Posture

Teens & Headaches? What?

~ Dr. Robert Speirs DC ~ Leave a comment

Migrane

​In 2016, researchers at Curtin University in Perth examined the seated posture and health data of 1,108 17-year olds in an effort to determine if any particular posture increased the risk of headaches/neck pain among late adolescents.

Among four posture subgroups—upright, intermediate, slumped thorax, and forward head—the researchers observed the following: participants who were slumped in their thoracic spine (mid-back region) and had their head forward when they sat were at higher odds of having mild, moderate, or severe depression; participants classified as having a more upright posture exercised more frequently, females were more likely to sit more upright than males; those who were overweight were more likely to sit with a forward neck posture; and taller people were more likely to sit upright.

While they found biopsychosocial factors like exercise frequency, depression, and body mass index (BMI) ARE associated with headaches and neck pain, their data did not suggest any one particular posture increased the risk of neck pain or headaches more than any other posture among the teenagers involved in the study.

This is noteworthy as studies with adults do indicate the risk for neck pain and headaches is greater in individuals with poor neck posture. In particular, postures such as forward head carriage, pinching a phone between the ear and shoulder, and prolonged neck/head rotation outside of neutral can all increase the risk of cervical disorders. This suggests that in younger bodies, the cause of neck pain and headaches may be multifactoral and not limited to just poor posture and that treatment must address all issues that may increase one’s risk for neck pain/headaches in order to reach a desired outcome.

The good news is that chiropractic has long embraced the biopsychosocial model of healthcare, looking at ALL factors that affect back and neck pain and quality of life. Through patient education, spinal manipulation, mobilization, exercise training, the use of modalities, and more, chiropractors can greatly help those struggling with neck pain and headaches!

Exercise of the Month!

~ Dr. Robert Speirs DC ~ Leave a comment

One of our favourites in the office; Thoracic Rotation.

An easy exercise for your upper and mid-back. No equipment required! – (Post link to article and video on your blog or post video directly on your social media account.)”

  1. Begin on your hands and knees and shift back so that your buttock is on your heels.
  2. Place one hand behind your neck with your elbow pointing downward.
  3. Rotate your trunk to move your elbow towards your opposite knee.
  4. Rotate back, raising your elbow toward the ceiling.
  5. Repeat three sets of 10 repetitions on each side twice per day or as directed.

Pregnancy and Low Back Pain?

~ Dr. Robert Speirs DC ~ Leave a comment

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Did you know that 50-72% of women have low back pain (LBP) and/or pelvic pain during their pregnancy but only 32% do something about it? Let’s look closer!
Pregnancy-related low back pain (PLBP) can be a highly debilitating syndrome that accounts for the most common cause of sick leave for pregnant women. In 2004, Americans spent $26.1 billion dollars in an effort to find relief from back pain during pregnancy. Statistics show one out of ten women will experience daily DISABLING LBP for at least two years following delivery.
Because of the limited number of treatment options available for the pregnant woman due to mother and fetus safety, and given the high propensity of potentially disabling PLBP that can significantly limit function and quality of life, chiropractic care seems to be a natural choice for this patient population! Obviously, pharmaceuticals and surgery are NOT appropriate options for the expectant mother, even during the post-partum breast-feeding time period. Chiropractic offers a non-invasive and safe approach to managing lumbopelvic pain that uses many different approaches.
In a 2009 research paper, 78 women participated in a study that investigated disability, pain intensity, and percent improvement after receiving chiropractic care to treat pregnancy-related PLBP. Here, 73% reported their improvement as either “excellent” or “good.” For disability and pain, 51% and 67% (respectively) experienced clinically significant improvement! Researchers followed up with them eleven months later and found 85.5% reported their improvement as either “excellent” or “good!” For disability and pain, 73% and 82% (respectively) experienced clinically significant improvement!
So, what’s causing LBP in pregnant women? Because of the biomechanical changes that occur in the low back and pelvis over a relatively short amount of time during pregnancy, especially in the second and third trimesters, common pain generators include (but are not limited to): the sacroiliac joint, facet joints, shock-absorbing disks, and the many connecting muscles (strains) and ligaments (sprains). During the later stages of pregnancy, the hormone Relaxin prepares the pelvis for delivery by widening the pelvic girdle, which can also be problematic.
Treatment options within chiropractic often include spinal manipulation, lumbopelvic exercises, patient education, posture correction, massage, an SI belt, soft tissue mobilization, and more. Exercises that target the transverse abdominus, multifidus, and pelvic floor muscles help to stabilize the lumbopelvic region. The American College of Obstetricians & Gynaecologists recommends exercise at least three times a week during pregnancy, and studies report NO obstetric complications (pre-term labor, premature ruptured membranes, or changes to maternal or neonatal weight) with exercise.
So, the answer is clear! When PLBP strikes, seek chiropractic care to safely and effectively manage the pain and disability and so you can ENJOY YOUR PREGNANCY!!!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honoured to render our services.

