Sarah Key Method - Stage 1: Stiff Spinal Segment

Posted by Nell Mead at 15:30 on 11 Jan 2011

Back in September, I started a series of blog posts detailing Sarah Key’s theory on back pain. I wrote about spinal anatomy and explained how the spine should work in a “normal” situation.

Now it’s time to start talking about what goes wrong with backs. Sarah’s theory is that back pain occurs in five consecutive stages.

She simply calls the first stage a “Stiff Spinal Segment”. Not a sexy or particularly gripping description, I’m sure you’ll agree; but most people have at least one, and it is a condition which underpins all the later and more devastating types of back pain.

As I mentioned, spinal segments (each segment consisting of a vertebra and the disc that sits on top of it) are barely viable at the best of times, so arduous is the journey from spinal canal or vertebral endplate to nucleus and back again, that fluid and nutrients have to take.

The many potential obstacles to the nutrients reaching the nucleus and waste products then being expelled include:
• Unremitting spinal compression – for example, staying in one position for too long, or carrying a heavy load for a prolonged period.
• Weakness of the tummy muscles, which allows uneven compression of the spinal segments.
• Chronic protective muscle spasm, which happens when you are in pain.
• Injury – a fall, for example, which can cause a traumatic rupture of the vertebral endplate.

The problem in all of these scenarios is that the disc is compressed (thus squeezing out fluid) but not unloaded again. It’s therefore not able to suck in fluid and nutrients to replace the fluid that has been lost. As a result, the all-important proteoglycan synthesis is not stimulated and thus the disc begins to become dehydrated and to flatten. In turn, the spinal joints then become stiff, which is the point at which you are likely to notice it, because stiff joints hurt when you try to make them do perfectly normal everyday activities, such as putting your socks on.

Manual therapists such as physiotherapists can feel these stiff joints when we palpate, or poke, your spine. (That’s the bit where we make noises like a car mechanic finding a dodgy spark plug and you start to worry for the safety of your wallet.)

The good news is that – with a bit of manual therapy and a lot of home exercise - a stiff spinal segment is a reversible condition. That is, it is possible to get the joints moving again, and thus to promote better disc metabolism; it may even be possible for the discs to rehydrate. In my next blog post, I’ll explain the basic exercises that everyone with a stiff back should be doing to help themselves.

In the mean time, I am at the Foundry on Mondays and Tuesdays, and at the Back Shop on Wednesdays and Thursdays. Please e-mail me for an appointment.
  

Introducing Abby

Posted by Nell Mead at 09:00 on 7 Jan 2011

Victory is growing!

I'm absolutely delighted to be able to introduce the fabulous Abby Hussein who is the newest member of the Victory team and provides Victory’s administrative backbone.

With a strong background in private medical practice, Abby is dedicated to ensuring the highest quality service to make the Victory experience unforgettable for all our clients. She is hugely excited at being a part of Victory in its early stages and in helping to shape its vision.

When she is not busy helping clients, organising Victory’s diary, planning events, overseeing the development of our website and marketing strategy – and reminding Nell of all the myriad tasks she hasn’t yet done! - Abby enjoys relaxing with a glass of wine and a good book; this has been a hobby of hers for so long she has decided to attempt writing a novel herself! Abby also enjoys belly dancing and tries to fit in an hour of this every day, as her fitness regime.

If you would like an appointment with any of Victory’s team, please contact Abby by e-mail or on 07943 372591

New year, new venue

Posted by Nell Mead at 14:00 on 4 Jan 2011

Happy New Year everyone!  I hope you had a great night on Saturday, and that Father Christmas was in generous mood last week.

My mood was certainly lifted on Christmas eve when my phone beeped to herald a text message from the lovely Dave and Helen Thomas, owners of The Foundry, a fantastic personal training studio and gym at 11 Artillery Lane, between Liverpool St Station and Spitalfields Market.  It's one of my favourite areas in London for its hustling, upbeat mood.

They and I had been discussing the possibility of collaboration and I'm delighted to announce that - as of next week - I will be offering physiotherapy sessions at The Foundry every Monday and Tuesday.  I'm really excited and can't wait to start. 

I'll also be teaming up with The Foundry's superb personal training team to offer joint assessments - an injury and performance MOT, if you like - though we're still working out the exact details, so watch this space...

Please e-mail me for an appointment at The Foundry.

Sarah Key Method - Appeasing exercise

Posted by Nell Mead at 16:00 on 31 Jan 2011

Moving on from last week's diversion - back to the back pain!

This exercise from legendary Australian physiotherapist Sarah Key is suitable for virtually anyone's back, and is the first exercise I teach my patients who have low back problems.  The key is to be very subtle with your movements - in this instance, less is definitely more.  The idea is to gently appease the low back muscles and coax them out of spasm, muscle spasm being the body's natural - but in this situation unhelpful - response to pain.

