Neuropathic Pain – New Treatment Hope?

nerve cellsResearchers at Duke University in the United States have made a potentially very important discovery in the fight against neuropathic pain.

In mice with neuropathic pain they injected bone marrow cells into the spinal cord area and found a significant reduction in their chronic pain for a relatively long period.

Treatment of pain from neuropathy is limited and has not greatly changed for many years, with improvement from medication measured in hours rather than longer periods.

The bottom line is that if a person has a chronic, neuropathic type pain, treatment options are limited. They have to suffer an unpleasant pain problem with poor relief and little change in their symptoms.

A neurologist may confirm they have a peripheral neuropathy and prescribe medication or a TENS machine but they are unable to get at the cause of the problem. Pain management may be a useful way to manage chronic pain but does not greatly change the pain problem itself.

Neuropathic pain is not well recognised or understood by the general public. However, anyone who has neuropathic pain knows very vividly what it’s all about. It can be severe, persistent and resistant to treatment, cutting badly into a person’s quality of life.

What Is Neuropathic Pain? A Quick Definition

The nervous system normally works as a transmitter of impulses generated in the tissues. In an ankle sprain for example, ligament tissues are damaged and the local nerves transmit pain up the nervous system to the brain where we can interpret what ‘s happened and take action as necessary.

In neuropathic pain, due to damage, disease or injury the nervous system becomes a generator of pain itself. Changes occur in the structure and in the electrical and chemical behaviour of nerves. This occurs in nerves in the body, the nerve bundles near the spinal cord, in the spinal cord and in the brain itself.

This means that treatment for a nerve pain in the ankle, back, neck or face will have a very limited effect as the problem is in the way the wiring is working. The nervous system lines have been rewired, a problem that drug treatment cannot reach.

Neuropathic pain conditions include trigeminal neuralgia, complex regional pain syndrome, peripheral neuropathy and diabetic neuropathy amongst others. Phantom pain after amputation could also be included in this category.

The Recent Research in Nerve Pain

Researchers damaged the lower limb nerves of mice by tying ligatures around them or by cutting short pieces of the nerves out so they could not transmit any more. These techniques are known to cause the central nervous system to set up a severe pain reaction.

They then removed a particular type of bone marrow cells from the mice, cells with the ability to develop into a variety of different cells. These cells are also able to suppress immune reactions in the nervous system.

Bone marrow cells were injected into the spinal canal via lumbar puncture (on a mouse!). The results showed several weeks of suppression of neuropathic pain from both types of deliberate nerve injury. A chemical (transforming growth factor beta one or TGF-β1) was shown to be a powerful changer of the pain transmitting mechanisms.

The pain relief started quickly, at around a day from the injection, and lasted for five weeks. Even if the pain was allowed to develop for 14 days before treatment, there was still a reduction in pain. The more cells that were injected the longer the period of pain relief.

This research is very important, although I don’t pretend to understand the complex anatomy and biochemistry laid out in the paper. For the first time it is possible to greatly reduce neuropathic pain for a significant length of time. This holds out hope that we will be able to find effective treatments for a large number of people who must live every day with pain.

Reference:
Intrathecal bone marrow stromal cells inhibit neuropathic pain via TGF-β secretion
G Chen, CK Park, RG Xie, RR Ji – The Journal of clinical investigation, 2015
Image credit: On Flickr Album of neurollero

Elbow pain – tendonitis update

It’s been about five weeks since I started my regime of strengthening my forearm muscles and there has been progress. I’m not yet sure if it’s affected my tennis elbow pain but I’m only just starting.

When I began squeezing the weaker of the two hand grippers I could do about seven proper closes, where the handles came together with an audible click to show I had fully closed them.

Now I can easily do 12 closes and for three sets, using this to warm up my forearms before I move to the stronger set of grippers. I bought the .5 (point five) gripper which has a closing strength of 120 pounds but as my grip was very weak to start with I could not close it even half way.

Well I still can’t close the .5 gripper all the way even once yet, but I’m getting closer and doing seven good reps for three sets after I have warmed up. My forearm then feels really pumped up and overall my grip feels stronger.