Condition Of The Month: Thoracic Joint Restriction

~ Dr. Robert Speirs DC ~ Leave a comment

T Spine Joint

Your spine is made up of 24 bones stacked on top of each other with a soft “disc” between each segment to allow for flexibility. Normally, each joint in your spine should move freely and independently. When one or more of your spinal vertebra is slightly misaligned and restricted, we call this condition a “spinal segmental joint restriction”. A “thoracic joint restriction” means that this misalignment or restriction is located in your upper or mid-back region.

To help visualize this, imagine a normal spine functioning like a big spring moving freely in every direction. A spine with a joint restriction is like having a section of that spring welded together. The spring may still move as a whole, but a portion of it is no longer functioning.

Joint restrictions can develop in many ways. Sometimes they are brought on by an accident or an injury. Other times, they develop from repetitive strains or poor posture. Being overweight, smoking, strenuous work, and emotional stress can make you more susceptible to problems.

Restricted joints give rise to a self-perpetuating cycle of discomfort. Joint restriction causes swelling and inflammation, which triggers muscular guarding leading to more restriction. Since your spine functions as a unit, rather than as isolated pieces, a joint restriction in one area of your spine often causes “compensatory” problems in another. Think of this as a rowboat with multiple oarsmen on each side. When one rower quits, the others are placed under additional stress and can become overworked.

Joint restrictions most commonly cause local tenderness and discomfort. You may notice that your range of motion is limited. Movement may increase your discomfort. Pain from a restricted joint often trickles around your rib cage or up & down your spine. Be sure to tell your chiropractor if your symptoms include any chest pain, shortness of breath, unusual cough, indigestion or flu- like complaints.

Long-standing restrictions are thought to result in arthritis – much like the way a slightly misaligned wheel on your car causes premature wearing of your tire.

You should recognize that your problem is common and generally treatable. Chiropractic care has been shown to be the safest and most effective treatment for joint restrictions. Our office offers several tools to help ease your pain. To speed your recovery, you should avoid activities that increase your pain. Be sure to take frequent breaks from sedentary activity. Yoga has been shown to help back pain sufferers so consider joining a class or picking up a DVD.

What the heck is a trigger point?

~ bryancobb ~ Leave a comment

By Bryan Cobb, Advanced Remedial Massage Therapist

trigger-point-referred-pain-shutterstock_228843211

What is a Trigger Point?

Trigger Points (TP’s) are defined as a “hyper-irritable spot within a taut band of skeletal muscle. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”1

Put into plain language, a TP is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that TP’s produce, at some time in your life.

TP’s were first brought to the attention of the medical world by Dr. Janet G. Travell. Dr. Travell, physician to President John F. Kennedy, is the acknowledged Mother of Myofascial Trigger Points. In fact, “Trigger Point massage, the most effective modality used by massage therapists for the relief of pain, is based almost entirely on Dr. Travell’s insights.”2 Dr. Travell’s partner in her research was Dr. David G. Simons, a research scientist and aerospace physician.

Trigger Points are very common. In fact, Travell and Simons state that TP’s are responsible for, or associated with, 75% of pain complaints or conditions.1 With this kind of prevalence, it’s no wonder that TP’s are often referred to as the “scourge of mankind”.

Trigger Points can produce a wide variety of pain complaints. Some of the most common are migraine headaches, back pain, and pain and tingling into the extremities. They are usually responsible for most cases of achy deep pain that is hard to localize.

A TP will refer pain in a predictable pattern, based on its location in a given muscle. Also, since these spots are bundles of contracted muscle fibres, they can cause stiffness and a decreased range of motion. Chronic conditions with many TP’s can also cause general fatigue and malaise, as well as muscle weakness.

Trigger Points are remarkably easy to get, but the most common causes are

TP’s (black X) can refer pain to other areas (red)

 

Sudden overload of a muscle

  • Poor posture
  • Chronic frozen posture (e.g., from a desk job), and
  • Repetitive strain

 

Once in place, a TP can remain there for the remainder of your life unless an intervention takes place.

 

Trigger Points Not Well Known

With thousands of people dealing with chronic pain, and with TP’s being responsible for — or associated with — a high percentage of chronic pain, it is very disappointing to find that a large portion of doctors and other health care practitioners don’t know about TP’s and their symptoms.

