Friday, April 29, 2016

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
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 26, 2016

Chiropractic Care For Seniors

Canadian Chiropractic Association

The musculoskeletal (MSK) system plays an important role in maintaining health and independence1 as we age. More so, to manage chronic conditions like diabetes and heart disease requires a healthy MSK system to stay active and mobile. Yet, we know that the prevalence of MSK conditions tend to increase with age. For example, 25% of people over the age of 60 report significant disability and pain due to osteoarthritis.

Did you know?2

  • 30% of Canadians over the age of 75 years old report suffering from either mild, moderate and severe pain
  • 80% of seniors suffer from chronic pain
  • Over 25% of Canadian seniors report activity or daily living limitation due to MSK pain
MSK conditions can seriously affect your health, quality of life and independence. Every year, hundreds of thousands of Canadians suffer from fall-related injuries3. We know that the risk of morbidity and even mortality can increase significantly after a fall, so preventing them is critical.
Chiropractors, as part of your healthcare team, can help address MSK injuries early to help maintain mobility and function. Healthy aging relies on your ability to keep moving and enjoying activities of daily living with little pain or limitations. Care may help:
  • Manage pain
  • Increase range of motion
  • Improve function
  • Help decrease progression of joint degeneration
  • Correct posture
  • Increase balance
  • Reduce the risk of falls
Of course, taking care of your MSK health should start early and continue well into your golden years. It is well known that active living is an important part of healthy aging. In fact, even a moderate level of physical activity can improve balance, endurance and bone strength.
Find additional resources we’ve created to help take care of your MSK health below:
For more information, check out some of our blog posts, or talk to your chiropractor!

1Canadian Memorial Chiropractic College, “Chiropractic Care and the Geriatric Patient,”
2Canadian Memorial Chiropractic College, “Chiropractic Care and the Geriatric Patient,”
3 Public Health Agency of Canada. 2014. Seniors Falls in Canada: Second Report. retrieved from

Friday, April 22, 2016

Common Conditions Of The Shoulder Joint

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

The shoulder is one of the largest and most complex joints in the body.  It is anatomically designed to allow for an individual to perform a wide range of movements and activities.  This versatility, along with the high physical demands placed on a shoulder can also make it vulnerable to breakdown and injury.

Listed below are some of the conditions that commonly cause shoulder problems: 
·        Osteoarthritis: Results from the protective layers of cartilage in the shoulder becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage. This process may also be related to previous injury/trauma to the shoulder joint.
·        Frozen Shoulder:  Also known as adhesive capsulitis, this condition is a painful and persistent stiffness in the shoulder.  It is believed to be caused by thickening, swelling, and tightening of the flexible tissue that surrounds the joint.  Symptoms can vary greatly and can last anywhere from several months to several years.
·        Rotator Cuff and Soft Tissue Injuries:  The rotator cuff is a group of muscles and tendons that provide stability and rotational movements of the shoulder joint in a balanced fashion.  Other shoulder muscles are responsible for different ranges of motion of the upper arm (humerus) and proper positioning and movement of the shoulder blade (scapula) along the ribcage.  An injury can occur to any of these muscles which can lead to shoulder problems.
·        Mechanical Conditions:  Scapular dyskinesis is a mechanical term used to describe irregular movement of the shoulder blade.  It can be an early sign that a shoulder problem may develop, or it may already be accompanied by pain or dysfunction in the shoulder.  A mechanical change in shoulder blade movement can be associated with a variety of problems including an internal pinching of soft-tissue structures (impingement), irritation of the cushioning bursa (bursitis), or a feeling of the shoulder dislocating with certain movements (instability).

