IOM Pain to Performance Solutions

27/05/2025

21/04/2025

Recently I approached Nutriwell_iom to help me create a post about the mineral, Magnesium.

I have had several clients who have presented with muscle cramping, and have found great benefit from Magnesium supplementation. I wanted a deeper look into Magnesium not only in regards to muscle cramps but also looking at the other many benefits the mineral has to offer. We hope you learn a thing or two about this important mineral. Thanks to Gemma and Ben from Nutriwell IOM

03/03/2025

Always interesting reading, thanks Em Stuart Injuries

B12 vitamin deficiency can manifest itself in several ways and affects both cognitively and physically.

B12 is necessary for? Firstly, we need it for DNA synthesis which is the building block of every cell of our bodies. It directly affects our blood, nerves, cardiovascular and gastric system.

B12 deficiency’s effect on our nervous system? – B12 helps our bodies produce and repair the sheath around our nerves called the myelin sheath, which helps with neural transmission. We can develop altered reflexes, myelopathies and neuropathies as a result. Peripheral neuropathy is very common and experienced as muscle weakness and atrophy, numbness, pins & needles or even burning sensations in the arms, hands, legs and feet.

It helps keep our homocysteine levels down, without which our bodies inflammation increases. Raised levels of homocysteine increase our chances of increased cardiovascular disease, stroke and even dementia. Deficiency can also cause infertility and higher risk of stomach cancer.

Common symptoms of B12 deficiency.
• Chest pain
• Fatigue
• Muscle Weakness
• Pins and Needles/Numbness (sometimes on both sides of the body)
• Cramps and Muscle Twitches
• Coldness in your hands and feet
• Headache
• Sensory and Motor Impairments
• Dizziness, Loss of Balance and Coordination (Ataxia)
• Soreness of mouth
• Emotional disturbances, Depression and Confusion
• Poor Memory
• Dementia or Cognitive changes
• Shortness of breath
• Pale or yellowish skin
• Loss of appetite and Weight loss
• Vision problems from neuropathy to the optic nerve

Why do we become vitamin B12 deficient? Sometimes we don’t get enough from our diets. Sometimes our bodies don’t produce an enzyme called intrinsic factor that allow us to absorb B12, this is an auto immune condition known as pernicious anaemia.
People that suffer with Crohn’s disease where damage is sustained to the small intestine or celiac disease where there is inflammation of the gastric system, and surgeries to the gastric system may struggle to absorb B12.

Use of the medicine Metformin or proton pump inhibitors for long periods of time can affect absorption as well.

To get B12 through our diet we need to eat fish, meat, eggs, dairy, and fortified foods.

What can you do about it? In most cases, taking a supplement can help and symptoms will resolve in 1-3 months. Sometimes, the damage may not be reversable.

For those where supplements are not enough, you can get injections of B12. B12 is stored in the liver but if you have too much you simply urinated it out of your system. Usually a course of 5 injections over a two-week period are recommended.

14/12/2024

Part 2 of Joint Hyermobility Syndrome (Part 1 is lower down in my feed). These articles are compliments of an amazing Sports Therapist in the UK, Em Stuart who I have so much respect for.

Joint Hypermobility Syndrome Part 2

As previously mentioned, this condition is more commonly seen in females, but it’s also more common in non-Caucasian populations, particularly Asian and Afro-Caribbean populations.

Joints hypermobility syndrome (JHS) and Ehlers Danlos Syndrome (EDS) have a genetic link, however, they do not have any known genetic markers, so there is no blood test that can be done to confirm its presence.

What is predominantly affected is collagen and elastin that make up our body, affecting not only the skin but the fascia, muscles, bone, ligaments, tendons, joint capsules, cartilage, our spinal discs and also the brain. So basically, abnormal collagen.

How does Hypermobility affect the brain?
Anxiety and JHS and EDS have a long-established history together but links to ADHD and autism are well documented in literature, this also explains why JHS sufferers experience altered sensation.
A large proportion of people with JHS (over 70%) have psychological symptoms including panic disorders, anxiety, and depression.

Eating disorders
Studies that look at eating disorders have found that high proportion of participants have JHS. This is true of ARFID (avoidance restricted food intake disorder) and other forms of eating disorders including, but not limited to, Anorexia Nervosa.
Some studies have reported that 41% of participants with eating disorders had JHS which is a much higher percentage that the population that have been diagnosed with JHS (approximately 3% but other studies suggest it’s as high as 10% of the population). There appears to be a gut-brain interaction dysfunction. Some of my clients report that they have slow transit of food and consequently, reduced oral intake. This can be difficulty swallowing, vomiting, low grade constant nausea (a common symptom in POTS), indigestion, bloating, irritable bowel syndrome and altered oesophageal and/or gut motility (slow transit of food). Oesophageal hypersensitivity is also more common in people with hypermobility.