So I’m continuing to use the strengthening, every other day, to see if it helps my tennis elbow pain tendonitis problem. If you’ve got any good ideas to help this troublesome and not easily treated problem please let me know.

Tennis Elbow – Get A Grip Of Elbow Pain

tennis elbowGetting a decent grip on things is the major issue with tennis elbow. Elbow pain is one of those annoying musculoskeletal problems that plague us as we get older and seem to just become part of who we are.

As time goes on the list increases of all the things you’ve “got wrong with you” and if you remember back to when you were in your twenties you had none of them at all.

When it’s acute it’s a real bitch. Ever had an acute tendonitis, the type which comes on strongly after you’ve overdone something? If you have you’ll remember it as I remember the pain in the extensor tendon of my right thumb. At night I held it up in the air because putting it down anywhere resulted in such severe pain.

It was a day or so before I put it into a splint, rather an oversight for a physiotherapist who’s supposed to know how to manage these things. It did settle down completely because it was an “-itis”, an acute inflammation in  response to high physical stresses.

Most tennis elbow symptoms are much less acute and many episodes never have an initial, highly painful episode, just grumbling from the onset.

What is Tennis Elbow?

Tennis elbow is an overuse syndrome and perhaps the most common. This means we get tennis elbow because we do too much of one thing for too long. We’re designed to do a large variety of things not very often, not one thing a lot of times such as in repetitive work with our hands.

Although tennis elbow may start off with an “-itis” as in acute tendonitis, once we’ve had it for a while there seems to be no ongoing inflammation so we need to give it a different name to be accurate.

Now tennis elbow has got a whole armful of names. Lateral epicondylitis, elbow tendonitis, lateral epicondyle tendinopathy, lateral elbow tendinopathy, lateral epicondylalgia and more. Although the accepted medical name now is lateral epicondyle tendinopathy (LET), it’s still referred to as tennis elbow by pretty much everyone as it’s so easy and descriptive.

anatomy of tennis elbowLateral epicondyle tendinopathy means an “-opathy” or change in structure for the worse, occurring in the tendon(s) on the outside of the elbow at the bony prominence called the epicondyle.

Medial epicondyle tendinopathy (golfer’s elbow) means the same thing but occurring on the inside of the elbow.

Tennis elbow involves most commonly the tendon of the muscle known as extensor carpi radialis brevis, the extensor of the wrist (carpi) on the outside (radialis) which is the shorter (brevis) one. This implies there is a “longus” as well, which there is. Two other muscles, extensor digitorum and extensor carpi ulnaris, may also be affected.

Pathology of Tennis Elbow

Tendons “insert” into our bones, it’s the way that muscles anchor themselves to bone so they can pull or push as required. Just before this insertion point into the bone tendons have a zone which is very poor in blood supply and this may make them more likely to suffer degenerative changes in this area. The commonest area for this problem is around 1-2cm from the insertion of the tendon of a muscle known as extensor carpi radialis bravis (see below).

When the affected area is examined under the microscope there are typically no signs of inflammation but an excess of blood vessels, increased numbers of fibroblasts (these make collagen which tendons are made of) and disorganisation of the collagen structure of the area with small tears.

Tennis Elbow Symptoms

The definition doesn’t cover the most important thing to us though, the elbow pain. Tennis elbow gives pain where the forearm extensor muscles originate at the lateral epicondyle, brought on by gripping and repetitive manual work. This can radiate down the forearm.

Who Gets Tennis Elbow?

Tennis (and golfer’s) elbow are commonest in men and women over 40 years of age, with no particular difference between the sexes. Its occurrence peaks between 40 and 50 years of age, with an overall occurrence of from 1-3% of the population. The pain mostly comes on slowly in a sneaky fashion although people can usually remember overdoing some activity recently.

The pain worsens with forearm activity, often around a day to three days after the aggravating event and improves with rest.

