May 28, 2014
It used to be common knowledge that you were supposed to stretch before and after your workouts. It was how you “warmed your muscles up” and prepared them for activity... ahhh.... how things in the health field change. More recent studies have shown that static (or stationary) stretching increases running time in runners, as well as lowers the 1 repetition maximum in power lifters. Receptors in your muscles are being told the muscle is elongated, so when they contract, they do not contract to the same shortness as they would do had they not been elongated in the first place.
To add insult to injury – most studies have shown that static stretching actually does very little to increase range of motion through the joints (“flexibility”) in the first place! Most of the stretch is just being felt by the receptors but doing very little to change the way you move.
So now if you're saying to yourself “I have very tight hamstrings!” or calves, or shoulders or whatever muscle you're thinking about right now.... I want you to ask yourself “WHY?!” are they right in the first place! Is it disuse? Overuse? Imbalance? There is a reason that the muscles are tight and don't feel “normal”, and this underlying cause is the reason you have tightness in your body. Address the underlying concern, and the tightness will disappear on it's own!
May 5, 2014
Lumbar disc bulges and herniations are without a doubt one of the more challenging conditions I see in my office. Mostly because they are so sensitive! The good news is, symptomatic herniations are also reasonably rare: many causes of back pain are not related to the disc and even when they are, it's very few that are extremely symptomatic. If you happen to be one of the unlucky few who experience numbness and tingling down the leg and all the way into the foot: know this: there are even fewer cases that require surgery. The other part of the good news is, there are definitely things you can do to help manage your symptoms at home and encourage a faster recovery. Health care professionals talk about something called “centralization”, this means getting the pain to locate to one area, instead of being spread out over a diffuse area. In this instance, centralization refers to experiencing back pain (and even a bit of increased back pain) and not the numbness and tingling into the legs and feet. You should stay in positions where the leg and feet symptoms are not present, and avoid activities that cause those symptoms to come on – even if it means a bit more back pain, at least the nerve is not being irritated. It's important to get good advice on exercises that can be done during this time, and manual therapy can help relieve the muscle spasm, as well as try to create some “suction” for the disc to move back into the centre.
April 11, 2014
How much time does it take out of my day? Is it really hard? I commonly introduce myself as a exercise-based chiropractor, but what does that really mean? It doesn't mean all I do is exercise, I absolutely perform soft tissue therapy, muscle release, joint mobilizations and of course, when required, manipulation (adjustments). It also means I try to take it one step further. Most of you have probably heard my speech about fixing function: if the way the body is working is defective, there's no way you are going to get rid of the pain. Using my hands will help take away symptoms, but what caused those symptoms in the first place? Likely a dysfunctional movement pattern. How are we going to correct it? That's right, it's the E-word: Exercise!! For many people, this may seem very intimidating. How many people do you know that have started an exercise program only to drop it because it was uncomfortable, or hard, or took too much time? Well here's the good news: to restore the function it typically takes 5-10 minutes/day. How many of us can say we don't have 10 minutes a day to stop hurting all the time, especially if it made other tasks easier (which also means you could do them faster!). Okay, but they're still hard, right? Now I don't want to claim that they're not, teaching your body to work again absolutely takes some effort, but most people are surprised with how simple and easy the exercises are. For instance, to train the neck's deep neck flexors (great exercise for many people with neck pain) you are lying on your back, tucking your chin in (like a double chin) then lifting your head 1 inch off the ground (no higher!) then hold for up to 2 minutes. Not complicated at all, right? But the results from this simple training tool can be astounding.You don't need to be “good” at exercise, or even like it to be able to do it, and once you've mastered it is becomes easy and routine. So don't let the word exercise fool you, it's simpler than you think!
March 31, 2014
Not quite sure what to do with the shoulder injury you have? Or the recurrent sprained ankle? Did you know that Chiropractors don't just fix backs? Chiropractors have 210 hours of training in orthopedics, and 540 hours of training in human anatomy. Yes, there is a significant amount of time dedicated to the spine, but we also learn about the extremities of the body! We are experts in the field of diagnosis and management, and treat any disorder of the neuromusculoskeletal system – meaning nerves, muscles and joints. Sometimes adjustments are involved (and yes, things besides your back can be adjusted!) but many conditions can also be managed through soft tissue therapy, and active rehabilitative exercises. Even for your back, if you don't like being adjusted, there are many other options to help make you feel better! Next time you are having a problem with your head, shoulders, knees or toes, remember there is a treatment option available to you at your Chiropractor's office!
