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Lower Back pain and your core

Pain and the placebo and nacebo effects

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Pain and the Placebo and Nacebo effects


I have written about many studies where there has been a strong placebo effect, the power of positive thought affecting the outcome of a result, but have you heard of the power of the ‘nacebo’ effect.


It’s well documented. Even Shakespeare knew about it over 400 yrs ago. To quote the bard from hamlet ‘there is nothing either good or bad, but thinking makes it so’, or lets quote Jesus ‘as you think, ye shall be’. The power in your thinking has great ramifications, both good and bad. Another quote I love is ‘we become what we think about all day long’. And from Dr. Wayne Dyer ‘you’ll see it when you believe it’. And my personal favourite ‘wherever I go, there I am’. Your thoughts can be your greatest assets or your greatest enemies and when it comes to healing, your health and your wellbeing this is extremely relevant and unbelievably important.

In a study done 7 years ago, researchers discovered that women who believed that they were prone to coronary disease were 4 times more likely to die from it compared to women with similar risk factors but who didn’t hold the same fatalistic viewpoints. Four times more likely to die because of their beliefs! Welcome to the nacebo effect.

The placebo effect refers to the benefits people have when they shouldn’t have any benefits. An example of this is when they give patients in studies sugar pills instead of the real medication without the person knowing and it makes them better. Another example is sham acupuncture where they put needles in areas where there is no known acupoint and the persons’ condition improves. The opposite of the placebo is the nacebo where the person presumes the worst in regards to their health and that is exactly what they get.

According to Dr. Arthur Barsky who is a psychologist at the Brigham and women’s hospital in Boston, he says that these people firmly believe, in fact they are convinced that something will go wrong as it invariably does. It is a self fulfilling prophecy. Dr. Barsky wrote a paper in the journal of the American medical association asking his peers to be very mindful of the nocebo effect with regards to their patients.

Another powerful nocebo effect is voodoo and witchdoctors. People die simply because they have been put under a spell, a curse or a hex and they are firmly convinced in the power of that person who put the curse on them. They are literally scared to death. The word nocebo is Latin and means ‘I will harm’.

According to Dr Irving kirsch who is a psychologist at the university of Connecticut in Storrs and specialises in the area of ‘peoples thoughts and the outcomes that are produced because of them’, says that nocebos produce a physical effect when there is nothing physically wrong with the person. It really is mind over matter.

A Harvard professor, Mr Herbert Benson says that surgeons are extremely cautious when dealing with patients that have needed surgery and wanted to die to be with their family who had passed away before them. These patients no longer wanted to live. The research done in regards to these types of patients has shown that nearly every single one of them died in surgery!

Another classic example of the nocebo effect happened 10 years ago in the United States. The researchers were doing studies on a new drug for blood thinning in heart patients in three separate hospitals. At two of the hospitals the pharmaceutical representatives told the doctors to inform their patients that there were side effects of the drugs that could produce gastrointestinal problems. At the other hospital they accidentally forgot to tell them.

When researchers reviewed the data, they found an amazing result: Those warned about the gastrointestinal problems were almost three times as likely to have the side effect. Though the evidence of actual stomach damage such as ulcers was the same for all three groups only those that knew about the side effects felt pain.

Another classic study was shown by a research group who made an allergy sufferer start wheezing and sniffling by showing him an artificial rose. In the 1980s, they had 34 students in a room and the students were told that they would have an electric current passed through their heads. They were told not to worry as there would be no lasting effects. However, they were told that they may experience a headache after the current had been given to them. No current was ever used but 70% of the students suffered headaches.

Over the years I have seen a few clients who I believe did not want to get better and so they did not. Their symptoms are very real for them and they generally have seen practitioner after practitioner but to no avail. Quite often they have underlying reasons for remaining unwell. One of the major reasons is to remain in what I call victim mode. This is a form of attention seeking behavior where you can receive sympathy from others who are worried about you and all of your physical ailments.  If you get better you stop having people sympathizing with you and therefore you remain unwell and suffering in pain.