If you jerk or move too forcefully while doing this exercise, you are likely to stimulate the stretch receptors in the muscles, which could potentially make the spasm worse.  But if you can keep your movements smooth, and "under the radar" of the stretch receptors, then it will really help to soothe your back pain.

• The first step is to lie on your back on a firm surface - a folded blanket on the floor is fine, or in my therapy rooms I use a yoga mat.

• Pull your tummy in gently, as this supports your spine, and bring one knee up to your chest.  Hold the knee in the same hand - i.e. if you have lifted your right knee, hold it in your right hand.

• Keeping your tummy pulled in, bring the other knee up to join the first, and hold it in the other hand.

• Cross your ankles, and drop your knees apart, still holding them in your hands.  Let your tummy relax.

• Producing the movement with your hands, move your knees gently back and forth, left and right, until you find that your weight is over the sore part of your back.  This is where the muscles need to let go.  Oscillate your knees gently and repeatedly over this area - I describe this to my patients as "ironing the spine" - for a minute or two until the muscle relaxes and the pain subsides.
• After a minute or two, use your hands to bring your knees back to the middle, pull your tummy in gently, and then lower first one foot to the floor and then the other.  Rest for a minute or two and then repeat twice more.  
• On the second and third repetition of the exercise, you may find that the sorest spot in your back has moved a bit.  Hunt around until you find it; but remember to keep the movements subtle and gentle.

If your back is really sore, you may need to do this exercise very regularly, perhaps as often as every hour at first.  Some people also find that heat is helpful, so you may also want to try using a hot water bottle on your back (obviously, all the usual precautions apply here: please don't burn or scald yourself!)

If you can't relieve your pain by yourself, then of course please do e-mail me for an appointment.  I am at the Foundry on Mondays and Tuesdays, and at the Back Shop on Wednesdays and Thursdays.

Thanks to my lovely model Graeme at The Foundry - the cheque's in the post!

Trust me, I'm a doctor...

Posted by Nell Mead at 12:00 on 20 Jan 2011

I was going to demonstrate a simple exercise for back pain today, but I've just seen this article in the Daily Mail online and it's taken priority.  Normal service will be resumed very soon!

To summarise, it seems that this chap "Dr Charles Ahme" - a 50-year-old football referee with an online first aid qualification - set up a "physiotherapy and sports injuries practice" in Levenhulme, Manchester.  Wearing a white coat, he asked female patients to strip naked and then massaged them, in some cases indecently.  He wasn't investigated until a GB athlete visited his practice for treatment and realised that his practice wasn't exactly standard.  She reported him and he is now apparently "facing a lengthy prison sentence".  Good.

OK, so where do I start?  How do you choose a physiotherapist, or in fact any healthcare practitioner?

• Word of mouth is a sensible place to start.  Ask around: if your friend or colleague has seen a really good practitioner, the chances are that they may be able to treat you well, too.  Most of my patients come to see me because one of their friends has recommended me.
• Check their website - most good practices have one these days, and you should be able to get a feel for what's available: does the therapist offer services you think you will need, and do you like the tone of the site?  If you like what they write, the chances are that you will like the therapist.  Good rapport between patient and therapist is an excellent first step to successful treatment, as if you trust your therapist, you will relax and the treatment will be more beneficial.  Most websites will also include testimonials from past patients and, provided that these are genuine, they will also give you an idea of the therapists' areas of particular expertise.
• Chartered status is no guarantee of quality, but it does at least mean that the therapist has been received the training that they say they have, and that their insurance and qualifications are up to date!  You should check that your therapist is registered with the Health Professions Council.  Physiotherapists should also be registered with the Chartered Society of Physiotherapy; any private physiotherapist registered here or here is a CSP member.
• Instinct is possibly the most important thing.  Don't automatically trust the therapist who wears a white coat!  We are programmed to do this, but as Stanley Milgram showed in his famous experiment, someone who wears a white coat (or other uniform or clothing that denotes professional status) is not necessarily what he seems.  The therapist should greet you, make you feel at home and always explain what they are about to do to you, what you are doing and why they are doing it.  You should always be able to ask questions, and if you feel uncomfortable at any time, tell them so and they should stop what they are doing immediately and discuss it with you, modifying any treatment so that you are comfortable with it.  If they don't, or if you are not happy with the treatment in any way, let them know; and if you're dissatisfied with their response, you are perfectly within your rights to raise your concerns to the Health Professions Council who will investigate.

Please don't get taken in by a bogus therapist!

For an appointment with Nell (a totally genuine Chartered Physiotherapist with years of experience treating musculoskeletal injuries!) please contact us or send her an e-mail.  She is available at The Foundry on Mondays and Tuesdays, and at The Back Shop on Wednesdays and Thursdays.