Hippocrates noted, around 400BC, the effects of winds and rains on chronic diseases in his book Air, Water, and Places (1).

In Asia and China, ‘rheumatism’ is translated as ‘wind wet disease.’ (2).

In Shakespeare’s A Midsummer Night’s Dream, Titania speaks of ‘contagious fogs’ and ‘distemperature’ in which ‘Rheumatic diseases do abound’
(2.1.70-91).

This is a good point to note that ‘rheumatism’ is an old-fashioned term for aches and pains anywhere in the body. It is no longer used in medical literature, but today ‘Rheumatology’ means the study of joint diseases, including the many types of arthritis.

The types of conditions and diseases which often said to be associated with ‘weather pain’ are indeed those which cause chronic pain in the muscles and joints.

These include rheumatoid arthritis, osteoarthritis, phantom limb pain, scar pain, gout, trigeminal neuralgia, and non-specific low back pain (3). Weather patterns that have been studied in relation to pain are: temperature, barometric pressure, precipitation, humidity, thunderstorms, sunshine, and increased ionization of the air.

So is there a link between the weather and muscle and joint pain? A number of studies have been conducted, with mixed results. It’s challenging for scientists to analyse something so subjective as peoples’ experience of pain, when other factors are undoubtedly involved, such as level of exercise, mood, and diet. Also, many arthritic conditions have a cyclical nature of flare and remission. Add this to the variable patterns observed in the weather, and it is likely that at some point these will match up. It’s human nature to look for patterns and to notice coincidences, and some of the more sceptical reports believe that this is what’s happening (4). However our own clinical experience tells us that there is a link between muscle and joint pain and weather conditions, and it’s worth taking a look at some specific studies to try to find out what’s really happening.

Recent research has focused on the possibility that changes in atmospheric pressure may be responsible for increased pain in those with arthritic conditions or chronic pain, specifically just before or during a spell of low pressure, and the cold and damp conditions that accompany it. As air pressure drops, air molecules and gases expand. The theory is that low pressure causes gases and fluids in our joints to expand in a similar way, causing pressure on nerves and sensitising them to pain. In addition, in an area of microtrauma, such as an arthritic joint or scarred muscle, tissues of different densities may expand and contract in different ways to those beside them, increasing stiffness and pain (3). There is no conclusive evidence to prove this theory. A 1995 study claimed of 557 people concluded that ‘changes in barometric pressure are the main link between weather and pain’ (5). A population-based survey of 2491 people between the ages of 25 and 60 living in the North West UK in 2005-6 found that

‘pain reporting was higher on days with the lowest average pressure, but the relationship with pressure was inconsistent and there was no evidence of any trend in the relationship. The strongest relationship with pain reporting was with hours of sunshine and daily average temperature.’ (6)

The survey discovered that

‘Participants who completed the questionnaire on days when the temperature and hours of sunshine were highest were significantly less likely to report any pain and were approximately half as likely to report pain that was chronic and widespread.’

In general, we feel happier and more relaxed when the weather is warm and sunny and perhaps less likely to notice or report pain.

We hunch ourselves up when we are cold, making muscles tighter and less mobile. When it’s sunny we have more exposure to vitamin D, which fortifies our bones and cartilage. Studies have shown that osteoarthritis patients with low levels of Vitamin D experience a worsening of their symptoms (7). We also know that warm muscles are longer and more supple – this is why we ‘warm up’ before exercising to avoid injury, and apply heat to sore muscles to relieve pain.

Packing up and moving somewhere with a warm, sunny climate is not the answer, although it can help temporarily. Evidence suggests that when people move to a warmer climate, they feel better for the first few months, ‘but then their body acclimates to that weather pattern and they start feeling just like they did before.’ (9) So don’t to pack your bags just yet, but there are actions that you can take to help minimise aches and pains through the winter months.

Crucially, on warm, sunny days, people are much more likely to exercise. The human body is built to move, and regular exercise is the best thing we can do for our general health. This is especially true for those who have arthritis and other painful conditions of the muscles and joints (8), though it is important to do a level of exercise that is appropriate for you. If you are already in pain, the idea of exercising may seem overwhelming, but gentle movement of any kind is better than no movement at all.

Regular exercise will ease stiffness, strengthen muscles, improve circulation, help to control weight – putting less strain on joints, help maintain bone density, improve sleep and boost mood. All of which help to prevent pain.

After a fantastically warm and sunny year, the nights have well and truly drawn in, there’s a chill in the air, and many of us are preparing to go into hibernation on the sofa, with a cosy blanket and a hot chocolate. It’s great to keep warm, but don’t be afraid to complement this with regular exercise and movement to help you feel fitter, healthier and happier, and stave off those aches and pains. And try to get outside on those rare sunny days!

