Let me tell you about two conversations (and one rude remark) I had recently:

I was discussing an upcoming knee replacement with a neighbour. He is about 5' 5", very rotund and in his late 60's, and he said

"They won't do the surgery until my BMI is lower. They want it below 40. But the thing is, when I was 20 I used to play rugby, and I just don't think they're taking into account the muscle on my legs from back then."

I was telling a friend of mine, who is a personal trainer, about this conversation. His background is in boxing and martial arts, having been county champion about 3 years ago. He now trains athletes and is in excellent shape himself. He's over 6' tall and in his early 20s, and he said:

"I went to the GP recently about some symptoms I was having and he said that with my BMI being technically overweight, my issues were down to being too fat. I asked if he was kidding so he asked what I ate. I told him that, because of how I train, I have to eat around 6000 calories a day to maintain my muscle, and he told me I should cut it down to 2000."

Now for the rude remark. I was telling my mum about both of these conversations, when an extended family member, who is roughly half my height but weighs more than me and recently had open heart surgery, interrupted and said

"These two stupid women..."

They all count towards your daily exercise quota!

OK, so technically sex isn't included in the list of NHS recommended exercises, but I reckon it meets the criteria for aerobic activity (see below).

Why bother?#

"Yeah, yeah, another blog post telling me I need to exercise. Whatever."

Part of the "Pain and the Brain" series

I was recently thinking about a wonderful evening I spent in London several years ago. I was attending the Royal Society of Public Health Award Dinner, and it was a fantastic night. It was so wonderful to see all the great work that different charities and organisations do to improve the health of the nation.

However, there was one enormous highlight for me: the children from Breathe Arts Magic Programme were performing magic tricks for us at our table. These children all suffer with a condition called hemiplegia - paralysis or weakness on one side of their body - which can severely impact their ability to perform everyday tasks. The Magic Programme essentially took their physical therapy programmes and integrated them into magic tricks, which the children then learned, practised and performed. After only 2 weeks, the children were much stronger and more able to carry out their daily activities.

Part of the "Pain and the Brain" series

For most of us, our understanding of how pain works goes something like this:

1. You get an injury, which causes pain in the area
2. Pain signals travel from the area to your brain
3. You become aware of the pain and respond appropriately

But, if we thought about it a little more, we might come up with a few problems with this model of pain. For example, have you ever been doing some DIY and suddenly realised you were bleeding from a small cut? You've had an injury with no pain. Or those cases you hear of when someone has been in a bad car accident, and managed to get themselves out of the car and run a safe distance away before they realise they've broken their leg? There's a serious injury with no pain. I've seen things like that before at rugby matches whilst doing pitch-side first aid. Or what about Phantom Limb Pain? This is a condition where a patient has a limb amputated, but the limb still feels present and is in pain. We might even look at something like pain threshold, where people's tolerance to pain can differ hugely when exposed to the same painful stimulus. All of these things would give us a clue that pain might be more complicated than our 3 step model above.

From what we know from the best available pain science, the mechanism of pain actually looks more like this:

Part of the "Pain and the Brain" series

So far in this series looking at the PAIN EQUALS DAMAGE myth, we've come to understand that:

• Pain is not an accurate indicator of tissue damage
• Pain is an output of the brain that is projected onto your body
• The experience of pain is greatly influence by context, such as the language we use to describe our pain
• Misinformation and untrue beliefs about our health and bodies can lead to an increase in pain

And so if you're dealing with long-standing pain, then let me give you 3 truths to combat this myth and help you with your own pain:

Part of the "Pain and the Brain" series

Last week we explored the PAIN EQUALS DAMAGE myth and saw that:

If the brain feels there is credible evidence of a threat, it will create the experience of pain to protect you. Like that fire alarm sensing smoke or heat, it will sound the alarm. This in essence means that pain is not something that exists in the body, it is created by your brain and projected onto your body.

Now, I just want to pause here and deal with a thought that many of you are having right now. You might be thinking "Are you saying that for some people their pain is in their head?"

Part of the "Pain and the Brain" series

In this post, we'll explore a huge myth. This myth is about pain and it could be considered a leading cause of persistent low back pain.

Here it is - are you ready?

At this time of year, it's only natural to look back and reflect on the year that has been, as well as make plans going forward. We may even make a resolution or two.

I've historically never been one for resolutions, but last year I made a few and found it really helpful. It was actually amazing to see how small changes, made regularly and turned into habits, make a huge difference by the time New Year rolls around again. It even became my unofficial motto for the year: "It's better to be consistently good than occasionally brilliant"

A large study done a few years ago by The Kings Fund - a large, independent charity working to improve healthcare in England - found that over 80% of diseases and conditions here in the UK are either partially or entirely mediated by 3 lifestyle factors. Put another way - crack these 3 lifestyle habits, and 8 out of 10 premature diseases could simply pass you by.

And here are those 3 factors:

When you are in a stressful situation, your body releases two stress hormones, adrenaline and cortisol. These bring about changes in your body which are referred to as the Fight or Flight Response - they prepare your body to either run and hide, or defend yourself from danger.

Part of the "Myth Busting" series

Stretching is one of the most commonly prescribed exercises for people with low back pain or neck pain. But what does it actually do to the muscles?

The current narrative around stretching is very focused on muscle length. Patients are often told that the reason their muscles are sore is because they have become short, and that stretching will make them longer. But is this true?