Thursday, April 27, 2017

Get Set To Garden

Ontario Chiropractic Association (OCA)


Plant and Rake Without the Ache
Gardening is a great way to stay active and have fun in the sun. But many Canadians sustain injuries that can be easily prevented with a little know-how.

The right moves

Use the right moves to lighten the load on your back. Kneel, don’t bend, to plant. Change your body position often. Take frequent breaks. Alternate between light and heavy chores. Drink lots of water. And most importantly, loosen-up before you start out.
 

Warm up

Before you begin any physical activity, warming up is a key factor in preventing injury. Take a walk, even on the spot. Ten to 15 minutes should do it. Don’t forget to lift your knees and gently swing your arms.
 

Stretch before you start

To plant and rake without the ache, do each of these stretches five times. Don’t bounce, jerk or strain. Stretches should be gentle and should not cause pain.
 

Upper Body

YOUR SIDES

  1. Extend your right arm over your head.
  2. Bend to the left from the waist.
  3. Hold for 15 seconds and repeat on the other side.

YOUR ARMS AND SHOULDERS

  1. Hug yourself snugly.
  2. Slowly rotate at the waist as far as is comfortable to the left, then to the right.

YOUR BACK

  1. In a seated position, bend forward from the hips, keeping your head down.
  2. Reach for the ground.

 

Lower Body

YOUR THIGHS

  1. Face a wall or tree and support yourself against it with one arm.
  2. Bend your right knee and grasp your ankle or pant leg with your left hand.
  3. Hold for 15 seconds and repeat on the other side.

YOUR HAMSTRINGS

  1. Stand.
  2. Reach your hands to the sky.
  3. Then bend at the waist and reach toward your toes.
  4. Hold for 15 seconds.

Monday, April 24, 2017

Plantar Fasciitis: A Common Source Of Heel Pain

By Dr. John A. Papa, DC, FCCPOR(C)


Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes.  This condition is a common source of heel pain that can be quite disabling.
 
Plantar fasciitis usually develops gradually, but it can also come on suddenly.  Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic.  Pain and discomfort can also extend into the arch of the foot.  Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity.  If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight-bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.
 
Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot.  Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed.  This may occur with activities that require running, jumping or prolonged walking and standing.  Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.
 
Faulty foot mechanics may also contribute to the development of plantar fasciitis.  Individuals with flat feet or those who excessively pronate (role feet inward) will experience added strain on their plantar fascia.  Old lower extremity injuries such as ankle sprains and fractures can increase susceptibility due to altered lower limb movements.  Being overweight is also a risk factor.  Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.
 
Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.
 
Plantar fasciitis that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic or laser modalities to assist in healing, manual and soft tissue therapy to supporting structures, therapeutic taping of the heel, and specific rehabilitative  exercises for the muscles and joints of the lower leg and foot.  A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.
 
It is important to establish an accurate diagnosis of plantar fasciitis.   Other causes of heel pain may include stress fractures, heel fat pad syndrome, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.
 
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tuesday, April 18, 2017

Non-Invasive Recommendations For Managing Low Back Pain

By Dr. R. Greg Lusk, DC

In January of this year a new clinical practice guideline was published in the European Journal of Pain with respect to the non-invasive management of low back pain (LBP).  A clinical practice guideline aims to summarize research evidence, with the goal of optimizing patient care and improving health outcomes, and to prevent clinicians from considering interventions that are ineffective, expensive or harmful.  LBP affects 80% of people throughout their lives, is a common cause of disability, and is the most common musculoskeletal complaint for which people visit a healthcare provider.  In more ways than one it is a very expensive condition that warrants guidance from best evidence.  For this particular guideline, over 2500 research titles and abstracts were reviewed with only 10 previously published guidelines being included due to quality.  The recommendations are as follows.
 
For Acute LBP (i.e. LBP that started suddenly or has only been present for a few days or weeks), or Chronic LBP (i.e. LBP that persists beyond 3 months), all 10 guidelines recommended:
 
1.    Advice, reassurance or education with evidence-based information regarding the expected course of recovery and effective self-care options (e.g. ice or heat for pain, short-term rest, medication).  With respect to course of recovery, most cases of LBP improve much or completely within six weeks of onset, with a slower rate of improvement noted beyond six weeks if it persists.  Recovery is also affected by risk factors such as job demands, sedentary lifestyle, body weight, age, and smoking.
 
