Shoulder pain is the third most common musculoskeletal complaint after back and neck pain. Shoulder pain can be caused by a variety of conditions including frozen shoulder (adhesive capsulitis), shoulder impingement syndrome (damage to the tendons within the shoulder joint complex) and muscle imbalance. Shoulder pain is defined as chronic if it has been present for 3 months of more. It is often left untreated, treated with pain killers or treated through other home remedies such as applying heat, ice or self-massage.
Living with shoulder pain can have a big impact on quality of life due to reduced range of movement, sleep disturbance, inability to perform daily tasks and reduced movement in other areas of the body including the neck.
So, what is the best way to treat chronic shoulder pain? The research states that exercise is the most effective way to reduce pain and restore functionality in chronic shoulder injuries as it is associated with the least negative side effects.
What does the research say specifically?
This might sound complicated - I am sure you are thinking “How on earth do I apply this to my problem?”
You have a few options; you could book in for an assessment with a sports therapist, get your shoulder assessed and get some advice on what exercises to perform. Or, if you are ready to take charge of your injury and commit to 3 hours per week, then our Pain Free Program is the one for you. We take all the latest evidence and the results from your assessment to create a specific exercise regime for you to complete in our gym with the assistance of our qualified exercise professionals. If you are interested in finding out more about our pain free program, then message us today.
Fibromyalgia is a chronic condition that causes wide-spread pain and other disruptive symptoms. Fibromyalgia occurs in roughly 1 in 50 people and symptoms can develop at any age. It is more commonly experienced by women.
The main symptoms of fibromyalgia are wide-spread pain, hypersensitivity and stiffness, however the condition presents differently from person to person. For example, some individuals experience pain everywhere, others experience most of their symptoms in the lower half of their body, whilst some complain of more specific areas of pain. An example of a more specific fibromyalgia symptom is rib pain, or costochondritis, which is inflammation of the rib cartilage which can cause pain during exercise, when coughing or when lying in certain positions. It is important to remember that unlike conditions such as arthritis, the pain experienced with fibromyalgia is not causing any damage to the joints.
Other symptoms include IBS, headaches, anxiety, depression and ‘fibro fog’ which is characterised by loss of concentration, memory problems and confusion.
There is currently no known cause of fibromyalgia, but it is believed that a number of factors are involved in the development of symptoms.
Alterations in Pain Processing
It is thought that people with fibromyalgia have developed changes in their central nervous system which affects the way in which their brains process pain. The central nervous system includes the brain, spinal cord and nerves and so changes to this system explain why pain is constantly felt across the body.
Through research, it has been discovered that fibromyalgia patients have lower than normal levels of certain hormones including serotonin, noradrenaline and dopamine.
These hormones are key regulators of mood, sleep, behavior, appetite, stress response and processing pain messages. It is possible to increase the levels of these hormones through medication prescribed by a GP.
Although disrupted sleep is a symptom of fibromyalgia it could also be a cause. It has been found that when an individual suffers from chronic fatigue due to lack of sleep, they also have increased levels of and sensitivity to pain.
Research has suggested that certain genes can increase a person’s predisposition to developing fibromyalgia. This explains why some people develop the condition after an event or trigger whilst others do not.
Fibromyalgia can develop at any point in a person’s life and often follows a stressful event - be it physical or emotional.
Likely triggers include:
Fibromyalgia can also develop on its own without an obvious trigger.
How can Sports Massage help?
The main way a sports massage can help is to reduce muscle and joint stiffness and to increase relaxation.
Massage can reduce stiffness in muscles and joints by increasing circulation and bringing vital nutrients to the soft tissue. An increase in blood flow also raises the temperature of the muscles and joints which increases pliability and relieves tension. As muscles span joints, a reduction in muscle tone will reduce joint tension as well.
Sports massage promotes relaxation through reducing physical muscular tension and increasing the happy hormones including endorphins, serotonin and dopamine. Increasing levels of these hormones can improve sense of well-being and reduce anxiety.
If you have never had a massage or have not had a massage since you were diagnosed with fibromyalgia it is important to bear in mind that it may aggravate your symptoms. During your first appointment, light, gentle pressure will be used and your therapist will work with you to figure out which techniques you react best to.