So, while there is no definitive evidence as to whether the weather can influence musculoskeletal pain, there are many anecdotal reports that it is the case. What do you think? We’d be interested to read your comments.

References

1. Tversky, Amos, 1995, ‘On the belief that arthritis pain is related to the weather’ http://www.pnas.org/content/93/7/2895.full.pdf

2. Smedslund, Geir et al, 2009, ‘Does the Weather Really Matter…’ http://onlinelibrary.wiley.com/doi/10.1002/art.24729/pdf

3. Jamison, Robert N, 1996, ‘Influence of Weather on Report of Pain’ https://www.brainlab.org/wp-content/uploads/2014/03/Influence-of-Weather-on-Report-of-Pain.pdf

4. Redelmeier, D, 2005, ‘Does damp or wet weather really make arthritis pain worse? If so, how?’, Scientific American http://www.scientificamerican.com/article/does-damp-or-wet-weather/

5. Wikipedia, 2014 ‘Rheumatism’ http://en.wikipedia.org/wiki/Rheumatism#.22Rheumatism.22_and_weather

6. Macfarlane, Tatiana V et al, 2009, ‘Whether the weather influences pain? Results from the EpiFunD study in North West England’ http://rheumatology.oxfordjournals.org/content/49/8/1513.full

7. ‘Taking Charge of Arthritis,’ p.192, Reader’s Digest Health Solutions.

8. ‘Why is Exercise Important?’ Arthritis Research UK http://www.arthritisresearchuk.org/arthritis-information/arthritis-and-daily-life/exercise-and-arthritis/why-is-exercise-important.aspx

9. Nazario, B, ‘Do Your Aches, Pains Predict Rain?’, MedicineNet.com, http://www.medicinenet.com/script/main/art.asp?articlekey=52133

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Massage techniques have been developed and passed on as part of an oral tradition for millennia. But it is only in the last few decades that research, using sophisticated methods of scientific analysis, has been used to test this collective wisdom.

Evidence-based practice requires healthcare providers to use research inquiry and evidence in their clinical work and many are nervous or suspicious of what they see as the cold, methodical dissection of the custom and practice of their profession. Massage therapy is both an art and a science and the fear is that this eclectic mixture of instinct, common sense, experience and technical skills would be replaced with a limited and uncompromising set of ‘cookbook’ treatments that have been validated by the scientific method. Should we only use techniques that have been thoroughly tested and researched?

This was addressed by Smith and Pell(2003) in an amusing but apposite paper on ‘Parachute use to prevent death and major trauma related to gravitational challenge’. Their argument is that there is very little research evidence on the effectiveness of parachutes. The evidence is almost exclusively anecdotal and single case reports. Bearing this in mind, should the use of parachutes be banned until high quality trials have been completed utilising control groups and placebos? Fortunately we don’t need research, involving randomised trials, to know that parachutes are a very good idea and I for one wouldn’t want to be in the placebo group!

It is important to distinguish between ‘Research’ and ‘Evidence’, they are not necessarily the same thing. Evidence can come from more than research findings. Clinical experience, patient feedback and the local context in which therapist works are all recognised as important factors and sources of evidence.
Evidence-based practice is about using the best evidence available to you, to promote the effective care of patients to the best of your ability.

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Recent research suggests that massage is beneficial in reducing inflammation.

In summary, when administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial bio-genesis.

Research Article

Buck Institute News

To a large extent we have to take research of this complexity at face value and trust the skill and interpretation of the scientists involved. In the past I was involved in preparing biopsy samples myself for a research project and I am surprised that such an invasive procedure was permitted on healthy subjects. However the research was permitted and the results are in and match well with anecdotal and case study evidence. Although encouraging, we do have to be careful not to read too much into this research, it was a small sample and much more needs to be done before the evidence is conclusive…

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Anecdotal evidence and personal experience cannot and should not be ignored, the views of the patient will always be important. Patient feedback needs to be carefully considered and integrated into any treatment plan in order to optomise the outcome.

Case studies are a more formal presentation of clinical evidence. This is particularly useful when part of a case series, where a number of case reports that share similar presentations and treatments are compared and written up together.

Randomised Control Trials (RCT) are a relatively new source of evidence in massage therapy and are normally carried out under controlled ‘laboratory’ conditions. Randomised Control Trials require great care and experience when interpreting the results. Because of the scientific analysis involved they are generally regarded as a higher quality form of evidence. I wouldn’t go so far as to say I disagree with this but in my view a single RCT, taken in isolation, has no more value than a case series and is in far greater danger of being overblown and misinterpreted.

The gold standard of research evidence are narrative reviews and systematic reviews. This is where collections of different research studies are compared and statistically analysed.

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