health tips

News about Well+Able and massage therapy, pregnancy, running, and health

The Importance of 'Aging in Place'

By: Rhonda Doram, HoneyDo Lifestyle Assistant

One of the most prevalent topics seniors face these days is the idea of ‘Aging in Place’.  While resources struggle to keep up, local facilities close, and the aging population grows, there’s a visible shift to try to keep our elders at home longer instead of moving into care too soon. New provincial pilot programs such as “Better at Home” advocate this very model. While each situation is unique, there are many benefits to managing in your family home if you are safely able to do so.

Staying in your own home allows you to continue with your own routine that works best for you, even if that may mean asking for some help. Whether that’s 5am walks, or family dinners on Sundays, these traditions help combat loneliness & depression, while keeping focused on staying busy and positive. 

Statistics support that when returning home to recuperate, rather than in hospital, many 
patients do so at a faster, more successful rate. You’re more comfortable surrounded by your own things at home, promoting quicker healing, better sleep and greater security. With home support options available, it is completely possible to receive medical and daily living needs as an out-patient.

Perhaps even more importantly, staying in and being active in your community brings along a connection to the people around you. Having ties to your neighbours, recreation & church groups, local resources, and especially your family, encourages vitality, purpose and meaning. Staying involved has a profoundly positive affect on your daily outlook and ability to cope through a network of support. 

Investing in your lifestyle with moderate assistance allows you to maintain a focus on what you are able to do. By building on your abilities, it is possible to safely maintain your lifestyle, at your pace, at home. Safe ‘Aging in Place’ can be paramount to sustaining a healthy lifestyle for the elders in our community. 

HoneyDo Lifestyle Assistant has been providing “Grandma Approved” senior assistance in South Delta for over 5 years and was Voted #1 for Customer Service in 2013. Their unique, client-directed services allow seniors to remain independent and vitally connected within their community. 

Get a Grip on Osteoarthritis

By: Michael Reoch, RMT

The online medical dictionary defines Osteoarthritis (OA) or degenerative joint disease (DJD), as a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints. The name osteoarthritis comes from three Greek words meaning bone, joint, and inflammation(1)

The common perception is that OA is caused by wear and tear of the cartilage in the joint. Eventually this cartilage is worn down and we get a “bone on bone” situation that we are told is very painful (2). Now, there are new ideas emerging on what helps to cause OA and what its relationship is to painful experiences (3).
Instead of looking at OA as your cause of chronic pain, it may be that it is the chronic pain that comes first(4)(3). Lets say you get a RSI (repetitive strain injury) from doing a task without rest, such as using a mouse too often (5)(6). This injury will cause long-term inflammation chemicals such as a group called cytokines to hang out in the area where pain is felt. Over time these inflammation chemicals may cause the tissues in the area to degenerate or break down(7)(8). This is first felt as achiness accompanied with stiffness in movement, usually after waking up in the morning(2). Over time the OA has a central nervous system component(3). What that means is the brain and spinal chord play a major role in the pain you feel. There is an increase in cytokines in the spinal chord, which start to inhibit our natural pain dampening ability(7)(9). Also, some brain regions may have glitches in processing the signals between it and the painful joint(10). Studies show people with OA are more likely to feel pain with less provocation not just in the involved joint(s) but in areas away from the joint(s)(11)(3). There are also studies coming out that are showing that joint surgery for knee arthritis is no better than placebo surgery(12)!

The take-home message is that joint damage is a poor indicator of how much pain you actually feel.

If you feel pain in an area from doing repetitive tasks you should make an effort to permanently decrease that pain: Ask your RMT for help. If you already have bony changes from OA seeing a RMT should be part of your pain management program. This program should involve tweaks to make your activities easier, exercises and massage therapy, as well as any medications your doctor may prescribe. To better understand this new way of viewing OA, you can watch this video or this interesting one that uses mirrors and video tricks to decrease OA pain!

