Study: When is bending too much?

This recent study looked at sustained bending and the time it takes before our postural muscles give in and we begin to rely on our passive structures for support.

Alessa 2017

How long is too long, to be in a forward, bent posture? Many of us spend hours doing house chores; weeding, DIY, working on the car etc. Not to mention the time spent leaning over a computer desk or looking down at your phone.

Back pain

Your muscles play an amazing role of suspending us in these positions, but just like with exercise our muscles will reach a point of fatigue. When the postural muscles aren’t able to provide the support we then rely on “passive” structures like ligaments and fascia, which is not their primary role, eventually leading stress and increased risk of injury.

This study looked at 2 angles of the spine leaning forwards and found that within 40 seconds the participants transitioned from the support of postural muscles to the passive structures. While this was found to be a natural transition the prolonged strain on the passive structures has been shown to increase the risk of lower back pain as suggested in another study.

As mentioned in a previous blog, these positions are not “wrong” but it’s better for the overall health of the spine to regularly change position and break from sustained load on an individual structure to provide balance.

Abstract

Static trunk bending is an occupational risk factor for lower back pain (LBP). When assessing relative short duration trunk bending tasks, existing studies mostly assumed unchanged spine biomechanical responses during task performance. The purpose of the current study was to assess the biomechanical changes of lumbar spine during the performance of relatively short duration, sustained trunk bending tasks. Fifteen participants performed 40-s static trunk bending tasks in two different trunk angles (30° or 60°) with two different hand load levels (0 or 6.8 kg). Results of the current study revealed significantly increased lumbar flexion and lumbar passive moment during the 40 s of trunk bending. Significantly reduced lumbar and abdominal muscle activities were also observed in most conditions. These findings suggest that, during the performance of short duration, static trunk bending tasks, a shift of loading from lumbar active tissues to passive tissues occurs naturally. This mechanism is beneficial in reducing the accumulation of lumbar muscle fatigue; however, lumbar passive tissue creep could be introduced due to prolonged or repetitive exposure.

 

Alessaa F. et al (2017) Changes of lumbar posture and tissue loading during static trunk bending. Human Movement Science

Continue reading “Study: When is bending too much?”

Strength Training for Endurance

This is a literature review of the benefits of including resistance training into your running or cycling training programme.

Rønnestad 2014

For recreational runners and cyclists, strength training is not always considered important when developing increased pace, endurance and mechanics. But this paper from 3 years supports the involvement of explosive strength training as part of a training program for endurance runners/cyclists. With benefits of improved endurance to muscle fibres when in an anaerobic state, increased tendon stiffness and greater explosive power.

The study went on to find numerous benefits with the addition of strength training. And provided these recommendations.

  1. To improve the chance of increased endurance performance following a strength training program, the resisted exercises should engage similar muscle groups and imitate sport specific movements. This will result in firing up the same neural pathways connected with the motion of running or cycling.
  2. Force output may increase the ground strike in runners or force velocity in cycling if an explosive focus is put on the concentric phase of the muscle. For example pushing fast out of the back squat.
  3. At least 2 sessions per week of strength training to develop maximal strength over a 12 week program. Beginning with lighter loads in the first 3 weeks to learn correct form before increasing load. Working within 8-12 reps and 2-3 sets.

Some beneficial lifts for runners and cyclists would include back squats, dead lifts, hip thrusters and bent over rows.

Abstract

Here we report on the effect of combining endurance training with heavy or explosive strength training on endurance performance in endurance-trained runners and cyclists. Running economy is improved by performing combined endurance training with either heavy or explosive strength training. However, heavy strength training is recommended for improving cycling economy. Equivocal findings exist regarding the effects on power output or velocity at the lactate threshold. Concurrent endurance and heavy strength training can increase running speed and power output at VO2max (Vmax and Wmax , respectively) or time to exhaustion at Vmax and Wmax . Combining endurance training with either explosive or heavy strength training can improve running performance, while there is most compelling evidence of an additive effect on cycling performance when heavy strength training is used. It is suggested that the improved endurance performance may relate to delayed activation of less efficient type II fibers, improved neuromuscular efficiency, conversion of fast-twitch type IIX fibers into more fatigue-resistant type IIA fibers, or improved musculo-tendinous stiffness.

