Tuesday, 6 February 2018

Stress and Wellbeing in the Workplace and Life in General (Part One)

Historically, has always been a view that there is a link between physical and mental well-being and vice versa. A great deal of research has been carried out into such relationships between physical and psychological well-being over the years. There is an ever-increasing evidence base from multiple areas of research suggesting that physical and mental well-being are inextricably linked. Elite Sports and Elite Military units have always understood the links between physical health, psychological welfare, and superior performance. Such organizations have invested heavily in time, finance, research, and effort to ensure that they recruit, select, train and retain the very best candidates. In the case of the worlds elite military services, this includes individuals who are the best physically and psychologically suited to the demands of such a career. Diversity also plays a considerable part in the effectiveness of such Elite teams, with the selection of individuals coming from all walks of life, provided that they meet high and exacting physiological and psychological standards set by the selection course(s).  Industry can learn a great deal from these elite level individuals and top performing teams. Such, organizations and cultures continually strive to push the boundaries of human performance on a daily basis or as one now infamous British Military Unit would say, 'the unrelenting pursuit of excellence.' Even slight enhancements in performance can prove critical regarding winning and losing, or life and death. It is also of paramount importance that organizations can get a good return on their investment, concerning utilization and career longevity from these elite level personnel.  Not only does physical and mental wellbeing have a direct impact on performance, but it is relatively easy to see the links between physical and psychological well-being.

As remarkable and as versatile as the human body is, the body does make various trade-offs. The human body has some extremely sophisticated systems and yet these do not all need to be running concurrently and all of the time. Indeed, each system or process will utilize various resources and the human body only has finite resources and operates on an efficiency basis. Historically, various food sources would have been in short supply and processes within the body all require energy, various nutrients, and water. Examples of efficiency tradeoffs include the way the brain works, how we make decisions, how tissues within the body heal and how we deal with stress. Hence, the human body manages resources to be as efficient as possible, by moderating the level that various systems operate at and by turning systems on and off accordingly.

A primeval Survival Mechanism - Fight, Flight or (Freeze) Response

Pretty much any form of stress creates a similar initial physiological response within the body and initiates the "fight, flight or (freeze)" response. This response is virtually instantaneous regardless of the stressor, and the body takes the view that there is an imminent threat to life. Fortunately, it is fairly uncommon for the vast majority of the population to experience a real threat to life in today’s society. However, "perception" plays a huge part in what one might deem a threat or “stressor.". A “stressor” can take many forms, physical, biological, psychological, social, financial, environmental or any multitude of form factors.

The human Central Nervous system (CNS) is made up of various parts, divisions, and sub-divisions. In simplistic, terms the “fight, flight or (freeze)” response aims to give a person or animal the best chances of survival in any, given perceived life-threatening situation. In essence, the body becomes turbocharged in order to “fight” or “flight” (run away), from a life-threatening situation to live for another day. The “freeze” response is slightly different and is thought to occur due to the perceived life-threatening situation overwhelming a person or animals abilities or capacities to cope with the given situation. In some situations, people or animals will not "fight" or "flight" (run away),  and will just “freeze,” much like a deer in the headlights. In some, perceived life-threatening situations the “freeze” response might work, but not in others could prove fatal. The physiological processes that enable/control the “fight, flight or (freeze)” response are related to the CNS.  Physiologically, there are two particularly important parts of the Central Nervous System (CNS) involved in dealing with threats and repairing the body. These parts of the nervous system are part of the Autonomic Nervous System (ANS) and are called the Sympathetic and Parasympathetic Nervous Systems. 

Sympathetic Nervous System (SNS)