Scientific research on TP’s dates back to the 1700’s. There are numerous medical texts and papers written on the subject.

But, it still has been largely overlooked by the health care field. This has led to needless frustration and suffering, as well as thousands of lost work hours and a poorer quality of life.

 

How Are Trigger Points Treated?

As nasty and troublesome as TP’s are, the treatment for them is surely straight-forward. A skilled practitioner will assess the individual’s pain complaint to determine the most likely location of the TP’s and then apply one of several therapeutic modalities, the most effective of which is a massage technique called “ischemic compression”.

 

Basically, the therapist will apply a firm, steady pressure to the TP, strong enough to reproduce the symptoms. The pressure will remain until the tissue softens and then the pressure will increase appropriately until the next barrier is felt. This pressure is continued until the referral pain has subsided and the TP is released. (Note: a full release of TP’s could take several sessions.)

 

Other effective modalities include dry needling (needle placed into the belly of the TP) or wet needling (injection into the TP). The use of moist heat and stretching prove effective, as well. The best practitioners for TP release are Massage Therapists, Physiotherapists, and Athletic Therapists. An educated individual can also apply ischemic compression to themselves, but should start out seeing one of the above therapists to become familiar with the modality and how to apply pressure safely.

 

 

 

1 Simons, D.G., Travell, D.G., & Simons, L.S. Travell and Simons’Myofascial Pain and Dysfunction: the Trigger Point Manual.

Vol. 1. 2nd ed. Lippincott, Williams, and Wilkins, 1999.

Patellofemoral Pain Syndrome

~ Dr. Robert Speirs DC ~ Leave a comment

knock knee

Patellofemoral pain syndrome (PFPS), also called “Runners Knee”, describes the symptom complex of knee discomfort, swelling, or crepitus that results from excessive or imbalanced forces acting on the joint. It is the most common cause of knee pain in the general population, affecting an estimated 25% of adults.

PFPS is most commonly related to lateral tracking of the patella. The patella has a natural tendency to migrate laterally due to the pull of the quadriceps and the slight natural valgus of the lower extremity. A new study in the Journal of Sports Medicine (1) provides additional confirmation that when managing patellofemoral pain syndrome, clinicians must address two critical yet often overlooked issues.

This study concludes that PFPS and dynamic knee valgus do not arise primarily from knee dysfunction, rather from hip abductor/ external rotator weakness and/or foot hyperpronation.

“The most effective intervention programs included exercises targeting the hip external rotator and abductor muscles and knee extensor muscles.” and “PFPS patients with foot abnormalities, such as those with increased rearfoot eversion or pes pronatus, may benefit the most from foot orthotics.”

Since gluteus medius and VMO weakness are key factors in the development of PFPS, strengthening exercises that target those muscles prove most effective. Stabilization exercises may include pillow push (push the back of your knee into a pillow for 5-6 seconds), supine heel slide, terminal knee (short-arc) extension, clam, glut bridge, semi-stiff deadlift, posterior lunge, and monster walk.

Myofascial release and stretching should be directed at hypertonic muscles, including the TFL, gastroc, soleus, hamstring, piriformis, hip rotators, and psoas. Myofascial release or IASTM may be appropriate for tightness in the iliotibial band, vastus lateralis, posterior hip capsule, and lateral knee retinaculum.

Manipulation may be necessary for restrictions in the lumbosacral and lower extremity joints. Hypermobility is common in the ipsilateral SI joint with restrictions present contralaterally. Evidence has shown that patellar tracking braces, i.e. BioSkin® or PatellaPro®, may lead to better outcomes.

Lifestyle modification may be necessary to reduce pain-provoking endeavors, especially running, jumping and other activities that induce a valgus stress. Athletes should avoid allowing their knee to cross in front of their toes while squatting. Arch supports or custom orthotics may be necessary to correct hyperpronation. Runners should avoid cross-over gaits and change shoes every 250 to 500 miles.

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#pain

#kneepain

#chiropractic

#fitness

#sports

#wellness

#fitness

#healthyliving

#healthychoices

#Winnipeg

References

1. Petersen W, Rembitzki I, Liebau C. Patellofemoral pain in athletes. Open Access Journal of Sports Medicine. 2017;8:143-15

Why Does My Back Hurt?