Rønnestad et al (2014). Optimizing strength training for running and cycling endurance performance: A review. Scandinavian journal of medicine & science in sports

21617700_1637509319612971_4403438680384241559_n.jpg

Hip Opener for Hinge Shapes

The hip hinge is an important movement in daily activities as well as in sports. Many people are unaware this movement exists and struggle with reaching their potential.

Many lifting injuries result from a lack of movement awareness and weakness of the posterior muscles. The hip hinge is a foundational movement for so many actions like deadlifts, squats, sprinting, jumping. Lacking an effective hip hinge is like racing a formula 1 car on flat tyres.

Developing a good hip hinge will improve the strength of the posterior chain. This includes muscles like the glutes, hamstrings and back extensors. The hinge movement is primarily coming from the hip. The goal is to maintain a neutral spine throughout the movement, the hips start to bend with your butt moving backwards and minimal flexion in the knee. This will increase the tension on the hamstrings and glutes.

The majority of people find this pattern of movement unnatural, as it’s rarely practiced and in most cases, are quad dominant. This quad dominant pattern causes weight to be distributed anteriorly, which is fine with some activities, but most actions we need to be more engaged with our posterior chain.

hip hinge movements.jpg

 

Below are a series of stretches and strengthening exercises to help Improve your hip hinging abilities.

Weighted Hip Hinge

This exercises is a great way to warm up and encourage the hip back movement while fighting the resistance to maintain a neutral spine.

Banded Hip Distractions

These two movements are also great for warming up. Both encourage release of the hamstrings but also the band provides a traction force on the hip socket. This should allow the joint to move free’er and help you access more range in the joint.

Dynamic Hamstring stretch

This is a deeper stretch of the hamstrings. Having more flexibility here will help you hinge better at the hip which will off load the knees.

Jefferson Curl

This movement is a great way of developing movement segmentally and will help build strength when maintaining a stable spine. It’s important to note if you have a spinal injury to avoid this movement until you have gone through the appropriate phases of rehab.

Continue reading “Hip Opener for Hinge Shapes”

Do your hips get the green Light?

Functionally the hip has certain positions that create stability and power. We should be looking at accessing its full range to ensure the health of the joint.

Healthy joints make difficult movements easier

Just like the shoulder, the hip has an important role in allowing us to function in various positions. It’s also a ball and socket joint, with both joints acting as catalysts for power, stability and accuracy of its connecting limb.

Unlike the shoulder as you may already know, the hip is held within a deeper socket, but still has a multitude of muscles surrounding the joint, including its own rotator cuff. The hip also has a ligamentous capsule with fibres angling in different directions. Using the capsule the joint can wind up into some very strong and stable positions. Accessing these ranges of tension puts the joint into a safe place to absorb load.

Gray339

These high torque shapes held by the hip are our start and finish points of most movements of the lower limb. Most of the time we can function well within the realms of the inner movement. But if we struggle to start from these positions it becomes difficult to transition and finish in a safe end shape. The goal should be to have full physiological capacity.

In the hip, there are 3 shapes we should all be able to achieve.


  1. The first movement is the squat/hinge a combination of flexion and external rotation at the hip. This movement takes all the glory, it’s all of our squat movements, it’s dead lifting, it’s rowing and the list goes on.
  1. Next is the Lunge/run which is full extension of the hip with internal rotation. This could be the bottom of a split Jerk, in running it would be your trailing leg before leaving the ground.
  1. Pistol is the last movement which alludes a lot of people (including myself), requiring full hip flexion but also full ankle dorsiflexion.

While the squat/hinge position is the most common hip shape used. We should also feel competent at the other 2 positions. Over the next few weeks I’ll go through the 3 movements and provide some ideas to achieve full depths.

The Holiday Workout

Most of us when on Holiday completely switch off from exercise. If you don’t want to miss out on training try some of these workouts.

This blog follows on from The Office Workout I published a few months ago. There are times we neglect exercise, most commonly in the Office and when taking time off, going on holiday.

The usual story is you’ve been training hard all year and then go on vacation. At home you’re a finely tuned machine with a strict routine. In holiday mode, that routine usually goes out the window. Now try not to fear, a week away from the gym will not cause significant losses in muscle mass or fitness.

