PhysioMonkey

I'm thinking of setting up a workshop / lecture for circussy types and parkour-ers at maybe the University in Leicester.  The plan would be for a day session of lectures on injury, warm-ups and prevention of problems.  To sweeten the pill I'd lay on a massage workshop too. 

In addition I'd try and get a parkour expert in as well as trainers to do some actual physical training.  But assume this bit won't happen at first.

Does this sound doable?

How much could I charge for a day chock full of professional teaching/workshops?  I had a look at the Circus Space website and they charge £95 per person (!) for a circus taster day.  I was thinking something more like £10-15 (as an initial offer) with handouts extra.  I think a max of 12 people would be about right too.

Would anybody want to come?

Suggested plan for the day (Jugglers only):

10.00 - 10.30 Intro and questions answered.

10.30 - 11.00 Sudden injury (lecture) - What to do and how to avoid.

11.00 - 12.00 Repetitive injury (lecture) - What to do and how to avoid.

12.00 - 12.30 Warm-ups (Myths and falsehoods) (Lecture)

12.30 - 1.00 Break

1.00 - 2.00 Neck and back control (Workshop)

2.00 - 2.30 Practice and questions answered

2.30 - 3.30 Shoulder control (Workshop)

3.30 - 4.00 Practice and questions answered.

4.00 - finish Break then massage (Workshop).

I thought I'd put the sit down stuff at the start when people are alert and then the workshops at the end to get people moving and working rather than sitting listening again. 

Now whole books have been written about this and I'm trying to do it in a short form on a web-page.  Hmm?  May not work but we'll have a go. 

Myths:

• Back pain means something serious has happened.

"My back has broken"!  Well yes in a way.  Something has happened that's serious enough for you to have noticed a problem.  It's not likely serious enough to suggest a major medical or physical problem though.  The incidence of serious pathology is about 5% of those incidents of back pain.  By serious pathology I mean anythng from "slipped disc" to spinal tumours.  These are very rare and usually have some specific symptoms in addition to excruciating pain.  We'll come to those later.  Most back pain will get better without recourse to surgery, chemo or scans.

• My doctor says it's just lumbago and he's only given me some tablets.

Firstly, "Lumbago" is just another name for back pain.  It's like going to the doctor with head pain and he "diagnosis" it as "head ache".  Not very helpful.  Now most back pain will go within 6 weeks of onset.  That's why doctors don't bother too much with recent attacks of back pain.  They know things will improve just with time and the drugs are to tide you over.

• I feel I need an x-ray/a scan.

Not necessary in nearly all cases of back pain.  A lumbar spine x-ray is massively more powerful than a chest x-ray.  One study suggested that for every 20000 lumbar x-rays performed there was a new cancer in one of those patients (x-rays are carcinogenic).  The flip side is that a lumbar x-ray very rarely will show anything of note.  Most commonly they show nothing out of the ordinary.  So you're giving yourself a higher risk of cancer for no benefit.

Scans can be useful but they're only necessary if the medics suspect something worrying and also if the result of the scan is likely to affect future management.  In other words why do a scan if your treatment will not be affected by the result?

• I've had back pain so my back will always be "weak".

No no no.  It will remain weak if you ignore it between bouts of pain.  But like any muscles if you train your back support muscles then they will get fitter.  The problem is that most folk don't know how to.  We'll come onto that in the treatment posts.

• Sciatica is worse than back pain.

That's entirely a matter for each individual.  Sciatica is pain in the sciatic nerve, it doesn't always come from the back though.  If it does come from the back it may indeed be "worse" in terms of pain but is still generally dealable with.  Really bad disc problems can cause very nasty referred pain indeed and may need surgery.  That's probably where this myth comes from.

• My chiro/physio/doctor says one of my legs is longer than the other.

Rubbish.  It may well be but unless there's a huge difference you're very unlikely to get symptoms of severe back pain directly attributable to this.  Studies generally show that there is no increased risk of back pain in those with an actual leg length difference within about 2cm.

Note I said "actual leg length difference".  You can get an "apparent leg length difference" which may mean something else and seem to give back pain.  This is likely to be a problem with the joint between your back and pelvis.

• I need ultrasound/TENS/electrotherapy treatment of whatever ilk.

Ultrasound is a complete waste of your time for back pain (and I would argue for just about everything).

TENS is a pain relief modality that may help but is entirely symptom based, ie you'll get rid of pain for a while but you're not dealing with the underlying problem.  The same goes for any other electro modality.

• Don't use heat on it.

Why not?  Commonly the problem is muscle spasm rather than any inflammatory issue.  If it feels like the muscles have spasmed up then heat will help to relax things a little.  Don't make it too hot and don't continue if it's not helpful.

Some folk use ice.  This can work by relieving pain thus cutting down on muscle spasm.  I'd use heat and stretches myself.

• I must rest my back when it hurts.

Possibly the worst advice.  Yes give it a break for a day or so then get using it again.  Start gently and stretch it out.  You shouldn't feel too much pain but you should feel that you are stretching.

• I must sleep on the floor or a plank of wood.

No no no again.  Sleep wherever you find comfortable.  If you can actually get to sleep somewhere then you're getting basically a decent support for your back.  If the base is not appropriate for you you'll really struggle to sleep.

• If I look after my back properly, doing everything correctly, I won't get back pain.

Really not that simple I'm afraid.  1 in 4 of us will get back pain in any given year but some of us who specifically look after our backs will still get some problems with them in just the same way that life-long non-smokers may still get lung cancer.  But you will minimise your chances by looking after yourself.

That'll do for myths although there may well be more that I'll cover at a later date as and when they occur to me. 

So what is the truth?

• The vast majority of back pain is not medically concerning.
• The majority of back pain cases can not be accurately assessed - meaning we don't know exactly what is wrong in the vast majority of cases.  This is not a worrying fact.  In fact the standard term is now either "Mechanical back pain" or even "Non-specific back pain".
• Not knowing what exactly is wrong doesn't mean we can't successfully treat the condition fully.
• Back pain is more commonly lots of little problems with lots of structures rather than one thing gone badly wrong.  This is why we can't often say exactly which structures are the cause of symptoms.
• 95% of back pain episodes will end in less than 6 weeks.
• Your back is very powerful and won't "break" even if you use it whilst your back hurts.
• Your back is supported by some very effective muscles.
• Sadly these muscles pack up when you have episodes of back pain.  They also DON'T automatically come back into use after an episode of back pain, you need to specifically train them.  This, if ignored, is why many people get repetitive episodic back pain.
• Most back pain CAN be treated reasonably well.

Related Posts

What is - Back Pain

Back Pain - Treatment 1 - What others can do for you

Back Pain - Treatment 2 - What you can do

I ran the workshops for the first time yesterday at the Leeds Juggling Convention.

Thoughts about the workshop:

Goods:

• I finally got to run through both the lectures/workshops in front of people who haven't had to hear me wittering about it whilst they were being writ.
• People seemed interested and generally seemed to follow things.
• I got through it.
• Lap-top worked well.

Hmms:

• Complex stuff done too quickly. - Should this mean do less or be more specific?
• Too few of me- couldn't get round everyone to check things working as they should.
• Clurby suggests that the injuries stuff at the beginning wasn't desperately relevant to jugglers.  True but I had advertised it as such.  Will start on tendons and repetitious pain next time unless talking to trapezers and acro folk.

Bads:

• My voice died that afternoon and it still hurts.
• Nothing too heinous I don't think.  If you have any comments (and were there) please tell me what you thought.  If I don't know what was cack then I can't improve it.

Have fun.