2.    Acetaminophen (e.g. Tylenol) or NSAIDs (e.g. Advil) if indicated, with advice and consideration of risks and warning signs and symptoms.
 
For Acute LBP only, all guidelines encouraged an early return to activity, staying active, and the avoidance of prolonged bed rest.  A short course of muscle relaxants alone or in addition to NSAIDs if acetaminophen or NSAIDs did not reduce pain was also an option.  Spinal manipulation (i.e. spinal joint "adjustment") was also advised for those not improving with self-care methods.  Also, in rare cases when the pain is severe and unmanageable, short-term use of opioids was mostly recommended as long term use is associated with significant risk, something we have all become increasingly aware of due to the amount of media coverage on the topic.
 
For the management of Chronic LBP, other interventions recommended by all guidelines were exercise or yoga (for up to 12 weeks), manual therapy (i.e. spinal manipulation or mobilization) for up to 12 weeks, and extensive rehabilitation with both physical and psychological components over 8 weeks.  If acetaminophen or NSAIDs have not provided adequate pain relief, short-term use of opiods was also recommended taking into consideration side-effects, risks, and evidence of ongoing pain relief on re-assessment.  Massage, acupuncture, and antidepressant medication was also recommended by most guidelines.
 
Some interventions for Chronic LBP were also NOT recommended by most guidelines.  This does not mean these treatments don't provide relief, just that the supporting evidence isn't strong enough to warrant a recommendation.  This included the use of muscle relaxants, gabapentin (a medication for nerve-based pain), and passive electrotherapeutic modalities including TENS, laser, IFC, or ultrasound.
 
A key thing to remember with all of these interventions is that there are options and patient preference is an important consideration.  Some people want to avoid medications at all costs and others have no interest in having their low back manipulated.  For chronic LBP, results are often better with the inclusion of a more active component of treatment (e.g. exercise) but many patients admit that they will not comply with a regular program.  Thankfully the passive approaches still have value.
 
This article is for general information purposes only and is not to be taken as professional medical advice.
 
 

Wednesday, April 12, 2017

Nutrients That Support Musculoskeletal Health

By Dr. John A. Papa, DC, FCCPOR(C)

The musculoskeletal (MSK) system includes the muscles, tendons, joints, and bones of the body.  Many nutrients contribute to the healthy functioning and integrity of the MSK system.  Included below is a summary of 5 common nutrients that significantly contribute to MSK health.
 
1.    WATER brings vital nutrients to muscle tissue to support movement and decrease the risk of cramps and strains.  Water also eliminates waste products and toxins from the body and helps to protect our joints by providing lubrication and cushioning.  The consequences of inadequate water intake/dehydration include:  muscle and joint pain, cramping, and fatigue.  A general rule of thumb to follow is to consume 0.5-1 litre of water daily for every 50 pounds of body weight.
 
2.    CALCIUM is best known for building strong bones.  It is also needed for muscular growth and contraction.  A deficiency in calcium status can lead to aching joints, muscle cramps, and osteoporosis.  Foods such as milk, yogurt, and cheese are good sources of calcium but may not be suitable for individuals sensitive to dairy products.  Other healthy foods high in calcium include pinto, navy, red and white kidney beans, sesame seeds, almonds, and dark leafy vegetables.
 
3.    VITAMIN D is essential for helping bones absorb calcium, keeping them strong, and preventing osteoporosis.  Signs of Vitamin D deficiency may include painful muscle spasms, leg cramps, numbness in the extremities, bony malformations, and arthritic pain.  Vitamin D is naturally found in food sources such as cod liver oil, salmon, mackerel, tuna fish, sardines, and egg yolks.  Sensible and safe sun exposure is also an important natural source of Vitamin D.

