Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a progressively debilitating disease that primarily effects the spine. The small tendons and ligaments in your spine become inflamed which is bad enough in itself but as they heal they calcify, effectively turning into bone. The flexible tissue turning into rigid bone stiffens and eventually fuses the spine, your other joints, your eyes, heart, lungs and bowel can all be effected by AS too .

AS effects three times as many men as women and the average age for the onset of symptoms is 24. The pelvis and spine are effected in all adult AS sufferers, in women the pain is less severe but their wrists and ankles are more likely to be effected than with men. Children are less likely to experience back pain with AS but their hips and knees are worse and sometimes need replacement surgery at a relatively young age.

Weight loss and fatigue are common, the symptoms are worst in the early morning and improve with exercise, night sweats and fever are common too. The body in general will be better with regular stretching but more than anywhere else the muscles in the front of your thighs and hips (lateral to your groin) need to be kept flexible. If an AS sufferer allows their hip flexors to stiffen they will not be able to stand up straight, they can develop a permanent stoop forward at the hips.

There are effective drugs that can help control the symptoms of AS but you will be even be better still if you get regular body work or manipulative therapies, not just for your hip muscles but all over. Sometimes physicians may not specifically recommend other therapies such as remedial massage or chiropractic to their AS patients but this does not necessarily mean that these therapies will not help them. If you have AS and your doctor has no specific objections to other types of musculo-skeletal therapies it might be in your interests to try them.

Climate has it’s effects too, AS sufferers usually find that cold whether much more adversely effects them than warm weather. It may not be practical for you to move to a warmer place away from family, friends and work but something as simple as the way dress can make a difference. About a year ago I suggested to an AS  client that he wear a scarf to make his neck feel more comfortable and  it worked very well for him. He had never thought of trying this before, his doctor did not suggest it and it took me while to think about suggesting it too, sometimes simple things work very well.

The lungs of AS sufferers are effected through inflammation in rib joints making breathing uncomfortable, this can be helped by being posture conscious at all times, not wearing tight restrictive clothing, not eating large meals, bodywork and most importantly learn to breath from your diaphragm not costally (deep not shallow).

Get advice from your therapist about using Self Massage and stretching to alleviate your AS.

Exercise balls

Since the 1960’s large inflatible balls have become an increasingly common object in gymnasiums in many lands around the world. Starting in Switzerland they have been known as Swiss Balls, Fit Balls, Gym Balls, Sweda Balls etc.

The first time I really took notice of what they could do was several years ago when a former co-worker who had long suffered lower back pain, was at her desk sitting with perfect posture. I had never seen her sit this way before, she had always been such a bad sloucher in all the time I knew her. When I complimented her on her improved posture she told me that she bought a Swiss ball and used it whenever she could.

What surprised me most was that my co-worker was not a good exerciser and didn’t seek much remedial treatment considering how much her back seemed to bother her and yet the Swiss ball seemed to be just what she needed. Most of her back pain was gone and she looked better too, the way everybody does when they have a good posture.

Exercise balls tend to range in size between 55 and 90 centimetres, the taller you are the bigger the ball you need. The deepest muscles in your body that hold you upright are your core muscles (these include your psoas, erector spinae and rectus abdominus) and these are the muscles Swiss balls work best on.

Part of the reason why these large inflatible balls work so well is that they are always making you move or sit or lie on them in a balanced way, if you didn’t you would fall off. They are comfortable too if you can’t kneel down and reach the floor.

There are not a huge range of different exercises to do on Swiss balls but once you get used to them,you will find that making slight variations to your posture will improve your all round balance and strength.

Swiss balls can be useful aids to doing stretching exercise too but even if you only want to use them as a chair, regularly and in the right way they should help your back and straighten you up.

Exercise balls are not a bad way to start getting fit again for men or for women and they hurt alot less than dumbells do if you drop them. If you already are ripped give them a try anyway, see how many of your favourite exercises you can do on them particularly for bench-work.

Another advantage that large exercise balls have is that if you need to put it away for a while you just let the air out and fold it into a neat, flat easy to store bundle. You will find a number of Swiss ball exercises in Self Massage that will assist you with your balance as well as your flexibility.

PMR (Polymyalgia Rheumatica)

As the name suggests PMR effects our muscles (myalgia) and joints (rheumatica). PMR is one of the 80+ auto immune diseases that can strike without warning, with no easily discernable cause and can be very debilitating. The symptoms of PMR vary from person to person although it does seem to be universally agreed that the larger joints in your body are the worst effected particularly your shoulders. Other symptoms may include a sudden inexplicable weight loss, jaw tension headaches and pain in other joints including your fingers, wrists, elbows, spine and toes. A blood test would reveal a high ESR, more women than men suffer from PMR,  50+ is the typical age demographic and the symptoms of PMR can be similar to the symptoms of other auto immune disease such as fibro myalgia or rheumatoid arthritis.

PMR tends to be episodic, for most the symptoms  start in the shoulders and are most severe first thing in the morning. Raising your arms above your head when your shoulders are acute can be very painful and restrictive, though fortunately they usually respond well to anti-inflammatory drugs…..so long as you have no high blood pressure or stomach ulcers. Corticosteroids such as prednisone can lessen the symptoms significantly though apart from being contra-indicated for hypertension and stomach ulcers you may experience weight gain using this drug aswell as severe mood swings and an inability to relax. The original onset of symptoms can last from 12 months to 4 years but if it recurs it is usually of less intensity than the first time.

Unlike muscular problems where you get a little warning before you get into a painful position, PMR can suddenly feel very intense and stop you in your tracks the moment you bend a joint even a little too far. Potentially the most serious symptom of PMR is Giant Cell Arteritis (GCA), it is this that causes the jaw tension headaches which, if left untreated can blind you.

