Winnipeg Chiropractor

MRI Truths & Myths

~ Dr. Robert Speirs DC ~ Leave a comment

Arthritis

Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!

Patients will often bring in a CD that has an MRI of their lower back to a doctor of chiropractic and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!

Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!

This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.

Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!

Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain!  So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!

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.

What are some good exercises for Fibro?

~ Dr. Robert Speirs DC ~ Leave a comment

acgtive seniors

Fibromyalgia (FM) is a very common, chronic condition where the patient describes “widespread pain” not limited to one area of the body. Hence, when addressing exercises for FM, one must consider the whole body. Perhaps one of the most important to consider is the squat.

If you think about it, we must squat every time we sit down, stand up, get in/out of our car, and in/out of bed. Even climbing and descending steps results in a squat-lunge type of movement.

The problem with squatting is that we frequently lose (or misuse) the proper way to do this when we’re in pain as the pain forces us to compensate, which can cause us to develop faulty movement patterns that can irritate our ankles, knees, hips, and spine (particularly the low back). In fact, performing a squatting exercise properly will strengthen the hips, which will help protect the spine, and also strengthens the glutel muscles, which can help you perform all the daily activities mentioned above.

The “BEST” type of squat is the free-standing squat. This is done by bending the ankles, knees, and hips while keeping a curve in the low back. The latter is accomplished by “…sticking the butt out” during the squat.

Do NOT allow the knees to drift beyond your toes! If you notice sounds coming from your knees they can be ignored IF they are not accompanied by pain. If you do have pain, try moving the foot of the painful knee about six inches (~15 cm) ahead of the other and don’t squat as far down. Move within “reasonable boundaries of pain” by staying away from positions that reproduce sharp, lancinating pain that lingers upon completion.

There are MANY exercises that help FM, but this one is particularly important!

Can WRD cause my dizziness?

~ Dr. Robert Speirs DC ~ Leave a comment

MVA

Whiplash, or better termed “Whiplash Associated Disorders” (WAD), is a condition that carries multiple signs and symptoms ranging from neck pain and stiffness to headache, confusion, ringing in the ears, and more. But can WAD cause dizziness? Let’s take a look!

Dizziness is a general term that is used rather loosely by the general population. We’ve all experienced dizziness from time-to-time that is considered “normal,” such as standing up too quickly or while experiencing a rough flight.

Often, dizziness and problems with balance go hand in hand. There are three main organs that control our balance: 1) the vestibular system (the inner ear); 2) the cerebellum (lies in the back of the head); and, 3) the dorsal columns (located in the back part of the spinal cord). In this article, we will primarily focus on the inner ear because, of the three, it’s unique for causing dizziness. Our vision also plays an important role in maintaining balance, as we tend to lose our balance much faster when we close our eyes.

It’s appropriate to first discuss the transient, usually short episode of “normal” lightheadedness associated with rising quickly. This is typically caused by a momentary drop in blood pressure, and hence, oxygen simply doesn’t reach the brain quick enough when moving from sitting to standing. Again, this is normal and termed “orthostatic hypotension” (OH).

However, OH can be exaggerated by colds, the flu, allergy flair-ups, when hyperventilating, or at times of increased stress or anxiety. OH is also associated with the use of tobacco, alcohol, and/or some medications. Bleeding can represent a more serious cause of OH such as with bleeding ulcers or some types of colitis, and less seriously, with menstruation.

The term BPPV or benign paroxysmal positional vertigo, has to do with the inner ear where our semicircular canals are located. The canals lie in three planes and give us a 3D, 360º perspective about where we are in space. The fluid flowing through these canals bends little hair-like projections, which are connected to sensory nerves that tell the brain about our spatial position. If the function of these canals is disturbed, it can mix-up the messages the brain receives, thus resulting in dizziness. Exercises are available on the Internet that can help with BPPV (look for Epley’s and Brandt-Daroff exercises).

DANGEROUS causes of dizziness include: HEART – fainting (passing out) accompanied by chest pain, shortness of breath, nausea, pain or pressure in the back, neck, jaw, upper belly, or in one or both arms, sudden weakness, and/or a fast or irregular heartbeat.  STROKE – sudden numbness, paralysis, or weakness in the face, arm, or leg, especially if only on one side of the body; drooling, slurred speech, short “black outs,” sudden visual changes, confusion/difficulty speaking, and/or a sudden and severe, “out of the ordinary” headache. CALL 911 (or the number for emergency services if you’re outside the United States) if you suspect you may be having a heart attack or stroke!