March 18, 2014
Let's see how many people this next sentence resonates with: “I'm ___ years old now, there's no way I can _______”. Of course everything is easier in your youth! Your cells are continually replacing themselves, development is at is peak, your fear of hurting yourself or having a major injury that could put you out of work isn't even on your radar when you're young! But this doesn't mean that change isn't possible. In fact, last winter, my adopted 7-year-old golden retriever learned to sit. Trying to change a behaviour, especially when health related such as: starting an exercise program; eating better; quitting smoking is still possible! Let's talk about the Transtheoretical model of change. This model is great for explaining the stages of change in health related behaviours. It involves Pre-contemplation, Contemplation, Preparation, Action, Maintenance and Termination. Pre-contemplation is the part where you are not ready to think about the idea of making a change. In fact, you are probably not aware that a change is required. Perhaps you are overweight but don't realise that it's a health risk, or that your back is somewhat bothersome, but doesn't stop you from doing anything. Contemplation is the part where you have realised that there is a problem, for instance, you have a bit of a nagging feeling in your neck, or you notice it's not as easy to reach things higher up, but aren't really sure what you are going to do about it. Preparation is getting ready to make a change: you know your diet isn't what it should be so you've purchased a journal to track your food intake and exercise output, or you've made an appointment with your chiropractor. Action. This is my favourite because this is where I can help you. This is working with me to make sure your knee stops aching as you are climbing stairs. I'll help you with the acute symptoms, and teach you how to keep them gone and prevent them from coming back. Maintenance is where you now have a home exercise program to keep your ankle sturdy and prevent another sprain. Your elbow pain is resolving and you are working on exercises at home. Termination applies to health behaviours that have now become part of your lifestyle. There is no temptation to smoke again, there is no temptation to be inactive or overeat. This is where change is no longer necessary because the behaviour is no longer a problem for you. I've found that most people get stuck in the contemplation stage, and age is often used as an excuse to prevent action. So maybe it's not as easy as it is for a 14-year old, but that doesn't mean it's not possible! I think if you gave it a try you'd discover how easy it is to make those changes and how little time it takes (relatively) before it becomes a habit and you are in the termination stage. Don't use age an excuse to suffer, or keep you from living the life you want!
Febraury 25, 2014
There is a long history of animosity between the Chiropractic and Medical professions. In the beginning, Chiropractic treatment was based on philosophy rather than science and research. This is not unlike medical roots: in medieval times medicine was based on the 4 humours of black bile, yellow bile, phlegm and blood, and many treatments involved blood letting. The difference is that the advancement of the profession happened sooner in history than that of Chiropractic - it has only been in the past 50 years or so that research and education is becoming increasingly more important, with the Canadian Memorial Chiropractic College's curriculum being evidence based, and the professors involved in much of the ground breaking research going on in the world today. The curriculum involves 4,200 hours of academic and clinical education, including studies in biological sciences, anatomy, biochemistry, physiology, psychology, neurology and orthopedics.
A current hot-topic is inter-professional collaboration. As the Chiropractic profession becomes more and more mainstream, people are recognizing the benefit to have health care providers working together. It's not uncommon to have massage therapist, kinesiologists, and physiotherapists working together in the same roof, but a positive and increasing new development is to have chiropractors and medical doctors working together under the same roof.
The benefits to this are many. First of all, you know when a chiropractor is working with a medical doctor, that the way they practice is going to be based on research. A medical office would not want a chiropractor working in the office if they were going to jeopardize their professional reputation, so they will only allow a chiropractor who is up to date to practice out of the office. Secondly, there is better communication – if a medical doctor and chiropractor can work together on resolving your issue, you get the benefit of multiple approaches, this means you get both the pharmacological care required, and the treatment of the underlying condition so it doesn't return. Third, chiropractors are primary health care practitioners, which means you don't need a referral to go see them. If you go to see a chiropractor first, it cuts down on the patient load for medical doctors which means they have more time to treat other patients, and you are getting the help you need to treat your injury, immediately. If you happened to book an appointment with a practitioner that can't help you, there is another solution right down the hall!
In the end, think about booking in with an office that collaborates with other professionals, it may just give you and advantage towards faster recovery, and that's always the end goal!
February 11, 2014
If you were out in the snowmageddon blitz the other week, and are finding yourself with low back pain, there is some good news.