In your 40s your tendons have all changed significantly since you were 20 even though they work perfectly well most of the time. However if you overdo things you can inflame a tendon and if you really overdo it violently the tendon can rupture, although this is uncommon.

Achilles tendon rupture is well known in squash players older than 40 years and this reflects the age related reduction in strength which occurs in us all.

Risk Factors for Tennis Elbow

While the underlying pathology and treatment of this condition are not clear, it has been linked with a number of risk factors. These include:

  • Handling loads over 20kg more than 10 times a day
  • Handling tools of over 1kg,
  • Repetitive movements of the arm and hand for over 2 hours a day
  • Lifting the arms up in front of the body
  • Hands which have to be in a bent or twisted position
  • Doing precision movements

(From a paper by van Rijn and other authors, see below).

In normal life this means that anything we do with our hands at a higher level than normal in terms of force and repetition can bring on tennis elbow.

The Prognosis for Tennis Elbow (how it’s going to go)

Most episodes settle down if you don’t continue to re-stress the area by doing more of the aggravating activity, but at one year after onset 20% of people still have their pain symptoms.

Tennis Elbow Treatment

This is where things get tricky. Not only is there no clearly accepted understanding of what goes on in the tendons, there’s no clear leader in which therapy to choose. Benign neglect, where you forget about it and try not to stir it up too much, may be as good as anything.

Treatments include:

  • Benign neglect or watchful waiting
  • Strapping
  • Orthoses such as braces and wrist splints (improves grip and pain in 2-6 weeks after onset, wrist brace may be better)
  • Corticosteroid injections (reduce pain in the short term but little long term effect)
  • Drugs (non-steroidals such as ibuprofen may have helpful short term effects but little else)
  • Deep transverse frictions (no benefit has been shown so far)
  • Ultrasound (some small effects)
  • Acupuncture (no benefit has been shown so far, some short term help perhaps)
  • Laser (no benefit has been shown so far)
  • Exercise and stretching (may be useful)
  • Extracorporeal shock wave therapy (no benefit has been shown so far)
  • Pulsed electromagnetic therapy
  • Autologous blood injections (some evidence of help with injection of your blood into the area of tendon thought have poor blood supply)
  • Platelet rich plasma injections (show some promise of help in cases resistant to simpler therapies)
  • Surgery (removal  of the abnormal tendon tissue may be effective in difficult cases)

And so on. Pretty much anything we can do to someone has been tried – electrical energy, sound, light, force, activity, blood, drugs and cutting people open.

When you get this list of therapies, which is probably not exhaustive, you know that no-one has a clue how to treat the condition effectively. Or that a bunch of different approaches may have some benefits at different stages of the condition.

***

My Tennis Elbows

I’ve had tennis elbow for some years and I think it’s partly because I’ve done a lot of weight training. I have small bones and narrow limbs and I’m not built for strength. When I was 21 I was six foot one (183cm) and 152 pounds (68kg).

The pains in my elbows have come and gone and nowadays I mostly manage them by avoidance, in other words by not doing things which might stir them up. I’m not sure this is a good strategy so I have decided to do something about it, to attack my tennis elbows and see if I can fix them.

They were bad, at least the left was bad enough to hurt in many hand activities and to reduce my grip strength, never very great, to about a third of normal levels. And giving the obligatory firm handshake with my right hand to any man I meet has been painful over the last few years.

My brother, who works hard manually, said it would settle down after a year or so, that it would come and go, and he was right. Now they are a lot better and give me little problem in normal life. But I reckon if I did something vigorous with my hands it might return and I get sudden tweaks of pain when I do certain things.

Being a physio I’m more attracted to the exercise options of the possible treatments, so I decided to do an experiment on my own tennis elbow. What if I improved my grip strength massively? Could I do that? Would that help my elbow pain or just make me stronger?

***

Tim Ferriss and Pavel

So I was listening to this Tim Ferriss podcast and he was interviewing Pavel Tsatsouline,  an ex-Soviet strength trainer who has graduated from training Russian special forces to being a consultant to the US equivalent.