·        Traumatic Injuries:  Vigorous lifting, pushing, and pulling activities, or a fall onto or blow to the shoulder can result in ligament sprains or muscle strains.  More significant injuries can result in shoulder dislocations and separations, rotator cuff and soft tissue tears, cartilage labral tears, and fracture.
Balanced and stable movements are key to a healthy shoulder.  If this does not occur, there is potential for many shoulder problems to exist simultaneously at any given time.  For example, an individual may strain their shoulder from heavy lifting.  The shoulder strain may be causing pain, but it can also be accompanied by pain and weakness from impingement and bursitis that may arise from the irregular movement pattern of the shoulder.  Therefore, it is important that a proper evaluation is performed to best guide the treatment of shoulder conditions.

If you suffer from a shoulder problem that is limiting your daily functioning, contact a qualified health professional who can prescribe appropriate therapy, rehabilitation, and self-management strategies specifically for your circumstance.  For more information, visit
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 19, 2016

Be Careful Going Head First

By Dr. R. Greg Lusk, DC

Going head first, as the expression goes, refers to not taking time to think about your actions before starting whatever it is that you're doing.  The results with this sort of approach, as one can imagine, can be mixed.  On the other hand, the "head first" scenario that I am referring to, from the perspective of a health care practitioner, is that of anterior head carriage (AHC), where the potential for negative outcomes is the clear winner.  AHC refers to loss of vertical alignment of your head over your torso, where a plumb line should pass through the flap at the front of your ear and the tip of your shoulder when viewed from the side.  Instead, the head is shifted forward in relation to the shoulders.  It is synonymous with forward head posture or simply "bad posture" as so many of us have been told.  In this position the lower neck and upper back are excessively bent forward whereas the upper neck, the area just below the back of our head, is in hyper-extension.  This causes increased strain on the tissues at these levels and frequently results in pain and/or other symptoms.  Neck pain, headaches, jaw (i.e. TMJ) pain, pain into the upper back or around the shoulder blades, and symptoms such as pain, tingling, numbness, or weakness in the arms and hands are common examples.
It is easy to appreciate the increased strain on the body in this position.  I often pose a question to patients - "Would you rather hold a weight in front of your chest all day or with your arms fully extended with the weight as far away from the body as possible?"  Unless your goal is to get an exhausting workout the answer to keep the weight close and decrease leverage is obvious.  However, to correct this problem, the direct approach of saying "improve your posture", "sit up straight", or "don't slouch", doesn't work well in my experience.  Similarly, how often does saying don't smoke or don't eat junk food really work?  Ultimately, you need to create an environment for success.  With the goal of a better head position, you can support a better posture by setting up your desk, computer, car seat, etc. in such a way that you don't get lured forward.  Keep your chair close to the desk, your computer monitor or steering wheel close to you, and your buttocks all the way back on the chair.  Better yet, employ a good lumbar support to keep your low back curved nicely and you'll notice that it is much more difficult to poke your chin out.  Your neck and low back will thank you.
An exercise for your deep neck flexor muscles can also be done periodically to improve the alignment of your head and neck and to balance out strains in the involved tissues.  Often called chin tucks, neck retractions, or the "give yourself a double chin" exercise, you can do it in either a seated position or lying on your back.  While keeping your eyes looking forward, the object is to draw your chin back as far as possible.  This extends the lower neck and flexes the upper neck, the exact opposite positions involved with poor posture.  Hold the end position for 1-2 seconds and repeat for 10 repetitions.  Doing a few sets daily can go a long way in preventing pain and symptoms related to AHC
This article is for general information purposes only and is not to be taken as professional medical advice.

Thursday, April 14, 2016

Understanding A Pinched Nerve In The Neck

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

About two-thirds of people will experience neck pain at some point in their lives.  Occasionally, neck pain can spread to involve other structures such as the upper back, shoulder, and arm regions.  Pain in these regions is often dismissed simply as muscle pain.  However, a “pinched nerve” originating from the neck can radiate pain to these nearby anatomical sites and be a significant source of discomfort.