Some PMR sufferers try an alkaline or nightshade free diet and find they do not help, others who try claim such diets definately do work. In either case you can still take your medications if you want to use both, so long as any food you eliminate from your diet has it’s nutritional values replaced by some other food. Many who get diagnosed with PMR find alot of relief from acupuncture, ice packs, massage, osteopathy and chiropractic, these therapies can be used in conjunction with pharmacuetical treatments too.

For a previously active and able bodied person the onset of PMR can be scary and demoralising, any exercise at all in the early acute stages may prove impossible, even having sex may require some adjustment. Practising meditation and relaxation techniques can help you cope with PMR as will planning what you do when you go out, if your knees are affected you might find that stairs are best avoided and getting into and out of coats can be embarrassingly difficult too. Like many other health problems that effect your abilities your facility to distract yourself and remain positive is an important part of  managing PMR.

Climate change and TCM

Whether climate change is an acute crisis brought about through human behavior or an as yet little understood natural cycle there will be implications for our health, even the fear of  it can have an effect. The prospect of tropical diseases becoming  active in previously sub-tropical environments is one of the more obvious possibilities not only for people but for plants and animals too, whatever effects our agriculture impacts on us . If we were to properly study how our attempts to control our own environments impacted on our health we may be surprised, air conditioning is a good case in point. Even though air conditioning has been with us for decades now we still have not come up with a system that can be kept germ free past the twenty year mark, keeping hospital infection rates down is difficult for this reason alone. How ironic it was when CFC’s in our refrigerators and airconditioners were found to be effecting our ozone layer.

Long distance air travel often exposes us to sudden climatic change too, perhaps some of what we experience as jet lag may be a bit of climate shock effecting the body in a weakened state from body clock interruption. Climatisation is thought to usually take a healthy adult about two weeks when they travel to a place with a different climate to home. When a person  lives in a cold climate they acquire better immunity (all other things being equal), but lose their extra natural resistance after several weeks in a warmer climate.

In Traditional Chinese Medicine (TCM) the last two weeks of the current season and first two weeks of the next is called “doyo”, doyo is considered to be like a lunar year (one callender month) of transition from one season to the next. Many herbal, acupuncture and even chi gong practices are oriented to not only observe the current season but the next also, in all five seasons- summer, autumn, winter, spring and doyo* (in four parts).

There are no doubt other traditional medicine practices around the globe that innovatively and effectively deal with severe weather, in Russia for instance kindergarten children are marched bare foot in circles through tubs of icy water just  before winter hits and few children seem to get colds later on.

Maybe too many of us urban dwellers just don’t go outside enough anymore, we now know that not everybody gets enough vitamin D from sunlight so in a sense climate induced disease (and the fear of it) is already with us but we are only starting to notice it. Some urban and city environments because of the orientation of their streets and buildings create some very unpleasant wind tunnel effects and not much sunlight falls to the ground in high rise areas in winter time, making them fashionable climate ghettoes.

I have never had a client ask me to tune them up for the next season with acupuncture but I treat plenty whose problems are in some way connected to climatic factors, even the wind entering your car window on a still day creates a very localised wind that your body can react to, weather is not what it used to be for many reasons.

Climate, Health and TCM III

Heat, whether it comes in the form of an unseasonably hot day in a cooler month, during normal summer weather or as a result of a hot  artificial environments has  health significance in TCM. People are considered to be more accident prone, have headaches more often, suffer “hot-blood” conditions like psoriasis, suffer more from cardiac conditions, febrile diseases and insomnia, when exposed to heat and hot weather.

Psychological illness can be exacerbated in the heat too, people tend to be more manic and excitable when it is hot and crime waves have been known to correspond with heat waves. Many become reckless in the pursuit of having a good time in summer, in TCM summer is the season of accidents. Just as the heat can quicken your pulse, so too do “heat causing” food and drink like alcohol, coffee, chilli, chocolate and drugs that rev you up like ice and speed. In Summer time people are more sociable, venture  into nature and celebrate alot. In Australia more babies are born in August and Serptember than in the other months of the year, in TCM Summer is the season of joy.

People who dislike the heat often have a tendency to suffer from the energy states listed above just as people who prefer summer to winter often find that things like their osteo arthritis and blood circulation worse when it is cold. There is a feature of perceived heat in TCM too, where a “full heat” condition like heat stroke, hyperthyroidism or malaria does raise your body temperature, “empty heat” often does not.

In TCM empty heat is viewed as a condition caused by deficient body fluids rather than a fever, in my time as a nurse I encountered quite a few elderly people who would kick their blankets off and complain of feeling too hot even when the air temperature was not particularly warm.  These poor souls often looked emaciated (due to chronic dehydration) and were flushed across the nose and cheeks (malar flush). They even looked dried out  but would rarely drink water when it was offered, much to the frustrations of the nurses and doctors looking after them.

Empty heat (Yin deficiency) can be experienced by younger people too in the form of AIDS and Lupus. Whether heat is full or empty when you suffer from it it makes it hard to properly relax and be still. Burn out from living a frantic life style for too long is regarded as a heat condition in TCM also.

The five pernicious climates (cold, damp, dryness, wind and heat) interact with each other, heat and damp cause “hot damp” conditions- high humidity during monsoon can literally drive people mad who are not acclimatised to it because the moisture in the air will not allow your sweat to dry and cool you. When cold and wind combine the cold and flu season starts and wind dryness plays havoc with allergy sufferers.

In TCM so long as the transition from one season to the next is gradual rather than sudden and weather extremes do not occur we adapt and are less susceptible to illness.