But if you’re feeling fidgety and can’t just lie in the sun, I’ve put together some options. Also try making some up yourself, get creative with the movements you use in the gym.

Take a rope…

One of the easiest pieces of equipment you can take away. It’s small and light to carry. Work on singles or doubles. Develop your technique and surprise your training buddies when you get back.

75DU’s – 50 air squats – 25 burpees – 20 push ups – 25 burpees – 50 air squats – 75DU’s

Other DU options….

30 HSPU/Push ups – 40 Mountain limbers – 50 Sit ups – 60 Squats – 70DU’s

3 rounds: 20 DU’s – 30 Walking Lunges – 40 Push ups – 30 Squats – 20 V-sit ups – 10 Burpees

Use the ocean…

Unless you’re a CrossFit Games athlete, how often are you doing interval training with swimming?  Find a quite section of beach and jump in the water.

8 Rounds: 100m swim – 10 Push ups – 15 Sit ups

Other swimming options…

30 mins AMRAP 50m Swim – 10 Push ups – 15 Air squats

15 mins AMRAP 50m Swim – 30 seconds treading – 50m Swim 

Use the Beach…

The sand creates another challenge of instability that you don’t have in the gym. Train in the sand to make the workout harder.

5 Rounds: 10 Push ups – 15 Air squats – 50 Walking lunges – 10 Burpees

21 – 15 – 9 Push ups and Air squats – 400m run each round

15m Bear Crawl – 20 Push ups – 15m Crab Walk – 20 Squats – 15m Burpees broad jumps – 20 Mountain Climbers

Get Creative

Think of other possible ways of training on holiday. They might not always work but it’s worth trying.

Understanding shin splints

There is no satisfaction without a struggle first

Those that have experienced shin splints know how frustrating it can be to train. Whether it’s running, skipping or box jumping. Pain can be so intense that we stop doing these movements for a short period or permanently out of fear. With shin pain, there are many different factors that cause it. This is why having it assessed and treated appropriately can help you ease back into these activities with more control over symptoms.

  • Shin splints is a vague term used to describe overuse or repetitive strain of structures in the lower leg.
  • In athletics and military, “shin splints” can affect up to 35% and is more prominent with females. (1)

Take a look at the several muscles in the shaft of the lower leg, and the layers we have in our bone.

It’s very easy to label the condition as “shin splints”. But looking at the different structures involved with shin pain a more accurate diagnosis would help direct treatment and management of the problem. Shin pain can also be produced by other conditions.  Another reason to get assessed.

Shin splints (other conditions)

Bony shin splints

The outer layer of bone called the periosteum has a great blood and nerve supply. This makes it a common area for feeling shin pain. When training under normal stresses with adequate rest the density of bone increases which allows us to tolerate running for longer. If stress forces increase with little rest time in between, inflammation and pain develops. Pain ignored for long enough could result in a stress fracture.

Rest period of stress fracture: Depending on the severity and nature of the fracture it may take 4-12 weeks. Having it assessed and possibly X-rayed will help guide the timeframe.

Rest period for inflammation of the bone: This requires a shorter rest time but should be closely monitored to ensure we identify the cause of extra stress to the bone. Usual rest periods will be 4-6 weeks.

Muscular shin splints

Compartments of lower leg.gif

Muscles of the lower leg are held within compartments wrapped up by fascia. During running for example these compartments build up in pressure. As the pressure rises, oxygen levels lower, toxicity builds and then results in pain. A condition known as Exertional Compartment Syndrome (ECS). If ignored this could lead to chronic exertional compartment syndrome which often requires surgery . 

Rest period for ECS: Similar to the inflammation of bone, it may require between 2-6 weeks of rest. In this time, it is about identifying the issues causing the problem and building up a tolerance to the activity.

Tendon shin splints

Tendons are the pulleys of muscles, they connect to specific bony points to cause a movement. Inflammation of the tendon can be cause by excessively loading the tendon . Three tendons that lead to shin related pain are the Achilles, tibialis posterior and the peronei. Most common being tibialis posterior.

Shin splints tendinopathy

The Tibialis posterior muscle supports the arch and if it fails can result in many changes to the foot and ankle. Catching this fault early will allow you to correct the problem easier.

