So we all know that feeling that we get after exercise – we feel generally happier, less stressed, less anxious and also sleep better. Exercise produces a rush of happy hormones we also know as endorphins. So what are these endorphins and why do they make us feel happy?
Endorphins are chemicals that are produced in our brains in response to stress or pain. Running, doing a hard workout, playing a sport or any exercise at all that increases our bodies stress response has the ability to make our brains release endorphins. The endorphins have the ability to travel through our neural networks as a neurotransmitter. One thing we do know about endorphins is that they make us feel really good. So how does this work then?
A part of the brain called the hypothalamus sends a signal to increase endorphin uptake through our bodies neural network when we subject ourselves to certain activities like exercise, sex, eat certain foods or experience pain. The endorphins then attach themselves to specific receptor sites within our neural network – these are called opioid receptors. These special receptors have the ability to block out pain signals and also to increase that euphoric happy feeling we get after we exercise. It is the same receptors that are locked onto when we take pain relief in the form of opiates.
Once we achieve a positive result in something we do, either though through exercise or simple activities like sticking to a plan you’ve made, your brain will also release another happy hormone called dopamine. Dopamine is responsible for us feeling addicted to pleasure seeking behaviors. By setting regular and achievable exercise goals that you reach it is highly possible to make exercise the trigger for your brain to release dopamine.
Serotonin is another one of our brains happy hormones that act as a natural anti-depressant. When we exercise serotonin levels in our brain increase and so does your level of happiness.
I know all these terms may seem confusing but there is another very important happy hormone called oxytocin. Oxytocin is released when we feel loved, cared for and connected to others. Your brain will also release oxytocin when you are kind to others.
So no matter how hard it may seem to get yourself moving on some days, putting one foot in front of the other and pushing yourself to move and exercise is not only good for your muscles and joints but also stimulates your brain. You’ll produce your very own happy hormones, reduces your stress levels and have you wanting to repeat it all over again next time. Give your fellow team mates, friends and family an encouraging kind words regularly as well- it will not only help them feel happy but will increase your happiness as well.
“Tension headaches” are often talked about and we see a lot of patients with these headaches. In our diagnosis of these conditions, about eighty five percent of all headaches arise from the neck, or cervical spine, which refers pain into the head through the nerves which go to both areas. Neck problems cause head pain because some of the nerves which come from the spinal cord have branches which go to the upper neck joints and other branches which spread over the back of the head, with still others going to the front of the head. When one area is sore the brain interprets the pain as coming from all the areas the nerve branches go to.
CAUSES OF TENSION HEADACHES
Patients who have “Tension Headaches” or “stress headaches’’, are often very busy and have work related problems, a tough boss, urgent deadlines, problems with managing work flow and they often have trouble sleeping because of work problems and their worries. This causes the patient to be mentally and emotionally stressed and their relationships at work and with their families suffer.
They develop a headache which they cannot shake and they feel helpless, tired, tense, anxious and in pain. We have seen many cases where the headaches have continued for weeks and frequently kept recurring, sometimes over many years.
It is important to understand that a Tension Headache is due to “physical tension” in the tissues, often from a poor working position and the damage it has caused, not the other mental “tensions” listed above. Once full neck movement has been restored with treatment, the tissues have healed and the postural strains have been removed, patients often cope better with the other aspects of their lives. This is where Physiotherapy can help by breaking the vicious “Physical Tension” cycle. It is better to think of these as “structural headaches”.
Our neck is made of seven vertebrae stacked one above another. They support the head and they are joined together at the front by discs and at the back by facet joints. When we bend forward, the vertebra above tilts and slides forward, compressing the disc and stretching the facet joints which join the back of the vertebrae. When we bend backward, the disc compression is reduced at the front and the facet joints are compressed at the back. The junction of the first vertebra and the head does not have a disc and the joints there are particularly susceptible to leaning forward which causes the weight of the head to strain the joints, ligaments and muscles as gravity causes a shearing force as the head slides downward.