 

Bibliography:

1.             osteoarthritis - definition of osteoarthritis in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia. [Internet]. [cited 2014 Mar 4]. Available from: http://medical-dictionary.thefreedictionary.com/osteoarthritis

 

2.             Osteoarthritis Symptoms and Causes | Information about Osteoarthritis Diagnosis [Internet]. [cited 2014 Mar 4]. Available from: http://www.arthritis.com/osteoarthritis_symptoms

 

3.             Lee AS, Ellman MB, Yan D, Kroin JS, Cole BJ, van Wijnen AJ, et al. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene [Internet]. 2013 Sep 25 [cited 2014 Jan 21];527(2):440–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23830938

 

4.             Brandt KD, Radin EL, Dieppe PA, van de Putte L. Yet more evidence that osteoarthritis is not a cartilage disease. Ann Rheum Dis [Internet]. 2006 Oct 1 [cited 2014 Jan 21];65(10):1261–4. Available from: http://ard.bmj.com/content/65/10/1261.full

 

5.             Van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet [Internet]. 2007 May 26 [cited 2014 Mar 4];369(9575):1815–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17531890

 

6.             Ratzlaff CR, Gillies JH, Koehoorn MW. Work-related repetitive strain injury and leisure-time physical activity. Arthritis Rheum [Internet]. 2007 Apr 15 [cited 2014 Feb 27];57(3):495–500. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17394178

 

7.             Fernandes JC, Martel-Pelletier J, Pelletier J-P. The role of cytokines in osteoarthritis pathophysiology. Biorheology [Internet]. 2002 Jan [cited 2014 Feb 22];39(1-2):237–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12082286

 

8.             Al-Shatti T, Barr AE, Safadi FF, Amin M, Barbe MF. Increase in inflammatory cytokines in median nerves in a rat model of repetitive motion injury. J Neuroimmunol [Internet]. 2005 Oct [cited 2014 Mar 4];167(1-2):13–22. Available from: http://www.sciencedirect.com/science/article/pii/S0165572805002365

 

9.             Elliott MB, Barr AE, Kietrys DM, Al-Shatti T, Amin M, Barbe MF. Peripheral neuritis and increased spinal cord neurochemicals are induced in a model of repetitive motion injury with low force and repetition exposure. Brain Res [Internet]. 2008;1218:103–13. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2553006&tool=pmcentrez&rendertype=abstract

 

10.             Nijs J, Van Houdenhove B. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice. Man Ther [Internet]. 2009 Feb [cited 2012 Aug 3];14(1):3–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18511329

 

11. <span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Full Text: Recent Approaches to Understanding Osteoarthritis Pain [Internet]. [cited 2014 Mar 4]. Available from: https://jrheum.com/subscribers/04/70/54.html

 

12.            Moseley JB, Wray NP, Kuykendall D, Willis K, Landon G. Arthroscopic Treatment of Osteoarthritis of the Knee: A Prospective, Randomized, Placebo-Controlled Trial: Results of a Pilot Study. Am J Sports Med [Internet]. 1996 Jan 1 [cited 2014 Mar 4];24(1):28–34. Available from: http://ajs.sagepub.com/content/24/1/28.short

 

 

 

 

What is DNM? By: Michael Reoch, RMT →


The term DNM Stands for Dermo (skin), Neuro (nervous system) Modulation (a change from one state to another). It is a method of manual therapy/massage therapy used to change the state of the nervous system from a painful, hyperactive state to a less painful and reactive one through the skin receptors. Diane Jacobs, a Canadian PT with 40 years of experience, developed DNM as a way to treat people with chronic and persistent pain better. I have had the pleasure of learning from and working directly with Diane over the last four years.
She explains the background of the method:

     

