Why there’s often no black or white answer.
I’ve been treating a lovely lady of late for some grumpy neck pain. A few years ago, she had an episode of severe pain which had associated neurological symptoms – weakness and pain in her arms, inability to use certain muscles etc. As such, she was referred to a surgeon and underwent an operation, which was thankfully quite successful and assisted her greatly.
When her neck started to “play up” again recently, she was quite uncomfortable, finding difficulty sleeping and with her day to day tasks, and described herself as grumpy and irritable. She was relying upon medication to dull her discomfort.
Due to her previous experience with neck pain, she had reluctantly come to the conclusion that she required another MRI, and quite likely, another operation. Her GP obliged her and referred her for the MRI, which showed what we would likely find in many people over the age of 40 or so, degeneration of the joints and discs in her neck.
Upon seeing the report, my patient forlornly discussed with me her concern that she would need to book in for another operation. I undertook a thorough clinical examination, read her report and took her medical history at this point.
My patient mentioned that she’d recently had a recurrent nasty infection, and had needed very strong antibiotics. She’d been lethargic, her white blood cell count was low, and her doctor had mentioned that her “immune system wasn’t very strong at the moment”. Her lethargy had rendered her too tired to undertake her regular exercise or activity, and she’d been feeling nauseous and dizzy. She was also recovering from a routine operation on a separate body part, which was only minor but had still knocked her around. She’d found this experience quite stressful.
It was my clinical opinion that her neck pain wasn’t predominantly caused by the degeneration seen on her scan, so therefore an operation wouldn’t be of much assistance. I discussed with my patient the concept of inflammation leading to nerve sensitisation, the immune system’s role in pain production, and the lack of activity/exercise leading to stiffness and deconditioning of her neck muscles.
We’re now a few weeks down the track and my patient has noticed a vast improvement. She’s recovered well from her minor operation and infections, and has more energy to undertake things like gardening. As such, last week she asked me if there was anything she SHOULDN’T do, so as to not allow her neck to flare up again.
This is a tricky question. We know that neck extension (the act of looking up at the roof) is certainly a trigger for her neck, and due to previous shoulder injuries, she develops discomfort with any heavy lifting overhead.
However, exercise and movement categorically assist with keeping muscles strong and supple, improving and maintaining joint mobility and assisting with good blood and lymphatic flow.
I explained that whilst there may be some activities which need to be monitored, (such as cleaning high cupboards) I would much prefer her to remain active as the net benefit of performing these activities outweighs the net harm, as long as the risk is mitigated. (Not staying in the neck extended position for long periods of time, using a stepladder to change the angle of the neck/shoulder when cleaning high cupboards).
I also discussed with her that the human body is in a constant state of flux, that our ability to undertake any task will greatly depend on our internal environment, which changes from day to day.
For instance, she was able to relate the feeling weaker, more sore, less supple, more stiff whilst she had been sick. She also noted times in her life where she was stiff or sore whilst she was stressed, or feeling lethargic after being inactive for a few weeks (as I am feeling at the moment after the Christmas period!).
Stress and illness affect our hormones and immune system, which are innately wired to our body’s capacity to produce inflammation. If we aren’t well within ourselves, our ability to use our musculoskeletal system is diminished, therefore we are at an increased risk of hurting ourselves when doing certain tasks.
There is never a black and white answer to “Can I do this or should I not?”. There is, however, the evidence available that whenever possible, sensible exercise is likely to be far more beneficial than sedentary behavior.
Sensible exercise might require breaking a movement up into smaller, digestible chunks which can be performed daily and consistently. We may be able to increase your body’s tolerance to exercise by performing and increasing it slowly.
So, as a general rule, doing the movement is better than not, as long as it’s performed sensibly.
If you’re not sure what sensible movement might look like for you, contact us to find out!