Trigger point massage

~ bryancobb ~ Leave a comment

Session Description

 

A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.

 

The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.

 

The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.

 

The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.

 

Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.

 

After treatment, it is usually recommended that the client apply moist heat to the area treated.

 

How can I make my neck pain less severe?

~ Dr. Robert Speirs DC ~ Leave a comment

HA C Spine

Neck pain is very common! According to one study, between 10-21% of the population will experience an episode of neck pain each year with a higher incidence rate among office workers. Between 33-65% will recover within one year, but most cases become “chronic, recurrent” meaning neck pain will come and go indefinitely. The more we can learn WHAT to do to prevent these episodes, the better.

1.  SLEEP: Use a cervical pillow so the NECK is fully supported during sleep. This keeps your head in alignment with your spine. Also, if possible, sleep on your back!

2. OFFICE: Position the computer screen so that it’s at or slightly below eye level and straight in front of you. The “KEY” point is that you feel comfortable with the height of the monitor. Keep your chin “tucked in” so the 10-11 pound (4.5-5 kg) weight of your head stays back over your shoulders—this will place less of a load on your upper back and neck muscles to hold your head upright! Set a timer on your cell phone to remind you to get up and move around every 30-60 minutes.

3. TELEPHONE: If you are using the phone a lot during the day, GET A HEADSET! If you are pinching the phone between your shoulder and ear, you WILL have neck problems!

4.  EXERCISE: Studies show people who are more physically active are less likely to report neck pain.

5.  NUTRITION: Search for information on the “anti-inflammatory diet.” It’s basically fruits, veggies, and lean meat, with a few other twists. Also, stay hydrated by drinking plenty of water each day.

6.  LIFT/CARRY: A heavy purse, brief case, or roller bag can really hurt your neck. Take ONLY what you need and put the rest in a secondary bag that stays in your car or where you can access it when needed. Switch to a backpack if possible vs. a heavy brief case.

7.  SELF-MASSAGE: Reach back and dig your fingers into your neck muscles and “work” the tight fibers back and forth until they loosen up. Roll your head over the top edge of a chair by sliding down until the top of the chair back rests in your neck. Search for the tight fibers and work them loose!

8.  WHIPLASH: If you are injured, DO NOT WAIT! Those who seek chiropractic care shortly after an accident have less long-term trouble!

What is the current “best evidence” in WRD right now?

~ Dr. Robert Speirs DC ~ Leave a comment

Up Trap Ext

Whiplash, or WAD (Whiplash Associated Disorders), refers to a neck injury where the normal range of motion is exceeded, resulting in injury to the soft-tissues (hopefully with no fractures) in the cervical region. There are a LOT of factors involved that enter into the degree of injury and length of healing time. Let’s take a closer look!

Picture the classic rear-end collision. The incident itself may be over within 300 milliseconds (msec), which is why it’s virtually impossible to brace yourself effectively for the crash as a typical voluntary muscle contraction takes two to three times longer (800-1000 msec) to accomplish.

In the first 50 msec, the force of the rear-end collision pushes the vehicle (and the torso of the body) forwards leaving the head behind so the cervical spine straightens out from its normal “C-shape” (or lordosis). By 75-100 msec, the lower part of the neck extends or becomes more C-shaped while the upper half flexes or moves in an opposite direction creating an “S” shape to the neck. Between 150-200msec, the whole neck hyper extends and the head may hit the head rest IF the headrest is positioned properly. In the last 200-300 msec, the head is propelled forwards into flexion in a “crack the whip” type of motion.

Injury to the neck may occur at various stages of this very fast process, and many factors determine the degree of injury such as a smaller car being hit by a larger car, the impact direction, the position of the head upon impact (worse if turned), if the neck is tall and slender vs. short and muscular, the angle and “springiness” of the seat back and relative position of the headrest, dry vs. wet/slippery pavement, and airbag deployment, just to name a few.

Some other factors that can predict recovery include: limited neck motion, the presence of neurological loss (nerve specific muscle weakness and/or numbness/tingling), high initial pain levels (>5/10 on a 0-10 scale), high disability scores on questionnaires, overly fearful of harming oneself with usual activity and/or work, depressive symptoms, post-traumatic stress, poor coping skills, headaches, back pain, widespread or whole body pain, dizziness, negative expectation of recovery, pending litigation, catastrophizing, age (older is worse), and poor pre-collision health (both mental and physical).

