• Nigel Peek MSc (chiro) PGDip (pain) PGCert (acu)

Aches and Pains in Lockdown



Being on the frontline of pain care, I am aware of the escalating need for relief during and after lockdown. This phenomenon is well reported in overseas studies (1, 2). There is also evidence to suggest that lockdown measures may result in increased pain duration, severity and disability (3).


Typically, I hear stories of people with poor workstation set-up, this is usually blamed as the number one culprit. Whilst this may be contributory, I wonder if we could look at why people may be experiencing more pain in general or perhaps more predisposed to pain in the context of the current BIO-PSYCHO-SOCIAL crisis?


Let’s talk about the current health emergency from a broader perspective and then discuss why back and neck pain may be more prevalent during a time like this.


There is not doubt that we are probably moving less than we normally do in lockdown, and this, along with our home workstation set-up may be having an impact on our aches and pains. I don’t think this needs much explanation.


Raising the “Alert Level”


It is not implausible to speculate when we go into lockdown that our social being (being apart from family and friends) and our psychological being (worries about our future, our finances, and the world in general) may be in a state of hyper-arousal or perhaps a state of generalised threat to our whole being.


This state of stress over an extended period of time places increasing demand on the body's systems resulting adverse consequences. This is called allostatic load. Remember, pain is an output (see here) of the central nervous system that is principally determined by the need for protection. It is not solely governed by the physical dimension (i.e., tissue damage). Pain is often a non-specific projection or summation of threat potential to the whole person, not just the state of the tissues (damage). In other words, pain is a distress signal that has evolved to withdraw us from threat or harm.


"Fear and uncertainty combined are a potent elixir driving our centre of arousal –

perhaps pain is just one expression of this state of being"


It is not inconceivable to think that our “threat alarm” may begin to sound when the state of the whole system is entangled in a state of potential danger, distress, or un-ease. Incoming alert signals go beyond the physical and include our psychological – remember that thoughts are nerve impulses too!


I often liken neck and back pain to a barometer of generalised stress. Many of us can relate our “tight shoulders” to the amount of stress or tension we are under. This is not hard to interpret – when we are in a state of preparedness for fight or flight our muscular system gears itself towards action (increased muscle activity). The problem is that we are not imminently about to flee from a super predator, instead we are sitting still, constrained at our desks gawking at the computer screen and worrying about the world. Pain in the neck? – probably.


Lockdown provides a perfect melting pot for pain to emerge. We are currently existing in a world where potential threat is coming at us thick and fast! Fear and uncertainty combined are a potent elixir driving the centre of our arousal – perhaps pain is just one expression of this state of being.


Pain has a primitive function that serves to protect us. It is not a system that is always refined or accurate when it comes to tissue damage. An example of this would be when you get a paper cut. The experience of this can be quite distressing (a lot of pain), with very little “damage”. This experience therefore may be determined by the amount of sensory nerve endings in the finger, not the amount of damage. Similarly, we know that people can have significant tissue changes without any pain (see here). These things make pain an interesting phenomenon, one that is currently more complex than we can fully grasp.


What can you do?


"Self-efficacy, refers to an individual's belief in their capacity to execute behaviours necessary to produce specific performance attainments. Self-efficacy reflects confidence in the ability to exert control over one's own motivation, behaviour, and social environment (11)".


Move


We’ll start with the obvious – movement is medicine, or as we like to say – motion is lotion. There is no perfect recipe, but a variation of movement is key. This is particularly relevant when you are pretty much desk bound.

I tend not to get too detailed about what types of movement are best, I think finding something you like or at the very least tolerate is important (walking, running, yoga, Pilates, or resistance training are all ok, just try to get at least 30-40 minutes a day).


Walk and Run


The spine likes rhythm – a good walk or jog are recommended. Although it’s important to start running very incrementally if it is not something you have done before. There are plenty of free resources to get you going.

Research shows us that walking alone is just as beneficial as other forms of exercise for back pain (3) and pain in general (5). Other studies show that walking alone was as effective as walking in conjunction with physiotherapy for the treatment for low back pain (6). Similarly, running has been shown to be protective for low back pain (7).


Yoga and Pilates


There is evidence that yoga (8) and Pilates (9) may be helpful in the management of low back pain. These mind-body movement practices can have benefits beyond pain management.


Here is a link for free Yoga – great resource for beginners to masters


Mindfulness and Meditation for Pain Management


There is a growing body of robust research that supports the use of meditation and mindfulness-based practices that can improve cognitive and health outcomes (including pain) (10). These approaches are no longer considered woo-woo. Listen to a guided meditation for pain from one of the great proponents of mindfulness Jon Kabat-Zinn.


Daily Stretches


Try to focus your attention or set a reminder to get up more regularly and stretch. We have great resources for stretching on our website

https://www.peekpractice.co.nz/lower-back-exercises


https://www.peekpractice.co.nz/exercises


References

1. Smith TO, Durrant K, Birt L, Belderson P, Chipping J, Yates M, et al. Accessing health services for musculoskeletal diseases during early COVID-19 lockdown: Results from a UK population survey. Rheumatology advances in practice. 2020;4(2).

2. Fallon N, Brown C, Twiddy H, Brian E, Frank B, Nurmikko T, et al. Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain. British journal of pain. 2021;15(3).

3. Galbusera F, Côtè P, Negrini S. Expected impact of lockdown measures due to COVID-19 on disabling conditions: a modelling study of chronic low back pain. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2021;30(10).

4. Vanti C, Andreatta S, Borghi S, Guccione AA, Pillastrini P, Bertozzi L. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disability and rehabilitation. 2019;41(6).

5. O'Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2015;96(4).

6. Hurley DA, Tully MA, Lonsdale C, Boreham CAG, van Mechelen W, Daly L, et al. Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092). Pain. 2015;156(1).

7. Maselli F, Storari L, Barbari V, Colombi A, Turolla A, Gianola S, et al. Prevalence and incidence of low back pain among runners: a systematic review. BMC musculoskeletal disorders. 2020;21(1).

8. Wieland LS, Skoetz N, Pilkington K, Vempati R, D'Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. The Cochrane database of systematic reviews. 2017;1(1).

9. Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RW, Cabral CM, et al. Pilates for low back pain. Sao Paulo medical journal = Revista paulista de medicina. 2016;134(4).

10. Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Annals of the New York Academy of Sciences. 2016;1373(1).

11. www.apa.org https://www.apa.org/pi/aids/resources/education/self-efficacy. Retrieved 2021-10-12.

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