Dr Barsky has spent many years researching these kinds of people and has in fact written a profile of people who fall into this category and are likely to experience a nocebo effect. He says it’s normally a person that he sees who has a history of vague, difficult to diagnose symptoms and complaints. These people are almost certain that any types of therapy or medications are going to help them and that is generally exactly what happens.

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one of the best ways to get lower back pain and sciatica

Posted by in Lower Back pain and your core |



Why does your back hurt more in the mornings? I am going to explain to you why doing certain back exercises after just getting out of bed is one of the worst things you can do for your lower back.

Have you ever wondered why it’s easier to take your socks and shoes off at the end of the day as compared to when you put them on in the morning? Overnight you get taller and during the day you shrink! In fact it has been measured that by the end of the day you can be up to 2cms shorter (Reilly, tynell and troup, 1984). Put simply, overnight your discs fill up with fluid and during the day that fluid gets pushed back out again. It has been noted that 54% of this fluid disperses from the discs in the first half hour after waking.

Here is the important part!

That extra fluid in those discs puts a lot more stress on the spine and its ligaments. In fact, Adams and colleagues have measured that the disc bending stresses are increased by 300% and ligament stresses by 80% in the morning compared to the evening! It has also been well documented that a great majority of lower back injuries happen in the mornings.

Here is the tip:

Avoid full lumbar flexion in the mornings. You should already know that you should bend at your hips keeping your back straight (retaining the inward lordotic curve) to avoid putting pressure on your discs and ligaments. In the mornings it’s even more important. Did you know that by bending forwards at the hips with a straight lower back puts virtually no stress on the discs or ligaments? However, if you bend at the lower back putting the spine into flexion the shearing forces that you put on the discs and ligaments are enormous. This is one reason why many people bend forwards just to pick up something light like a pencil and ‘bang’, their back ‘goes out’. It is simply the straw that broke the camels back.  It is the same with a person who has a heart attack, the plaque builds up over years and then one day it just happens out of the blue seemingly. Your back can only take so much. Whether its bending forwards poorly all day at your job or lifting poorly or slouching, all of these have cumulative effects on your ligaments until finally your back gives in and ‘goes out’. And it’s completely avoidable!

Therefore  if you like to go gardening in the mornings and bend forward pulling out weeds, make certain you are either bending at the hips or go down onto your knees or if you can, get into a squatting position to protect your back. Another alternative is to bend forwards the way golfers pick up the ball. That is, have a straight back and bend forwards on one leg with the other leg extended behind you which acts as a cantilever. It’s an excellent back-saver.

I have written in other posts on lower back pain that bringing your knees to chest, touching your toes with a rounded lower back, rolling up into a ball etc puts enormous damaging forces on your lower back discs and ligaments and you should not do them-period. If you do these first thing in the morning you are putting yourself at an even higher risk of damaging your back-300% higher!

So to have a happier lower back:

No slouching, no bending forward with a curved lower back and definitely no sit ups!

For more information please feel free to email me at

Mark Perren-Jones

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should i do a cooldown after exercise?

Posted by in Lower Back pain and your core |

You are probably thinking what a stupid question. Of course you should do a cool down. We all should. It’s what we have learnt since we first started exercising. And it’s important. Isn’t it?

When I played school football (and played very poorly I might add) we always did a cool down. At tennis we did a cool down. After a run. After a bike ride. After a gym workout. Always. It’s because a cool down, um… stops you getting sore after exercise I think. No, it’s um…because you won’t get tight short muscles and they will cool down in a relaxed state or something. No that’s not it, I think it’s because we need to get the lactic acid out isn’t it? Look, we just have to do a cool down that’s all.

You may be very surprised to know that the literature behind doing a cool down after exercise or sports is next to zero! The research on the benefits is pretty much non existent. We have machines in the gym that have ‘cool down phases’ at the end of the exercise. But here’s the thing. The problem, says Hirofumi Tanaka, an exercise physiologist at the University of Texas, Austin, is that there is pretty much no science behind the cool-down advice.

The cool-down, Dr. Tanaka said, “is an understudied topic.”

”Everyone thinks it’s an established fact,” he added, “so they don’t study it.”

However, most people are not even clear on what a cool down should be. Is it stretching? Or doing the same exercise but more slowly? Or is it a walk from the gym to get into your car?