Research shows the best outcomes occur when patients are assured that most people fully recover and when patients stay active and working as much as possible. Studies have shown it’s best to avoid prolonged inactivity and cervical collars unless under a doctor’s orders. It’s also a good idea to gradually introduce exercises aimed at improving range of motion, postural endurance, and motor control provided doing so keeps the patient within reasonable pain boundaries. Chiropractic manipulation restores movement in fixed or stuck joints in the back and neck and has been found to help significantly with neck pain and headaches, particularly for patients involved in motor vehicle collisions. A doctor of chiropractic may also recommend using a cervical pillow, home traction, massage, and other therapies as part of the recovery process.

It is important to be aware that fear of normal activity and not engaging in usual activities and work can delay healing and promote chronic problems and long-term disability. It’s suggested patients avoid opioid medication use due to the addictive problems with such drugs. Ice and anti-inflammatory herbs or nutrients (like ginger, turmeric, and bioflavonoids) are safer options. Your doctor of chiropractic can guide you in this process!

Fibromyalgia and Exercise

~ Dr. Robert Speirs DC ~ Leave a comment

Listen

Are there differences in lifestyle between people with vs. without fibromyalgia (FM)?

A recent study found women with FM found spend more time engaged in sedentary behaviors and less time in physical activity. In the study, researchers followed 413 female patients with FM and 188 age-matched healthy female controls. Researchers used three different approaches to access physical activity: a triaxial accelerometer to examine sedentary time, time spent in physical activity, and step counts.

They discovered those who suffered from FM spent an average of 39 more minutes per day in sedentary activity and 21 fewer minutes per day in light physical activity, 17 fewer minutes per day in moderate physical activity, and 19 fewer minutes per day in moderate-to-vigorous physical activity. In addition, those with FM took a mean of 1,881 fewer steps that those without FM.

Now, this isn’t really a surprise given the fact that people with FM are in pain and more likely to have difficulties sleeping and tolerating prolonged activities. After comparing the sufferers to the non-sufferers, the researchers found only 21% of FM patients vs. 46% of non-FM controls achieved the recommended 150 minutes/week (a little over 20 min. / day) of “moderate-to-vigorous” physical activity. They also found that only 16% vs. 45%, respectively, walked the recommended ≥10,000 steps per day.

One of the BEST forms of exercise for most people is walking. A walking program should be a staple exercise. It’s important to note that this should be GRADUALLY introduced so as to avoid an overuse injury—strain or sprain of the muscles and joints. This gradual introduction into activity is ESPECIALLY important for the FM sufferer as overuse injuries can make them afraid to do something that can REALLY help when done correctly!

How do Chiropractic adjustments help my neck pain?

~ Dr. Robert Speirs DC ~ Leave a comment

Whiplash 11

We all know what it’s like to have neck pain—whether it’s after a long drive, pinching the phone between the head and shoulder, star-gazing, or from talking to someone who is seated off to the side. There are many causes of neck pain, but the question of the month is, how do chiropractic adjustments help neck pain? Let’s take a look!

Chiropractic, when broken down into its fundamental Greek derivatives, means “hand” (cheir) and “action” (praxis). The technique most often associated with chiropractic is spinal manipulation where a “high velocity, low amplitude” thrust is applied to specific vertebrae in the spine, which does several things: 1) It restores mobility in an area with restricted movement; 2) It stimulates the sensory “neuroreceptors” in joint capsules, which has a muscle relaxing reflex effect; 3) It can affect surrounding neurological structures in certain parts of the spine such as the parasympathetic (cranial & sacral regions) and sympathetic (mid-back) nervous systems, which can have beneficial effects on the digestive system, cardiovascular system, and other body systems not typically thought about when seeking chiropractic care.

Joint manipulation is not new, as it can be traced back to as early as 400 BCE. The profession of chiropractic began in the later 1800s and has grown in popularity ever since. There is now an overwhelming body of evidence that supports spinal manipulation as both a safe and highly effective treatment for neck and back pain, headaches, and many other maladies.