Research has shown the best predictor for pain relief from manipulation is when your pain is present for less than 16 days, and it doesn't travel anywhere below the knees! Changing the pain-spasm pain cycle quickly before the muscles are in full spasm and the joints are locked seems to have a major impact on recovery! Pain below the knees? Pain been going on for a longer period of time? No worries, manipulation can still help, it just might take a little longer than someone who meets the other 2 criteria!
What to do if you are uncomfortable with manipulation? Don't worry, I've got lots of tricks up my sleeves that don't involve the “popping” sound, that will still provide you with relief! The important thing to remember is that the faster you look for help, the faster we can make it go away. As for the snow... I don't think there's anything I can do to make it disappear any faster!!
January 24, 2014
“Are you going to x-ray my back”?
The short answer is no. Unless you need it.
X-rays, otherwise known as radiographs, emit radiation. It's true the amount of radiation is less than it used to be thanks to newer technology, but radiation is cumulative over the lifespan, so the less we can irradiate you the better. Adding to that, as a Chiropractor, I have guidelines on when I am to x-ray a patient: I am trained to look for specific red flags that would lead me to believe there is something more sinister than a simple sprain of the muscles or problem with the joint. Those are the rare cases where imaging is the best course of action. If you think about it, the curve on your back is going to look very different if you sit up straight and pull your head back versus leaning forward and slumping. These are subjective changes and do no reflect the structure of your spine. I use range of motion, orthopedic tests, palpation and functional assessments to determine what the cause of your symptoms are. There is lots of science and research showing that these tests are excellent predictors of muscular and joint problems.
Another thought on the matter is MRI. Your medical doctor has to be the person to requisition an MRI for you, but before you push them to do so, here's a thought: there are virtually no people who will have a textbook perfect spine. At a certain age, most people will have some signs of arthritis, maybe some defects that have been present since birth, and frequently signs of a disc bulge. The thing to note about imaging is that unless the findings match the symptoms, the little “imperfections” in your spine are of very little value when determining the best course of management. In many cases, even pre-surgical patients will find lots of relief with a course of conservative treatment (see: Chiropractic and exercise!). But that's maybe a topic for another day... So next time you have an ache or pain, trust that the cause can usually be found even without having to “look deeper”.
January 15, 2013
The Sciatic nerve starts from several branches of your spinal cord, comes together to runs down the back of your leg and splits at the knee, which then runs down the rest of your leg. When this nerve is injured, people experience a sharp shooting pain anywhere along it's course.
Sciatica in and of itself is not a diagnosis. Just like a runny nose can mean allergies, the flu or a cold, sciatica is a symptom of another problem.
The most commonly known problem is a disc herniation. This is where material from the spaces between your vertebrae is pushed back and to the side and puts pressure on the nerve. Most people will experience pain going down into the back of the leg, often below the knee and into the foot.
Another common cause of sciatic nerve pain is a tight muscle in the buttocks called the piriformis. Because the sciatic nerve travels under and/or through the piriformis, if this muscle is tight, it can cause sciatic nerve pain. More commonly this pain only goes to the level of the knee and no further.
It is possible to have pain into the glutes and into the front of the leg that have nothing to do with the sciatic nerve!
My point is this: if you are having back pain, and it travels or radiates anywhere, it may not be your sciatic nerve, and it may also not be the end of the world! Often times it's not the worse case scenario and a little bit of treatment with exercises will solve the problem! So next time you hear someone say their sciatica is really bad, tell them it could be a quick fix!
January 5, 2013
Have you ever wondered if you've had a massage, if Chiropractic can still help? Or if there's any point in going to both? Well the answer is yes. Chiropractic and therapeutic massage can be very complementary to one another. When your joints have become dysfunctional it can be a “chicken or the egg” scenario – as in your joints become dysfunctional, then your muscles go into spasm, which creates more dysfunction in the joints. As a Chiropractor, I do a fair amount of work on the soft tissues surrounding the joints, so that when I go to manipulate the joints they are not being held so tightly by muscles in spasm. Going to see a massage therapist before I manipulate joints allows me to get into the joints even better, as the focus of the treatment is relieving the spasm. Some conditions are purely muscular, however if you go for a massage and the joint is still not moving the way that it should, chances are the spasm in the muscle is going to come back. Long term, the weak muscles should be strengthened to prevent re-occurrence!