Rest period for a tendinopathy: This really depends on the length of time you’ve suffered, the severity and foot mechanics. Recovery time can take up to 12 weeks. Giving time to offload the tendon and building up stress’ again.

Managing shin splints

As mentioned above, it’s important to make a clear diagnosis to provide adequate rest and adjust back into your activity. Along with normal hands-on therapy and exercise prescription, physio can help shin pain specifically through adjustments made to the following:

  • Training error – over training, excessive distances, change in running surface.
  • Poor foot mechanics – A foot with a high arch or that rolls in poses a higher risk for stress fractures and tendon pathologies when running.
  • Footwear – Shoes lacking adequate arch support for an unstable foot causes muscles/tendons to work harder.
  • Running form – Analysing running form will help identify weak structures and correct poor patterns.
  • Movement and balance control – Good balance at the ankle, knee, hip and a strong “core” of your trunk muscles play vital roles in evenly distributing the force.
  • Muscle flexibility – Tightness of muscles can put excessive load on the tibia while running.
  • Ankle mobility – Increased ankle range of movement with joint mobilisations and stretches can reduce stresses on the lower leg.
  • Muscle strength and endurance – The strength of a muscle helps maintain a good position while running or jumping. But it also requires stamina to repeatedly hold position.

Returning to running

Returning to normal running with shin splints is always an uphill battle and is never a smooth transition. It’s a learning experience, understanding what your body can withstand and tailoring your rehab appropriately. It can be frustrating, but having patience with the process will get you back into your activity.

Disc Prolapses that Reabsorb

A recent study shown that re-absorption of disc prolapses is higher than previously thought.

Zhong 2017

The Concern and fear that the words “slipped disc” “disc bulge” or “degenerative disc disease” can be worse than the actual symptoms of pain. The image of being broken and not being able to recover. But as previously noted in another blog about MRI scans, a large number of the general public suffer with a disc prolapse without symptoms. They manage to carry out a normal fulfilled life.

This new study of pooled data from the UK and Japan showed a significantly high number of lumbar disc re-absorption. To be precise it was 66.6% (82.94% in the UK I might add!!). All patients received conservative treatment, there was no invasive treatments like surgery or steroid injections.

This goes to show that with patience in your recovery and the right guidance, spinal problems will resolve without being too hasty for surgery.

 

Original Abstract

BACKGROUND: Lumbar disc herniation (LDH), a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. The incidence of this phenomenon, however, remains unknown.

OBJECTIVE: To analyze the incidence of spontaneous resorption after conservative treatment of LDH using computed tomography and magnetic resonance imaging.

STUDY DESIGN: Meta-analysis and systematic review of cohort studies.

SETTING: The work was performed at The Suzhou Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine.

METHODS: We initiated a search for the period from January 1990 to December 2015 using PubMed, Embase, and the Cochrane Library. Two independent reviewers examined the relevant reports. The references from these reports were also searched for additional trials using the criteria established in the PRISMA statement.

RESULTS: Our results represent the pooled results from 11 cohort studies. The overall incidence of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was 62.58% (95% CI 55.71% – 69.46%).

LIMITATIONS: Our study was limited because there were few sources from which to extract data, either in abstracts or published studies. There were no randomized, controlled trials that met our criteria.

CONCLUSIONS: The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials are necessary to study the phenomenon of spontaneous resorption of LDH.

Chiro.jpg

Reference

Zhong et al, (2017) Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician

Sitting Posture – How important is it really?

Sitting posture is something that get’s heavily criticised and over analysed. There could be more to it than simple ergonomics.

Your best posture is your next posture

In the last several years sitting posture has been classed as the “new smoking” or a dangerous position that will ruin your life. There are various arguments for and against sitting from different health experts and research. My opinion on this topic comes from my own clinical experience and taking value from all of the other respective parties.

First of all, sitting is not dangerous. But the longer we sit over a prolonged time is not healthy

Our body is dynamic and multi-functional, one of these functions is sitting. What’s up for debate is length of time and position. Recent studies have documented the following long term health risks from prolonged sitting.

diabetes-infographic

**These studies are predictors for potential health risks, but are also contributed by poor nutrition, sleep deprivation and lack of exercise.

What’s the physical problem with sitting?