~ Dr. Robert Speirs DC ~ Leave a comment
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It’s been said that if you haven’t had back pain, just wait, because (statistically) some day you will! The following list is a list of “causes” that can be easily “fixed” to reduce your risk for a back pain episode.
1. MATTRESS: Which type of mattress is best? The “short answer”: there is no single mattress (style or type) for all people, primarily due to body type, size, gender, and what “feels good.” TRY laying on a variety of mattresses (for several minutes on your back and sides) and check out the difference between coiled, inner springs, foam (of different densities), air, waterbeds, etc. The thickness of a mattress can vary from 7 to 18 inches (~17-45 cm) deep. Avoid mattresses that feel like you’re sleeping in a hammock! A “good” mattress should maintain your natural spinal curves when lying on your sides or back (avoid stomach sleeping in most cases). Try placing a pillow between the knees and “hug” a pillow when side sleeping, as it can act like a “kick stand” and prevent you from rolling onto your stomach. If your budget is tight, you can “cheat” by placing a piece of plywood between the mattress and box spring as a short-term fix.
2. SHOES: Look at the bottom of your favorite pair of shoes and check out the “wear pattern.” If you have worn out soles or heels, you are way overdue for a new pair or a “re-sole” by your local shoe cobbler! If you work on your feet, then it’s even more important for both managing and preventing LBP!
3. DIET: A poor diet leads to obesity, which is a MAJOR cause of LBP. Consider the Paleo or Mediterranean Diet and STAY AWAY from fast food! Identify the two or three “food abuses” you have embraced and eliminate them – things with empty calories like soda, ice cream, chips… you get the picture! Keeping your BMI (Body Mass Index) between 20 and 25 is the goal! Positive “side-effects” include increased longevity, better overall health, and an improved quality of life!
4. EXERCISE: The most effective self-help approach to LBP management is exercise. Studies show those who exercise regularly hurt less, see doctors less, have a higher quality of life, and just feel better! This dovetails with diet in keeping your weight in check as well. Think of hamstring stretches and core strengthening as important LBP managers – USE PROPER TECHNIQUE AND FORM; YOUR DOCTOR OF CHIROPRACTIC CAN GUIDE YOU IN THIS PROCESS!
5. POSTURE: Another important “self-help” trick of the trade is to avoid sitting slumped over with an extreme forward head carriage positions. Remember that every inch your head pokes forwards places an additional ten pounds (~4.5 kg) of load on your upper back muscles to keep your head upright, and sitting slumped increases the load on your entire back!
We have only scratched the surface of some COMMON causes and/or contributors of back pain. Stay tuned next month as we continue this important conversation!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Exercise and Low Back Pain

~ Dr. Robert Speirs DC ~ Leave a comment

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Low back pain (LBP) is a very common problem that affects most of us at some point in life and for some, it’s a daily issue. Through education and research, researchers have found low back-specific exercises can not only help get rid of LBP but can also prevent future exacerbations or episodes. Like brushing our teeth, low back exercises are equally important in order to maintain, preserve, and optimize function. But because there are SO MANY exercise options available, it’s hard to know which ones are best, especially for each specific person.
There are different methods for determining the right low back exercises for the patient. One of the most common is to try different exercises to determine individual tolerance, but this is not very specific, as it only determines whether or not the patient is comfortable with an exercise. Another is using physical performance tests (PPTs) that measure the strength and endurance of specific muscle groups, muscle shortness, balance, aerobic capacity, and spinal range of motion.
Physical performance tests are much more specific because they address each patient’s differences. Also, many PPTs include normative data to compare against the patient’s own performance, so repeat use of the abnormal PPTs on a monthly interval can gauge their progress (or the lack thereof), which is motivating to the patient and serves as a great outcome measure!
PPTs are typically done two to four weeks after an initial presentation or at a time when the condition is stable so as not to irritate the condition. Initially, the decision as to which exercise is best is often made by something called “directional preference” or positional bias. This simply means if a patient feels best by bending over, we initially give “flexion-biased” exercises.
Flexion-biased exercises include (partial list): pulling the knees to the chest (single then double), posterior pelvic tilts (flattening the low back into the floor), sitting and/or standing bend overs, hamstring stretches, and more. If a person’s low back feels best bending backwards, their doctor of chiropractic may give extension-biased exercises, which include (partial list): standing back bends, saggy push-ups (prone press-ups), and/or laying on pillows or a gym ball on their back, arching over the ball.
Chiropractors generally add exercises gradually once they’ve determined tolerance and will recheck to make sure the patient is doing them correctly. Studies show that spinal manipulation achieves great short-term results, but when exercise is added to the treatment plan, the patient can achieve a more satisfying long-term result. Unfortunately, other studies have shown that ONLY 4% of patients continue their exercises after pain is satisfactorily managed and they fall back into old habits of not exercising.
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