There is a culture of maleness which worships power such as grip strength and the ability to dead lift. I’ve never subscribed to this, or had the physique to exhibit it, but it gave me the idea. Perhaps I could train my forearms to be stronger and less painful.

The Captains of Crush®

captains of crushPavel introduced me to the Captains of Crush®, grip-strengtheners but not as we know them. You can buy poor imitations at sports shops across the country but the Captains are another thing altogether.

So I bought the weakest set, called the Guide, the lowest and most wussy resistance. A review on their site suggests this one is for girls or for just using two fingers!

I reckoned my grip was well below average and I was right, the lowest strength was the one to start with. They were £24.95, which may show I have somewhat more money than sense, but a solid product arrived through my letterbox.

They’re compact and heavy with sharply knurled handles which abrade your hands as you squeeze them but I reckon I’ll get used to that as I toughen up. The emphasis in training is to do good quality reps so you close the handles together completely.

The interesting thing about the Captains of Crush® is that they are calibrated to specific closing strengths and you can progress up the ladder of resistance as you become stronger. Strong men can become officially certified as being able to close the more powerful models, with only a few men in the world able to demonstrably close the No. 4 gripper.

So I’m starting with strengthening my grip because I like the idea and my grip has become weak over the years. It’s an easy thing to do, uses a cool bit of equipment and takes very little time. I’m sure my grip will get stronger as I progress through a few grippers of increasing resistance but I’m interested to see if my elbow pain changes much.

***

power gripThe Grip

If you’re paying attention you may ask the question “What have the grippers got to do with tennis elbow which involves the extensor muscles, the opposite ones to the flexors which provide grip power?”. Yes it’s a good question but strong gripping involves co-contraction, the simultaneous contraction of the flexor and extensor muscle groups. Without the extensors the grip cannot get good strength from the flexor muscles alone.

Let’s try some experiments.

Lie your arm along the arm of the sofa with your hand resting on the surface. It’s likely your wrist is in slight flexion, i.e. is angled down a little. Now grip. What happened? Your wrist instantly moved up into extension and your knuckles are now pointing up into the air. This is the power position for grip and any other wrist position reduces grip power.

Now for a second experiment. Have your elbow bent at 90 degrees and flex your wrist as far as it can easily go, just letting it flop will do it. Now grip while keeping your wrist bent. How weak was that! Very weak indeed with the grip at a significant mechanical disadvantage when the wrist is in flexion, or bend.

In the power position the wrist extensors and flexors are not providing the power, they are holding the wrist in the best position for gripping and thereby allowing the finger flexor muscles to do their power work holding on to something.

The wrist flexors have been measured as 62% stronger than the extensors. So the strength of the wrist extensors and their ability to maintain the wrist position with sufficient power and endurance will dictate grip power and time. The extensors are a smaller and weaker muscle group than the flexors so they may be the limiting factor, weakening early and letting the power position fail. This will then let the grip fail. So it’s important to have strong extensors which can keep up a contraction for as long as you want to maintain your grip.

In normal life, or even in weight training, it may not be necessary to train the extensors directly, they may get enough work with all the gripping of normal objects or the weight bars.

Types of Grip

There are many aspects of grip but the major types are hook, power, key and pinch or precision grip. They each involve a different combination of joint position and a different mix of muscular efforts. Our ability to use our hands in such flexible ways distinguishes us from our primate cousins the chimpanzees, gorillas and orang-utans.

Hook Grip

A common grip we are familiar with, we use it for carrying bags for instance. In weight training we use this grip a lot as we hang on to the bars in pulling exercises such as chinning and rowing. This grip method is mostly performed by the superficial and deep finger flexor muscles.

Power Grip

This grip only works on something small enough for the hand to get right round it and form a loose fist, such as a rope, ball or thin bar. Or your hand if you’re unlucky. The whole range of wrist flexors and extensors is working here with the finger flexors.

Key Grip

key-gripHold a key and insert it into a lock and you’re using the key grip. This grip is very important not just for keys but for holding things like magazines, newspapers and mobile phones.

