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The importance of context: When relative relief renders pain pleasant

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Studie som viser at kontekst som vi pakker behandlingen inn i er viktig som smertedempende effekt.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590449/

«Furthermore, the change in outcome hedonics correlated with activity in the periacqueductal grey (PAG) of the descending pain modulatory system (DPMS). The context manipulation also significantly increased functional connectivity between reward circuitry and the PAG, consistent with a functional change of the DPMS due to the altered motivational state. The findings of this study point to a role for brainstem and reward circuitry in a context-induced “hedonic flip” of pain.»

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Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity

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En studie som ofte blir referert til fordi den nevner at ryggsmerte har en større korrelasjon til pust og inkontinens enn til overvekt og aktivitet. Manglende aktivitet i pustemusklene bidrar til minket kontroll over ryggmuskler.

http://svc019.wic048p.server-web.com/AJP/vol_52/1/AustJPhysiotherv52i1Smith.pdf

«Unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain. This relationship may be explained by physiological limitations of coordination of postural, respiratory and continence functions of trunk muscles.»

» Notably, control of the trunk is dependent on activity of muscles such as the diaphragm (Hodges et al 1997), transversus abdominis (Hodges et al 1999), and pelvic floor muscles (Hodges et al 2002), and reduced postural activity of these muscles has been argued to impair the mechanical support of the spine.»

» Our findings provide initial support for the hypothesis that compromised postural control of these muscles, secondary to disease- specific challenges, may contribute to the development of back pain.»

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Pain and faulty breathing: a pilot study

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Nevner hvordan pusten har sammenheng med smerter, spesielt i nakke, og beskriver normal vs abnormal pustefunksjon.

http://reactivemovement.com/images/stories/pain%20and%20faulty%20breathing.pdf

http://www.bodyworkmovementtherapies.com/article/S1360-8592(03)00085-8/abstract

«Breathing mechanics are influenced directly by

  • * Bio-mechanical factors such as rib head fixations or classical upper/lower crossed patterns of muscle imbalance.
  • * Biochemical factors involving anything that affects the body’s delicate pH balance including allergy, infection, poor diet, hormonal influences or kidney dysfunction.
  • * Psychosocial factors such as chronic anxiety, anger or depression. «

«For example, ketoacidosis, a byproduct of a very popular diet which promotes high protein/low carbohydrate intake, increases the acidic state of the blood which will promote deeper, faster breathing (the higher CO2 content stimulates the breathing drive).»

«Alkalosis causes a decrease in the threshold of peripheral nerve firing, an increase in muscular tension, muscle spasm, spinal reflexes and significantly heightened perception of pain, light and sound. Alkalosis can also result in emotional lability and produce a sense of apprehension and anxiety that frequently leads to panic attacks and phobic behavior (Chaitow et al., 2002; Chaitow, 2000).»

«With each normal (resting) breath this bucket handle movement occurs at every rib level, which has a gentle micro-massaging effect maintaining healthy spinal movement, blood and nutritional flow to the musculo-skeletal struc- tures.»

normal pust

«Although the pectoralis major, pectoralis minor, latissimus dorsi, serratus anterior and trapezius are not typically considered accessory respiratory muscles, they assume a more respiratory than postural function in the dysfunctional or paradoxical breath- er and contribute to the faulty pattern of lifting the ribcage up during inspiration (Hruska, 1997). When chest lifting becomes a faulty breathing pattern, chronic lifting of the clavicles creates the appearance of deep clavicular grooves as seen in Fig. 5 (Lewit, 1999).»

unormal pust

«The same criteria were applied for normal (relaxed) breathing as for deep breathing. A ‘‘normal’’ breath according to these criteria would:

  1. Initiate in the abdomen, which would expand outward during inhalation and inward during exhalation.
  2. Have some degree of horizontal lower rib motion (even if slight).
  3. Have no lifting up motion in the upper ribs.
  4. Have no clavicular grooves. «

«Only one type of pain had a statistically significant relationship with faulty breathing – neck pain»

«This study showed that 87.2% of the participants have experienced some sort of musculo-skeletal pain. This high percentage is no surprise. What was remarkable were the high percentages of this sample population with faulty breathing me- chanics; 56.4% of the population studied had faulty relaxed breathing and 75% showed faulty breathing when taking a deep breath. »

«If the results of this study reflect the general population, as clinicians your chances are 3 in 4 that the new patient you see today will have some level of abnormal breathing patterns.»