There is only one particular fact that exercise researchers agree on in regards to the benefits of a cool down. If you exercise really intensely, the blood vessels in your legs expand to send more blood to your legs and feet and your heart is beating very fast. If you stop all of a sudden, your heart slows down and your blood is pooled in your legs and feet. This can cause you to feel dizzy or even pass out.

The elite athletes are at most risk says Dr Paul Thompson, a cardiologist at the Hartford hospital in Connecticut.

“If you are well trained, your heart rate is slow already, and it slows down even faster with exercise,” he said. “Also, there are bigger veins with a large capacity to pool blood in your legs.”

According to Carl Foster, an exercise physiologist at the University of Wisconsin,

This effect can also be problematic for someone with coronary disease, because blood vessels leading to the heart are already constricted which makes it difficult for blood to get in. “That’s always a concern,” Dr. Foster said. “But to my knowledge there is not a wealth of experimental data.”

Ok, well that’s for your highly trained elite athletes. But what about your average Joe who pays some sports, a bit of tennis maybe, goes to the gym and does his workout.

“Probably not a great deal,” Dr. Thompson said. And moreover, people don’t just exercise and then stand in the one spot. They walk around to get to the locker room, or to get to their cars or even to the next machine. This is a cool down in a sense.

The whole idea of a cool down originated from the thought that if you didn’t do it, lactic acid would stay in your muscles and leave you sore afterwards. We now know that to be completely wrong. In fact it is actually good to have lactic acid in your muscles because it’s a fuel. There was a study of cyclists done where the conclusion was made that it was better not to cool down because the lactic acid was changed back into glycogen, a fuel for the muscles, when they just stopped however, when they cooled down it was wasted. It was used up to fuel their muscles.

The muscle soreness theory also has no justification either. There is no physiological basis for it. There was a South African study done where they had 52 people walk backwards downhill on a walking machine for 20 minutes to induce muscle soreness. Half the group did cool downs and the others didn’t. There was no difference in the muscle soreness between the two groups.

And muscle tightness? There is also absolutely no evidence that this reduces muscle tightness.

“In a different generation we would have called it an old wives’ tale,” Dr. Foster said. “Now I guess I’d call it an old physiologists’ tale. There are no data to support the idea that a cool-down helps.” But, he added, once again, “It’s an idea we can’t get rid of.”

As far as Dr Thompson is concerned, if he does a really intense track workout he will do a small jog just to avoid the possibility of getting dizzy afterwards. As far as Dr Tanaka is concerned, when he plays his weekly soccer match he doesn’t bother to cool down at all. According to Dr Tanaka, he sees no point in doing anything after his game other than just to stop.

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Can you get the flu from exercising? yes and no.

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Sneeze-300x200A new study shows that doing too much exercise can actually decrease your immune system but doing just the right amount will increase it. How much is too much?

Back in my wild and crazy days I remember going to dance clubs and coming home when the sun came up and every time I would do this I would have a cold or flu the following day. Here’s why.

Yes folks, there was a time when I would go to bed at 5.30 am, not get out of bed like these days. To tell you the truth, I never really wanted to go ‘clubbing’. After all, it’s a place where you ‘dance’. And those of you who have been unfortunate enough to see my dancing you would understand why it’s about the last place I would want to go.  Its not that I don’t like dancing, I do kind of like it, but it’s a bit like the singer in the shower, you don’t mind singing by yourself in the bathroom but you are not going to be singing for all and sundry to hear. Not if you are as bad at singing as I am at dancing. Since being in Latin America though I have taken some salsa lessons and after about 10 lessons my friend said watching me do salsa was not so much like watching a man dancing but more like watching a man putting out a fire with his feet. The rhythm gods were not kind to me at birth I’m afraid. Please god, let my son inherit his mother’s genes when it comes to dancing.

Anyway, I would go out all night and I would then get a cold soon after-every time! I knew I was just doing too much by being out all night and it would tip my immune system over the edge and ‘bang’, the cold and flu bugs would say ‘yes, a compromised immune system-go get him boys!’