In his grip the the index finger and thumb are in slight flexion at each joint and the grip is being maintained by the thumb flexors against the resistance of the index finger abductor (the muscle which moves the finger away from the palm sideways).

Pinch or Precision Grip

Our hands are amazingly designed to do large range and powerful activities and then fine,  precision movements such as playing the guitar or making a model. Our thumbs are arranged so the pad can move round to meet the pads of the index and middle finger in the precision grip. With this grip we can pick up  pins, pieces of paper and manipulate small objects like winding a watch.

With the grippers I’m training the power grip. Training the other types of grip is uncommon and probably not necessary unless you have a loss of power or specific requirements. Such as playing a very tough guitar!

***

My Training Programme at the moment

Every other day.

hand grip strengthenerI warm up with some gripping and ungripping of my hands for a few minutes. Then I do three sets of six reps with the Guide Gripper, which has a closing resistance of 60lbs force.

I’ll increase the reps by one every week until I’ve reached 12 then I’ll move on to the next strength gripper up. Since then my forearms have felt a little different, as if they have done some work, so it’s had an effect at least.

Once I have tested improving my forearm gripping power I’ll have to decide what to do next if my pain isn’t much better. I might then move on to eccentric exercises, the type of exercise most favoured for tendinopathy.

I’ll update this blog with my progress, such as measuring my grip strength if I can find a local device, as I go through an attempted rehab programme for this difficult condition.

There’s a lot we don’t know about managing tennis elbow in its different forms and severity, have you got any useful stories and tips you could pass on? If so please leave a comment, I read everything that comes in.

***

References

Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rogier M. van Rijn and others, Rheumatology, 2009.

A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. L Bisset and others, British Journal of Sport Medicine 2005; 39:411-422.

The management of tennis elbow. J Orchard, A Kountouris, BMJ 2011;342.

Common overuse tendon problems: A review and recommendations for treatment. JJ Wilson and TM Best, 2005, American Family Physician website at www.aafp.org/afp

An exercise programme for the management of lateral elbow tendinopathy. D Stasinopoulous, K Stasinopoulous, MI Johnson. British Journal of Sports Medicine, 2005;39:944-947.

Medscape “Lateral epicondylitis” (you may need to register to get the best info from this site)

 

Pacing For Pain

Seeing thousands of people with pain problems over ten years has meant I have listened to a ton of stories of how it started, what it’s like now and how the person is coping with it. Over time these stories organised themselves into patterns in my brain and led to my interest in controlling activity.
Activity in chronic pain problems is often badly restricted and many people resent this more than the pain itself.
So I’ve finally written down all I know about activity, pacing and how to stop yourself pushing too hard and getting worse with time.
My ebook is called Pacing For Pain and is available from Smashwords in all the major ebook formats or from your favourite retailer. You can get a FREE sample of 20% of the book so you can read some of it and make up your mind. And if you sign up on the right you can get 50% at Smashwords now!

Pacing for Pain on Kobo

Pacing for Pain on iBooks

Pacing for Pain at Barnes and Noble

Pacing for Pain from Oyster Books

Pacing for Pain from Flipkart

Pacing for Pain from Overdrive
 
My website Pacing For Pain has more information on this publication.
I’d be really grateful if anyone would like to leave me comments via this site (hopefully before posting a poor review!) so I can improve the book with time.

CRPS – Pain After Wrist Fracture

Notes From A Fracture Clinic

You always get one eventually.

One after another the assembly line of wrist fractures goes through the clinic. They arrive in their backslabs (half plasters) that Accident and Emergency have put on. Once seen by the doc they have the plaster completed. Then they get the advice and exercises and an appointment for five weeks.

On return the plaster is taken off and we get the first look at the whole hand and forearm. Most are ok although they could do with a good wash. Some however are not.

This one wasn’t. The lady in her 60s came along with her daughter. She held her hand out stiffly for me to look at.

The hand and wrist were puffy and a little shiny as the swelling had eliminated some of the wrinkles. She held her fingers in a slight bend and couldn’t do much to change them.