The “cervical spine” is the medical name given to the region of the neck.  Nerve roots originate from the cervical spine on each side.  These nerves send off various branches that travel to distinct regions in the upper back and arms to supply strength to muscles and provide sensation/feeling.  The term “pinched nerve” is often used to describe a mechanical and/or inflammatory irritation directly affecting any component of the nerve root(s) in the neck/cervical spine.

A “pinched nerve” in the neck can cause symptoms almost anywhere along the nerve pathway.  This may result in neck symptoms only, and/or symptoms that radiate into the chest, upper back, shoulder, arm, hand and finger regions.  The symptoms can vary widely and may include:  a cramping or achy feeling, tightness, burning or a sharp electric shock sensation, numbness, tingling, and arm muscle weakness.  The symptoms may start gradually and intensify over time.  Activities such as movement of the neck or shoulder, prolonged sitting or laying down, lifting, and even coughing or sneezing may aggravate the symptoms.
Below is a brief summary of three common causes of a "pinched nerve" in the neck:
1.     Spinal disc herniation/bulge – Spinal discs separate and cushion cervical vertebra.  Repetitive and cumulative loads or a heavy single load has the potential to cause a disc bulge or herniation, thereby causing a mechanical and/or inflammatory irritation of the nerve root(s).  This most commonly occurs in adults aged 20-50.
2.     Degeneration and Osteoarthritis – The normal aging process causes cervical disc degeneration and osteoarthritis of the cervical joints.  The consequence of these processes is that mechanical irritation from bony spurs on the vertebrae along with inflammation can cause irritation of the nerve root(s).  This most commonly occurs in adults over 50.
3.     Cervical spinal stenosis – This condition may cause “pinched nerve” symptoms due to narrowing of the spinal canal and/or nerve pathways, which puts pressure on the nerve root(s) or spinal cord.  This most commonly occurs in adults over 60.  It is usually secondary to degeneration and osteoarthritis.
Other causes of a “pinched nerve” in the neck include: direct irritation of nerve tissue by overlying muscles; direct trauma or injury to the nerve root(s); and mechanical changes in the neck associated with poor postural habits (i.e. head poking forward in the sitting position).  Some common causes of symptoms that act like a “pinched nerve” in the neck include muscular trigger points, ligament sprains and arthritic joints from the neck, upper back, and shoulder regions.
Treatment for a “pinched nerve” in the neck will often be different depending on the underlying cause of the symptoms.  Therefore, it is important to obtain an accurate diagnosis.  A proper medical history, along with physical examination consisting of range of motion, strength, neurological and orthopaedic testing, along with diagnostic imaging (if necessary) should be performed to aid in the diagnosis.  It is extremely important to rule out rare causes of “pinched nerve” symptoms such as spinal tumors, fractures and infections.  Disorders of the esophagus, trachea (windpipe), heart and thyroid can cause symptoms that overlap with those of a “pinched nerve” in the neck.  These potential causes require appropriate medical referral when applicable.

There are natural and conservative treatment options available for those suffering from a "pinched nerve" in the neck.  These may include: mechanical traction, spinal manipulation and mobilization, soft tissue techniques, acupuncture, ice/heat application, electrotherapy, activity modification, postural education, and rehabilitative exercise.  A qualified health professional can determine the cause of your symptoms and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit
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.

Monday, April 11, 2016

Tips For A Safe & Pain Free Run

Ontario Chiropractic Association

As summer approaches, sticking to an indoor exercise regime can be difficult as temperatures warm up. Running outdoors is a great way to take advantage of the weather, while keeping fit and improving energy and stress levels.

If you take your running routine outside, remember these 5 simple stretching tips to help avoid strains and pains. 
1. Upper Calf

Place your hands against a wall, or sturdy object in front of you. Stand feet comfortably apart, toes pointing forward. Put one leg back, keeping your heel flat on the ground. Gently bend the knee of the front leg, so your hips move forward and lean into your hands. Hold this stretch for 30 seconds.