It’s important to note that there are many different types of manual therapies that chiropractors utilize when caring for neck pain patients. There are “low-velocity, low amplitude” or non-thrust techniques that do NOT produce the “crack” that is frequently associated with chiropractic adjustments. The term “mobilization” is often used when referencing these non-thrust methods, and this often incorporates a combination of manual traction (pulling of the neck), left to right and front to back “gliding” movements usually starting lightly and gradually increasing the pressure as tolerated. In many cases, a doctor of chiropractic may utilize a combination of manipulation and mobilization as well as “trigger point therapy” (applying sustained pressure over tight “knots” in muscles), depending on a patient’s needs.

Low speed collision; what happens?

~ Dr. Robert Speirs DC ~ Leave a comment

Whiplash 11

You may have heard the comment, “If there’s no damage to the car, then there’s no injury.” Unfortunately, that does not always seem to be the case.

There are MANY factors that affect the dynamics of a collision and whether or not injury occurs. A short list includes: vehicle type and design, speed, angle of collision, momentum, acceleration factors, friction, kinetic and potential energy, height, weight, muscle mass, seat back angle and spring, head position upon impact, etc.

Consider Sir Isaac Newton’s Third Law of Motion: “For every action there is an equal and opposite reaction.” This law applies to a car accident at any speed. Using the analogy of hitting a pool ball into the corner pocket straight on, when the cue ball stops, its momentum is transferred to the target ball which accelerates at the same speed…hopefully into the corner pocket!

This example is not quite the same as an automobile collision because the energy transfer is very efficient due in part to the two pool balls not deforming (crushing or breaking) on impact with one another. If either ball did deform, more energy absorption would occur and the acceleration of the second ball would be lower.

In fact, in the United States, vehicle bumpers are tested at 2.5 mph with impact equipment of similar mass with the test vehicle’s brakes disengaged and the transmission in neutral. National Highway Transportation Highway Safety Administration (NHTSA) vehicle safety standards demand that no damage should occur to the car in this scenario.

However, energy transfer occurs very quickly and with a greater amount of force when there is no vehicle deformation (damage). As a result, a greater amount of energy (described as G-force) is directly transferred to the occupants inside the vehicle—increasing the risk of injury. A 1997 Society of Automobile Engineers article provided an example in which the same 25 mph (12 m/s) collision resulted in a five-times greater force on the occupants of the vehicle when the crush distance of the impact fell from 1 meter to .2 meters.

So be aware that even low-speed impacts can still place quite a bit of force on your body, even if the bumper of your car doesn’t have a scratch on it.

Is my Shoulder Pain a SITS Tear?

~ Dr. Robert Speirs DC ~ Leave a comment

neck pain 1

One of the most common causes of shoulder pain is a rotator cuff (RC) tear. To determine just how common this is, one study looked at a population of 683 people regardless of whether or not they had shoulder complaints. There were 229 males and 454 females for a total of 1,366 shoulders. (The participants’ average age was 58 years, ranging from 22 to 87 years old.)

The research team found 20.7% had full thickness rotator cuff tears. Of those with shoulder pain, only 36% had tears found on ultrasound. Of those without shoulder pain, 17% also had tears! Risk factors for an increased for tearing of the rotator cuff include a history of trauma, the dominant arm (ie your right arm if you’re right handed), and increasing age.

In a review of radiologic studies of 2,553 shoulders, researchers found full-thickness rotator cuff tears in 11.75% and partial thickness tears in 18.49% of the subjects for a total of 30.24% having some degree of tearing. In this group, about 40% of tears were found in pain-free shoulders. The researchers concluded that rotator cuff tears are common and frequently asymptomatic.

Both of these studies support the necessity to FIRST consider the patient’s clinical presentation and then correlate that with the imaging results. In other words, the presence of a RC tear on an image (usually MRI or ultrasound) does NOT necessarily mean there is pain (and vise versa)!

So what other things could be causing the shoulder pain? There are many: impingement, tendonitis, bursitis, muscle strain, capsular (and other ligament) sprain, frozen shoulder, and osteoarthritis (the “wearing out” type). Also, rheumatoid arthritis, lupus, polymyalgia rheumatica and other autoimmune types of “arthropathies,” fibromyalgia, a herniated cervical disk, shoulder dislocations, whiplash injuries, and more!

Most importantly, we must NOT forget to include referred pain to the shoulder from an impaired heart (such as coronary heart disease or heart attack), lung, liver, or gall bladder as these problems commonly refer pain to the shoulder and may represent a MEDICAL EMERGENCY!