The hand was painful to attempt to move and when I touched it. Movement was limited and the hand could not be used effectively.

She was, not surprisingly, being protective with the hand as it was so painful.

After the assessment I had to decide what to do. This lady’s instinct would be to do as little as possible with the hand due to the pain. I had to get through to her how serious this could be.

I explained about the hand and what the potential problems could be. I encouraged her to do the exercises and not to pay too much attention to how bad it felt. Then I said “If you don’t do what I suggest then your hand could become worse than you can possibly imagine”.

The look of shock on their faces was clear. I felt the risk was worth it because CRPS is bad. Very bad. “Come back in four days and show me your progress” I said as I wrote the physio referral. I couldn’t risk her sitting for weeks on a physiotherapy waiting list. I had to see what changes she was making in the short term, to get her going.

When she came back the hand was much more mobile, less swollen and more functional. She said “You really shocked me when you said that about my hand last time”. “Sorry”, I said “I wanted to be sure you knew what could happen if you didn’t get over the pain and do the work”.

Sometimes it’s worth being really, really frank. Because the result of it turning out badly can be well, really really bad.

 

What is Pain?

This is my first try at a presentation – What is Pain – which I have uploaded to YouTube. It’s an introduction to pain for someone who has no experience in this area. It sets out a few ideas and problems with our normal way of looking at this important subject.

No Pain No Gain, Part Two

Last time I looked at why no pain no gain might not be a good idea for “normal” people doing activities and sports. However that may be important it’s not where the real problems with this approach lie.

It’s in pain conditions that no pain no gain becomes a critical issue. A person with a pain condition is different from someone who has pain from an acute (recent) injury. In chronic (long term) pain everything is different.

In chronic pain the central nervous system acts as an amplifier and is highly sensitive to a wide range of incoming messages, interpreting many of them as pain. The pain is highly irritable. This means it is very easy to stir up, severe when present and takes a long time to settle down.

This puts the person with chronic pain at risk from getting stuck in a vicious circle of pushing themselves and suffering severe pain and reduced activity.

Once the pain has subsided after a period of enforced inactivity the person is again at risk of overdoing the tolerance levels of their central nervous system nerves. For this group of people no pain no gain is not only an unhelpful idea, it’s positively disabling.

Pushing to get things done leads inevitably to increased disability, to doing less and less, to having more and more pain, to getting so much less out of life than possible.

Pushing beyond your tissue tolerances, whether it’s your Achilles tendon or your central nerves, always leads to undesirable consequences.

That’s why I hate no pain no gain, because it’s unnecessary in normal circumstances and harmful to people with injuries or pain conditions. Pacing is a much better alternative I will be covering soon.

So do you have any stories of how you overdid it madly and suffered badly afterwards? Leave a comment for me.

No Pain No Gain

“No Pain No Gain” – Why I hate this phrase and you should too

“No pain no gain” the smiling gym trainer says patronisingly as I groan under the strain of another rep and obviously want to give up. ‘Do you really expect to see ANY improvement if you wimp out so easily??’is underneath this motivational remark.

No pain no gain is so well dug into our health and exercise culture that it’s hard to see a clear alternative. We’re encouraged to push hard if we are going to get any improvement at all from our exercise or other efforts. How can you get the results you want if you won’t put in the work? If you let a bit of pain put you off you ain’t gonna get nowhere man!

Injury

One problem with no pain no gain is that it takes you much closer to the point of injury and so increases the risks of exercise or activity. It’s normal to push a bit when you’re exercising, to get a bit more out of yourself But pushing strongly can make it more likely you’ll get a muscle tear, tendon injury or an joint or ligament strain.

You can get good results from your training without pushing yourself that hard. Top athletes train hard but for them the possibility of injury is too great to risk it. It would ruin their preparations for an important event so they never push too strongly. Just hard enough to get the gains they’re looking for.

Rehabilitation

No pain no gain is even less useful and more risky when you’re recovering from an injury or operation. You are unfit and your muscle strength is reduced as well as its capacity to cope with training stresses. You can put out relatively little effort and get good increases in training strength and endurance.