Here is a look at two recent studies:

The first was published in the journal of brain, behavior, and immunity where they had two groups of mice. One group took it easy in their cages. The article actually quotes them as ‘resting comfortably’ which is a funny image for me to think of a group of mice just hanging out resting comfortably. However, I digress. (Again). The other group were put through their paces on little mouse treadmills until they were completely exhausted. They did this for three days running. (I know which group I would have rather been in) After this, they exposed the two groups of mice to the flu virus. Many more of the treadmill group that had been exhausted got the flu and with symptoms that was more severe.

The second experiment was also published in the same journal by a group of scientists from the University of Illinois. What they did was to infect their mice with the flu beforehand . The first group was in the comfy chairs resting comfortably and the second group ran for just 20 minutes which is ‘an easy jog for a mouse’ says the article. The third group was made to run for 3 hours (which I imagine is not such a ‘walk in the park’ in mouse running terms). They did this for three days running (no pun intended) until they began to show flu symptoms. Over half of the group that were resting on their behinds doing nothing died, only 12% of the group who were doing the leisurely 20 minute jog died but over 70% of the exhausted group died and the other 30% of those were on their last legs!

So you see there is something called a j-shaped curve where too little exercise leaves you susceptible to colds and flu but also too much as well. Doing nothing or too much exercise not only leads you more susceptible but will also worsen your condition if you do have symptoms. A little exercise however, improves your immune system.

How this actually affects our immune system is still not exactly clear. Although the more intense the exercise and longer the duration, the longer your immune system will be down. It could be from a few hours to a few days.

There was a study done in the journal of strength and conditioning research which looked at the cellular markers of immune system activity in the saliva of 24 professional football players from Spain. They checked them before and after a strenuous 70 minute soccer match.  Before the match the soccer players all had normal levels of immunoglobulin which are your little guys that fight off colds, flu’s and infections. However, after the match they had levels that had fallen considerably.

Another study was done with marathon runners. They asked 1694 runners if they had had colds, flu’s or other infectious illnesses 3 weeks coming into their events (an increase in workload normally) or 3 weeks after their event. Over 20% of the runners were sick during that period. However, that still means that 80% were ok.

Therefore, if you are a couch potato you stand a higher risk of getting colds and flu’s. If you overly exercise you have an even higher risk and if you moderately exercise you are at a much lower risk than both of these groups because it actually helps boost your immune system. Of course, we haven’t looked at the elements involving poor diet and nutrition, stress factors etc which also have an affect. So if you feel a cold coming on you may like to go for a small walk to improve your resistance. I advise you to listen to your body though. If you have no energy you are more than likely going to overdo it. If you have a cold don’t go running that 10 mile jog today as you will more than likely worsen your symptoms.

And I still want to see that group of mice who were supposedly resting comfortably’. I just can’t get the image out of my mind of mice sitting around the TV with their feet up watching the game ‘resting comfortably’.

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If sit ups damage my back, what should I do instead?

Posted by in Lower Back pain and your core |

If sit ups damage my back, what should I do instead?

I have written in previous articles why you should not do sit-ups and how damaging it is for your back. So what should you do to get those abs strong?

If you are still doing sit-ups-stop! You are hurting your back. Firstly, sit-ups are pretty ineffective because they use a lot more of your hip flexors to bring you off the floor rather than your stomach muscles. Secondly, and more importantly if you do enough of them you will damage your lower back. The posterior loads that you put on your back and discs are enormous when doing these crunches. How much force? You actually exceed the compressive loads that are recommended as safe by the national institute for occupational safety and health. You know not to be bent over with a rounded back or slouched at the computer because it hurts your back. Sit-ups encourage that rounded posture that we know is so damaging in daily activities. The last thing you need to have is more forward rounded posture. So how do you strengthen your abs without wrecking your back?

Before we start you should know that in order to protect your lower back from injury doing abdominal strengthening exercises are only one part of the program. If you think of a tent pole as your spine and tie three ropes from the tent pole to the ground in each direction, those three ropes represent your stabilising muscles for your spine. If you strengthen one muscle group too much the other will get pulled and lengthened too far thus causing instability once again. It’s just like if you were to pull one of your guy-ropes on your tent pole too tight, the pole would lean to one side. The abdominals represent only one rope. The other two ropes or muscle group need to be strengthened as well. I will write more on this in a later post.