    The nervous system is comprised of 72 km of nerves and a brain 5 times bigger than it needs to be to run a critter our size. Even with all this length, even with the giant brain, it's tiny, only 2% of the whole body. Still, because it's busy 24/7, even when we're asleep, and because it runs all operations, it sucks up an amazing 20% (!) of all available oxygen and glucose all the time at speeds of about 270 miles per hour, so it's a big energy suck. You are part of it. It's not part of 'you' how we usually think of our body parts. You are part of it. 'You' are the human bit in there, but most of it we have in common with all the other critters out there that have vertebrate nervous systems. It runs 'you'. It looks after 'you'. It keeps 'you' alive. It puts 'you' to sleep at night so it can do other things, but it keeps your heart beating and your lungs working, right? It's your survival machine and your threat detector. It wakes 'you' up in the morning because it needs you to get it something to eat. It never shuts off! It's your operating system. It's an old, evolved thing, and some parts are really old while other parts are quite new, and they're all hooked together, and sometimes it can get itself into a glitch. Usually, that's all that's the matter. So, we do a systems check and help it fix itself. 
This unique nervous system goes all the way from the brain to the skin and back. There are Billions of sensors in our skin. On average sensors are one to two cells apart. These sensors tell our brain what is happening in the world around us, what is happening within us and what is happening to us. There are many different sensors and each have specific rolls. There are sensors for just heat others for just cold, there are sensors for just heavy pressure others for light pressure, ones for quick stretch others for slow stretch and so on...

 

DNM is a method of manual care that puts the patient and their needs first. Instead of operating a recipe treatment, the treatment is an interaction between the patient and the therapist. We work together to find the areas that need attention and remove the tenderness and pain felt in that area. The focus is on changing the signalling within the nervous system to decrease your pain. Pain does not happen in the muscles and other tissues but in the nervous system itself; therefore, whether or not the area of pain is damaged, we can reduce that pain with DNM.
 
The manual part of DNM involves changing the input signalling from some of these receptors to help the brain get a better picture of what is happening to/in the body. We want to show the Brain that the area where you feel pain is not under the threat that the brain perceives it to be in. 


Some effects of an effective DNM treatment:

You will get sleepy
You will have less swelling/inflammation after
You will feel warming, an ease of movement, and a softening of hardened muscles
Your pain relief will continue throughout the day of the treatment and will usually peak 72 hours after the treatment.

See it in action

How does stress make pain worse?

Do you ever have neck or back pain after a stressful day? Maybe a headache?
Why do you get tight muscles when something stresses you out?

Nerve receptors are involved in pain generation. Their job is to send a signal to the brain that they have been stimulated. The brain knows that a signal from these receptors in the body is usually a sign of danger and will usually then decide that the body is in pain, specifically in that area. In his talks, David Butler often mentions adrenaline-sensitive peripheral nerves and the amazing ion channel turnover. Specifically, this means that these nerve receptors can become extra sensitive to the chemical adrenaline, also called epinephrine. With this sensitivity, less stimulation is needed to send a danger signal to the brain. Think of a car alarm set to go off when someone breaks the window. When the alarm is hypersensitive, it may go off if a loud truck drives by. No damage happened to the car, but the alarm still went off. When we are stressed out, our bodies produce more adrenaline. This can be a good thing because it helps us to prepare for action. Unfortunately, if a nerve is damaged, stretched, or pressed on for too long, it will create "baskets" of adrenaline-sensitive fibres. As David says here:
"If a person has a highly adrenoreactive area of peripheral nerve and if they are in a state of persistent elevated stress then repeated firing into the CNS will occur. And if the person is stressed, central inhibitory controls will probably be lifted anyway, and a persistent neuropathic pain state may ensue."

What this means is that if someone has a nerve that is sensitive to adrenaline and is always stressed out, the danger signal to the brain will be almost constant. If that is the case, the Drug Cabinet in the brain will be lifted away, and persistent pain will likely develop. Not fun.

Fortunately, you have some control over this. The first line of defence is to reduce your stress level, thus reducing your adrenaline. Also, knowing that your pain is not from a damaged muscle but stress chemicals, your brain will be less likely to think of the signal as pain. Third, if you get out and move your body in a way that reduces any specific nerve perturbations you will have less chance of a future sensitivity. Most good Manual Therapists (RMT, Chiro, PT, etc) will know how to help you do this.

Most forms of massage therapy have good evidence behind their ability to reduce stress. Two of the modalities Michael implements, DNM and Simple Contact, work on a model that directly addresses pain and adrenal-sensitive nerves.
If you have any questions about this, feel free to contact us at well+able. We would love to help you out. It would also be beneficial to watch the previous stress video, the Drug Cabinet video, and the What is Pain video.

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