Functional neurological disorder (FND)
FND is when the brain does not work as designed which can lead to symptoms such as difficulties in movement, seizures, memory loss/cognitive issues; speech, vision or heating issues, chronic pain, fatigue and sensation issue (numbness) to name but a few.
Some of my hypermobile clientele have, or are being investigated for, functional neurological disorder. Its is believed hypermobility, anxiety and depression all contribute to FND.

How does Hypermobility affect the nerves?
Restless leg syndrome, I have at least ten hypermobile clients with this condition, and is linked to JHS. Restless leg syndrome is when you just have to move your legs, the urge is irresistible. Due to the extra joint range, nerves are stretched more than normal so neurological pain symptoms are not uncommon.

Mast Cell activation Syndrome (MCAS)
JHS sufferers on occasion also experience MCAS which is condition where the bodies Mast Cells (a form of white blood cell) go into overdrive and release too many chemicals into the bloodstream. Symptoms include.
Heart – Low BP, tachycardia and feinting. Gastrointestinal – abdominal cramping, constipation/diarrhoea, nausea and vomiting. Breathing - Shortness of breath and wheezing. Skin -Itching, rashes, swelling, hives and skin writing. Neurological symptoms - Headaches, fainting, brain fog, balance problems, memory problems, anxiety, depression, mood swings.
These episodes can be triggered by stress, insect bites, temperature changes, foods, medicines, strong chemical odours and exercise.

Blood
Some of my hypermobile clients have, for no reason the medical profession can explain, a high C-reactive protein marker (CrP); these are normally present only when a systemic infection is present, however, in these clients they are consistently high without the presence of infection. I have yet to be able to find out why this happens, only that it does in many cases. If any haematologist wish to enlighten me feel free to comment! I will continue to research however.

Joint and tendon pain & autoimmune links
JHS is also prevalent in rheumatoid arthritis populations and a link has long been recognised. Usually the presence of HLA-B27 (a rhumatoid arthritis marker in the blood) is present, but again several clients lack this marker but still get rheumatoid arthritis like symptoms.

Arthralgia – pain emanating from the joints.

Myalgia – pain emanating from the tendon, ligaments and soft tissue. It can present with or without muscle cramps.

Arthritis – premature osteoarthritis is common with JHS and EDS, as is lower bone mass so earlier presentation of osteopenia (the pre-curser to osteoporosis) and osteoporosis itself.

Tendon issues including bursitis, tendinopathies, and irritation to tendons and their surrounding tissues which include tennis elbow, golfers elbow, De quervains, medial tibial stress syndrome and Achilles irritations.

Disc herniations – Because of the affect on the collagen and its matrix, this makes discs easier to herniate in JHS populations. Those with this are more likely to require a surgical solution.

Coccygeal joint dysfunction – Instability of the coccyx is also prevalent with JHS, suffers experience pain in the coccyx area (the tail bone) of their spines, and symptoms are aggravated by sitting.

Temporomandibular joint (TMJ) pain and dysfunction are a common presentation as well.
Tinnitus – Those with TMJ disorder have a higher likelihood of having tinnitus with it.

Bones
Osteopenia – I had a client back in the early years of my clinic present with a herniated disc. While going through her medical history, she has been diagnosed with osteopenia (the pre-curser to osteoporosis) and degenerative disc disease (DDD) in her 20’s! When she had an MRI her herniated disc was so bad it was labelled a sequestration (Grade IV). Interestingly, no pain medication her GP prescribed affected or lowered her pain. She scored highly on the Beighton scale.

Earlier signs of osteoarthritis (often a decade earlier) and osteopenia (the precursor to osteoporosis) which can be from altered gait and biomechanical dysfunction as well as poorer cartilage quality leading to earlier degeneration.

Lower bone mass, reported in some studies on young adults could account for poor and delayed bone healing in some cases. This is something that can be later exacerbated in perimenopause and menopause.

Gait abnormalities
Flat feet (pes planus), bunions (hallux valgus) and Genu valgus (knock knees) are also more common in JHS sufferers.

B12/Folate levels
One thing that commonly comes up with my JHS clients is low folate and low B12 for no reason that can be explained.
B12 and Folate function together. Folate deficiency links to some types of JHS but the mechanisms are still being explored.