Here’s one way to strengthen your abs safely:

Lay on your back with the hands under your lower back palms facing down. This is essential to protect your back. You do not want to flatten your back to the ground. Have one le straight and the other leg bent with the knee flexed at 90 degrees. By having the leg bent helps prevent the spine flattening to the floor as well. You then lift your upper back and neck off the ground as one unit. It is imperative that you do this correctly. Make sure that you are not curling your neck or pushing your chin forwards. Imagine that you have a steel rod through your neck and upper spine. Also, place your tongue on the roof of your mouth behind your front teeth. This will engage your neck stabilisers.

The beginning stage of these curls is to do them without lifting your elbows off the ground. The next level is to do them in the same way but lift your elbows off the ground an inch or so.

If your neck hurts doing these you may need to do some isometric neck stabilisers. These are very easy to do.

If you would like more information please feel free to email me at

Mark Perren-Jones

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Back surgery-some facts.

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Back surgery-some facts.

I see many people through the clinic who have either had back surgery or may be considering back surgery. But here’s something you may like to consider as well.


Many news articles are now in fact reporting that back surgery in not more effective than non-surgical methods. One of the major reasons that patients have surgery is that they are generally told that if they don’t have surgery they could get far worse and possibly become paralyzed. That would certainly put the fear of god into me too. However, a New York Times article recently stated, “many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded.” The chairman of the department of orthopedic surgery at the University of California said in regards to this “I think this will have an impact. It says you don’t have to rush in for surgery.” Hmmm. Interesting. Very interesting.

The article in the times went on to say “no one who waited had serious consequences, and no one who had surgery had a disastrous result.” Let us just quantify what it means by “no one who had surgery had a disastrous result”. The thing is, in surgical terms it is not considered a “disastrous result” if you have lived in fear of having to  have someone do surgery on your spine and you then are no better after surgery or perhaps even worse. It is not considered a ‘disastrous result’ if you are still living in pain after the surgery and now have other health problems due to the side effects of the drugs you are taking. It is not considered a “disastrous result” because you have lost your job due to the time you had to have off from work to have surgery and rehabilitation. It is not considered a “disastrous result” if you have gained weight after you surgery because you couldn’t exercise after and you are now suffering from other health problems because of it. It is not considered a “disastrous result” if you now have marital or relationship problems or family problems because they think that you are a still whining after your surgery which should have ‘fixed your complaining’. It is not considered a “disastrous result” that you had to pay thousands of dollars to have surgery, have now had to use a large chunk of your savings to live and pay for your rehabilitation because your insurance refused to cover you and you still are unable to return to your old job because of persistent pain after surgery. And of course its not considered a “disastrous result” if you can no longer attend your physiotherapy sessions because your insurer has stopped your payments, you cant afford to pay for them, you are still in agony after surgery and are now in the post surgery/post rehab scrapheap. You are depressed because no one understands your pain. Your are depressed because you are on strong drugs that you never believed you would have to take in your lifetime and it seems no one understands your situation-not even your wife.

I implore you to seek your alternatives, get VERY GOOD advice on your back pain, your sciatica or your disc problem and don’t think that a surgeon’s opinion is the be-all and end-all. Don’t listen to the well meaning advice of your cousin, your neighbor or your best mate.

Over the years I have seen clients who were told by their surgeon or perhaps even two or three surgeons that they needed surgery for their backs and refused. They started getting conservative treatment, did specific exercises, assumed good postural and lifting techniques in their daily lives and are now pain free without the need for surgery.

Just one example:

One of my clients came to me 2 years ago with sciatica in both legs going down to his heels. He had seen three different surgeons who all said that he had to have surgery. They even told him if he didn’t have it now he would need it within six months (the fear of god-it will get worse if you don’t do anything about it scenario-as mentioned above). His surgeon would even call him at his home to ask him when he could schedule a date for surgery. However, my client flatly refused to have surgery on his back. He was referred to me; he had to drive 3 hours from the Caribbean to see me to get his treatment. He did his exercises, he kept good posture at all times, he lifted properly and he is still pain free, sciatica free and surgery free.

If you would like any more information please feel free to email me at

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