«But why is the relationship between faulty breathing and neck pain so pervasive?
The answer may be simply that the most common fault in respiration of lifting the thorax with the accessory muscles of respiration instead of widen- ing it in the horizontal plane overstrains the cervical spine and musculature, contributing to recurrent cervical syndromes (Lewit, 1999)»

«He especially found this in patients with forward head postures, temporo-mandibular dysfunction and chronic sinus problems. Clinically, Hruska has identified hemidiaphragm hypertonicity complementing ipsilateral abdominal and oblique muscle weakness and contra lateral cervical symptoms (Hruska, 1997).»

«This study has shown that normal patterns of breathing are the exception rather than the rule. An overwhelming 75% of those studied exhibited faulty breathing mechanics. If the results of this study reflect the general population, as clinicians, your chances are 3 in 4 that the new patient you see today will have faulty breath- ing patterns.»

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Breathing evaluation and retraining in manual therapy

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Nevner mye rundt opptrening av pustefunksjon, men fokuseres på Capnografi fordi forfatteren selger Capnotrainer apparatet.
http://reactivemovement.com/images/stories/breathing%20evaluation%20and%20retraining.pdf

«According to Hodges et al. (2007), trunk muscle functions of spinal stabilization, continence and respiration are all interrelated. They conclude that when dysfunction occurs in one system, it can negatively impact the other two. Further, it is known that people with back pain brace with their superficial abdominal muscles and diaphragm and have poor core muscle activation (Hodges and Richardson, 1999; Radebold et al., 2001; O’Sullivan and Beales, 2007).»

«In neck pain, it is known that there is frequent evidence of over-activation of some of the inspiratory muscles, such as the scalenes, sternocleidomastoid and upper fibres of trapezius (Falla, 2004; Nederhand et al., 2000).»

«Symptoms associated with hypocapnia
Cerebral
Headache, impaired intellectual function, confusion, giddiness, visual disturbances, light headedness, dizziness, syncope, seizures, hallucinations, depersonalization and unilateral somatic symptoms (Thomson et al., 1997; Gardner, 1996; Lum, 1981). Muscular
Increased membrane excitability (Thomson et al., 1997)
Cardiac
Chest pain, coronary artery spasm (Thomson et al., 1997; Nakao et al., 1997; Laffey and Kavanagh, 2002; Gardner, 1996)
ECG changes (Thomson et al., 1997; Rutherford et al., 2005; Sullivan et al., 2004)
Respiratory
Bronchospasm with or without asthma, breathlessness (Levitsky, 2003; Laffey and Kavanagh, 2002; Gardner, 1996; Lum, 1996)
Gastrointestinal
Increased tone, motility and sensitivity (Ford et al., 1995; Bharucha et al., 1996; Cooke et al., 1996)
Women’s Health
Decreased CO2 levels during pregnancy (Thomson et al., 1997; Jensen et al., 2007, 2008)
Decreased CO2 levels during luteal phase of menses (Slatkovska et al., 2006)
Large drops in CO2 in women with Pre- menstrual Syndrome (Ott et al., 2006) «

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better chemistry through breathing

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Nevner blodsirkulasjon og hvordan blodårene forholder seg til pH endringer.

Klikk for å få tilgang til Kaiser%20Permanente%20Better%20Chemistry%20Through%20Breathing.pdf

«For the majority of people, just 1 minute of determined overbreathing reduces cutaneous and peripheral blood circulation (colder hands, paler skin); interferes with peripheral nerve conduction (tingling in fingers and lips); lowers muscle contraction thresholds (more susceptible to twitching); and stimulates cerebral vasoconstriction (interference with vision, hearing, sensory perception, balance, orientation, judgment, and cognition). »

Hvis dette skjer etter 1 minutt med hyperventilering, hva skjer ved kronisk hyperventilering?