December 11, 2013
Hello friends! This week's post is dedicated to anyone who has been given rehabilitative exercises and thought: “I'm in a lot of pain and doing these hurt, so I'm just going to wait until the pain goes away to get stronger”. I'd like to take a minute to try and motivate you to keep trying! When your body is first damaged, it sends signals to your brain saying that something is wrong (in the damaged tissue) and the response from your brain is the pain signal. This is used to protect you from doing more damage to the injured area. Your body then changes the way you move, and a constant pathway is created from your brain saying that if you use the injured tissue you will hurt. You then use the structures surrounding the injured area to support you during your activities, even though this is not their primary job. After a while these structures will become tired and burnt out and more injuries will happen.
By the time your body has had time to do some repair and remodelling (see: renovations!), your brain has already formed a pathway telling you that using this tissue will cause you more pain. Now you have a weakened tissue, that's likely formed scar tissue, and is getting weaker by the day. Rehabilitative exercises are used to correct these pathways and put the focus back on the injured area. They should start after your body has had time to renovate to the best of it's ability – your health care provider (see: friendly 404 Chiropractor!) will help you figure out which stage of healing you are in. Now it's time to get to work. If you completely avoid doing the movement that originally caused your pain, that structure will continue to get weaker and weaker, and you will become more and more sore. If you slowly start to rebuild that tissue, it regains it's function, takes the pressure off the surrounding structures, and most importantly: starts changing the way your brain perceives the movement! Once your brain is convinced that moving the way that you're supposed to move doesn't hurt anymore, you will stop feeling the pain. But if you keep avoiding it, there's nothing anyone can do to get rid of the pain for you. So if you've been told to start rehabilitative exercises, keep moving, keep trying and you'll be feeling better soon!
December 2, 2013
One thing I find myself talking about often these days is footwear. It seems as though with winter here, many people are buying new boots and are sometimes developing pain as a result of it. It is so important to get a good quality shoe that is well made and fits your foot. After all, your shoes are what support your foot, which supports the rest of your body! This is called the “Kinetic Chain”, and when there is a problem with the Kinetic Chain, problems can happen not only in your foot, but everywhere that this chain leads! This could be your knees, hips, and even low back. When you are buying new footwear, there are a few things you should consider.
First and foremost is comfort. If a shoe is rubbing your foot in places leaving blisters or callouses, the shoe you have chosen is not for you.
Second, you need to make sure that the shoe's sole is stable enough. Without a stable base, your foot will be sliding all over the place!
Third, make sure the shoe stands up straight. How are you supposed to stand up straight if your shoe is crooked?
Fourth, there should be lost of support in the back of the shoe, and your foot should have good interaction with the back of the shoe so that there is no blistering, and your foot knows where it is in relation to the ground.
Fifth, it is important to note if the shoe bends at the right spot for your toes. This is even more important in flat-footed people as it helps prevent things like bunions from developing!
Of course this is just scratching the surface of what you should be looking for when it comes to a shoe, and different conditions (Achilles tendinosis, plantar fasciitis, Morton's neuroma, bunions etc) will all have their own special considerations. This is, however, a good guideline to be thinking about as you are looking for that next pair of shoes for this season's holiday parties!
November 25, 2013
It's an exciting time to be a Chiropractor! As any patient who has walked into my office knows, before starting treatment I discuss the risks and benefits of treatment with you. Part of this is the risk of stroke associated with cervical manipulation, or, adjusting the neck. As a practitioner, I find it a difficult topic to bring up, as there is lots of research indicating it is effective for acute and some chronic neck pain conditions, but who would want to put themselves at risk of such a serious complication?
Previous accusations have discussed how the vertebral artery has a twisting path up to supply the brain, and how with some positions, this artery is stretched and can cut off blood flow. However, a person having a stroke after neck manipulation happens so infrequently that it's almost impossible to say if the manipulation caused the stroke, or if, as Chiropractic and Medical professionals have suspected, the patient entered the office with a stroke in progress and after the manipulation the symptoms got worse. What I can say with certainty is that I thoroughly screen each patient before adjusting his or her neck for signs and symptoms of stroke and that a stroke is no more likely to happen in my office than after having gone to a medical office.
Okay, now here's the great news: On November 18, 2013, the Journal of Manipulative and Physiological Therapeutics published research called "Changes in vertebral artery blood flow following various head positions and cervical spine manipulation". It was done on 10 healthy males between the ages of 24 to 30, and results were that there were NO significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various had positions and cervical spine manipulations. YES it is a small sample size and NO we cannot apply this to everyone across the board, but this is the first step in what I suspect to be a long line of evidence showing what Chiropractors already believe: Neck adjustments are a SAFE and EFFECTIVE way of relieving acute and chronic neck pain.