The neck muscles are often blamed as the cause of pain but this is rarely the whole story. Muscle pain often develops as the muscles contract to prevent further damage, as they protect the primary underlying structures. This pain is secondary to the underlying pathology and when the muscles are massaged, given acupuncture, etc, there is temporary relief but the pain will always comes back as the muscles resume their protective bracing. The most common sources of primary pain are the facet joints and their ligaments in the upper neck and the discs in the lower levels of the neck.
A facet joint strain is much like an ankle sprain, strained by excessive stretching or compressive forces. The joint ligaments, joint lining and even the joint surfaces can be damaged.
In the upper neck, facet joint strains typically occur during excessive bending or twisting movements and may follow trauma such as a car accident causing whiplash but generally, Tension Headaches occur with prolonged forces such as slouching, keying and reading.
There is often a previous history of pain coming and going as the damaged area became inflamed, was treated and settled for a while but as the underlying problem still remained, the pain flared up repeatedly every time it was strained. This type of injury, although often chronic, responds very well to specific Physiotherapy treatment.
There are many other sources of headaches and neck pain including arthritis, crush fractures and various disease processes. Your Physiotherapist will advise you should a more serious condition be suspected.
SYMPTOMS OF TENSION HEADACHES
Symptoms of “Tension Headaches” arising in the neck, are always affected by movement of the head and neck. This is important to understand. Symptoms are sometimes severe and may be sudden in onset but also may be mild and of gradual onset. There are other serious conditions which can produce headaches. If you have severe headache symptoms which are not affected by movement and a recent history of fever or nausea, you must consult a doctor urgently.
Facet joints, discs, muscles and other structures are affected by our neck positions and movements and when damaged, will respond very well to Physiotherapy treatment.
DIAGNOSIS OF TENSION HEADACHES
“Tension Headaches” often appear complex and require a full understanding of the history and a comprehensive physical examination. It is important for your Physiotherapist to establish a specific and accurate diagnosis to direct the choice of treatment. In some cases, the pain may arise from several tissues and these coexisting pathologies are treated individually as each is identified. Where the Physiotherapist requires further information or management may require injections or surgery, the appropriate x-rays, scans and a referral will be arranged.
TENSION HEADACHE RELIEF
Some of these cases will temporarily respond to a general non-specific treatment such as bed rest, ice and anti-inflammatories, however Musculoskeletal Physiotherapists have developed diagnostic skills and treatment techniques, targeted to stopping “Tension Headaches”. We will identify the reasons for the development of the pain and advise strategies to promote healing and to prevent further damage.
Specific techniques are chosen to correct the structural and mechanical problems. Among many choices, treatment may include joint mobilisation, stretching, ice, strengthening and education.
When normal function has been achieved, the inflammation and pain has settled and the structures have healed, using your new strategies will reduce the possibility of the headaches ever recurring. We use this approach to reduce or stop chronic pain. While we have the choice to manipulate or “click” joints, those with ongoing pain will seldom benefit from repeated “adjustment”. This is because our tissues are elastic and the benefit of the quick stretch of manipulation is lost as the tissues tighten up again. Potentially dangerous “adjustments” of this type have little long term benefit and can lead to an unhealthy dependence on the provider. Your Physiotherapist will choose a safe and appropriate treatment for you.
PROGNOSIS OF TENSION HEADACHES
Physiotherapy for “Tension Headaches” can provide outstanding results but it is a process, not magic. The damage which produces “Tension Headaches” takes time to develop and time to repair and heal. You will understand there are often several interacting factors to deal with and your compliance is necessary.
Foot Pain OUCH!
You leap out of bed in the morning and you get stabbing pains in your heels or the arches of your feet. You hobble a few steps, and then hobble a few more until the pain reduces. Most of the day your feet feel OK …except when you tackle stairs or when you have been sitting for a while when the pain makes a reappearance.
Pain in your heel or the bottom of your foot is most commonly caused by Plantar Fasciitis. Your Plantar Fascia is the ligament that goes from the underneath of your heel to your toes. If you strain it, micro tears can form, which leads to swelling and sharp pain.