4.    VITAMIN C plays a vital role in collagen production and tissue repair.  Collagen is the building foundation for many body tissues and is found in all MSK structures.  There is an abundance of Vitamin C in strawberries, citrus fruits, and vegetables including, red peppers, broccoli, spinach, brussel sprouts and cauliflower.
 
5.    GLUCOSAMINE SULPHATE is a normal element of cartilage matrix and joint fluid and provides the body with the building blocks necessary to repair joint damage.  As we age, our bodies slow down the production of glucosamine sulphate.  Published research suggests that glucosamine sulphate is beneficial for arthritic patients, particularly for those individuals with mild to moderate osteoarthritis of the knees.  Some glucosamine sulphate supplements also contain anti-inflammatory herbs that can be combined with other nutrients such as Omega-3 fatty acids to help with arthritic pain.
 
Sensible eating should include nutritional balance with the correct proportion of quality carbohydrates, proteins, healthy fats, and adequate water intake.  Although nutritional supplements can help support MSK health, many nutrients appear to be most effective when consumed in their natural state within whole foods.  For additional information on diet, nutrition, and how you can improve your MSK health, visit www.nhwc.ca.
 
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Tuesday, April 4, 2017

Knee Pain And Prevention

By Dr. John A. Papa, DC, FCCPOR(C)
 
Knee pain is often caused by either a one-time acute injury or repetitive motions that stress the knee, particularly as we age.  Included below are some of the conditions that commonly cause knee pain:
 
·        Osteoarthritis results from the protective layers of cartilage in the knee becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.  This may result in a number of symptoms including:  joint pain and stiffness, decreased ranges of motion, weakness, swelling, inflammation, and instability.
 
·        Patellofemoral pain syndrome refers to knee conditions that involve the kneecap and/or the structures around it.  Pain can be generated by breakdown of the cartilage under the kneecap, tight or weak tissues around the kneecap, or misalignment of the kneecap.
 
·        Meniscal injuries directly involve tearing/damage to the cartilage cushioning in the knee.  This type of injury can result from a sporting event or fall where the knee undergoes a sudden twisting motion or impact.  It can also occur in older individuals who develop a chronic tear in a worn meniscus.
 
·        Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the knee or there is an awkward fall or twisting motion involving the knee.
 
·        Tendons are strong tissues that anchor muscles to bones, and these structures can become torn or inflamed around the knee joint leading to tendonitis and muscular strains.
 
·        Bursitis can involve several fluid-filled structures in your knee that help provide more cushioning in the joint.  Certain activities, such as kneeling on the floor, can cause a bursa to become irritated.
 
Below are some useful tips that can help individuals avoid or minimize the chance of knee pain and injury:
 
1.    Maintain a healthy bodyweight to decrease the overall stress on your knees.
 
2.   Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.
 
3.    Prepare your knees for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the thighs and lower legs.
 
4.    Choose activities that are knee friendly for you.  This may include low impact activities such as walking or cycling.  Remember to start slowly and build up the intensity gradually.
 
5.    Strength, balance and flexibility exercises can train your leg muscles to better support your knees and avoid injuries.
 
In the event that you suffer a knee injury that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of knee pain.  For additional information on knee pain and treatment of muscle and joint injuries, visit www.nhwc.ca.
 
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Wednesday, March 29, 2017

Cervicogenic Headache

By Dr. John A. Papa, DC, FCCPOR(C)
 
Cervicogenic headache is defined as a headache which has its origin in the area of the neck.  The source of pain arises from biological tissues such as muscles, ligaments, joints, and nerves that have become injured and/or irritated.  When these structures become stimulated, their nerve endings send pain signals from nerves in the neck to the head.

Cervicogenic headache is a relatively common cause of chronic headache and has symptoms similar to those seen in other well known headache disorders such as migraine and tension type headaches.  For example, both migraine and cervicogenic headaches affect females more than males, with headache symptoms generally located unilaterally (on one side of the head).  These headache sufferers may complain of severe pain, head throbbing, sensitivity to light and sound, and nausea.  Neck pain and muscular tension are also common symptoms in tension headaches, migraine attacks, and cervicogenic headaches.  The problem of symptomatic overlap in these common and frequent headache types makes the accuracy of precise diagnosis difficult.  Furthermore, the fact that an individual may have two or more headache types co-existing at any one time further elevates the diagnostic challenge.
 