You should feel the stretch along the back of the leg and below the knee.
2. Lower Calf
Keeping the same position as the upper calf stretch, shift the foot of your back leg forward until your toes are just behind the heel of the front leg. Keep both heels on the ground and lower your hips by bending both knees. Hold this stretch for 30 seconds.
You should feel the stretch through the back of the ankle. 
3. Front of thigh
Standing near a sturdy object, place hand on it for balance and use your free hand to grasp your ankle or foot. Keeping your upper body straight, pull that heel up towards your buttock and hold for 30 seconds. Repeat the stretch for the other leg. 

You should feel the stretch through the front of your leg.
4. Back of thigh
Place one foot up on a low surface with your toes pointing upward. Place hands on that thigh. Keeping the leg on the ground straight, bend forward from the hips. Keep your lower back flat by bringing your chest towards your knee. Hold this stretch for 30 seconds, and repeat with the other leg.
You should feel the stretch along the back of the front leg.
5. Hips/Buttocks
From the back thigh stretch position, bend your front knee so that the foot is on the edge of the surface. Placing hands on your hips, lean slightly forward over the bent leg. Keep the leg you are standing on straight. Hold this stretch for 30 seconds, and repeat with other leg.
You should feel the stretch in the back of the hips and buttocks.
Follow these simple tips for a safe and pain free run. Remember, don’t overstretch and never stretch a cold muscle.

Thursday, April 7, 2016

Knee Pain & 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
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.

Friday, April 1, 2016

Common Back Pain Myths

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

80% of all Canadians will suffer from at least one significant episode of back pain in their lives.  Below are some of the common myths surrounding back pain and what modern science has to say about them.

Myth 1:  If you’ve injured a disc (i.e. herniation, rupture), you must have surgery.

Truth:  Surgery to relieve back pain should only be used as a last resort.  Even if specific testing reveals a damaged disc, recovery often results without surgery.  An injured disc in the back may become inflamed and put pressure on nerves and surrounding pain sensitive structures.  Non-surgical treatment aims at minimizing pain and discomfort from joint irritation and muscle spasm, and prescribing specific exercises to help with recovery.

Myth 2:  Most back pain is caused by injuries or heavy lifting.

Truth:  Injuries caused by heavy lifting do not account for all back pain.  In up to 85% of cases, individuals can’t recall a specific incident that brought on their back pain.  Back pain can result from a single exposure to a bending or twisting incident or it can be small cumulative loads placed on the spine over time.  Scientific research also links the following risk factors to back pain: smoking, being overweight, poor posture, poor physical fitness, and stressful life events.

Myth 3:  X-ray images, CT and MRI scans can always identify the cause of pain.

Truth:  Even the best imaging tests cannot identify a muscle spasm or ligament sprain that may be the cause of pain.  Imaging is usually reserved for special cases such as those suffering trauma in a fall or accident, surgical candidates, unresolved cases of severe chronic back pain, and suspicion of underlying tumor, infection or other serious disease.

Myth 4:  If your back hurts, you should take it easy until the pain goes away.  Bed rest is the mainstay of therapy.

Truth:  Clinical data indicates that individuals who remain active do better than those who try bed rest.  Remaining active means continuing with daily activities as tolerated and easing back into a regular routine.  Activities may have to be modified while recovery occurs, but movement is important for recovery provided it does not put the individual at risk for further injury.

Myth 5:  Diagnosing back pain is simple and straightforward.

Truth:  The causes of back pain can be complex and difficult to diagnose.  There are many biological tissues that can generate pain in the back.  These may include muscles, ligaments, bones, nerves, and joints.  Quite often it is a combination of several or all of these structures that can manifest into back pain, and potentially radiating pain into the buttock or leg regions.  Sometimes stress and depression can also contribute to back pain.  A licensed health practitioner who deals with back pain is best trained to diagnose the source(s) of your problem and prescribe appropriate therapy when required.  For more information, visit

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.