While most people experience the pain in their heel, some also get pain through to the arch of their foot. In about 70% of cases, the pain is in both feet, making walking a very painful experience.
You most commonly notice the pain first thing in the morning when you get out of bed and it reduces as your feet warm up with movement. It can reappear during the day after periods of rest or sitting, if you have been standing for a while, or when climbing stairs or ladders.
Plantar Fasciitis is more common in middle-aged people, although it can also affect younger people who use their feet a lot like joggers, dancers, or soldiers. That’s why it is also often called Joggers Heel.
Causes of Plantar Fasciitis
While the actual causes of plantar fasciitis are not known, there are risk factors that will increase the likelihood of you getting plantar fasciitis.
Overuse – excessive running, walking or dancing, or changing your training pattern so you dramatically increase hill running (for example).
Standing on hard surfaces
Flat feet or high foot arches (this is one time when average is better!)
Tight Achilles tendons or calf muscles
Your feet roll in when you walk or run
Ill-fitting shoes, worn out or unsupportive footwear such as thongs/slides
Walking barefoot on hard surfaces
First aid for Plantar Fasciitis
Generally, plantar fasciitis is gradual onset, which means it gradually increases in severity over time. If you ignore it and try to run through the pain, then the symptoms can get worse, ultimately leading to you changing your gait, limiting your activity or triggering the growth of heel spurs.
For initial symptoms, you need to rest, apply ice packs (15 minutes at a time every 2-3 hours), and take anti-inflammatory painkillers such as ibuprofen.
You don’t need a referral from a doctor to see a physiotherapist. If the pain is moderate then you can seek treatment with your Physiotherapist immediately as the sooner you begin treatment, the sooner you will experience relief.
Occasionally your plantar fascia can snap and you could hear a clicking or snapping sound, accompanied by swelling, intense pain and significant swelling. You need to see a doctor urgently if this occurs.
Physiotherapy & Treatment Options
Your physiotherapist will assess the extent of your injury, and will explore the causes of your injury.
Depending on your symptoms, you may have the soles of your feet taped or strapped to support your feet and reduce pain. You may also need to wear a plantar fasciitis brace or heel cups in the initial stages of healing.
Your physiotherapist will take you through a number of gentle stretching exercises for your feet, as well as exercises to address any tight Achilles tendons or calf muscles.
We will combine these with pain reduction techniques that you can do at home such as rolling your foot on a frozen water bottle or frozen golf ball to help ice your injury site.
Massage, joint mobilisation techniques, dry needling and ultrasound therapy will also be used to reduce swelling and restore movement.
For your footwear, we recommend you replace your joggers every 650km of use, and only wear shoes that support your feet while healing. Definitely no thongs or slides!
It also helps to put your shoes on first thing in the morning, before you take your first steps. Avoid barefoot walking on tiles or hard surfaces while you heal.
If the cause of your injury is your feet shape or foot pronation, you may need special orthotics. If this is indicated, we would conduct a walk/run assessment on you and have your technique analysed.
To maintain your fitness during your treatment, we recommend swimming and cycling. Don’t return to running until you have been pain free for at least one week, and then only run on soft surfaces until you rebuild your strength and stamina. If pain is felt at any time, then go back to swimming and cycling rather than running.
Unfortunately, Plantar Fasciitis is a long-term injury, and may take a number of months to fully heal even with the most aggressive treatments.
Things to Remember
Plantar Fasciitis is the most common cause of heel and arch pain, and is caused by micro tears to the plantar fascia.
It is a gradual onset injury and causes sharp pain when taking the first few steps in the morning or after rest.
Physiotherapy can treat plantar fasciitis, while reducing pain and increasing movement during healing.
Your physiotherapist may advise you of techniques for the improvement of your walk/running style, or provide you with solutions for arch support, to help prevent further reoccurrence.
Healing may take many months for full recovery.
A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).
The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”
According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial. These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”
Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery.
Patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. Thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.
According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; 130318220107009 DOI: 10.1056/NEJMoa1301408