The Sympathetic Nervous System (SNS) is continuously working at a base level maintaining homeostasis, even when the Parasympathetic Nervous System (PSNS) is operating. Sensory inputs and information are continually being sent to the brain for processing via the CNS. The control of essential life support functions and homeostasis happens at a subconscious level. We do not even have to think about making our heartbeat, breathing, or the maintenance of other vital life-giving actions, such as blood PH, blood glucose level or temperature regulation. Such essential aspect of self-maintenance have a "normal or safe" operational level, and relatively small deviations from these normal "safe" levels can prove fatal. Hence, all of these functions are taken care of subconsciously, and the vast majority of these functions cannot be directly controlled consciously by us.  There are various sensors within the body, which are constantly being monitored, with the body making any necessary adjustments on the fly to maintain homeostasis. There are also sensory inputs that we are far more familiar with or at least know are working. These sensors are typically referred to as the basic five senses; touch, sight, smell, hearing, and taste. If any of these primary senses detect anything that the brain perceives as a threat, then the Sympathetic Nervous System instantaneously activates.  The activation of the Sympathetic Nervous System is a highly efficient and effective primeval survival mechanism, commonly referred to as the “fight, flight or (freeze)” response.  The stress response involves the sending of sensory information to the amygdala from any one or number of the "primary" sensors. The amygdala is a small part of the brain, located near the brainstem and which is involved in the processing of emotions. If the amygdala interprets '"perceives" inputs from the primary sensors as a threat, then a distress/alarm signal is instantly sent to another part of the brain the hypothalamus. The hypothalamus is often viewed as a control center, due to the far-reaching effects it can have on the body. There are two parts to the “fight, flight or freeze” response. Firstly, the hypothalamus activates the initial “fight, flight or freeze” response, via the autonomic nervous system. The hypothalamus instructs the adrenal glands to release both adrenaline and norepinephrine into the bloodstream.

The hormonal release produces a large number of changes throughout the body, including shutting down the Parasympathetic Nervous System function. If one is about to have to "fight" or run away from a threat, then all resources need to be aimed at those activities and not digesting food, resting or procreating. The initial release of adrenaline and norepinephrine into bloodstream creates multiple changes within the body including, increasing heart rate, respiration, blood pressure, muscle tension and releasing stored nutrients and energy from tissues within the body. The increase in oxygen and nutrients within the blood supply to the brain heightens all five of the primary senses. The increase in muscle tension helps to protect the body from potential physical harm and also reduces blood flow to the superficial tissues (skin). Reducing blood flow to the superficial tissues would reduce blood loss should the person or animal get injured while dealing with imminent danger. The increase in oxygen, nutrients and energy supplies within the blood also primes the musculoskeletal system, to "fight" or "flight" (run away) from danger. The “fight, flight or (freeze)” response is so efficient that the human body has already reacted subconsciously before us consciously registering a threat. This is why people can often get out of the way of danger before getting injured.

The second part of the “fight, flight or (freeze)” response is relatively instantaneous, but slightly slower than the initial reaction and enhances the primary response and keeps the body in a high state of readiness. The hypothalamic-pituitary-adrenal axis is responsible for the release and control of levels of cortisol in the bloodstream, via a negative feedback loop. The hypothalamus releases corticotropin-releasing hormone (CRH), which makes the pituitary gland release adrenocorticotropic hormone (ACTH). The presence of ACTH is detected by the adrenal glands and these glands then release cortisol into the bloodstream.

Historically there would have most likely been some form of physical activity straight after or shortly after the “fight, flight or (freeze)” process had been initiated, hopefully resulting in personal survival. Once a perceived threat to life has passed, then sensory inputs to the brain allow the brain to return the Sympathetic Nervous System to running at a base level. Blood cortisol levels would then be able to reduce via the negative feedback loop, which is inhibited during the “fight, flight or (freeze)” response. Under normal circumstances, the detection of high levels of cortisol in the bloodstream blocks the release of CRH and thus the release of ACTH. This, in turn, results in a decrease in cortisol within the bloodstream. Importantly, the removal of the perception of a “stressor” stops the inhibition of the Parasympathetic Nervous System from functioning normally.

Parasympathetic Nervous System (PSNS) - Rest and Digest / Feed and Breed

The Parasympathetic Nervous System plays a crucial role in calming the body after a perceived threat has passed. The PSNS is responsible for functions involving “rest and digest” and or “feed and breed” and is also part of the Autonomic Nervous System (ANS). The PSNS is responsible for controlling a number of bodily functions, which are essential to physical and mental health and the continuation of the human species. Besides slowing the heart rate and blood pressure after the initiation of the “fight, flight or (freeze)” response, the PSNS also plays a major role in the regulation of other functions. Other functions include the regulation of digestion, urination, defecation, sexual arousal, menstruation, memory formation and the repair of tissues and structures throughout the body. The metabolic processes that the PSNS controls can only be regulated, if the PSNS can function and inhibited by the SNS during a “fight, flight or (freeze)” response.