In unsupported sitting (i.e. on the floor, perched sitting) we have some activity from core muscles that stabilise the spine. With no activity we would collapse into a heap.

Our central nervous system cleverly adapts to positions we hold most in the day. In supported sitting our body adjusts, slowly loosing flexibility in the thoracic spine, hips and hamstrings. The trunk muscles, “the core” reduce activity in sitting and loose their primary function of support when doing physical activities. Other muscles like the glutes, scapular stabilisers and posterior rotator cuff become short or weakened.

With the lack of support our body naturally falls into the path of least resistance and this is when changes in posture begin to happen. Essentially causing us to hang off the tension of ligaments and other soft tissue, instead of support from the tone and strength of stabilising muscles.

Chemical changes are brewing while sitting

The longer we sit without movement puts more stress and pressure specific tissues. Causing reduced blood flow to that area, meaning it gets less oxygen and less removal of metabolic bi-products. The muscle becomes increasingly toxic and acidic.

Luckily our tissues hold acidic sensing Ion channels that detect changes to PH levels. When in an acidic environment it sends our brain a signal and we get the feeling of discomfort.

Choosing to ignore the discomfort and stay in the same position causes an increase in toxicity and will result in the development of the trigger point phenomenon. Another phenomenon called central sensitisation may also happen. When pain signals constantly bombard the brain with pain signals it lowers your pain thresh-hold, making you more susceptible to pain in stressful environments.

Whats the answer to sitting?

Looking at the physical and chemical changes that happen in a sustained position you can see that any position for a prolonged time is not beneficial to us.

A posture that doesn’t move isn’t a postural problem, it’s a problem of movement.

“Neutral” spinal and postural alignment is all well and said. But even sitting in an ergonomically aligned position will feel uncomfortable if sat this way for 8 hours.

To counteract the negative effects of sustained sitting positions, here are some recommendations:

1. Position variation

Look at the postures below. Some of them were traditionally classed as “bad” postures. But these postures vary the tensions and stress’s applied to different tissue. By regularly changing these forces it will allow you to tolerate sitting for longer. Making a conscious effort to change position every 15-20 minutes (remember you can still work, just change position).

Sitting variation

2. Get up and move

Offload the stress and compression of your toxic butt! Giving a chance for tissue to oxygenate and flush unwanted toxins away. Also reducing eye strain, stress levels and fatigue. Not to mention all the other long term health benefits displayed above.

Studies have shown improvements in performance with intermittent breaks every 30 minutes (4). Consider standing when taking a phone call. Think about how many calls you get a day!

3. Sit-standing desks

Standing desks have taken off and are all the rage in open plan offices. Standing gives those stablising muscles a chance to work their magic. But even with standing you should consider regularly changing standing positions to offload pressures. Using a perching stool or foot stool to alternate step-standing.

4. Exercise

If this component is not included all of the above strategies will be wasted. Standing desks are not an exercise, it encourages a little more activity and is more sustainable. But your body needs to be challenged in other positions other than the one you hold most of the day. The long term health benefits are well documented for exercise.

Remember if you are just starting to exercise and coming from prolonged sitting over a number of years, ease into exercise gradually. Start off with regular power walks or exercycle. But as your fitness improves try to challenge it more, through other sources like pilates, yoga, resistance training or team sports.

Sitting isn’t the problem, it’s not moving enough. 

  1. Bell et al, (2014) Combined effect of physical activity and leisure time sitting on long-term risk of incident obesity and metabolic risk factor clustering. Diabetologia
  2. Schmid et al, (2014) Sedentary behavior increases the risk of certain cancers. J Natl Cancer Inst

  3. Katzmarzyk et al, (2012) Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis. 
  4. Thorp et al (2014), Breaking up workplace sitting time with intermittent standing bouts improves fatigue and musculoskeletal discomfort in overweight/obese office workers. Occup Environ Med.

Ligament Sprains & Timeframes

Ligament sprains are one of the most common injuries, as their main role is to support the
joint. If poorly managed there is a risk of further injury.

Patience is not about doing nothing. Patience is about doing everything you can. But being patient about Results

What are ligaments?