«A “compensated hyperventilator” will often feel out of breath; because much of the bicarbonate buffer is gone, there is less of a defense against the rising acidity associated with retaining CO2. Normal breathing will feel insufficient. Thus breath-holding time is typically shorter than average—often below 15 seconds. »

«If the breath is stopped or inhibited, CO2 rises and blood vessel diameter increases in order to maximize transfer of glucose and oxygen out of the bloodstream and into the tissues. But with hyperventilation, the opposite happens: blood vessels constrict, inhibiting transfer of nutrients from the bloodstream. »

CO2 blodsirkulasjon

«Because hyperventilation is associated with alkalinity, the kidneys start retaining acid and more of the blood’s bicarbonate (alkaline) buffer is excreted. Although this does return the pH toward normal, it creates a false, fragile equilibrium that depends on continued hyperventilation. This new “set point” makes recovering a normal breathing pattern difficult. This person will be oversensitive to both exercise and relaxation and may suffer anxiety, chest tight- ness, fatigue, and muscle pain.»

«In some individuals, blood vessel diameter fell by 50%; in others, much less. Those with the strongest constriction general- ly reported more symptoms of panic.»

«Hyperventilation restricts circulation more in the cortex than in the lower brain levels and can seriously impair cortical functioning, disrupting judgment, perception, memory, orientation, and reaction time, and slowing EEG frequencies. »

«Excess sighing and deep breaths are markers for panic disorder (Wilhelm, Trabert, & Roth, 2001).» «For such a person, deep but urgent breathing may be an attempt to over- come a tight diaphragm or other muscular rigidity, so emphasizing muscle relaxation and gentler breathing might be more helpful than recommending deep breathing.»

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morgensmerter

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Har du smerte om morgenen?

Mange har spurt meg om hvorfor de opplever mer smerter om morgenen. Det er mange faktorer som spiller inn (som alltid når det gjelder smerte), men de daglige hormonsvigningene som styrer søvn og våkenhet er ekstra tydelige bidragsytere. 

Om morgenen synker melatonin og cortisol økes. Problemene oppstår når denne naturlige mekanismen fungerer dårlig. Og kronisk stress, konisk smerte eller kronisk feil kosthold er de værste bidragsyterene.

Melatonin er et smertestillende hormon, så med lite melatonin i kroppen økes også sensitiviteten for smertet. Mennesker som har hatt langvarige smerteproblemer får generelt en lavere produksjon av melatonin, så søvnen blir dårligere og smertene oppleves større.

Cortisol økes om morgenen for å vekke oss. Hos mennesker med langvarig stress eller smerteproblemer blir cortisolproduksjonen etterhvert veldig dårlig. Det kalles Binyretretthet.

Cortisolproduksjonen om morgenen blir lav, og dette bidrar til økt sensitivitet for smerte.

Og det er jo åpenbart, ingen kunstige tilførsler av melatonin kan egentlig måle seg med kroppens evne til å produsere sitt eget melatonin. Vi ønsker å øke melatoninproduksjon og normalisere cortisolproduksjonen, uten å måtte ty til kunstige medisiner. Mat, kosttilskudd, jordingslaken, stressmestring, osv, er noen grep vi kan gjøre.

Men INGEN TING kan måle seg med meditasjon og å puste med diafragma(som masserer binyrene, når det gjøres riktig) når vi vil normalisere kroppens hormonproduksjon.

Meltatonin og smerter: http://nopr.niscair.res.in/bitstream/123456789/11609/1/IJBB%2048(2)%2082-87.pdf
Cortisol om morgenen: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740898/
Lav Cortisolproduksjon gir mer smerte om morgenen: http://www.ncbi.nlm.nih.gov/m/pubmed/22445364/
Meditasjon om kvelden øker melatonin: http://www.sciencedirect.com/science/article/pii/S0301051100000351
Diafragma-pust om kvelden øker melatonin, senker cortisol og gir økt restitusjon i utholdenhetsidrett: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139518/