Ancient Survival Mechanism in a Modern World

Historically, the primeval “fight, flight or (freeze)” response would have initiated due to an imminent threat to life. One would then have had to "fight" or "flight" (run away), to survive. Provided that one survived and the threat to life had passed, the SNS would start to return to running at base level again. Either way, the stress response usually required an element of physical activity after being initiated. The time it can take for SNS to return to running at base level after starting the stress response can vary a great deal and take anything from 30 minutes to a couple of days. Such variations are thought to be down to a number of factors including, but not limited too, genetics, health/fitness, diet, training and previous experiences. 

Hence, historically the chances of the SNS consistently activating would have been slim at best, meaning that the functions of the PSNS would have been able to operate on a regular basis. However, the modern world we live in today is hugely different to that of our ancestors. Today’s modern world has very different stressors, which are rarely life-threatening and yet the bodies primeval response to stress is the same. Furthermore, the stress response can be initiated multiple times a day and even for extended periods of time. If the stress response is continually activated then the PSNS is continuously prevented from regulating critical metabolic processes.

Stress and Wellbeing in the Workplace and Life in General (Part Two), will look in more detail at the possible effects of long-term Stress and various interventions, which relate to Corporate Wellness and human health in general.

Article written by Dr Terry Davis MChiro, DC, B.Sc (Hons), Adv. Dip. Rem. Massag.,  Cert. WHS.

TotalMSK - The Corporate Wellness, Musculoskeletal and Chiropractic Specialists - www.totalmsk.co.uk

Sunday, 9 July 2017

Foam roller self massage, the right way

Foam Roller Self-Massage

A large proportion of the active and even inactive population have no doubt either come across or used a foam roller as a form of self-massage. Results can often vary significantly between individuals and in some cases, symptoms can be made worse. In order, to get the best out of your foam roller, it is essential know a little about the principles behind the massage techniques the roller attempts to replicate. It is equally useful to know a little about anatomy, physiology, and types of injury.

An American Physical Therapist, Sean Gallagher is commonly referred to as the originator of the foam roller, as used for self-myofascial release. The use of foam rollers for self-massage appears to date back to the early to mid 1980’s. The foam roller industry has grown hugely in the last 5-10 years, and there are all kinds of videos and books of people happily (smiling) while foam rolling various parts of their body. That said there are many health and fitness products advertised with people happily smiling while using them. For those of you that have used a foam roller, it is undoubtedly not a happy experience, and at worst a gritted teeth experience. There is also an ever-increasing number of foam roller designs, shapes and sizes and a vast industry developed in a relatively short period.

Some common examples of foam rollers

Common example of orange textured foam roller

Common example of Blue Foam Roller

A good massage therapist has a number of advantages over a person attempting self-massage with a foam roller. In order, to get the best out of self-massage foam rolling one needs to understand these differences and try to account for them. When performed correctly a foam roller can be a valuable tool, though it does have limits and cannot replace a good massage therapist. Foam rollers are best suited to treating larger (longer) muscles in the body, such as the legs. It is hard and frequently impossible to foam roller smaller (shorter) muscles. Such muscles tend to be inaccessible to a foam roller, due to the muscles location within the body and the design of the roller and way one uses it. Shorter muscles within the body can and frequently affect longer muscles, which then become the symptom and not the cause. This article touches on the kinetic chain, and some of these other aspects later, though there is no scope to cover such things in detail. This blog post also does not have the time to cover such things as postural and phasic muscles, which are relevant to the kinetic chain. That said such things are likely to be included in future articles.