Ligaments are fibrous tissues that attach from one bone to another across a joint. The tissue is very strong, varies in thickness and is dense with nerve receptors. Its role is to provide stability, guide movement, maintain joint shape and act as position sensors for the joint.

Previously ligaments were thought of as inactive structures, they are in fact complex structures that influence the localised joint and the entire body once injured (1).

How are ligaments injured?

Ligament sprains are the result of loads exceeding the maximum strength of the ligament with little/no time to recover. This force causes acute tears of the ligament fibres.

These structures can be damaged through several mechanisms, like contact or direct trauma, dynamic loading, repetitive overuse, structural vulnerability and muscle imbalance (2). A sprain of ligaments usually affect the following joints:

How does it affect us?

As with most soft tissue damage there will be the typical acute pain and swelling. Injury to a ligament will compromise joint stability and ability to control movement. It can also reduce our balance, proprioception and muscle reflex time (3). With poor joint position comes restriction in movement and weakness of the surrounding muscles.

What types of ligament sprains are there?

The severity of ligament injury is graded using various clinical classifications. The most common is a three-level system that determines structural involvement.

Grade 1 Grade 1 sprain1

  • Slight stretching and microscopic tearing of the ligament fibres
  • Mild tenderness and swelling around the ankle
  • Heals within 1-2 weeks 

Grade 2

  • Partial tearing of 10-90% of the ligament fibresGrade 2 sprain1.jpg
  • Moderate tenderness and swelling around the ankle
  • Partial structural instability when tested by Physio or doctor
  • Healing takes up to 6 weeks

Grade 3

  • Complete tear of the ligamentGrade 3 sprain1
  • Significant tenderness and swelling around the ankle
  • Complete instability when put under stress
  • Poor weight bearing
  • Conservative treatment can take 12-16 weeks
  • Potential reconstructive surgery is required

*Timeframes are based upon the guidance of a professional. Treating injuries on your own poses a risk of not fully recovering and a greater chance of re-injury.

For an appointment, call on 095290990 

  1. Frank, (2004) Ligament structure, physiology and function. J Musculoskelet Neuronal Interact
  2. Gabriel (2002) Ligament injury and Repair: Current concepts. Hong Kong Physiotherapy J
  3. Hauser (2013) Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics. The Open Rehabilitation Journal

Coping with Stress – Part 1

We all suffer with stress and it’s becoming a growing problem where people struggle to cope and burnout. Stress impacts my patients on a number of levels, mainly with pain perception. When under control we have better recoveries from injury.

The Greatest weapon against stress is our ability to choose one thought over another.

Everyone can recognise stress in their daily life. Some people seem to have more stress than others, or is it simply their reaction to events that creates stress? What is stress? And why is a physio talking about stress?

What is stress?

Fight or flight is stress at its very basic. It’s an important mechanism our brain has to cope and be ready for any perceived threat. This causes many bodily changes to prepare us for action, such as increased neural activity, muscle tone, heart rate, breathing pattern disrupted sleep etc. But stress is also emotional and responds with the same physical response. There are two forms of stress positive and negative. It helps to have a balance of both to make logical decisions.

Positive: It can motivate us into action and achieve our goals.

Negative: Too much causes anxiety and other health issues.

There are many forms of emotional stress. Everyone manages stress differently, making it easier for some people to cope with than others. Below are the leading causes of negative stress.

  • Workplace environment, too many emails, phone calls, long hours
  • Divorce/breakups/relationship difficulties
  • Demands of family/children (sleep patterns, household duties, balancing activities)
  • Car accidents. Being stuck in traffic
  • Theft, burglary, loss of personal property
  • Loss of employment or business
  • Death of a family member or close friend
  • Cash flow problems
  • Poor academic performance/work overload

How can stress impact my injury?

When we’re injured we have the mechanical pain from the damaged structures. But carrying negative stress causes increased sensitivity of our pain receptors and decreases the inhibitory interneurones in the central nervous system that regulate how much pain we feel (1,2). If we find ways to channel our stress better the pains we feel from injury become more tolerable.

  1. Donello et al, (2011) A peripheral adrenoceptor-mediated sympathetic mechanism can transform stress-induced analgesia into hyperalgesia.
  2. Corcoran et al, (2015) The Role of the Brain’s Endocannabinoid System in Pain and Its Modulation by Stress.