This is where a good physiotherapist or other therapist can guide you. How much force to put through your tissues at each point of your recovery is the crucial decision. That way you can improve at the fastest speed with the least chance of setbacks.

Remodelling

If you push while you are still healing you are much more likely to reinjure as your tissues aren’t ready yet for normal exercise stresses. Soft tissue healing is complete sometime between six and twelve weeks but the tissues don’t return to normality for longer.

Once scarring is complete the tissue goes through a period of remodelling. The scarring that occurs after injury means the damaged tissue cannot be exactly as it was. However the stresses we put on our healing tissues mean they remodel to a similar type and strength of tissue.

Putting the right level of stresses on the tissues as they heal is the key skill. Mostly we just do this naturally unless we’re encouraged too much by someone who doesn’t understand the tissue healing process.

Tissue Tolerance before Soft Tissue Injury

Tissue Tolerance before Soft Tissue Injury

 

  • What do our tissues do?
  • How much work they are designed for?
  • How much work is too much?
  • How do we overdo the limits of our tissues?
  • What consequences can overdoing have?

Those are the questions I want to at least partially answer.

Understanding the idea behind tissue tolerances is key to the whole process of getting things done without suffering pain or disability. And key to injury recovery and pain management.

We’re all superbly designed for our daily activities so we can achieve the things we want or need to do. Our bodily tissues cope with the demands of moving our heavy bodies about and with any jobs we perform. We don’t usually think about it at all, we just get on with the stuff we are doing.

Until, that is, suddenly we have to do something different, something heavier or for a much longer period of time. Then we notice. Even then, it may not be much. Just a feeling of muscle soreness or an ache in a joint which settles in hours or days.

But sometimes it’s much worse than that, we get severe stiffness or pain after doing something, or even a soft tissue injury.

Body Building

I love the documentary programmes showing how the world’s biggest ship or the world’s most advanced aircraft engines are made. The complexity and attention to detail are staggering.

The engineers choose the designs and the materials to suit the stresses and strains the various parts of the machines must cope with to do their job best without failing.

Our bodies’ tissues are exactly the same. Each part of our body is “designed” to do a particular job and cope with a range of stresses and strains. Bone supports us and takes compressions strains, ligaments hold our joints together, muscles move us about, tendons transfer forces from our muscles to our bones, cartilage makes our joints easy to move under load.

Each tissue has its job. And each tissue has its “breaking point” in terms of the amount of force that we can apply and not suffer any effects. Luckily we don’t test our tissues to their actual breaking points all that often. Soft tissue injuries are common however.

This idea of our tissues having a tolerance for physical stresses is logical but quite difficult to grasp as it mostly just doesn’t occur to us.

Do and Overdo

As we do things our tissues change and react to the forces involved in a way that machines don’t.

  • Imagine cleaning a window. That was ok wasn’t it? No after effects, no aches and pains.
  • Imagine cleaning five windows. How are things now? Perhaps next day you have a bit of muscle soreness, a bit of shoulder or neck pain.
  • Imagine cleaning fifty windows. How’s that? I’m betting you’re in a lot of pain and having difficulty moving your neck and arm properly for several days after.

Those muscles that contract and relax hundreds of times, those joints which bend and stretch, those tendons which slide back and forth and those lubrication sacs which reduce friction are all under stress with this kind of activity. Too much stress and they become inflamed and painful. This doesn’t happen to the window cleaner as he’s had years of training and his tissues are used to it.

Overdoing means any activity done often enough or long enough to cause an inflammatory reaction in the tissues, indicated by pain and stiffness. This is a soft tissue injury.

Exercise

Exercise is a very common way that we overdo activities in daily life.

When we exercise, we cause what we call micro-trauma to the muscles concerned. This is good as it forces our muscles to repair, which they do and then respond by getting bigger and stronger.

Our tendons move back and forwards rapidly which can lead to the inflammation of acute tendonitis. Lubricating sacs help reduce the friction of our body parts against one another and can become inflamed with too much repetition. Anyone who has developed housemaid’s knee after kneeling too much will know what I mean.