Clinical Medicine, 9th Edition
Traditional treatment for chronic back pain has always involved rest, inactivity and prescription drugs. However, over the past decades, it is becoming widely recognised that a multimodal, lifestyle-centred approach to treatment including exercise intervention and stress management has significant results in reducing pain and improving quality of life.
Below is a summary of evidence-based advice that can help to improve your quality of life.
Quality sleep is of more importance than most other factors in the management of chronic pain as insufficient sleep is known to increase pain sensitivity. Extending sleep either by sleeping longer in the evening or by taking a mid-day nap can restore pain sensitivity to normal levels making symptoms easier to manage.
The increased energy to be gained from sleeping also encourages those living with chronic pain to spontaneously engage in more physical activity further reducing negative symptoms. Increased sleep also improves mood and perception of stress making day-to-day tasks easier.
We all know that we need to sleep- it is in fact the strongest natural urge humans experience after breathing- but in practice it isn’t always that simple. For a personalised sleep report and tips on how to improve your sleep, head to Sleepio, an online, science based sleep improvement program.
The current NICE (The National Institute for Health and Care Excellence) guidelines state that exercise is the key mode of treatment for back pain rating it more successful than even manual therapies including sports therapy (which is only recommended alongside exercise). No one type of exercise is more superior than the other but what is important is finding the type of exercise that you enjoy, that you can perform safely and isn’t going to cause further injury. The exercises that prove to be the most effective at reducing pain and disability include yoga (Holtzman, 2013), stability and movement control exercise therapy (Luomajoki, 2018) and aerobic and resistance training (Wewege, 2018). Our pain free program is based upon these findings- to find out more simply email firstname.lastname@example.org
Living with chronic pain causes psychological, emotional and physical stress which can impact upon mood, muscle tension, fatigue levels, pain perception and self-efficacy. As such, stress management is an important part of chronic back pain management.
NHS UK guidelines on managing stress include being active, setting time aside to do something that makes you happy, spending time with loved ones, setting yourself new challenges and avoiding unhealthy habits. Head to Mind Tools for more detailed tips on how to manage stress.
Diet & Nutrition
To maintain a healthy body, strong muscles and a strong back we need to ensure that we eat enough protein. The recommended minimum amount of protein to consume per day is 0.8-1g per kg of bodyweight. As your activity increases, your protein demands increase further to 1.6-2g per kg of bodyweight. Protein is an important part of every cell in the body and is used particularly to build muscle and repair tissue. Addressing protein intake is an often-neglected part of managing chronic pain but may be the missing part of the jig-saw.
Maintaining a healthy weight is also important if you suffer from chronic back pain as obesity is a risk factor for developing an injury itself. A recent study, where participants that suffered from chronic lower back pain were put on a nonsurgical weight loss program, found that along with a reduction in body fat, a reduction in pain and disability occurred simultaneously.
Graduates of our pain-free program receive access to our nutritional coaching which is an excellent tool to maintain a healthy weight and lifestyle.
Leading a sedentary life can increase weight gain, pain and mobility issues. Even if you exercise for one hour, this only accounts for 4% of your day, what you do with the other 96% is what can really make a difference. Daily activity does not mean pounding the pavements for hours at a time, it is the accumulation of movement that occurs during your daily routine. It can include cleaning your house or carrying out tasks at work.
If you find that don’t easily incorporate much movement into your day taking a walk can be one of the easiest ways to increase this. Walking has been found to improve pain, disability and quality of life and is a free, easy and accessible form of activity. It is recommended to walk at a moderate pace for 10 minutes building to 30 minutes, up to 5 times per week (NICE, 2015).
This information may feel overwhelming if you aren’t incorporating any of this advice into your day-to-day life already. However, pick one thing, master it and then move onto the next. You will find that one thing feeds the other for example, once you have improved your sleep, you will have more energy to exercise and when you are exercising you will be more motivated to improve your diet.
For more information about anything covered in this article or if you feel like you may benefit from our pain-free program email email@example.com
Malfliet, A.; Ickmans, K.; Huysmans, E.; Coppieters, I.; Willaert, W.; Van Bogaert, W.; Rheel, E.; Bilterys, T.; Van Wilgen, P.; Nijs, J. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J. Clin. Med. 2019, 8, 1063
Meucci, R.D.; Fassa, A.G.; Faria, N.M. Prevalence of Chronic Low Back Pain: Systematic Review. Rev. Saude Publica 2015, 49, 73
Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2017, Issue 4