloating, tender breasts or tiredness.

During the period, the broken-down lining of the uterus flows down through the cervix and out of the vagina. When you have a period, the uterus swells and expands and can become almost double the size and weight (pictured below).

Understanding the anatomy of the pelvis can help us understand why the back and pelvis can hurt during a period and during this time when the uterus is so enlarged. Here are some explanations:

• Firstly, the uterus is suspended in the pelvis to the sacrum (pictured below), which is the triangular bit of bone between your lower back and your tailbone. You can feel the top part of your sacrum, where the dimples in your lower back are. These ligaments are called the uterosacral ligaments. When the uterus swells, this puts pressure on the uterosacral ligaments, which can then create a dragging feeling, heaviness or pain on the sacrum and tailbone.

• Secondly, to push the uterine lining out through the vagina during menstruation, the uterus muscle contracts, and if it contracts sharply, it can make you feel strong cramps. Hormone-like substances called prostaglandins trigger these contractions, and prostaglandins are also involved in pain and inflammation processes. If a woman has high amounts of prostaglandins, she can have more severe menstrual cramps.
• If a woman has endometriosis, cells that resemble the lining of the uterus exist on other places within her pelvis, such as on her bladder, bowel, or vaginal walls. These cells can be triggered with a period and cause more pain and inflammation, which is why women with endometriosis tend to have more severe period pain.
• Sometimes the uterus isn't aligned neutrally within the pelvis, and this can contribute to pain that may be one-sided or to pain in the lower abdomen. The uterus may be tilted to the side or it may be tilted forwards. Visceral mobilization to re-position the uterus well inside the pelvis by a trained women's health physiotherapist can help bring back alignment to the uterus and surrounding tissues.
• Often the pelvic floor muscles can cramp because of the contracting uterus and vagina. This can also contribute to an increased perception of period pain, because not only is the uterus contracting, but the pelvic floor and pelvic wall muscles go along for the ride. Over time, these muscles can become stuck in a tight position from overworking for many months or years. Because these muscles also attach to the pelvis, tailbone and lower back they can add to your lower back or pelvic pain. Pelvic floor release techniques by a trained women's health physiotherapist can release these tight muscles, which can in turn reduce the overall pain during periods.

If you have period pain or lower back pain or pelvic pain, try seeing a women's health physiotherapist, as very often, having some physiotherapy can significantly reduce or completely eliminate your pain. Their treatment techniques can help with other menstrual symptoms such as spotting, irregular cycles, long cycles, and research is now showing the benefits of physiotherapy for fertility as well.

Join an online class  from the comfort of your home - Katrina the principle physio at The Fix Program has designed a series of pregnancy exercise programs that will help you immensely.