Blood Vessels
Varicose veins – Varicose veins, hernia, or uterine or re**al prolapse are more common in JHS populations.

The Heart
In the last part we explored postural orthostatic tachycardia (PoTS) which effect the heart, but JHS also affects Heart conditions such as mitral valve prolapse are more prevalent as well.

Eyes
Drooping eyelids, Astigmatism and myopia (short sightedness) are more commonly experienced.

Raynaud’s
Raynaud’s is when sufferers experience decreased blood flow to hands and feet. Having white or slightly blueish hands and feet isn’t uncommon. Some of my JHS clients wear thick socks even in summer.

Thyroid links?
Several of my hypermobile clientele have ‘thyroid issues’. There is a link between JHS and thyroid disorders because thyroid function can affect the formation of cellular components and collagen formation.
Despite researching this link and many JHS journals mentioning the role the thyroid plays, I cant quite find the ‘smoking gun’ that gives us a cause and effect but I will continue to search for it in literature.

What can be done to help?
Not to put too fine a point on it but this condition provides both diagnostic and management challenges…

With muscle weakness and sometimes a fear of movement (Kinesiophobia) due to suffering chronic pain, it might be advisable to use hydrotherapy. Not only does the water stabilise the joints but the hydrostatic pressure helps those that may be suffering with POTS (postural orthostatic tachycardia syndrome) due to improved venous return, but warmer water is better tolerated.

Soft tissue therapy can be very helpful in modulating pain in muscles, but care must be taken with regards to mobilisations of the peripheral joints. If I do mobilise a joint, then I treat my clients with caution, often a sustained traction is far better than an oscillating movement and produces less stress on their tissues.

From my experience with my clients all seem to respond well to soft tissue massage, dry needling, PNF stretching, carefully considered joint mobilisation and TECAR therapy. Physical therapy approaches to improve proprioception will help to decrease balance issues and low impact strengthening does work.

From a pain perspective, many journals also suggest cognitive behavioural therapy.

In part 3, I hope to explore pregnancy and post-partum challenges in hypermobile populations.

05/12/2024

💒 Announcing Mr + Mrs Kate Parsons 💒

💐 On 5th October 2024, Kate Stobart from Rehablab Physiotherapy and her better half Mark "got hitched"! What a day! 💐

Kate, thank you so much for including me in your special day...you looked stunning! It was also a real treat to hang out will the RehabLab crew!

🍾 Kate is in the process of changing her professional name to 'Parsons', so look out for it when booking for Physiotherapy with Rehablab Physiotherapy online or using wellness living app. It's still the KATE we know and trust.🍾

11/09/2024

I love helping people move better, be in less pain and be able to do everyday activities with confidence.

This message has made my day, it was an absolute pleasure and honour to help you Michele!

'Cheers from Kefalonia. I would not have been able to lift this heavy glass of beer without your help. Eternally grateful to you lovely lady xx'

22/07/2024

A very interesting article from a passionate, experienced and overall amazing Sports Therapist I know.

Joint hypermobility syndrome and associated issues Part 1

I have a particular interest in this condition because we have, running through our family, some form of connective tissue disorder that’s always confused and fascinated me. My siblings could all sit on the floor and chew their own toenails, not me of course but I do share some other traits. Many of our family members have flat feet and varicose veins, just two traits that can come under this condition and my cousin had, prior to surgery to stop this, kneecaps that would sub-lux (slip out of their groove) all the time.

Currently only 3% of the population are diagnosed with this but this is a severely under diagnosed and an overlooked condition. In most cases there is a genetic link and joint hypermobility syndrome (JHS) shares traits with other connective tissue disorders such as Marfan syndrome and Ehlers Danlos syndrome (EDS). Where a child was a dancer or gymnast, there may be hypermobility from years of forced and excessive range as well. It is much more prevalent in women; approximately 70% of sufferers are women and 30% men. Often, we use the Beighton scale as a first diagnostic tool to assess how hypermobile a person is and score a person up to 9.

Don’t panic, just because you might be a ‘Bendy Wendy’ and hypermobile in some joints does not mean you will necessarily develop any of the associated issues of JHS but I noticed in my practice that several of my really hypermobile clients share some unique traits and decided to do some research around it.

Equally, just because you might have joints that are hypermobile, doesn’t mean you’re necessarily flexible.