Cervicogenic headaches are usually unilateral (occasionally bilateral), and can be experienced in several different regions of the head including the base of the skull, the forehead, or behind the eyes.  The intensity of pain may fluctuate from mild to moderate to severe on a daily basis.  Individuals with cervicogenic headache may also exhibit physical signs of altered neck posture and restricted range of motion of the neck.  Headache symptoms can be triggered or reproduced by active neck movements or passive positioning.  Tenderness can also be palpated in the neck and upper shoulder region with muscular trigger points spreading pain upwards into the head.
 
The cause of cervicogenic headache may be singular or multi-factorial.  This may include a whiplash injury, sports injury, arthritic changes, chronic postural strain, stress, and fatigue.  The evaluation and assessment of headaches should include a proper medical history and physical examination.  Serious causes of headache symptoms must be ruled out before appropriate treatment can be administered.
 
After a diagnosis of cervicogenic headache is made, the goal of therapy is to minimize headache frequency and diminish levels of pain associated with each episode.  Treatment and management options that have demonstrated effectiveness include: postural correction, joint mobilization and manipulation, acupuncture, soft tissue therapy, and rehabilitative exercises.  Trying a variety of therapies or combination of therapies may be required to find relief.  It should be remembered that many patients who are diagnosed with migraine and tension headaches may also respond to these treatment strategies.
 
For those suffering from headache symptoms that may be interfering with their activities of daily living, a qualified health professional can prescribe appropriate therapy, rehabilitation, and self-management strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.
This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Thursday, March 23, 2017

5 Tips To Improve The Quality Of Your Child’s Sleep

Canadian Chiropractic Association

We often take great care to ensure our children build good personal hygiene habits such as brushing their teeth and bathing. But do we pay as much attention to our children’s sleep hygiene? As adults, we easily recognize the benefits of a good night’s sleep for ourselves, and certainly we want the same for our children. Sleep has an important restorative role to play and it is critical for healthy growth and development. Proper sleep can also help prevent health problems now and in the future.
 
It is important to understand your child’s sleep needs and identify potential sleep problems early. Children need an ample amount of sleep to ensure that they are energized and have the ability to excel at the activities they enjoy.
 
If you are concerned about your children’s quality of sleep, you may notice the following signs1:
• Falling grades in school
• Poor self esteem
• Either low or excessive appetite
• Headaches or migraines
• Hyperactive behaviour
• Difficulties with attention
 
As a family, there are ways to build in good habits into your nightly routine to help your children get better sleep.
 
The Encyclopedia on Early Child Development recommends the following tips for good sleep hygiene in children2:
 
Tip 1: A child’s bedroom should be a safe, secure, and quiet sleeping environment: Consider distancing electronics and devices away from the bed or keeping them out of the bedroom entirely.
 
Tip 2: Establish a bedtime routine: It is important to provide a short and consistent routine for children before bed. A good routine will relax the child and encourage sleep. The routine should be carried out in the child’s bedroom and should take place 15 to 30 minutes before bedtime. It is recommended that the routine is predictable and consistent. Also be sure that there is a set bedtime.
 
Tip 3: Keep a regular schedule: The bedtime routine and schedule should be followed every day,
with the routine continued on weekends.
 
Tip 4: Teaching a child to fall asleep alone: When a child is older (over six months) the parent can slowly remove themselves from their bedside, allowing the child to grow accustomed to sleeping on their own.
 
Tip 5: Encouraging daytime activities that help a child sleep at night: Exercise can help or hinder sleep depending on the time of the day that activity took place. Exercise during the day will help the child fall asleep at night, whereas exercise close to bedtime may cause sleep onset insomnia. Ideally, exercise should stop two to three hours before bedtime.
 
Getting a good night’s sleep is important for everyone. But, like many good habits, it’s important to start at an early age. With the new school year approaching, creating a routine now is one of the easiest ways to make good sleep hygiene a long-lasting practice for your children.
For more tips on maintaining sleep hygiene, visit your chiropractor.