So it’s fine if you don’t overdo it. I did once in particular. I caused so much micro-trauma that it wasn’t micro any more! The normal process of inflammation occurred at a much greater degree than I’d anticipated. This gave me widespread soft tissue injury and a high level of pain for a few days.

I had overstepped the tolerance of my tissues to physical stress. So I paid for it.

We all have tissue tolerances and it’s ok if we mostly don’t push our luck. But when we do push our luck it can have unpleasant consequences such as soft tissue injury or more and I’ll get onto that in another post.

The Human Body – Body Tissues

The Tissues Of The Human Body

I’ve been thinking about tissue tolerances. This is the tolerance of the human body’s tissues to cope with this or that amount of physical stress and how we tend to overdo it so often.

Sport is probably the worst offender. Mostly it doesn’t matter a whole heap but sometimes pushing ourselves can lead to injury or worsening of pain conditions. And then it can get important.

So before I get going on tissue tolerances, overdoing, activity cycling and pacing, I thought I’d review the different tissues of the human body as a starting point, a baseline from which we can go on to more complex ideas.

Bone

Bone is the structural tissue, it holds us up, our muscles attach to it and it takes the weight of our bodies as we move about. Our bones are an active tissue and constantly changing in response to the stresses we put on our bodies. Runners have denser bones than non-runners in their legs, indicating that bone changes like any other tissue but it’s just not as obvious or as quick.

Muscle

Muscle is the movement tissue. Its second and  very important function is to hold us up posturally in all the positions we take up. If we are standing still there’s no movement but many of our muscles are working hard to maintain us upright. Muscles also react to activity or inactivity by changing and this can be fast.

If we work out muscles hard, beyond their easy capacity, we damage them to a small degree. This is why the muscle can feel stiff or sore the next day or so. This minor damage is the stimulus the muscle needs to repair and as it repairs it gets stronger and larger. Bodybuilders do this to an extreme degree! However, this response occurs in all of us when we work our muscles a bit harder than normal.

Tendon

Tendons are the force tranmission tissue. Muscles have connective tissue through their structure, but at each end of the muscles this connective tissue thickens into a band or a rope-like shape. Tendons connect muscles to the bone. To be able to move anything, a muscle needs to be attached to a bone and it’s the tendons which do this job.

Tendons are also often neat and small so that they’re strong enough but don’t get in the way. There’s no room for big forearm muscles down near the wrist and hand and if you look at your hand when you’re moving your fingers you’ll see the long, slim tendons doing their jobs.

Nerve

Nerves are the irritable tissue. Their job is to be irritated in some way or other and communicate that input up to the brain where it can be processed. Nerves report back to the brain on a whole list of things going on around or in us – to pressure, heat, cold, touch, joint position and pain. And that’s not counting vision and hearing.

Nerves have a surprising degree of “plasticity”, meaning that they can react very differently to a stimulus depending on what’s been happening to them recently. They are not just on/off switches but change the volume of their responses.

Ligament

Ligaments are the binding tissue. Ligaments bind all our joints together and prevent them from going beyond their limits. Bend your finger back with your other hand and you’ll see it’ll only go so far. Push any further and you will feel pain. That’s your ligaments objecting to being stretched too far.

Joint

Joints are the hinge tissues. They allow movement in one direction or a number of directions so we can do what we want. An example is the shoulder joint – its job is to put our hands in front of our faces so we can see them and do things with them. Joints vary from large weight bearing ones such as the hip and spine, to small ones such as the fingers and toes.

Cartilage

Cartilage is the anti-friction tissue. Joint cartilage covers both surfaces of many of our joints and is very slippery and low friction. This allows us to move around easily even when there’s a big load on a joint such as going upstairs. It doesn’t really feel any different to going down apart from being a bit more work. This is important as we are large animals in the scheme of things and so weigh a lot.

Activity or inactivity has effects on each of these tissues of the human body although we are often not aware of the changes at the time.