JHS tends to be on a spectrum so no two people are ever quite the same, but it is defined as ligament laxity (loose ligaments) that allows for extra range in the joints. Years ago, we’d call people ‘double jointed’. In some cases, but not always, this extra range can come with additional issues; There is much more collagen produced, but it’s not of ‘good quality’ and this can negatively affect the tensile strength and integrity of tendons, ligaments, joint capsule, cartilage, skin and bone. Meaning their tissues are at a higher risk of damage. This also means healing can take longer but it may also fail or be incomplete on occasion. Scar tissue, because it’s made of collagen, is also of poorer quality, and often sunken below the surface (atrophic scarring). JHS sufferers also produce more scar tissue because of this.

So what traits do people with this condition have?

There may be a history of multiple ligament sprains or tendon strains or tendinopathy and often people are very clumsy and with poor balance (since childhood) perhaps with slightly delayed motor function (dyspraxia). Tight muscles can pull on the tendons and the already lax joints and, in some cases, non-traumatic traumatic dislocations or subluxations can occur.

Higher proportion of meniscus or labral tears, stress fractures, overuse injuries and non-inflammatory spinal and joint pain with varying degrees of degenerative disc disease (DDD); FYI we all suffer with DDD as we age but this is appears earlier with JSH. There may also be the presence of scoliosis in the spine in some cases. Localised inflammatory reactions can occur in other joints as well.

They may be more prone to hernia’s, organ prolapse, urinary complaints and incontinence issues.
They may also experience Gastrointestinal issues ranging from IBS to colitis, gynaecological and abdominal complaints which is often attributed to irritable bowel syndrome or ‘Women’s problems’. Many of my female clients with this experience endometriosis (suspected or diagnosed) and ovarian cysts to name but a few complaints.

Skin effects: unexplained stretchmarks, weird little lumps on the back of their heels known as Peizogenic papules and some have amazing velvety soft skin but others can have thin papery brittle skin prone to bruising and breakage. Because of the effect on the skin, some sufferers may have reactions to tapes and or plasters.

This condition affects more than just recurrent soft tissue injuries however.

Low orthostatic blood pressure is common, and some sufferers are affected by POTS – postural orthostatic tachycardia whereby standing up from laying down too quickly can cause rapid heart rate, dizziness, fatigue or syncope (feinting) which is thought to be because the blood vessels themselves are also hypermobile, so less efficient at pumping blood around the system.

Increased irritation to the nerves; it is theorised peripheral nerves would likely be at risk of injury due to increased movement of and traction. Carpal tunnel syndrome is also shown to have a higher occurrence.

In some cases, the autonomic nervous system (ANS) malfunctions resulting in the body not being able to regulate processes that are automatic in the body i.e. heart rate, blood pressure, digestion and many more, this is known as dysautonomia and can be short term or in some cases long term condition. An example is see quite often is hyperhydrosis (excessive sweating).

But yes, there’s more…JHS has an interesting effect on both pain and analgesia.

Both children and adults with this condition experience an amplification of pain and chronic pain. This pain is hard to pinpoint and one of my clients describes it as never-ending DOMS (delayed onset muscle soreness) which can be aggravated by any body movement, a change in job, a new physical activity or a particular life stress. I have another client which is so affected by this they resort to minimising movement so much as a means of pain avoidance, this is known as kinesiophobia. This can result in reduced strength and muscle mass but reduced power production in muscles can also be from poor force production from the tendons.

Children and adults with these symptoms are often diagnosed with fibromyalgia which may develop into chronic pain syndrome. Chronic pain often presents as pain that cannot be traced to an injury, with a ‘diffuse distribution’ which can be in just one area, half of the body or the whole body. This can also be accompanied by dysesthesia; a feeling of unpleasantness when touched which can be from aggravation to the peripheral nerves, Hyperesthesia; an extreme and sometimes overwhelming sensitivity to touch and allodynia; where a stimulus that shouldn’t really cause pain, actually causes pain, these can be hypersensitive trigger points in the soft tissue.

There also appears to be a resistance to not only local anaesthetics but also potent analgesics, including opiates, which seem to have little to no effect in reducing pain. A few of my clients have reported that even Oramorph (a form of morphine) has no effect on their pain.

Chronic pain is distressing and can unsurprisingly be linked to depression, anxiety and sleep disorders. JHS sufferers also report chronic and debilitating fatigue with cognitive fatigue being a common feature as well.

In addition to this, some JHS sufferers can suffer cervicogenic headaches (originating in the neck and spreading to the head). Those suffering daily headaches were found to have excessive movement in the cervical spine. In rarer cases, some suffer recurrent orthostatic headaches due to spontaneous intracranial hypotension theorised to be from cerebrospinal fluid leakage.

I have some clients that have been diagnosed with individual issues such as chronic fatigue and headaches but we are finally linking these together to get a clearer diagnosis for them.