The relevance of Pressure, Tissue reaction and Pain

When muscles are relaxed, they treat, or massage and a good massage therapist will use differing pressure and techniques according to tissue tension. Applying, too much pressure or the wrong type of therapy, which tends to be painful, making tissues tense up and create more pain.  People in pain often adopt rapid and shallow breathing pattern, which also has leads to further tissue tension. In essence, the body's “fight or flight or (freeze)” response becomes initiated, and the sympathetic nervous fully activates.   Trying to then pummel the tissues into submission then tends to prove hugely unpleasant for the patient and can even lead to bruising. It may then feel great afterwards, once the pain infliction has ended and the bodies natural endorphins have been released. That said a good massage therapist should know how to work with various tissues and get excellent results without all the pain. A massage therapist has a distinct advantage, the fact that the patient is laying down and can relax. The comfortable position means that the muscles are not under the additional load of holding the patient’s body weight. A good massage or sports massage therapist can then treat the tissues with relatively little pain, providing pressure is used correctly.

In the case of foam rolling, one frequently has to get into positions which result in the tissues one is treating becoming tense or placed under load. As mentioned, massaging muscles under pressure can be painful, even when using a self-massage foam roller. Ideally, one wants to try and have the tissues being treated with the foam roller under as little load as possible. One may have to find some innovative self-massage positions to, as a way to relax the tissues.

A Foam Roller and Massage Therapy

Massage therapy training can vary hugely concerning the types of massage techniques learnt and the duration of training. One of the more basic sets of massage and sports massage techniques taught and used by massage therapists is Petrissage.  The way in which one uses a foam roller is very similar to some of the petrissage massage techniques, such as squeezing and stripping. However, a massage therapist learns additional techniques and can use all of these methods more specifically than is possible with a foam roller. That said, self-massage with a foam roller should be able to produce some of the results that a massage therapist can with Petrissage techniques. Such benefits are believed to include, reduced muscle tension, increased venous and lymphatic return, increased tissue permeability, all of which can aid in the removal of waste products.

As a foam roller works based on principles of massage, it makes sense to take some learning from massage therapy. Early on in massage training therapists are taught to massage towards the heart, especially with deep tissue techniques. In brief, blood is pumped from the heart around the body and returned via veins. Blood is in effect, shunted through the veins via a series of one-way gates within the veins. As we move, this causes muscles contractions, which in turn squeezes the blood from section to section.  Lymph also similarly moves around the body via muscles contractions and movement. The shunting of the blood in effect pumps the blood back to the heart for re-oxygenation. The reason massage therapists are taught to massage towards the heart is due to the relatively fragile nature of these gates within the veins. Pushing blood the opposite way through these tiny one-way doors can lead to damage to these structures. Damage to or failure of the gates is commonly seen with varicose veins, as blood tends to pool in the various sections. Hence, it equally makes sense that when one is applying self-massage with a foam roller one works towards the heart, rather than backwards and forwards. As with Massage, it is easily possible to overwork soft tissues, which can lead to bruising, inflammation and longer recovery time. Again, a good massage therapist is trained and knows how not to overwork tissues.

Why NOT to Foam Roller an ITB

I have frequently seen people using foam rollers to treat tight Iliotibial Bands (ITB’s). Unfortunately, in many respects, ITB’s are a structural component, much like tendons and ligaments. Usually, one would not want to stretch structural elements as they provide stability to other parts of the body within the kinetic chain. Too much stretching can lead to laxity in the tissues, which then impacts how other tissues work. Also, a tight ITB is a symptom and so not only is stretching it a pointless exercise, but it is also a highly uncomfortable process. Although using a foam roller on the ITB may produce some tension relief, it is not going to fix the problem. The cause of the ITB tension is going to be somewhere else in the kinetic chain and is likely to be impacting multiple components in the chain. The ITB then usually becomes tight as a result of other dysfunctional tissues, which in turn create additional load on other tissues and further dysfunction.

In summary

  • Avoid applying too much pressure.
  • Avoid massaging muscles which are under load.
  • Massage towards the heart.
  • Avoid massaging the symptom (tight ITB) and address the cause.
  • Avoid overworking tissues.
  • Avoid using a foam roller to treat inflamed tissues, or tissues in spasm.
  • Avoid using a foam roller if you meet any of the contraindications for Massage, Sports Massage or Remedial Massage.
  • If in doubt seek advice from a suitably qualified therapist or primary care practitioner.

Article written by Dr Terry Davis MChiro, DC, B.Sc (Hons), Adv. Dip. Rem. Massag.,  Cert. WHS.

TotalMSK - The Corporate Wellness, Musculoskeletal and Chiropractic Specialists - www.totalmsk.co.uk